AHA Guidance on Hypertension, Latest on Angiotensin Link

What your doctor is reading on Medscape.com:

APRIL 01, 2020 — The American Heart Association (AHA) has issued new guidance for patients with hypertension during the COVID-19 outbreak. At the same time, several new review articles have been published further exploring the possible relationship between the renin-angiotensin system (RAS) and the virus.

The AHA guidance, titled “What people with high blood pressure need to know about COVID-19,” notes that individuals with raised blood pressure may face an increased risk for severe complications if they are infected with the virus. Data from the outbreak in Wuhan, China, shows a 10.5% death rate among people with COVID-19 who also have cardiovascular disease, 7.3% for those with diabetes, 6.3% for those with respiratory disease, 6% for those with high blood pressure, and 5.6% for those with cancer.

The advisory reiterates previous recommendations that patients should not stop taking prescribed angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for hypertension, heart failure, or heart disease. 

“These medications don’t increase your risk of contracting COVID-19. They are vital to maintaining your blood pressure levels to reduce your risk of heart attack, stroke, and worsening heart disease,” it states.

Under the heading “Caution is key,” the guidance warns that some common habits or medicines and supplements can raise blood pressure, including nonsteroidal anti-inflammatory drugs and decongestants. “People with heart concerns should limit or avoid them, especially if their blood pressure is uncontrolled,” it states.

It also advises that people taking medication for mental health, corticosteroids, oral birthcontrol, immunosuppressants, and some cancer medications should monitor blood pressure to make sure it’s under control.

The guidance advises that people should limit both alcohol and caffeine because too much can raise blood pressure. “Caffeine should be capped at three cups per day in general, and most people with high blood pressure should avoid it,” the guidance states. Some herbal supplements, such as licorice, can also raise blood pressure, it adds.

Latest on Angiotensin Drugs

Meanwhile, several more commentators have reviewed evidence on the relationship between the RAS and COVID-19 infection. These include commentaries published in the New England Journal of Medicine, Lancet Respiratory Medicine, and Mayo Clinic Proceedings. 

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