The ACE2 enzyme has a relationship to corona virus infections including Covid-19. There has been a suggestion on the internet that ACE inhibitor and ARB medications for hypertension can increase ACE2 and increase the risk of Covid-19 infection. Now people are asking “Should I stop my blood pressure medication?”

The European Society of Cardiology Council on Hypertension has made a statement regarding this notion. DO NOT STOP your ACE inhibitor (“pril”) or ARB (“sartan”) medications to prevent Covid-19 infection.

The biochemistry of the relationship between ACE2 and heart disease is complicated. Our previous blog introduced this topic, but because people are talking about stopping their medications, the issue deserves more clarification.

Angiotensin is a hormone that causes constriction of blood vessels and an increases blood pressure. It is part of the renin angiotensin system (RAS). The RAS regulates blood pressure, influences inflammation, and encourages sodium retention. Over-activation of the RAS is common with stress, aging, and chronic  disease, particularly heart disease. Angiotensin II is the hormone that mediates these effects.

Rather than ACE inhibitor and ARB worsening Covid-19, it is more likely that they are protective. Both ACE inhibitors and ARBs make the ACE2 receptor less available to the virus. ACE inhibitor and ARB blood pressure medications have been shown to reduce the effects of corona virus in animal studies.

Also in animals, elevated angiotensin II worsens corona virus infections. Medications to reduce angiotensin II, like ACE inhibitors can be beneficial.

These are theories not established facts. There is no information from human studies to support or refute the effects of ARB or ACE inhibitors on Covid-19 infection.

There is actually a study in progress to determine whether ARB medications are actually HELPFUL in people with Covid-19 infection.

What is very clear is that stopping blood pressure medication is dangerous. Abrupt and severe blood pressure elevation can cause stroke, heart attack, heart failure, sudden death, and heart rhythm problems.

It makes a lot of sense to suppress the effects of the RAS because reducing angiotensin II improves health in general.

RAS is increased with stress. Increase your attention mindfulness and meditation. Stay informed but turn the news off sometimes. Find ways to stay connected with your family and friends while social distancing. Get outdoors. Make an a major effort to get in touch with feelings of gratitude.

Sleep reduces stress and RAS activation. Get yours.

Food is medicine. There are many things in a whole food diet that are natural ACE inhibitors including, garlic, fiber, celery, yogurt, and others. Do your best to stay nutritionally solid with whole foods, not processed foods.

Please, do not stop any blood pressure medication without consulting your doctor. Be grateful that many people are working hard as we speak to resolve the questions brought up by ACE2 and every other aspect of treating this terrible infection.

J Thomas Svinarich MD FACC FHRS

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