High blood pressure and COVID-19

We are being asked two separate questions about high blood pressure (hypertension) and COVID-19

There are a lot of unknowns in a situation like this pandemic.  The scientific understanding and knowledge is developing rapidly.  At Cleveleys Group Practice we will try to keep up to date with the latest thinking, and try to interpret the evidence for you as it stands as best we can.

  • Does high blood pressure put someone at higher risk of complications if they get COVID-19.  And should people with high blood pressure follow the stricter guidance for social distancing?

High blood pressure on its own is not listed by Public Health England as one of the things that makes people more vulnerable to complications of COVID-19 infection. 

There is reference to it on one of the World Health Organisation (WHO) webpages.  This has understandably caused some confusion.

This question is currently under discussion in the scientific community.  The suggestion seems to have come from some early reports which describe features of Chinese patients who had more severe COVID-19 disease (in two studies 22-30% of these patients had high blood pressure).  The question about whether high blood pressure on its own is a risk, was posed so that the scientific community could investigate this question more closely to see if there is a link or not.  This is a work in progress.

The International Society of Hypertension, along with other expert bodies that focus on high blood pressure, has considered the information available so far.  They have issued a statement as follows:

“To date there is no evidence that people with hypertension are over-represented amongst those seriously infected by COVID-19. Indeed, the opposite is true given that most such cases occur in those over 60 years in whom hypertension usually affects the majority.”

https://ish-world.com/news/a/A-statement-from-the-International-Society-of-Hypertension-on-COVID-19/

So, at the moment, there is no robust evidence to say that people who have high blood pressure on its own are at increased risk of complications from COVID-19, but it is a question that is being explored by researchers.

The significant issue for people who have high blood pressure on its own is whether they should follow the firmer guidance on social distancing for vulnerable people.   As far as we can see at the moment, there doesn’t appear to be firm evidence to suggest that this is necessary, and we would suggest patients follow the current guidance from Public Health England. 

Of course, we are all being encouraged to follow strict social distancing advice regardless of any health issues we have.

Many people who have high blood pressure also have other conditions which do seem to increase the risk e.g. heart disease and diabetes.  These people should certainly follow the guidance on social distancing as best they can.

Good blood pressure control is very important to reduce the chances of heart disease, strokes and kidney disease.  Please do continue to take your blood pressure medication.

(b)  Are blood pressure medications such as ramipril, losartan and similar safe in COVID-19 infection?

These medications are used for high blood pressure and some heart problems. They are from two distinct groups of blood pressure medications – ACE-I (Antiotensin converting enzyme inhibitors) and ARB (Angiotension receptor blockers)

There have been some reports that these drugs might increase the chances of serious complications of COVID-19. At the same time some researchers are suggesting that these drugs could theoretically have some benefit in COVID19 infection. There are a number of studies underway to research both these questions.

The European Society of Cardiology (and many other bodies around the world) has issued a statement about this

https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang

The statement says:

“Speculation about the safety of ACE-inhibitors or ARB treatment in relation to COVID-19 does not have a sound scientific basis or evidence to support it. Indeed, there is evidence from studies in animals suggesting that these medications might be rather protective against serious lung complications in patients with COVID-19 infection, but to date there is no data in humans.

The Council on Hypertension of the European Society of Cardiology wish to highlight the lack of any evidence supporting harmful effect of ACE-I and ARB in the context of the pandemic COVID-19 outbreak.  The Council on Hypertension strongly recommend that physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACE-I or ARBs should be discontinued because of the COVID-19 infection.”

So for the moment it is not clear at all what effect ACE-Is and ARBs have, if any, on COVID-19 infection. At the moment there is certainly not enough evidence to advise patients who are well, and whose blood pressure is well-controlled, to stop taking them.

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