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Trial Tests Blood Pressure Drug as Covid-19 Treatment

Covid-19 illustration

(CDC.gov)

1 May 2020. A common type of blood pressure drug will soon be tested in a clinical trial as a treatment for severe cases of Covid-19 infections. The study, led by researchers at University of California in San Diego, is assessing angiotensin-converting enzyme, or ACE, inhibitors to reduce the severity of Covid-19 infections and strain on hospitals caring for severely ill patients.

ACE inhibitors are commonly prescribed to treat hypertension, or high blood pressure, as well as heart failure and diabetic kidney disease. The drugs work by decreasing the amount of sodium retained by the kidneys, which decreases the amount of water needed for processing sodium, and lessening blood volumes in the blood stream. ACE inhibitors also limits production of angiotensin-converting enzyme 2, a hormone that constricts blood vessels, thus allowing blood vessels to relax and expand. And the drugs reduce oxidative stress and inflammation found in diabetes and chronic kidney disease.

That same ACE2 hormone, however, is also found on the surface of cells in the lungs, blood vessels, and other organs. Under normal conditions, ACE2 balances ACE hormones to regulate blood pressure, but ACE2 acts as well as a target and entry-point for for coronaviruses. Researchers discovered this pathway in the severe acute respiratory syndrome or SARS outbreak of 2003, and is occurring today with infections from SARS-CoV-2 viruses.

Since the start of the Covid-19 pandemic, researchers are debating the role of ACE hormones in the disease’s progression and severity, as well as ACE inhibitors as a treatment.  Early studies of Covid-19 in China show infections occurring in older patients, with the most severe illnesses in people with hypertension, heart disease, kidney disease, and diabetes.

A team led by UC-San Diego gastroenterologist and medical school professor Rohit Loomba is investigating ACE inhibitors for limiting the severity of Covid-19 infections. The researchers say angiotensin is part of a larger renin-angiotensin-aldosterone or RAAS system that regulates overall water-sodium balance as well as blood pressure, affecting the performance of various tissue and nerves.

“Our hypothesis,” says Loomba in a university statement, “is that ACE inhibitor drugs help keep the RAAS system in balance and functioning optimally. SARS infections create an imbalance, triggering feedback loops that promote inflammation and injury, a vicious cycle of pathological consequences that wrack the lungs, heart and other organs, and kill.”

The mid-stage clinical trial is enrolling 560 patients hospitalized with Covid-19 infections in California and seven other states. Participants are randomly assigned to receive a 2.5 milligram capsule of the ACE inhibitor ramipril or a placebo each day for 14 days. Ramipril is marketed as Altace by Pfizer, a co-sponsor of the trial.

Patients will be evaluated after 14 days, then followed-up after another 14 days. The team is looking primarily at the need for mechanical ventilation or intensive care among participants, as well as mortality. Recruitment of participants has not yet begun.

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Disclosure: The author owns shares in Pfizer.

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