Higher doses of ACE inhibitors in black patients. Relevant in COVID-19?
In preparing the case for autoimmunity as a cause of COVID-19, I have to look at all aspects of the disease to formulate an umbrella theory. Part of this needs to explain the apparent higher risk of mortality in black and ethnic minority communities.
The overall consensus with managing hypertension seems to point towards using calcium channel blockers as first line in black patients versus ACE inhibitors for younger white patients (below the age of 55 years).
The research seems to suggest that generally angiotensin II levels in black patients are lower which may explain this disparity.
The trend of lower angiotensin II levels could suggest higher or more active ACE2 enzyme in black persons.
If an immune response to the virus produces ACE2 antibodies, it may therefore have a more significant effect with black patients compared to white.
This may mean that treatment with Angiotensin Receptor Blockers (ARB) could be critical in this group.
It is extremely important to understand the pathophysiology of this disease as the solutions may be much easier than we could have imagined.
Any further insights would be appreciated.