Switching to another antihypertensive effective drug when using ACEIs/ARBs to treat arterial hypertension during COVID-19.

This Commentary refers to: ‘SARS-CoV2: should inhibitors of the renin–angiotensin system be withdrawn in patients with COVID-19?’, by G.M. Kuster .

I appreciated the well-argued paper by Kuster et al; however, it seems that the authors forget that, at least to treat arterial hypertension, we have the possibility to choose other effective drugs such as calcium channel blockers, an antihypertensive master class. Indeed, even if there are no data supporting a causal relationship between angiotensin-converting enzyme 2 (ACE2) activity and COVID-19-associated mortality, we should not underestimate the way in which SARS-CoV-2 enters the cell that is well documented with an entry risk map, based on expression of ACE2 that, coincidentally, follows the initial clinical presentation of COVID-19. Furthermore, data updated on 20 March from the Italian Health Institute on a sample of 3200 deaths support: (i) a high mortality rate for elderly subjects (mean age 78.5, median 80, range 31–103, IQR 73–85); (ii) high co-existence of comorbidities (98.7% have ≥1 comorbidity); (iii) high blood pressure as the prevailing comorbidity since 73.8% of the subjects were hypertensives; and (iv) use of ACEIs/ARBs documented in 52% of deaths. We don’t know if this is merely a coincidence and we do not have data on patients affected by COVID-19 that are receiving ACEIs/ARBs and their relative mortality rates in China; nonetheless, if we exclude subjects with heart failure and/or ischaemic heart disease, what would be the reason not to switch to another drug to treat high blood pressure, obviously, without destabilizing blood pressure control?

Conflict of interest: none declared.