Doctors warn against discontinuing blood pressure medicines during COVID19

By Rajeev Khanna*
Amid the COVID19 outbreak in India, it is the exceptionally large community of high blood pressure or hypertension patients that stands out among the most vulnerable. Medical experts say that the number of hypertension patients in the country is more than 30 per cent of the total population.
They have emphatically underlined that these patients cannot afford non-compliance with the prescribed treatment for hypertension as it will further strain the healthcare systems already stretched to full capacity by the ongoing pandemic.
According to a spokesperson of Post Graduate Institute of Medical Education and Research (PGIMER) at Chandigarh:
“Hypertensive patients are at the highest risk of becoming dangerously sick or dying due to corona virus, experts have warned. Even as the medical fraternity rushes to put in place effective and credible treatment protocols to curb the global pandemic, some recent studies have suggested that ACE inhibitors ( class of medication used primarily for the treatment of high blood pressure and heart failure) and ARBs ( first-line antihypertensives) commonly used to treat blood pressure could aggravate the symptoms of COVID19 infection.
“Clearing the air on the matter, global public health experts and medical practitioners from premier institutions across the country have emphatically stated that it is too early to draw such conclusions and non-adherence to treatment could be dangerous.”
Dr Yash Paul Sharma, who is heading the Department of Cardiology at PGIMER said people with hypertension are indeed at a higher risk of catching the corona virus. Citing a recent systematic review and meta-analysis that appeared in ‘International Journal of Infectious Diseases’ that assessed the prevalence of co-morbidities in COVID19 infected patients, Dr Sharma observed that hypertensive patients with the underlying disease were more at risk in severe cases as compared to non-severe patients.
He added that COVID19 patients had a fatality rate of 8.4%, 13.2%, 9.2%, 8% and 7.6% in those with hypertension, cardiovascular diseases, diabetes, chronic respiratory diseases and cancer, respectively. “As such, avoiding blood pressure medications is a big risk that we in India cannot afford to have as our healthcare systems are already stretched because of the COVID19 spread,” he stressed.
Dr Sonu Goel of Department of Community Medicine and School of Public Health at the same institute highlighted the need of monitoring other risk factors such as tobacco use.
The PGIMER spokesperson went on to quote Dr Tom Frieden of Resolve to Save Lives which is an initiative of global public health organization Vital Strategies saying that evidence from around the world shows that people with hypertension should not forego their regular medicines. According to Dr Frieden:
“As we respond to the COVID19 pandemic, we need to protect and provide care for the most vulnerable among us, including people living with cardiovascular disease and other chronic diseases. People with hypertension and other chronic disease are more likely to become seriously ill and die from the virus. That’s why it’s more urgent than ever that people in India and around the world can access the medication they need, either through telemedicine, multiple month prescriptions or other safe methods.” The spokesperson said that the World Health Organisation (WHO) and the Centers for Disease Control and Prevention (CDC) have issued special warnings to safeguard those with chronic health conditions. A recent report in the "China Daily" stated that 50 percent of the 170 patients, who died in Wuhan in January, had hypertension or other non-communicable diseases. 

China Daily reports, 50% of 170 patients who died in Wuhan in January had hypertension and other non-communicable diseases

Although such claims are yet to be clinically substantiated, a WHO-China joint mission on the COVID19 outbreak has revealed similar findings. Top doctors from Wuhan, the ground zero of COVID19 have also corroborated that almost 50% of those dying from the disease were hypertensive.
The PGIMER spokesperson further quoted Prof Suneela Garg of Indian Association of Preventive and Social Medicine saying:
“Globally there are firm protocols in place that have been tested and are followed to treat hypertension. These depend on the age of the person, duration of being hypertensive and existence of co-morbidities, to name some. The current guideline being followed by physicians and practitioners across the globe is to continue hypertensive medications even while being treated for corona virus led infection.
“Hypertensive persons are best advised, in addition to their blood pressure medication, to follow non-pharmacological approaches such as taking up yoga, stress management and low calorie intake to keep their blood pressure levels under check.” Dr Tiny Nair who is another well-known cardiologist based at Thiruvananthapuram has stated that five prominent societies including European Society of Hypertension (ESH), European Society of Cardiology Council of Hypertension, Hypertension Canada, Renal Association UK, and Canadian Cardiovascular Society have independently announced that there is no data to withhold the important medicines for patients of hypertension in the background of emergence of COVID19.
He underlined, “For those millions of people of hypertension, controlled on these medicines, stopping blood pressure drugs on unfounded fear might create a far more dangerous situation than COVID itself.”
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*Senior journalist based in Chandigarh and Solan (Himachal Pradesh)