Cleveland Clinic study confirms no association between medications for chronic cardiac diseases and COVID-19

Despite recent controversy suggesting that popular medications prescribed to lower blood pressure may increase the risk of infection by the novel coronavirus and lead to more severe outcomes in COVID-19, a retrospective study by Cleveland Clinic, Ohio, US, has supported the view that there is no foundation to these claims, although the researchers called for larger studies as the pandemic develops.

The medications in question are Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs), both of which dilate blood vessels to increase the amount of blood pumped by the heart. The result is lowered blood pressure and increased blood flow, which helps to lower the heart’s workload and reduce the risk of heart failure. The medications are commonly prescribed in cases of coronary artery disease, heart failure, diabetes and hypertension (high blood pressure).

“Our analysis found no association between ACEI or ARB use and COVID-19 test positivity,” says Cleveland Clinic cardiologist Ankur Kalra, MD, the study’s corresponding author.

“These medications are important tools in the management of coronary artery disease, heart failure, diabetes and hypertension. As there may be a risk to withdrawing these agents, our findings support current professional society guidelines to not discontinue ACEI or ARB therapy in the context of the COVID-19 pandemic,” he added.

The Cleveland Clinic study looked at 18,472 individuals tested for COVID-19 at its locations in Florida and Ohio, with a mean age of 49 (± 21 years), and who were predominantly female (60%) and white (69%). Testing for COVID-19 was positive in 1,735 patients, or 9.4% of the total sample.

First study author Neil Mehta, MD of the Department of Medicine at the Cleveland Clinic Lerner College of Medicine, says: “Our findings with regard to clinical outcomes and measures of COVID-19 severity while on ACEI or ARB therapy give some reassurance. However, they must be interpreted with caution, due to the small sample size and the limitations of observational studies. They require replication and reanalysis in larger patient samples later in the course of the ongoing COVID-19 pandemic.”

A secondary analysis among COVID-19-positive patients showed no association between use of these medications and risk for mechanical ventilation.