Management of hypertension in COVID-19

Abstract

The ACE2 receptor plays a central role in severe acute respiratory syndrome coronavirus 2 host cell entry and propagation. It has therefore been postulated that angiotensin converting enzyme inhibitors and angiotensin receptor blockers may upregulate ACE2 expression and thus increase susceptibility to infection. We suggest that alternative anti-hypertensive agents should be preferred among individuals who may be exposed to this increasingly common and potentially lethal virus.

Keywords: Angiotensin converting enzyme inhibitor; Angiotensin receptor blocker; Carvedilol; Coronavirus disease-19; COVID-19; SARS-CoV-2; Verapamil

Core tip: The pathogenic mechanisms of severe acute respiratory syndrome coronavirus 2 remain under investigation, but data suggest that the ACE2 receptor plays a central role in infection. It is therefore possible that drugs known to increase ACE2 expression, such as angiotensin converting enzyme inhibitors and angiotensin receptor blockers, could promote viral proliferation. Data from animal studies have shown that carvedilol and verapamil attenuate inflammation in viral myocarditis. We are in agreement with the recommendation of major medical societies to maintain angiotensin converting enzyme inhibitor or angiotensin receptor blocker therapy in individuals who are already receiving treatment. However, in the age of coronavirus disease-19, alternative agents should be considered for patients with a new diagnosis of hypertension.