A recent study by Sama and colleagues published in the European Heart Journal found that men have higher concentrations of angiotensin-converting enzyme (ACE) 2 in their blood compared to women and that the ACE2 concentrations in heart failure patients are not affected by commonly used anti-hypertensives, ACE inhibitors, and angiotensin receptor blockers (ARBs). The study led to suggestions that higher levels of ACE2 in men could explain why men are more vulnerable to Covid-19 than women, as the SARS-CoV-2 virus is known to bind to the ACE2 receptor when infecting cells. The study also provides additional evidence that patients (specifically those with heart failure) should not discontinue treatment with these life-saving drugs. Recent conflicting media reports have led to speculations about the risk and severity of Covid-19 infection in patients using ACE inhibitors and ARBs. However, all major cardiology organisations still agree that the treatment with these drugs should not stop.

Previously, concerns have been raised about whether ACE inhibitors and ARBs increase Covid-19 severity and mortality, and whether these agents could increase a patient’s susceptibility to contracting Covid-19. However, the recent study by Sama and colleagues adds to the series of evidence published in recent weeks, which show that the ACE2 level in patients’ blood is not affected by these medications. These findings further support the current recommendations from the European Society of Cardiology, American Heart Association, American College of Cardiology, and Heart Failure Society of America, which all emphasise the danger of discontinuing the use of these drugs in Covid-19 patients.

Some contradictory findings have been found in various studies regarding possible differences in the effects that the two drug classes have on the patients who are receiving them. Despite the consensus that there is no increase in the risk of adverse outcomes in patients taking these drugs, more research is needed, as all studies that have been conducted so far have been observational rather than randomised.

Contradictory reports about these drugs have made many patients concerned about whether they should continue their treatment. An estimated 30% of the global population suffers from high blood pressure, which increases the risk of heart disease, stroke, and kidney failure. About 80% of these patients need to take anti-hypertension medications to control the condition, according to the US Centers for Disease Control and Prevention. ACE inhibitors (such as enalapril, lisinopril, and ramipril) and ARBs (such as losartan, valsartan, and candesartan) are widely prescribed anti-hypertensives.

The National Institute of Health in the US is currently seeking proposals for further studies on this topic. Additionally, as part of the Observational Health Data Sciences and Informatics program, which is an open-source research platform that enables large-scale studies, a global study has been launched to analyse the health records of thousands of Covid-19 patients in the US, Europe, and Asia.

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