COVID-19: No evidence that heart, kidney medications raise risk
01 April, 2020
An idea that is doing the rounds on social media shows that certain heart and kidney medications make persons more vunerable to COVID-19. A fresh commentary strongly disputes this.
The commentary warns that discontinuing these hypertension and kidney medications would seriously endanger the fitness of those taking the drugs for high blood circulation pressure, congestive heart failure, and chronic kidney disease.
A. H. Jan Danser, from the Department of Internal Medicine at the Erasmus Medical Centre in Rotterdam, The Netherlands, is the first author of the commentary, which appears in Hypertension, a journal of the American Heart Association (AHA).
Danser co-authored the paper with Dr. Murray Epstein, from the Division of Nephrology and Hypertension at the University of Miami Miller School of Medicine in Florida, and Daniel Battle, from the Division of Nephrology/Hypertension at the Northwestern University Feinberg School of Medicine in Chicago.
The data is inconsistent
As Danser and colleagues clarify in their paper, the theory that some heart and kidney medications may improve the risk of problems and death from a SARS-CoV-2 infection arose when it became known that the “angiotensin-converting enzyme 2” (ACE2) receptor facilitates the entry of the virus into healthy cells.
Namely, some researchers that Danser and colleagues quote have suggested that taking the renin-angiotensin system (RAS) blockers - specifically, angiotensin II type 1 receptor blockers (ARBs) - might improve the risk of developing a severe and potentially fatal type of COVID-19.
RAS blockers are drugs doctors use to take care of hypertension. ARBs also treat hypertension, congestive heart failure, and kidney disease, among other conditions.
In their commentary, the authors speak about studies that contain raised the concern that such a preexisting hypertension treatment may elevate the risk of extreme COVID-19. However, as Danser and colleagues find, there is insufficient evidence to sustain such a concept.
Amplified by social media and the mass circulation of inaccurate medical information, this notion led to some persons not taking their medication.
Danser and associates say that “at the crux of the […] prevailing confusion and panic that we are witnessing in the medical community” is the question “just how do RAS blockers affect ACE2?”
Firstly, they explain, “Portion of the confusion in social media and the general public on the whole stands because, sometimes, ACE inhibitors are confused with ACE2 inhibitors.”
The two will vary enzymes with different active sites and the effect of ACE inhibitors on ACE2 activity is unlikely to affect the binding of the SARS-CoV-2 virus, describe Danser and colleagues.
Secondly, however, the authors do note some “limited reports” in animal models that recommend ARBs may affect ACE2 activity in the heart and kidney, but these email address details are diverse, they vary by ARB and organ, and required very high doses of the drug.
“Even if the reported upregulation of tissue ACE2 by ARBs in animal studies and, generally, with high doses could possibly be extrapolated to humans, this might not establish that it's satisfactory to facilitate SARS-CoV-2 entry,” they write.
Having reviewed a lot more than 29 studies, the authors stress their conclusion: the findings are inconsistent.
Discontinuing treatment could possibly be ‘truly tragic’
“Folks are making an unadvised leap,” Dr. Epstein explains. “The logic goes that, if [the drug] enhances penetrability, it enhances susceptibility to the disease, but that’s a dangerous conclusion.”
“What investigators have found varies widely, depending on the organ studied, the experimental animal model, and the ARB being used in the study. In conclusion, you will find a complete insufficient consistency.”
“The only thing we can conclude definitively, predicated on all of the known data, is that there is absolutely no credible evidence whatsoever that ARBs enhance susceptibility to COVID,” says Dr. Epstein.
In fact, discontinuing treatment with ARBs and ACE inhibitors might lead to a lot of harm, particularly nowadays where healthcare systems everywhere are under a lot of strain already.
Source: www.medicalnewstoday.com
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