Arb medication
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Summary
10 papers analyzed
These studies suggest that ACE inhibitors and ARBs are safe to continue for patients with hypertension or cardiovascular diseases during the COVID-19 pandemic, and may even reduce inflammation and mortality in hypertensive COVID-19 patients, while Arbidol shows potential as a broad-spectrum antiviral.
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Angiotensin Receptor Blockers (ARBs) in Hypertension and COVID-19: A Comprehensive Review
Introduction to ARBs in Hypertension Management
Angiotensin receptor blockers (ARBs) are widely recommended as a first-line or add-on therapy for managing hypertension. They are known for their efficacy in lowering blood pressure and their benefits in conditions like heart failure and diabetic renal disease, especially in patients intolerant to angiotensin-converting enzyme inhibitors (ACEIs). ARBs are often combined with other antihypertensive agents such as thiazide diuretics or calcium channel blockers to enhance their blood pressure-lowering effects.
ARBs and COVID-19: Evaluating the Risks and Benefits
Concerns About ARBs Increasing COVID-19 Severity
Initial concerns were raised about the potential for ARBs to increase the severity of COVID-19 due to their role in upregulating ACE2, the receptor for SARS-CoV-2. However, a comprehensive review of animal and human studies found inconsistent evidence regarding ACE2 expression in response to ARB treatment. Most human studies indicated that ARBs do not significantly increase ACE2 expression, suggesting that ARBs do not elevate the risk of severe COVID-19 complications.
Meta-Analyses on ARBs and COVID-19 Outcomes
Several meta-analyses have been conducted to assess the impact of ARBs on COVID-19 outcomes. One meta-analysis involving 9,890 hypertensive patients found no significant difference in the risk of severe or lethal COVID-19 between those treated with ARBs and untreated subjects. Another systematic review and meta-analysis of 26 studies concluded that ARB treatment was associated with a lower risk of mortality and ventilatory support in hypertensive COVID-19 patients, reinforcing the safety and potential benefits of continuing ARB therapy during the pandemic.
Retrospective Studies on ARBs in COVID-19 Patients
A single-center retrospective study of 126 COVID-19 patients with preexisting hypertension found that those treated with ARBs had lower levels of inflammatory markers (CRP and procalcitonin) and a trend towards lower mortality and critical illness rates, although these differences were not statistically significant. This supports the continued use of ARBs in hypertensive patients with COVID-19.
Systematic Reviews on ARBs and COVID-19 Severity
A systematic review of observational studies involving 23,565 adults with COVID-19 found high-certainty evidence that ARB use was not associated with more severe COVID-19 illness. This review also found moderate-certainty evidence that ARBs did not increase the likelihood of testing positive for SARS-CoV-2 among symptomatic patients.
Broader Antiviral Potential of Arbidol (ARB)
Arbidol (ARB), a synthetic antiviral drug, has shown efficacy against a range of viruses beyond influenza, including hepatitis C, Ebola, and human herpesvirus 8 . This broad-spectrum antiviral activity positions Arbidol as a potential therapeutic agent for various viral infections, although it is not widely used in North America.
Conclusion
The current body of evidence strongly supports the continued use of ARBs in patients with hypertension, including those with COVID-19. ARBs do not appear to increase the risk of severe COVID-19 outcomes and may even offer protective benefits. Additionally, the antiviral properties of Arbidol highlight its potential as a broad-spectrum antiviral agent. Patients and healthcare providers can be reassured about the safety and efficacy of ARBs in managing hypertension and their role during the COVID-19 pandemic.
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