Professor Barbara Casadei: ACEi/ARBs & ESC's Most Common COVID-19 Questions

April 19, 2020
Patrick Campbell

Discussion the debate around use of ACE inhibitors and ARBS as well as other common questions the ESC has been fielding during the ongoing outbreak.

The coronavirus disease 2019 (COVID-19) has shaken the world and left clinicians and researchers with a plethora of unanswered questions, the most persistent of those questions among cardiologists concerns the use medications from the ACE inhibitor and angiotensin receptor blocker (ARB) classes.

Despite guidance released weeks ago by major cardiology organizations, including the European Society of Cardiology (ESC), the questions surrounding how discontinuation of the therapies might impact the severity or risk of contracting the disease still remain.

While early data from China and other hotspots have established SARS-CoV-2 binds to ACE2 receptors in the lungs and while this has contributed to the debate, much of the debate stems from an article published in The Lancet in early March. The article, which examined more than 1200 COVID-19 patients, suggested individuals with cardiovascular disease, hypertension, or diabetes, who are treated with ACE inhibitors or ARBs were at higher risk for severe COVID-19 infection. After a follow-up article weeks later clarifying their stance and urging against over-interpretation of results—despite the reply the original study has still birthed a myriad of questions.

A sign of an end to the debate has arrived with a new study from Perelman School of Medicine at the University of Pennsylvania, but the trial is currently enrolling and is not expected to be completed until December 2019.

For more insight on this topic, HCPLive® caught up with Barbara Casadei, MD, British Heart Foundation Associate professor of Cardiovascular Medicine at the University of Oxford and President of the ESC.