Renin Angiotensin Blockers, Telemedicine in India, and Hypertension as a Risk Factor

COVID-19 and Renin Angiotensin Blockers: Current Evidence and Recommendations

Another paper on this subject published in Circulation.  This paper focuses more on the potential benefit of RAS blockade in viral pneumonia. 

Summary Recommendations (which are overall consistent with prior papers on this topic in recent weeks):

1. In noninfected patients and patients at risk, there is currently no valid reason to discontinue RAS blockade
2. In healthy subjects at risk, evidence is not (yet?) sufficient to prophylactically recommend RAS blockade
3. If apprehension about increased infectivity persists, patients on ACEIs or ARBs could temporarily be switched to a direct renin inhibitor
4. In COVID-19-positive patients on RAS blockers, the drugs should be continued
5. In febrile patients with pulmonary symptoms on RAS blockers, close monitoring of blood pressure and renal function is advisable; RAS blockers should be discontinued only as clinically indicated.

‍

Telemedicine for diabetes care in India during COVID19 pandemic and national lockdown period: Guidelines for physicians

This study reviews the effectiveness of telemedicine in lowering HbA1c in pre-COVID-19 studies.  It also provides a list of recommendations for transitioning to telemedicine for chronic diabetes care during this pandemic to decrease disease transmissions in a vulnerable population while ensuring continuity of care. 

‍

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

This review focused on publications related to hypertension as a risk factor associated with poor outcomes in COVID-19 infection.  Search was performed up until 3/27/2020.

Pooled data from 10 Chinese studies involving over 2,000 patients found that in patients with COVID-19 comorbidities including htn, diabetes or CVD were present varying from 15 to 30% (average 21%), 5–20% (average 11%) and 2–40% (average 7%) respectively.  Although there has been an association between disease severity and comorbidities it has been difficult to control for all variables in analysis at this point, so exact risk for which comorbidity remains unclear.  The role of ACE2 in potentially providing benefit or harm with COVID-19 infection is reviewed and the recommendation that there should be no change in ACEI or ARB use is consistent with many other organizations.

‍

Should anti-diabetic medications be reconsidered amid COVID-19 pandemic?‍

This is a theoretical review of potential issues with various hyperglycemic medications and COVID-19 infection. No human clinical data is presented, therefore this should not be considered a recommendation.