COVID-19 – Renin-Angiotensin System Drugs

Posted on:

A BMJ Editorial on Drugs and the renin-angiotensin system in COVID-19 published 02/04/20 includes the following advice about decisions on continuing treatment during the pandemic (supported by a suggested algorithm):

The balance of potential benefits and harms from continuing ACE inhibitor or ARB therapy during an acute infection depends on the reason for prescribing. Many people taking these drugs long term—for example, those with mild hypertension—will gain benefit over years, rather than weeks or months. During the covid-19 epidemic, the people most likely to be infected—household contacts of infected people and healthcare workers—might choose to adopt the precautionary principle, deferring long term cardiovascular benefit to reduce a theoretical short term risk from continuing treatment while they are infected.

Patients who may deteriorate rapidly if treatment with ACE inhibitors or ARBs is stopped, including those with heart failure or poorly controlled hypertension, should probably continue to take them, even during active infection.

Most patients, however, will be able to take their medications as usual during the pandemic, only considering withholding treatment if they get an infection.