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Infectious Diseases

Updated 08 May 2020

Blood pressure medications do not increase Covid-19 risk

Some experts have expressed concerns about common high blood pressure medications increasing the risk of contracting Covid-19, or developing severe disease, but a new study disproves these concerns.

Many people with high blood pressure, medically known as hypertension, have been wondering whether their blood pressure medications could increase their risk of developing Covid-19, the disease caused by the new coronavirus. However, a new study, led by researchers from NYU Grossman School of Medicine, found that common high blood pressure drugs did not increase the risk of contracting Covid-19, or of developing severe disease.

This came after the American Heart Association, the American College of Cardiology and the Heart Failure Society of America issued a joint statement on 17 March, wherein they called for urgent research into whether high blood pressure medications worsen Covid-19 patient outcomes, a news release by EurekAlert reports.

The study was recently published in the New England Journal of Medicine.

Why the cause for concern?

The topic became popular recently when some experts questioned the relationship between common blood pressure medications and their ability to increase the risk of Covid-19. Among them was a letter published in the Lancet. The author recommended stopping ACE Inhibitors and ARBs – which relaxes the veins and arteries to lower blood pressure – in Covid-19 patients, based on seemingly legitimate theoretical concerns. For people with hypertension, this led to a wave of panic, causing them to stop taking their medication.

The NYU study specifically looked at medications that act on the renin-angiotensin-aldosterone hormonal system (RAAS), which regulates blood pressure. The researchers identified 12 594 patients in the NYU Langone Health electronic health record who had tested positive for Covid-19. They then analysed their medical history to compare treated and untreated patients.

The team looked at the link between treatment with four drug classes, and an increased risk of testing positive for Covid-19:

  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta blockers
  • Calcium channel blockers 

Their study concluded: “We found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 [including intensive care, use of a ventilator, or death] among patients who tested positive in association with five common classes of antihypertensive medications. 

"Before our study, there were no experimental or clinical data demonstrating the consequences of using these medications one way or the other in people at risk for Covid-19," senior study researcher Judith Hochman, MD, the Harold Snyder Family Professor of Medicine and Senior Associate Dean for Clinical Sciences at NYU Langone Health said.

"In terms of next steps, our plan is to use similar approaches to investigate other medications and their relationship to Covid-19 illness."

Lead author of the study Harmony Reynolds, MD, associate director of the Cardiovascular Clinical Research Center at NYU Langone Health, also said that considering nearly half of American adults live with high blood pressure, understanding the relationship between these common medications and Covid-19 was highly significant. 

"Our findings should reassure the medical community and patients about the continued use of these commonly prescribed medications, which prevent potentially severe heart events in their own right," Reynolds said.

Hypertension in SA

According to the Heart and Stroke Foundation South Africa, 225 South Africans are killed by heart diseases every day and 13% of global deaths are caused by hypertension. The World Health Organization (WHO) estimates that 1.13 billion adults worldwide are currently living with the condition. High blood pressure is the major risk factor for heart disease, stroke, and kidney disease.

In 2018, an estimated 42% to 54% of South Africans were suffering from hypertension, an article by Health-E News reported, and further explained that, according to a study by Wits University scientists, South Africa has the highest prevalence of the condition in southern Africa.

In response to the latest research, Professor Pamela Naidoo, CEO of the Heart and Stroke Foundation South Africa, said:

“The findings of this study, published in a very reputable scientific journal, provide important evidence for the treatment of hypertensive patients during the Covid-19 pandemic. It is important for individuals who have hypertension to take their medication and follow related treatment protocols as prescribed by their doctor, whether they have Covid-19 or not, or in fact whether they are hospitalised or not. 

“We need to always remember that health care professionals care deeply about their patients and follow evidence-based practice guidelines when they are treating their patients for hypertension, or any other medical condition."

Mkhize urges South Africans with comorbidities to take extra precautions

In a media release on 2 May, South African Minister of Health, Dr Zweli Mkhize said:

“We have looked at the data for patients who have been hospitalised and found that, consistent with evidence emerging worldwide, hypertension, diabetes and cardiac disease are the three most common comorbidities associated with serious illness from Covid-19.

“I would, therefore, like to urge our millions of South Africans who are over 63 years of age and those who live with these conditions to take extra precaution as we ease the lockdown.”