EMA affirms ACE inhibitors, ARBs safe during COVID-19
The European Medicines Agency (EMA) has issued a statement reiterating that people should continue to take certain blood pressure medicines during the COVID-19 pandemic.Recent observational studies, the agency said, have not shown that taking angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) increases the risk of contracting the novel coronavirus or worsening illness for people with COVID-19. The statement reaffirms EMA’s previous stance “that patients should continue to use ACE inhibitors or ARBs as advised by their doctors,” advising patients with concerns to contact healthcare professionals.
The concern about these medications’ safety stemmed from knowledge that SARS-CoV-2, the virus that causes COVID-19, achieves entry into human cells via the ACE-2 receptor. This receptor may be upregulated in people taking ACE inhibitors and ARBs, theoretically providing more targets for the virus’ spike protein, which binds to the ACE-2 receptor.
Despite early concerns about this potential mechanistic issue and early observational data showing increased risk for people with hypertension and diabetes, “20 recently published studies on the use of ACE inhibitors and ARBs during the COVID-19 pandemic were reviewed and showed that these concerns are not supported by the latest clinical evidence,” said EMA. The list of studies is appended to the press statement.
The EMA announcement follows a March statement from the European Society of Cardiology strongly recommending that patients continue ACE inhibitor and ARB treatment during the pandemic and if infected with SARS-CoV2. In March, a joint statement also came from the Heart Failure Society of America, the American College of Cardiology and the American Heart Association finding no evidence of benefit or harm using medicines in the broad class of renin-angiotensin-aldosterone system inhibitors during the COVID-19 pandemic; that statement also urged more research on the matter.
A panel convened by the US National Institutes of Health also recommends continuation of ACE inhibitors and ARBs for patients with COVID-19 in its treatment guidelines.