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ACE Inhibitors & COVID-19

Discussion in 'Ask A Question' started by type two paul, Mar 13, 2020.

  1. type two paul

    type two paul Type 2 · Well-Known Member

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  2. Antje77

    Antje77 LADA · Moderator
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    From that same article:
    "Scientists say the research does not prove a link between the medications and severe COVID-19, but that a potential connection should be studied more closely."

    So they do not say "the use of ACE inhibitors can increase the symptoms of Coronavirus", they say "There is a possibility the use of ACE inhibitors can increase the symptoms of Coronavirus but there is no indication yet that it does so.".

    However, there is a lot of proof on the dangers of high bp.
    I don't expect so. This is about one short article in The Lancet in which they speak of a hypothesis that hasn't even been worked out yet. For one, I expect GP's are way too busy doing their work at the moment to read The Lancet and secondly, there is nothing in that article to suggest suddenly moving thousands of patients to different drug would be a wise course.

    Here's a link to the article: https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf
     
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  3. type two paul

    type two paul Type 2 · Well-Known Member

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    Agreed, to stop Lisinopril could increase my risk of stroke and there are a lot of COULDs in this article. I will continue taking them. I guess we will all suffer different degrees of symptoms , so would never really know if it was the medication.
     
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  4. Daphne917

    Daphne917 Type 2 (in remission!) · Well-Known Member

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    The issue may be because ACE inhibitors can cause a cough and I’m wondering if Covid-19 exacberates it. My husband is on 8 different meds inc Rampril and, whilst we are a little concerned as to what will happen if he does get the virus, we’ve decided to cross that bridge if we come to it.
     
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  5. type two paul

    type two paul Type 2 · Well-Known Member

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    Hi,
    I don't think it's the cough as such. That's a side affect anyway.
    According to the article:coronavirus sticks to cells and attacks them by latching onto something called angiotensin-converting enzyme 2 (ACE2). Some people with high blood pressure or type 1 or type 2 diabetes have to take drugs which increase the amount of ACE2 that they have on their cells, in order to control their illness.

    So, I think the fact the medication increases the ACE2 means the virus has more to attach to.

    Lot's of COULDs in the article though, so I'm sticking to my meds.


     
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  6. Antje77

    Antje77 LADA · Moderator
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    Not at all what the article is about.
     
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  7. Struma

    Struma Type 2 · Well-Known Member

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    I've just read the articles, thank you both.
    Nothing has alerted me to immediately stop the ARB that I'm taking. BUT, I shall instigate hypervigilance in surveillance. This is logical to question, and then pull the plug on the pills.

    @Daphne917 A very good reason for medical personel to be cautious, and I think a fair few will overlook.
    The cough is due to inhibition of the breakdown of bradykinins, if you weren't aware. Now, the cough produced is very distinct indeed. I can, from experience, pick people out say, when I'm out shopping. I wish I had another ability!
     
  8. Oldvatr

    Oldvatr Type 2 · Expert

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    This is what
    Prof. Giovanni de Simone,
    Chair, ESC Council on Hypertension

    says about this speculative report

    https://www.escardio.org/Councils/C...cil-on-hypertension-on-ace-inhibitors-and-ang

    Edit to add: The Chinese report gives statistics regarding the mortality rates for different co-morbidities and the classes of associative diseases etc included
    Cardiovascular, Diabetes, and hypertension,

    So having high BP levels certainly seems to put one at greater risk of mortality. Old age is another. It is not stated in their report what form of diabetes is involved or if it was controlled or uncontrolled. Similarly CVD covers things like varicose veins, bad circulation to heart attack, MI, stroke or heart failure, so not a very helpful classification IMHO. I did not see COPD or other lung diseases in their list either, but suspect that sufferes of these conditions will also be at serious risk. Also imunosuppressed patients such as on chemotherapy or transplants. Very poor report so I do not believe their statistics either.

    But having diabetes tends to be associatd with higher BP and thus use of drugs like ACE inhibitors. CVD and heart failure likewise uses the same meds, especially Ramipril. So one could say that ACE meds are common to all of these co-morbidities. Bur that would be guessing.

    Speaking of guessing, I suspect that many of these patients were also on statin therapy and had high cholesterol too but that was ignored it seems.
     
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    #8 Oldvatr, Mar 13, 2020 at 10:07 PM
    Last edited: Mar 13, 2020
  9. Daphne917

    Daphne917 Type 2 (in remission!) · Well-Known Member

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    I had to stop taking Ramipril due to developing the cough and am now on Candasartan.
     
  10. Daphne917

    Daphne917 Type 2 (in remission!) · Well-Known Member

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    Apologies I seem to have gone down the incorrect rabbit hole here. I don’t normally comment on articles etc and probably won’t bother in the future.
     
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  11. Antje77

    Antje77 LADA · Moderator
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    Please keep commenting on anything, there's nothing wrong with your comment! Looking back on what I wrote, it sounds rather unfriendly. Not at all the way I meant it, I just meant to inform people reading this thread that no scientist has mentioned the connection you made.
    Apologies for not rereading how I worded my reply!
     
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  12. Jasper27

    Jasper27 · Newbie

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    Im type 1...was on lisinopril for last 17 years then tried others but back on the lisinopril..i was thinking of possibly reducing my dose in the light of this
     
  13. LucySW

    LucySW Type 1 · Well-Known Member

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    That’s correct. Apparently the way the virus reproduces itself is by latching onto ACE-2 receptors, wherever it finds them. That is the entry point - how we get it. ACE-2 receptors are produced by the epithelium, the surface of the walls of blood vessels, in the lungs (mainly), but also the intestine, kidneys, and heart muscle.

    (As I understand it. Someone correct me if I’m wrong.)

    So because some hypertension treatment significantly raises levels of these (in effect) gateway receptors, people taking hypertension medicines really need to try to protect themselves.
     
  14. Oldvatr

    Oldvatr Type 2 · Expert

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    The mechanism you describe is certainly associated with other variants of the virus in the same corona class e/g/ MERS and SARS, but although this may also be applicable to COVID-19 it is not established as being the same pathway. Certainly the use of hypertension medication is something that is common to all the 'at risk groups' so far labelled by the NHS. Cardiovascular Diabetes and Old Age all seem to suffer a need for lowered BP levels. My heart team have just doubled my ramipril dose to the max dose and I am about to do a trawl throgh the dossette boxes to turf the little pills out into the round receptacle by my chair.

    Edit to add: an up to date response from the cardiologists
    https://www.mdmag.com/medical-news/acc-aha-esc-advise-ace-inhibitors-arbs-use-covid19


    And here is a good discussion by doctor on the science of this
     
    #14 Oldvatr, Mar 18, 2020 at 11:31 AM
    Last edited: Mar 18, 2020
  15. Oldvatr

    Oldvatr Type 2 · Expert

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    Update: My heart support team have reponded to my request to come off the Ramipril by pointing me to the BHF website where the claims are being debunked thoroughly(?) and they are refusing to put me on anything different such as the Amlodipine that I was using quite successfully before they got involved.

    I note that there is info included in the BHF report that covers the Wuhan Study on co-morbidities associated with Covid-19 which may also be of interest to us as diabetics too..
    https://www.bhf.org.uk/informations...agazine/news/behind-the-headlines/coronavirus
     
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  16. JohnEGreen

    JohnEGreen Other · Master

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    Off topic a bit I know but it seems the reports about ibuprofen were wrong although NHS are still recommending we take paracetamol rather than ibuprofen.
     
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  17. Oldvatr

    Oldvatr Type 2 · Expert

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    Those of us on heart meds need to be aware that many heart meds are contraindicated with Ibuprofen and NSAIDS in general, so check the reputable websites like Drugs.com or Medscape or even the BNF
     
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  18. JohnEGreen

    JohnEGreen Other · Master

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    I'm asthmatic so ibuprofen is not a good idea for me any way though I have been known to chance it on occasion. I don't have a specific heart condition my problem was a triple A but have been diagnosed with an irregular heart beat in the past.
     
  19. Oldvatr

    Oldvatr Type 2 · Expert

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    The following treatise is a scientists review of the same topic as per the OP
    http://www.nephjc.com/news/covidace2

    It covers the same ground as the Youtube video I posted earlier, and reaches the same state of confusion, but is definitely in scientific language for anyone who prefers mindfuddling explanations.and an impressive list of experts signing the peer review.

    IMHO the Jury is still out. I have escalated my request to change my medication to the Consultant at the main Hospital in the County and await a reply.
     
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    #19 Oldvatr, Mar 18, 2020 at 11:30 PM
    Last edited: Mar 19, 2020
  20. lindisfel

    lindisfel · Well-Known Member

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    Have you guys seen the youtube video
    The Coronavirus Pandemic update 37?
    I found I couldn't link, it but it was excellent on the subject Ace inhibitors and Arbs and comes up early in a search.
    D.
     
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