Hajira Dambha-Miller
Project: ACE-Inhibitors/Angiotensin Receptor Blockers and risk of death for people infected with COVID-19: a prospective cohort study.
Research Group: Prevention Group, Primary Care Unit
Project Description: Analysis of RCGP Research Surveillance data of routinely collected GP records from May to August 2020 covering 530 practices.
In the UK, as of 24th March 2020, there were 8077 cases and 422 deaths from COVID-19. This figure is predicted to rise. Globally, mortality rates and severe complications have been high amongst those with hypertension (23.7%), cardiovascular disease (8%) or type 2 diabetes (16.2%). (Guan et al., 2020; Wu et al., 2020; Yang et al., 2020) Reports from the COVID-19 epicentre in China and a recent letter in the Lancet noted that amongst those with severe complications including death, ACE-I and ARBs were frequently prescribed. (Fang, Karakiulakis and Roth, 2020) COVID-19 binds to target cells through angiotensin-converting enzyme 2 (ACE2) which is expressed by epithelial cells in the lungs, kidneys and blood vessels. ACE-I and ARBs are thought to increase the expression of ACE2. It is hypothesised that these medications, therefore, make people more susceptible to COVID-19 and could also increase the severity of the infection leading to ARDS and death.(Patel and Verma, 2020) (Jia et al., 2005) This has caused some concern amongst prescribers and is leading to non-compliance amongst patients such that the British and Irish Hypertension Society, European Hypertension Society, Renal Association have released position statements calling for urgent evidence. While a mechanistic link is plausible, to date, there are no studies in human subjects while animal models show mixed results. Given that 65 million prescriptions of ARB/ACE-I have been issued by GPs in the UK in the last year alone and the COVID-19 epidemic is close to reaching its peak, it is essential and timely that this hypothesis is tested.
Research Group: Prevention Group, Primary Care Unit
Project Description: Analysis of RCGP Research Surveillance data of routinely collected GP records from May to August 2020 covering 530 practices.
In the UK, as of 24th March 2020, there were 8077 cases and 422 deaths from COVID-19. This figure is predicted to rise. Globally, mortality rates and severe complications have been high amongst those with hypertension (23.7%), cardiovascular disease (8%) or type 2 diabetes (16.2%). (Guan et al., 2020; Wu et al., 2020; Yang et al., 2020) Reports from the COVID-19 epicentre in China and a recent letter in the Lancet noted that amongst those with severe complications including death, ACE-I and ARBs were frequently prescribed. (Fang, Karakiulakis and Roth, 2020) COVID-19 binds to target cells through angiotensin-converting enzyme 2 (ACE2) which is expressed by epithelial cells in the lungs, kidneys and blood vessels. ACE-I and ARBs are thought to increase the expression of ACE2. It is hypothesised that these medications, therefore, make people more susceptible to COVID-19 and could also increase the severity of the infection leading to ARDS and death.(Patel and Verma, 2020) (Jia et al., 2005) This has caused some concern amongst prescribers and is leading to non-compliance amongst patients such that the British and Irish Hypertension Society, European Hypertension Society, Renal Association have released position statements calling for urgent evidence. While a mechanistic link is plausible, to date, there are no studies in human subjects while animal models show mixed results. Given that 65 million prescriptions of ARB/ACE-I have been issued by GPs in the UK in the last year alone and the COVID-19 epidemic is close to reaching its peak, it is essential and timely that this hypothesis is tested.