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Certain antihypertensive drugs protect cardiovascular patients from adverse course of COVID-19

Copyright: adobestock/Алина Троева

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People with high blood pressure get COVID-19 more severely and have an increased risk of death. Their immune cells are probably already pre-activated, but blood pressure-lowering ACE inhibitors could counteract the immune hyperactivation. This is reported by an interdisciplinary German research team, including DZHK scientists, in Nature Biotechnology.

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At the beginning of the pandemic, one question was much discussed: What role do hypertension-reducing drugs play in the course of the disease? This is because certain frequently used antihypertensive drugs act on the ACE2 receptor. The novel coronavirus also enters the host cell via this receptor. The drugs were suspected of increasing the number of receptors, leading to a higher susceptibility to infections.

Blood pressure drugs do not lead to more virus receptors on the cells

This is not the case. In the current study, the team examined single cells from the airways of COVID-19 patients. The hypertension-reducing drugs do not cause more receptors to appear on the cells, which would favour the entry of the virus into the cells and a severe course. On the contrary, cardiovascular patients who received antihypertensive ACE inhibitors had almost the same risk of a severe course as COVID-19 patients without cardiovascular problems.

ACE inhibitors prevent exaggerated immune response

Furthermore, the single-cell studies of COVID-19 patients and healthy controls showed that cardiovascular patients' immune cells were already pre-activated before infection with the coronavirus. After contact with the virus, these patients more often developed an augmented immune reaction associated with a severe course of the disease. Treatment with ACE inhibitors, but not angiotensin receptor blockers, prevented this enhanced immune response after infection with the coronavirus.

Certain blood pressure drugs delay degradation of the virus

The researchers also found that antihypertnesive drugs also influence how quickly the immune system can break down the viral load, i.e., the virus's concentration in the body. They found a clear difference between the different forms of treatment for high blood pressure. In the patients treated with angiotensin II receptor blockers, the reduction of viral load was significantly delayed, contributing to a more severe course of COVID-19 disease. They did not find this delay in the patients who had received ACE inhibitors to treat their hypertension.  

"Our study provides no evidence that treatment with antihypertensive drugs increases the risk of infection with the novel coronavirus. However, treating hypertension with ACE inhibitors could be more beneficial for patients suffering from COVID-19 than treatment with angiotensin II receptor blockers -  a hypothesis that is currently being further investigated in randomised trials," said Prof. Ulf Landmesser*, summarising the results of the research published in Nature Biotechnology.

* Prof. Ulf Landmesser is Medical Director of the Charité Centre for Cardiovascular Medicine, Director of the Medical Clinic for Cardiology and Berlin Institute of Health Professor of Cardiology at the Benjamin Franklin Campus of the Charité - Universitätsmedizin Berlin and Principle Investigator at the DZHK.

Original paper: Hypertension delays viral clearance and exacerbates airway hyperinflammation in patients with COVID-19, Nat. Biotechnology, DOI: 10.1038/s41587-020-00796-1

Source: Press release Berlin Institute of Health (BIH)