Leading Cardiology Organizations Advise Continuation of ACE Inhibitors, ARBs During COVID-19

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Patients who are already prescribed angiotensin converting enzyme inhibitors (ACE-i) or angiotensin receptor blockers (ARBs) should continue treatment, unless otherwise advised by their physician, according to a new joint statement from the American Heart Association (AHA), the Heart Failure Society of America, and the American College of Cardiology (ACC).

The statement was precipitated by a need to dispel misinformation circulating about the use of ACE-i and ARB medications among patients with COVID-19. 

“We understand the concern – as it has become clear that people with cardiovascular disease are at much higher risk of serious complications including death from COVID-19,” said AHA President Robert A. Harrington, MD in an AHA press release. “However, we have reviewed the latest research – the evidence does not confirm the need to discontinue ACE-i or ARBs, and we strongly recommend all physicians to consider the individual needs of each patient before making any changes to ACE-i or ARB treatment regimens.”

If a patient with cardiovascular disease is diagnosed with COVID-19, the organizations recommend that individualized treatment plans be made according to each patient’s hemodynamic status and clinical presentation. Physicians, therefore, are advised to not add or remove any such treatment, beyond actions based on standard clinical practice.

Despite most COVID-19 symptoms being respiratory-related, angiotensin converting enzyme 2 (ACE2) receptors have been found to be the entry point into human cells for SARS-CoV-2, the virus that causes COVID-19.

Both ACE-i and ARBs have been shown to upregulate ACE2 expression on the heart, although this has not yet been demonstrated in human studies or with COVID-19 infection.

Such potential upregulation of ACE2 by ACE-i or ARBs, however, has increased speculation of potential increased risk for COVID-19 in patients with a history of taking these medications, the statement noted.

“The continued highest standard of care for cardiovascular disease patients diagnosed with COVID-19 is our top priority, but there are no experimental or clinical data demonstrating beneficial or adverse outcomes among COVID-19 patients using ACE-i or ARB medications,” said Richard J. Kovacs, MD, president of the ACC, in the same AHA press release. “We urge urgent, additional research that can guide us to optimal care for the millions of people worldwide with cardiovascular disease and who may contract COVID-19. These recommendations will be adjusted as needed to correspond with the latest research.”

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