Lancet: Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

[Supa]

First hello to the group! New poster here but long time reader. I would like to add this to the discussion, that an article in the Lancet noticed that the increased susceptibility and mortality in some might be related to ACE inhibitor and ARBs medications they are taking to treat hypertension and prevent diabetes complications.

"These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19."

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

 

[kiwibird]

First hello to the group! New poster here but long time reader. I would like to add this to the discussion, that an article in the Lancet noticed that the increased susceptibility and mortality in some might be related to ACE inhibitor and ARBs medications they are taking to treat hypertension and prevent diabetes complications.

"These data suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. We therefore hypothesise that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19."

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(20)30116-8.pdf

https://en.wikipedia.org/wiki/ACE_inhibitor

Angiotensin-converting-enzyme inhibitors (ACE inhibitors) are a class of medication used primarily for the treatment of high blood pressure and heart failure.

They work by causing relaxation of blood vessels as well as a decrease in blood volume, which leads to lower blood pressure and decreased oxygen demand from the heart. They inhibit the angiotensin-converting enzyme, an important component of the renin–angiotensin system.

ACE inhibitors also increase the level of bradykinin, a peptide vasodilator, by inhibiting its degradation, thereby increasing their blood pressure lowering effect.

Frequently prescribed ACE inhibitors include benazepril, zofenopril, perindopril, trandolapril, captopril, enalapril, lisinopril, and ramipril.

also

[h=2]Adverse effects[edit][/h]
Common side effects include: low blood pressure, cough, hyperkalemia, headache, dizziness, fatigue, nausea, and kidney impairment.[SUP][9][/SUP][SUP][10][/SUP]

The main adverse effects of ACE inhibition can be understood from their pharmacological action. The other reported adverse effects are liver problems and effect on the fetus.[SUP][10][/SUP] Kidney problems may occur with all ACE inhibitors that directly follows from their mechanism of action. Patients starting on an ACE inhibitor usually have a modest reduction in glomerular filtration rate (GFR) that stabilizes after several days. However, the decrease may be significant in conditions of decreased renal perfusion, such as renal artery stenosis, heart failure, polycystic kidney disease, or volume depletion. In these patients, maintenance of GFR depends on angiotensin-II-dependent efferent vasomotor tone. Therefore, renal function should be closely monitored over the first few days after initiation of treatment with ACE inhibitor in patients with decreased renal perfusion.[SUP][10][/SUP] A moderate reduction in renal function, no greater than 30% rise in serum creatinine, that is stabilized after a week of treatment is deemed acceptable as part of the therapeutic effect, providing the residual renal function is sufficient. This is especially a problem if the patient is concomitantly taking an NSAID and a diuretic. When the three drugs are taken together, the risk of developing renal failure is significantly increased.[SUP][11][/SUP]