Should ACE Inhibitors and Angiotensin Receptor Blockers Be Withdrawn in the Current Setting of COVID-19 Infection?

At the end of February 2020 and early March 2020, the British Medical Journal and the Lancet Respiratory Medicine Journal, respectively, published reports which hypothesized that patients with cardiac diseases, hypertension or diabetes, who are treated with angiotensin converting enzyme ACE inhibitors or angiotensin receptor blockers (ARBs), were more susceptible to COVID-19 (SARS-CoV-2) infection.(1,2) In one of the largest published series in Wuhan, China, cardiovascular comorbidities such as hypertension, coronary artery disease and diabetes have reported to be common in patients admitted to hospital with COVID-19 infection.(3) In this study of 1099 patients with confirmed COVID-19 infection and of 173 who were classified as having severe diseases, hypertension was reported to be prevalent in 23.7%, diabetes mellitus in 16.2% and coronary artery disease in 5.8%.(3) Although these conditions are often treated in hospitals with ACE inhibitors and ARBs, the effects of these treatment strategies on mortality were not assessed in this study.