ACE and ARB does not increase the risk of dying from COVID-19

Observational studies have shown that the presence of diabetes and hypertension are associated with an increased risk of mortality from COVID-19, but whether the increased risk of death occurred independent of concurrent drugs that patients are taking is unclear. Relevant to this is the speculation that ACE and ARB – drugs widely used in people with diabetes and hypertension - maybe deleterious to COVID-19 outcome due to the propensity of the virus to bind to cellular ACE-2 receptors. In the absence of clear evidence, guideline from national and international hypertension societies have recommended that patients should not discontinue these drugs in the event of COVID-19 infection. A recent study from the USA, published in the New England Journal of Medicine, have provided some reassurance of the safety of these classes of drugs during COVID-19 infection. The study investigated clinical outcomes of 8910 patients admitted to hospital with COVID-19. After adjusting for confounders, they identified that age above 65 years old, having cardiovascular disease, COPD and being a current smoker was associated with a significant doubling of mortality rate. However, reassuringly, the use of ACE and ARB was not associated with an increased risk of mortality. NEJM (doi:10.1056/NEJMoa2007621).