Medications for the treatment of hypertension: Do they increase the chance of developing more severe coronary heart disease?

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In recent months, many assumptions have been made about the link between certain diseases and treatments and the chance of more serious illness in Corona. One of the significant hypotheses that has caused a great deal of controversy among the medical community is that a drug used as a major tool for the treatment of hypertension may increase the chance of contracting the new virus and even lead to the development of a more serious disease. Is this an unsubstantiated hypothesis or an important warning signal? Together with Dr. Avshalom Leibowitz, Director of the Internal Medicine Department at Tel Hashomer, a senior physician in the Hypertension Unit, we gathered what is important to know about the connection between high blood pressure and


The corona plague has brought about significant changes on the social, economic, emotional and health levels. Apparently, the health effect caused by the new virus is clear – it is a virus that causes respiratory damage, leading to widespread illness and even mortality. However, the impact on public health is not only related to virus infection, but it also has indirect consequences, one of the most significant of which is the impact on populations that suffer from background diseases and are defined as at-risk populations. For those suffering from background illnesses or health conditions that require follow-up and ongoing care, avoiding receiving medical care can sometimes be life-threatening.

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On the relationship between hypertension and corona

According to the U.S. Centers for Disease Control and Prevention, hypertension can be a risk factor for more severe coronary heart disease. In fact, patients suffering from high blood pressure were defined at the outbreak of the epidemic as a population at risk, along with diabetics, heart patients and more. Simply put, the body of people with unbalanced background illnesses has less “reserve” to deal with medical extremes. For example, it has been known for many years that the flu vaccine reduces heart attacks. This is probably also the reason why if people from these risk groups get sick in Corona their condition may be more difficult.

How is high blood pressure treated?

“Hypertension is a chronic condition characterized by damage to the arterial blood vessels. As a result of this damage the blood vessels lose their elasticity and become stiffer. The pressure caused by the fluid (blood) now flowing in a closed and stiffer system increases without adaptability and compensation of these vessels. Despite medical advances, we do not currently know how to “heal” the blood vessels and put the wheel back.

The drug treatment is aimed entirely at reducing the pressure in the system through dilating the blood vessels (for example – calcium channel inhibitors) or reducing the blood volume (diuretics) and thus helps in reducing the pressure in the system. There are several groups of drugs that each work in a slightly different mechanism for this purpose. One of the most important groups in the treatment of hypertension is called “Angiotensin converting enzyme inhibitors” which have recently been mentioned as relevant to coronary heart disease. The drugs in this group inhibit an enzyme that helps produce a vasoconstrictor. In the absence of the same enzyme – the blood vessels are looser and thus the blood pressure decreases. “

Can different medications used to balance blood pressure cause more severe coronary heart disease?

“In recent months, reports have surfaced that one of the main groups of drugs used to balance blood pressure, the enzyme ACE inhibitors, may cause more severe coronary heart disease. These reports were not based on unequivocal information, but caused panic among patients as well as doctors. In fact, many patients stopped treatment on their own and some doctors even adhered to this recommendation, “notes Dr. Leibowitz.

What is the explanation that supports the various reports?

“Let’s start from the base, a virus is not a living thing and in order to survive it needs a storage cell. Therefore, like many other viruses, the corona virus uses a receptor that is on the body’s cells and clings to the cell and continues to replicate. The receptor uses it. The corena virus is called ACE2.

Drugs from the ACE inhibitor group affect the protein system of the ACE2 receptor family. Animal studies (mice and rats) have shown that treatment with these drugs has led to an increase in receptor expression in various tissues in the body, including the lungs. From this, the researchers concluded that if the expression of the receptor increases due to the use of the drug, it may also lead to a higher chance of contracting corona as well as to the development of a more severe disease.

Although the researchers’ hypothesis sounds very reasonable, the supporting factual basis is lacking and insufficient to recommend cessation of use of the central drug group, “Dr. Leibowitz claims. “It is important to note that there is a huge gap between experiments performed in animals and those performed in humans, and clinical conclusions can not be drawn solely from animal work. In addition, contradictory studies have recently been published stating that taking drugs from the ACE inhibitor group did not increase receptor expression. A minority have even shown that these drugs have led to a decrease in receptor expression.Several blood pressure unions around the world have issued clear guidelines that treatment should not be discontinued, except in exceptional cases.Top discontinuation may cause significant damage and deterioration in patients’ condition.

A recent article in the esteemed medical journal New England Journal of Medicine argued that taking drugs from this group to treat blood pressure does not endanger patients, and it may also have a protective effect. This article has led to a significant sigh of relief among members of the medical community, however Surprisingly a few weeks ago the authors of the article withdrew it from publication, probably due to many methodological problems or suspicion of falsifying the results. In fact, the extensive information that exists around the corona and the desire to shed light on the course of the disease and its consequences lead to the publication of a great deal of information without screening and careful examination. ”

What are the practical recommendations for patients suffering from hypertension these days?

“The current recommendation is to continue treatment with hypertension without change, except in exceptional cases. Even in situations where treatment is discontinued, such as in cases where the patient suffers from kidney failure due to Covid 19 disease, this should be done under the guidance and supervision of the attending physician only. Balanced blood pressure is essential at any time, regardless of the raging epidemic. Balanced blood pressure helps the body to deal effectively with many and varied illnesses. In cases where blood pressure is unbalanced it is advisable to see a primary care physician for diagnosis and adjustment of treatment. “You should consult a specialist in internal medicine with experience in the treatment of blood pressure who will assist in the optimal planning of the treatment strategy.”



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