Reducing or eliminating high blood pressure medication if blood pressure becomes hypotensive could help prevent acute kidney injury and death in patients with coronavirus disease 2019 (COVID-19), according to a new study presented at the American Heart Association’s (AHA) Hypertension 2020 Scientific Sessions. 

During the early days of the COVID-19 pandemic, the AHA, the Heart Failure Society of America, and the American College of Cardiology issued a joint statement advising patients at risk of COVID-19 to continue their use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. In cardiovascular patients who have been diagnosed with COVID-19, there should be a full evaluation before adding or removing any treatments, according to the researchers. 

In order to determine which patients with COVID-19 were at the highest risk for kidney damage, investigators examined 392 patients treated at a hospital in Italy between March 2 and April 25, 2020. They found that nearly 60% of the patients had a history of hypertension, making it the most common comorbidity among the participants. 

Investigators also found that more than 86% of patients with high blood pressure were taking anti-hypertensive medication daily. According to the study, a history of hypertension was found to increase the risk of acute kidney injury by 5-fold. 

The most common group of patients with COVID-19 who developed acute kidney injury during hospitalization were those who were elderly, hypertensive, or who had severe respiratory distress. Those with severe hypotension, meaning they had a blood pressure lower than 95/50 mm hg, were 9 times more likely to have acute kidney injury, according to the study. 

"Our study suggests low blood pressure in a person with a history of high blood pressure is an important and independent signal that someone with COVID-19 is developing or has acute kidney injury…This also suggests that people with high blood pressure should carefully monitor it at home, and their kidney function should be measured when they're first diagnosed with COVID-19. If they or their doctors notice blood pressure levels going down to the hypotensive range, their doctors may consider reducing or stopping their blood pressure medications to prevent kidney damage and possibly even death," Paolo Manunta, MD, PhD, study author and chair of nephrology at San Raffaele University in Milan, Italy, said in the press release. 

Multiple other studies have confirmed these findings. Another study presented at the AHA sessions found that among more than 11,000 patients with COVID-19, 42% had hypertension and that hypertension was associated with a higher likelihood of death, according to the press release. 

Reference:
Research on the impact of ACE-i and ARBs for patients with COVID-19 continues to evolve [News Release] September 10, 2020. Dallas, TX. https://www.eurekalert.org/pub_releases/2020-09/aha-rot090220.php. Accessed September 24, 2020.