How COVID-19 Affects Blood Pressure & Blood Pressure Medications

What you need to know about your risk.

By Michael Bohl, MD, MPH
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April 30, 2020 — 12 p.m. EST

Over the past few months, it’s become clear that it’s possible for anyone to develop severe complications from COVID-19. According to the Centers for Disease Control and Prevention (CDC), those at higher risk include people >64 years old, people who have a weakened immune system, and people with chronic lung disease, heart disease, liver disease, kidney disease, diabetes, and severe obesity. But there’s another condition that isn’t on the CDC’s list that others have linked to COVID-19: high blood pressure.

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High blood pressure — also known as hypertension — is a condition in which the pressure of blood inside the arteries is higher than it should be. Normal blood pressure is around 120/80. High blood pressure is when the top number is consistently >129 or the bottom number is consistently >80.

According to a study in China, 30% of patients hospitalized with COVID-19 had high blood pressure. And another study found that 27.4% of patients with a certain lung complication from COVID-19 had high blood pressure. This has led some people to wonder if having high blood pressure puts you at higher risk for disease.

As of right now, there isn’t enough evidence to support this idea. While it’s true that many patients with severe symptoms also have high blood pressure, it doesn't necessarily mean one causes the other. Instead, there might be some third factor that causes both. In this case, researchers think that third factor could be age.

As we know, individuals >64 years old are at higher risk for severe disease. Older individuals are also more likely to have high blood pressure (according to a 2015–2016 survey, 63.1% of Americans >59 years old had high blood pressure). So, age is probably why many patients have both high blood pressure and severe disease — not because high blood pressure itself increases the risk of COVID-19.

COVID-19 & Blood Pressure Medications

Another point that’s cropped up in the past few months doesn’t have to do with high blood pressure itself, but with the medications that are used to treat high blood pressure.

Two of the most common types of drugs used to treat high blood pressure are the ACE inhibitors and the ARBs. Common ACE inhibitors include captopril, enalapril, and lisinopril. Common ARBs include losartan and valsartan.

ACE inhibitors and ARBs both increase the amount of an enzyme called ACE2 in the body. As it turns out, the virus that causes COVID-19 uses ACE2 to enter the body’s cells. Because of this, when COVID-19 began spreading, there was some concern that taking an ACE inhibitor or an ARB could put you at increased risk. In contrast, older research has demonstrated that ACE2 can actually help protect the lungs — so much so, that some researchers have suggested using ARBs to treat COVID-19.

All-in-all, there isn’t enough evidence to say exactly what the effects of ACE inhibitors and ARBs are on COVID-19. However, we know that high blood pressure is dangerous enough and that it is important to manage it. Untreated, high blood pressure increases the risk of problems such as heart disease, kidney disease, and stroke. Dr. Oz’s new plan, Total Health Take Back aims to lower your blood pressure numbers, blood sugar levels, and therefore lower your risk for developing COVID-19 complications. You can start the program today for free.

In March 2020, the American Heart Association, the American College of Cardiology, and the Heart Failure Society of America put out a joint statement stating that people with COVID-19 should continue taking ACE inhibitors and ARBs unless instructed to stop by their healthcare provider. They also urged more research be done in the area, saying they would update their recommendations as more information became available.

So, what does this all mean for you? If you have high blood pressure, you should do your best to control it — not necessarily because it makes COVID-19 worse, but because it has other negative health consequences. You should also continue taking all of your medications as prescribed — even if they are ACE inhibitors or ARBs. If you’re thinking about stopping a medication, always talk to your healthcare provider first.

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Article written by Michael Bohl, MD, MPH