Introduction:
The number of people who got infected with COVID-19 virus were around 43.7 million and the number of deaths was around 710 thousand by October 2021 in the United States according to the Center for Disease Control and Prevention (CDC) data tracker.
Recent data showed that patients with cardiovascular diseases such as hypertension who tested positive for COVID-19 had worse outcomes. Between 2017-2018, the prevalence of hypertension was 45% among adults in the USA. Millions of hypertensive patients use angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) as the first-line treatment.
There are conflicting data regarding the use of these medications, the severity of the COVID-19 infection, and the mortality rate (Figure 1). COVID-19 virus gains entry to pulmonary cells through binding to the membrane angiotensin convertase enzyme receptor 2 (ACE-2). Hence there is a concern about using ACEI and ARBs as these medications use the same receptors. There is a debate regarding the increased risk of COVID-19 infection in patients who use ACEI and ARBs by increasing the viral entry and subsequently increasing the viral load and the mortality risk. On the other hand, studies have shown that ACEI and ARBs medications can protect against COVID-19 infection by attaching to the ACE receptors, thereby decreasing the availability of those receptors to the COVID-19 virus, leading to the deactivation of the virus and decreasing the virus load. Hence many investigators have advised the use of ACEI and ARBs medications in COVID-19-positive patients even with no history of hypertension.
Figure 1: Two conflicting hypotheses of association between ACEI/ARB and COVID-19.