Consensus among expert groups is to continue ACEi and ARB use when there is a specific indication for their use, even in patients diagnosed with COVID-19.
SARS-CoV-2 uses the angiotensin converting enzyme 2 (ACE2) receptor for entry into host target cells, the expression of which is increased by two common classes of antihypertensives, angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB).1
Some have speculated that these medications may increase coronavirus disease 2019 (COVID-19) susceptibility or disease outcome.2
Retrospective studies 3,4 and meta-analyses 5 have thus far demonstrated that among hypertensive patients hospitalized with COVID-19, mortality rate is not higher among those patients treated with ACEi/ARB. Thus, the safety of continuing ACEis and ARBs has been reinforced by several recent retrospective observational studies in COVID-19 patients.
Professional societies (American College of Cardiology, European Society of Cardiology, Hypertension Canada) have released statements regarding ACEi/ARB use during the pandemic; consensus among the groups is to continue their use, even in patients diagnosed with COVID-19 when there is a specific indication for their use (e.g. left ventricular (LV) dysfunction, chronic kidney disease (CKD), secondary stroke prevention).1,6However, the new prescription of these agents over the other recommended first line antihypertensive agents (i.e. thiazide diuretics (THZD) and calcium-channel blockers (CCBs)) must await the results of ongoing randomized controlled trials (RCTs).6
A table6 summarizing recommended initiation or continuation of ACEi/ARB in patients with COVID-19 and those at risk can be found here.
Note: This clinical question is an active area of research worldwide; conclusions and recommendations may change over time.