Know Your Medicines
I am on Angiotensin Converting Enzyme inhibitors (ACE-Is) or Angiotensin Receptor Blockers (ARBs) for my blood pressu...

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The Take-Home Points:

Patients on ACE-Is and ARBs should not discontinue them on their own, particularly if they have compelling reasons to be on this class of medicines. 

If you have specific questions about your health status, please discuss this with your doctor or pharmacist in-charge.




The Issue

A recent scientific opinion paper published in the Lancet suggested that a particular bodily enzyme (by the name of ACE2) is raised in patients who were taking the above medications for their heart conditions and blood pressure, thus may put these patients at risk of COVID-19 infections. They mention a small case series of COVID-19 patients, many of whom had background use of ACE-Is prior to admission, suggesting that the use of ACE-I was associated with contracting COVID-19. They further speculate that ACE-Is and ARBs increase the levels of ACE2, and extrapolate that these medicines may be a concern with COVID-19 infections. They suggest that alternative medicines, which do not raise ACE2, could be considered for lowering blood pressure.

最近发表在《柳叶刀》(the Lancet)上的一篇科学评论文章指出,服用上述药物治疗心脏病和血压的患者体内一种名为ACE2的特殊酶濃度会提高,因此可能会使这些患者面临罹患covid19感染的风险。他们提到了一小部分的covid-19患者,在入院前就有使用ACE-Is的背景,这表明使用ACE-I与感染COVID-19有关。他们进一步推测,ACE-Is和ARBs增加了ACE2的水平,并推断这些药物可能与COVID-19感染有关。他们建议,可以考虑使用不会增加ACE2的替代药物来降低血压。

The Facts

Angiotensin Converting Enzyme inhibitors (ACE-Is) or Angiotensin Receptor Blockers (ARBs) are common anti-hypertensives used to manage high blood pressure through antagonising the renin angiotensin aldosterone system (RAAS) hormones. Some patients with weak heart function (also known as Heart Failure) or kidney problems (e.g. proteinuria) need to be on ACE-Is and ARBs.

Although there is some speculation about how these medicines may increase enzymes that makes COVID-19 infections easier or more severe, there is no strong scientific basis or evidence to support discontinuation of these agents at this time. The European Society of Cardiology and the American College of Cardiology, American Heart Association, and the Heart Failure Society of America have made official statements that there is no data in humans to prove that there is increased risk of COVID-19 infections in people who use RAAS antagonists. They have strongly recommended that doctors and patients continue treatment with ACE-I or ARBs.

Common examples of ACE-Is and ARBs used in Singapore include: enalapril, lisinopril, perindopril, ramipril, candesartan, irbesartan, losartan, telmisartan, and valsartan.




新加坡常用的ACE-Is和ARBs包括:依那普利 (enalapril)、赖诺普利 (lisinopril)、培那普利 (perindopril)、雷米普利 (ramipril)、坎地沙坦 (candesartan)、厄贝沙坦 (irbesartan)、洛沙坦 (losartan)、替米沙坦 (telmisartan)和缬沙坦 (valsartan)。



Authored by / 作者

Dr Wang Aiwen & Dr Doreen Tan Su-Yin / 王爱文 与 陈素音
Members of Pharmaceutical Society of Singapore / 新加坡药剂师协会会员

感谢 台湾年轻药师协会(Taiwan Young Pharmacists Group) 与林雪芬(Ms Stephenie Lim) 药剂师  协力翻译