How do blood pressure medications affect coronavirus patients? Specialists hope to crack the code

Researchers have launched a new multi-center clinical trial aimed at learning more about how various blood pressure medications impact the health of patients with COVID-19.   

The trial, dubbed REPLACE COVID-19 (Randomized Elimination or ProLongation of Angiotensin Converting Enzyme inhibitors and angiotensin receptor blockers in Coronavirus Disease 2019), will explore if angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) lead to “more severe symptoms and worse outcomes” among patients being treated for COVID-19.

A team from the Perelman School of Medicine at the University of Pennsylvania launched the trial, with professors Julio A. Chirinos, MD, PhD, and Jordana B. Cohen, MD, MSCE, serving as co-principal investigators. The plan is to enroll 152 patients who are hospitalized for suspected or confirmed COVID-19, with researchers working to develop a “global risk score” that takes numerous key factors into consideration.

“While some data suggests patients with underlying health conditions, like heart disease and high blood pressure, have a higher risk of developing a more severe form of COVID-19, we don’t know whether ACE inhibitors or ARBs are beneficial or harmful,” Chirinos said in a prepared statement. “There’s an urgent need to understand how these medications may alter the disease course so we can better guide our treatment for patients who are prescribed these therapies and infected with COVID-19.”

“Many people are changing their usual medical management right now based on limited or incomplete information,” Cohen said in the same statement. “Until we have high quality evidence, we recommend that patients continue to take these medications as prescribed unless they are told to stop them by their medical provider.”

In March, the American Heart Association, Heart Failure Society of America and American College of Cardiology released a statement telling patients with cardiovascular disease to keep taking these medications unless specifically instructed to stop by a physician.

“We understand the concern—as it has become clear that people with cardiovascular disease are at much higher risk of serious complications including death from COVID-19,” Robert A. Harrington, MD, AHA president and Arthur L. Bloomfield Professor of Medicine at Stanford University, said at the time. “However, we have reviewed the latest research—the evidence does not confirm the need to discontinue ACE-i or ARBs, and we strongly recommend all physicians to consider the individual needs of each patient before making any changes to ACE-i or ARB treatment regimens.”