A statement from the International Society of Hypertension on COVID-19

16 March 2020
 

The International Society of Hypertension (ISH) is aware of concern raised by speculation, which was amplified by the media and which suggested that hypertension (raised blood pressure) increases susceptibility to infection with COVID-19.

Further speculation reportedly suggested that two commonly used classes of blood pressure lowering agents (ACE-Inhibitors and Angiotensin Receptor Blockers (ARBs)) may worsen the outcome for those who are infected with COVID-19 (1).

The ISH completely endorses the content of two recent statements made by the Council on Hypertension of the European Society of Cardiology and the European Society of Hypertension (2,3) both of which made clear that 

there is no good evidence to change the use of ACE-inhibitors or ARBs for the management of raised blood pressure in the context of avoiding or treating COVID-19 infection.

In addition, the ISH would like to highlight the following four critical pieces of information:

1. 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. 
2. There are no clinical data in humans to show that ACE-Inhibitors or ARBs either improve or worsen susceptibility to COVID-19 infection nor do they affect the outcomes of those infected. 
3. In the absence of any such compelling data the ISH strongly recommend that the routine use of ACE-Inhibitors or ARBs to treat raised blood pressure should continue and should not be influenced by concerns about COVID-19 infection. 
4. It is possible that in light of new data it may be that the management of raised blood pressure should be modified to reduce susceptibility to or improve outcomes among those infected by COVID-19. However, currently no such data are available to make such recommendations, and so no changes should be made. 

References:

1. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med 2020;  https://doi.org/10.1016/S2213-2600(20)30116-8
2. Statement by the ESC: https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-an
3. Statement by the ESH: https://www.eshonline.org/spotlights/esh-statement-on-covid-19/