Hypertension and Losartan

[Delaney]

I have hypertension and I take Losartan Potassium for it. This condition (and perhaps this medication) puts me at high risk for COVID-19. Because of this, I am being very careful.

Listed below is a summary of my research so far. I intend to discuss with my Cardiologist once I have finished researching. Does anyone have anything to add.

From this Lark article, Coronavirus and Hypertension dated March 10th:
The World Health Organization (WHO) says people with hypertension are among the highest-risk groups for more serious cases of, and death from, COVID-19 [5]. The death rate 8.4% among confirmed cases and 6.0% among all cases. In comparison, the death rate among those with no-preexisting conditions was 0.9%. In addition, ICU patients in one study were more than twice as likely to have hypertension (58.3% versus 21.6%). [6].

The article concludes:
Patients on ACE inhibitors and angiotensin-receptor blockers and their doctors may need to reevaluate their use of these medications if infected by COVID-19.

This daily mail item from March 13th indicates medication may raise the risk of deadly symptoms

• ACE inhibitors and angiotensin receptor blockers may lead to worse illness
• Patients should not stop taking their medication unless their doctor says so

In contrast to the above, the University of Minnesota is testing the blood pressure drug losartan to see if it can prevent COVID-19 infection or reduce symptoms. (March 19)

 

[NW-Bound]

I have borderline "essential" hypertension (145/85) without med, and had been taking lisinopril. I am not diabetic (dieting blood glucose of 90), and not obese (BMI of 23.5 currently).

My ears perked right up when reading of hypertension being one of the comorbidities of the COVID-19, way back when the news was mostly reported out of Wuhan. Aye, aye, aye...

And then later, when the news out of Italy, I think, said that lisinopril added to the problem with the ACE2 receptors and all that medical mysteries, I switched to losartan. It was because it was also reported that losartan was in a different class of drugs, and did not have this side effect with COVID-19.

And then recently, there was also report that losartan even helped. What the heck? I was going to look further into it.

I happen to have both prescription drugs, because I was changing drugs, and still had both prescriptions valid. I have enough for the next 3 months. I will talk to my general practitioner the next time I see him, but suspect this stuff is too new nobody has any concrete info.

Recently, many medical associations have stated that the case against lisinopril is weak, and recommend people continue it for the time being. As for me, I can take either one, and will stay with losartan to be safe.

 

[RetMD21]

The information seems sketchy. I saw a report that there was more mortality in patients with hypertension and/or ARB or Ace inhibitors but if you don't control for age you would expect that since use of the drugs and hypertension is associated with age.

Here are a couple of papers from the last few days. I think the summary is that nobody knows for sure so you should probably stick with treatment.

https://www.nejm.org/doi/full/10.1056/NEJMsr2005760

https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.120.15082

 

[target2019]

"... these conditions appear to track closely with advancing age"

That is in the first article. Thank you for posting.

 

[gauss]

Hypertension - or the Treatment?

DW started, for the first time, treatment for hypertension. She is currently on Lisinopril, an ACE-Inhibitor.

I have seen videos from MD's mentioning the relationship between the ACE 'elements' (?) in the mucous membranes as the biological attack vector for the C19 virus.

So this begs the question, is the hypertension itself the co-mobility factor for the C19 or is the ACE-Inhibitor treatments?

The next questions are then 1) Is this an issue before someone contracts C19 or does it only come into play afterwards and 2)How long does it take stopping an ACE-Inhibitor for the body to purge its effect if one were to test positive.

-gauss

 

[RetMD21]

maybe ACEI and ARB reduce risk of death if you have the disease

https://www.ahajournals.org/doi/abs/10.1161/CIRCRESAHA.120.317134

 

[P.S.]

From the ACC (American College of Cardiology) statement:
joint statement from the ACC, American Heart Association and Heart Failure Society of America was posted online on March 17 and addresses using renin angiotensin aldosterone system (RAAS) antagonists in COVID-19. "The continued highest standard of care for cardiovascular disease patients diagnosed with COVID-19 is top priority, but there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE-I or ARB medications," said Richard J. Kovacs, MD, FACC. "We urge urgent, additional research that can guide us to optimal care for the millions of people worldwide with cardiovascular disease and who may contract COVID-19. These recommendations will be adjusted as needed to correspond with the latest research."

Remember Mar 10 was still very very early in COVID knowledge. We still don’t understand fully all the different implications of everything: virus, pathogenesis, meds, comorbidities. This is going to take years to figure out. Mar 10 was just a few wks after it was figured out virus enters cells through ACE2 receptor. ACEI and ARB’s upregulate ACE receptors...... Except that as of now, there is no evidence that ACEI or ARB’s result in more severe COVID, and yes, there is some data to suggest that these drugs actually attenuate disease.

This is not medical advice. Speaking with your cardiologist would be excellent.

 

[RetMD21]

Unadjusted mortality rate was lower in the ACEI/ARB group versus the non-ACEI/ARB group (3.7% vs. 9.8%; P = 0.01)

Just one study but rather reassuring. I suppose that you could imagine without evidence that the drugs make a person more susceptible and this may offset the benefit or maybe the benefit isn't there. I agree ask your doctor

 

[RetMD21]

Another reassuring article https://www.nejm.org/doi/full/10.1056/NEJMoa2008975?
That is no increased risk of illness or evidence of increased severity

 

[Delaney]

For multiple reasons, I think its clear that people should continue taking blood pressure medications.

This article from May 2nd states, "Common blood pressure medicines do not put people at a higher risk of severe or fatal coronavirus symptoms, three major studies have found." These are just statistical studies, but many data points are involved in these studies.

This article from April 21rst discusses a study partially funded by Bill Gates that tests to see if Losartan may prevent COVID-19 lung damage. "The hope is that Losartan might bind to an enzyme and block the extra angiotensin II, thereby preventing the lung injury."

 

[W2R]

"The hope is that Losartan might bind to an enzyme and block the extra angiotensin II, thereby preventing the lung injury."

Yeah, right. Hope and a dollar will buy you a cup of coffee, isn't that how the saying goes?

I am on Losartan but do not expect it to protect me from anything other than what it is prescribed for.

 

[MichaelB]

Yeah, right. Hope and a dollar will buy you a cup of coffee, isn't that how the saying goes?

I am on Losartan but do not expect it to protect me from anything other than what it is prescribed for.

Makes sense to me.