August 24, 2020

expert reaction to study looking at blood pressure medicines and COVID-19

A study, published in Current Atherosclerosis Reports, looked at the relationship between blood pressure medicines and COVID-19.

Prof Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said:

“This study combines data from a number of observational studies (their use of the word “trial” referring to studies included in the paper does not refer to randomised trials which might confuse some readers, but they do make it clear that none of the studies were randomised). There were early concerns that the coronavirus SARS COV-2 might have a greater impact in those who take these drugs for raised blood pressure, because of the mechanism of action of the virus.  The drugs are in very wide use (this commentator takes them and did not stop taking them at any stage!). These data do provide some reassurance that those who need these drugs for their high blood pressure should continue using them. Covid-19 is not the only disease that older people will die of during a pandemic and the benefits of the drugs on other, non-Covid-19, outcomes may be important. The authors note that, although they find some benefit to them, it does require randomised trials to be sure of their benefits, especially in those who do not need the drugs to treat high blood pressure. Certainly randomised trials are necessary, and it is perhaps unfortunate that some trials of other treatments excluded participants form being on these drugs.

“There are a number of limitations to the analysis that the authors do not note. It is not clear that they had a pre-specified protocol for the analysis, and this makes the findings of benefit in sub-groups of patients less robust than it might be. The choice of multiple outcomes can also potentially exaggerate the findings. There could be consistent biases across all the studies which could explain the results.

“We do not yet understand how the SARS COV-2 virus is affected by these drugs, so caution should definitely be exercised before recommending their use for prevention of bad outcomes in Covid-19.”

‘Effect of Renin-Angiotensin-Aldosterone System inhibitors in patients with COVID-19: a systematic review and meta-analysis of 28,872 patients’  by Baral et al was published in the journal Current Atherosclerosis Reports at 00:00 UK time on August 24, 2020.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Stephen Evans: “No conflicts of interest in relation to this.  I am funded (1 day/week) by LSHTM.  They get funding from various companies, including Astra Zeneca and GSK but I am not funded by them, I have no involvement in obtaining funding from them and I am not an investigator for any grants obtained from them. I am part of OpenSafely team who have studied this question.”