• People with cardiovascular disease have a higher risk of poor outcomes from COVID-19, but the interaction between cardiovascular medications and COVID-19 is unclear.
• Analyzing hundreds of observational and research studies, scientists found that cardiovascular drugs do not affect COVID-19 outcomes.
• The results indicate that people at risk of or with COVID-19 should continue taking cardiovascular medications as prescribed.
• The researchers plan to continue to build their evidence base as new studies are published, creating a “living” systematic review.

When the COVID-19 pandemic hit, one of the most striking observations was the wide variety of health outcomes among people who developed the underlying viral infection.

For people taking drugs to manage cardiovascular disease, the lack of knowledge about possible interactions between COVID-19 and the cardiovascular system can be a source of concern.

Now, an analysis of hundreds of relevant studies has found that heart medications do not affect the severity of COVID-19, according to researchers at the University of Liverpool, in the United Kingdom. Their findings are published in the British Journal of Clinical Pharmacology.

COVID-19 and the cardiovascular system

Cardiovascular disease is the most common cause of death worldwide. It encompasses conditions that affect the heart and blood vessels, such as angina, coronary artery disease, and heart failure.

“When the COVID-19 pandemic started, reports started emerging that patients with cardiovascular disease were more likely to [contract] the SARS-CoV-2 virus,” study authors Sir Munir Pirmohamed, a professor of pharmacology and therapeutics, and Innocent Asiimwe, a doctoral student in molecular and clinical pharmacology, told Medical News Today.

“And for those who [had the virus], the disease was more severe and led to worse outcomes, such as longer hospitalization times and higher chances of death, compared to those who did not have cardiovascular disease.”

Tim Chico, a professor of cardiovascular medicine at the University of Sheffield, in the U.K., who was not involved in the study, explained to MNT that the virus binds to a protein present in several tissues and lines the blood vessels, thus playing a role in the renin-angiotensin system that regulates blood pressure.

“This gives it the potential to worsen cardiovascular function in a number of ways and for it to affect people with preexisting cardiovascular disease more severely,” he said.

Adding medications into the mix obscures things further.

“Many common drugs used to treat diseases such as high blood pressure or heart failure also affect the renin-angiotensin system, which raised the possibility that they might affect the body’s response to the virus,” Prof. Chico told MNT.

A ‘living’ analysis

To search for a possible association between cardiovascular medications and COVID-19 health outcomes, the researchers combed through more than 500 databases for relevant studies.

However, the field is rapidly evolving, so reviews like this one can quickly become outdated.

“Given that we are still in the midst of a pandemic, the evidence base will continue to build, and we will therefore update our analysis,” says Prof. Pirmohamed.

In this way, the authors plan to continue this study and turn it into a “living” review, with periodic updates for up to 2 years.

Interaction with medication

In their analysis, the team identified that the most-used cardiovascular drugs were angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). Both of these drug classes are commonly prescribed to treat high blood pressure and ward off complications such as heart attacks and strokes.

To determine how these medications could affect COVID-19 severity, the team analyzed a smaller group that included only people with high blood pressure, also called hypertension.

“Based on prior work, we knew that hypertension independently contributes to poor COVID-19 outcomes. We also knew that many patients with hypertension also take some cardiovascular drugs,” the researchers said.

“If patients who are taking [medications] because of hypertension have poor outcomes, you may not be able to tell whether the poor outcomes are due to the hypertension.”

When the team separated the effects of the medications from the effects of hypertension, they found that cardiovascular drugs were not associated with a higher or lower susceptibility to SARS-CoV-2 infection, severe disease, or the likelihood of being hospitalized.

In fact, taking these drugs appeared to decrease the likelihood of dying from COVID-19 in people with high blood pressure.

This study corroborates previous findings, which suggest that heart medications are safe for those at risk of COVID-19, according to Dr. Edo Paz, a cardiologist and vice president of medical at K Health, a digital primary care provider.

“The current study indicates that ACE inhibitors and ARBs do not cause worse outcomes in COVID infection. The worse outcomes seen in patients with diabetes and hypertension relate to those underlying diseases themselves, and not the medications used to treat them.”

Prof. Chico told MNT, “The study’s findings are reassuring and emphasize the importance of continuing to take prescribed cardiovascular medications.”

Dr. Paz reiterated this advice:

“Since there is no convincing evidence of harm from these medications, but extremely strong evidence that the medications lead to improved outcomes in the diseases noted above, patients who take these medications should continue to do so unless their doctor or healthcare provider tells them otherwise.”

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