Hypertension and COVID-19 – is there a link? Q&A with Professor Alta Schutte

Recent claims linking hypertension treatments to COVID-19 led to a series of statements being issued by medical societies, including the International Society for Hypertension, cautioning against an overreaction.

We asked Professor Alta Schutte, President of the International Society of Hypertension (ISH), and Professorial Fellow, Cardiovascular Program at the George Institute, what it was all about.

How did it start?

Correspondence published in the prestigious Lancet Respiratory Medicine journal suggested that the most commonly used medications to treat high blood pressure - ACE inhibitors and angiotensin receptor blockers – may increase the risk for infection in patients with hypertension and diabetes mellitus, and may also increase the risk for severe and fatal COVID-19.

Amplified by social media and the mass circulation of inaccurate medical information, this idea led to confusion among healthcare professionals and some patients not taking their medication.

What was the basis for it?

The issue surrounding ACE-inhibitors and ARBs stems from the fact the COVID-19 virus binds to a particular protein on the cell surface – this is how it enters cells. What we know from inconsistent animal studies is that ARBs and ACE-inhibitors may increase the production of this protein in the body as many as three to five times. It’s a hypothesis for which there is a good logic, but it has not been proven in humans.

Why was it important for ISH to put out a statement on this?

The consequences of stopping taking ARBs or ACE inhibitors is that blood pressure can get out of control and this can lead to heart attacks and strokes. There is a much greater risk for these cardiovascular events than for getting infected with COVID-19.

Discontinuing treatment with these medications could cause a great deal of harm, particularly in these times where healthcare systems are already stretched.

So what do we know about the risk of COVID-19 infection in people with hypertension?

To date - there is no evidence that people with hypertension are over-represented amongst those seriously infected by COVID-19. Many challenge this statement as recent scientific reports from COVID-19 populations often suggest that hypertension was common in those with COVID-19 infection. It is important to point out that for all of these reports, no one accounted for the age of the populations. We know that people over the age of 60 have a >90%  lifetime risk to develop hypertension, and thus age (not hypertension) may be the main reason for infection.

What about the proposed association between hypertension treatments and worse outcomes from COVID-19?

There are no clinical data in humans to show that ACE-Inhibitors or ARBs either improve or worsen susceptibility to COVID-19 infection nor do they affect the outcomes of those infected. Important to note that there are also animal studies suggesting that the use of ACE-inhibitors or ARB could be protective in the setting of COVID-19 infection. But again no data is available in humans.

What’s your advice?

In the absence of any such compelling data the ISH strongly recommend that the routine use of ACE-Inhibitors or ARBs to treat raised blood pressure should continue and should not be influenced by concerns about COVID-19 infection.

Do you think this will change?

It is possible that in light of new clinical trial data in humans it may be that the management of raised blood pressure could be modified to reduce susceptibility to or improve outcomes among those infected by COVID-19. However, currently no such data are available to make such recommendations, and so no changes should be made.