ACE Inhibitors Not Linked with Increased Risk for Positive COVID-19 Test

A new paper in the New England Journal of Medicine shows that conventional hypertensive medications do not increase the risk for a positive test for SARS-Cov2 (COVID-19).

Researchers from the NYU Grossman School of Medicine undertook the study due to fears that drugs that acted on the renin-angiotensin-aldosterone system (RAAS), commonly used to treat hypertension, could elevate the risk for severe symptoms in patients exposed to COVID-19 [specifically, the viral receptor angiotensin-concerting enzyme 2 (ACE2), which is present on the outer membrane of lung cells and has been shown to be a connector for the virus].  The researchers looked at the relationship between previous treatment with ACE inhibitors, angiotensin-receptor blockers (ARBs), calcium-channel blockers, or thiazide diuretics, and the likelihood of positive or negative COVID-19 testing. They also examined the risk of severe illness (which they defined as intensive care, mechanical ventilation, or death) in patients testing positive for COVID-19.

The study included 12,594 patients tested for COVID-19. Of those, 5,894 (46.8%) tested positive, and 1,002 (17.0%) of them had severe illness. The authors also reported a history of hypertension in 34.6% of patients (2,573 [59.1%] in the positive group, with 634 having severe illness). According to the researchers, there were no observed associations between any single medication class and increased likelihood for a positive COVID-19 test, and none of the medication classes, including ACE inhibitors, were associated with an increased risk for severe illness in the patients who tested positive for the virus.

“With nearly half of American adults having high blood pressure, and heart disease patients more vulnerable to COVID-19, understanding the relationship between these commonly used medications and COVID-19 was a critical public health concern,” said lead study investigator Harmony R. Reynolds, MD, associate director of the Cardiovascular Clinical Research Center at NYU Langone Health, in a press release. “Our findings should reassure the medical community and patients about the continued use of these commonly prescribed medications, which prevent potentially severe heart events in their own right.”