Is Hypertension a Real Risk Factor for Poor Prognosis in the COVID-19 Pandemic?

Purpose of Review There is increasing evidence indicating an association between several risk factors and worse prognosis in patients with coronavirus disease 2019 (COVID-19), including older age, hypertension, heart failure, diabetes, and pulmonary disease. Hypertension is of particular interest be...

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Bibliographic Details
Published in:Current hypertension reports 2020-06, Vol.22 (6), p.43, Article 43
Main Authors: Drager, Luciano F., Pio-Abreu, Andrea, Lopes, Renato D., Bortolotto, Luiz A.
Format: Article
Language:English
Subjects:
Angiotensin-Converting Enzyme 2
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Betacoronavirus
Cardiology
Clinical Trials as Topic
Coronavirus Infections - complications
Coronavirus Infections - diagnosis
Coronaviruses
COVID-19
Family Medicine
General Practice
Humans
Hypertension
Hypertension - complications
Internal Medicine
Medicine
Medicine & Public Health
Metabolic Diseases
Nephrology
Pandemics
Peptidyl-Dipeptidase A - metabolism
Pneumonia, Viral - complications
Pneumonia, Viral - diagnosis
Primary Care Medicine
Prognosis
Resistant Hypertension (L Drager
Resistant Hypertension (L Drager, Section Editor)
Risk Factors
SARS-CoV-2
Section Editor
Topical Collection on Resistant Hypertension
Viral infections
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Summary:Purpose of Review There is increasing evidence indicating an association between several risk factors and worse prognosis in patients with coronavirus disease 2019 (COVID-19), including older age, hypertension, heart failure, diabetes, and pulmonary disease. Hypertension is of particular interest because it is common in adults and there are concerns related to the use of renin-angiotensin system (RAS) inhibitors in patients with hypertension infected with COVID-19. Levels of angiotensin-converting enzyme 2 (ACE2), a protein that facilitates entry of coronavirus into cells, may increase in patients using RAS inhibitors. Thus, chronic use of RAS inhibition could potentially lead to a more severe and fatal form of COVID-19. In this review, we provide a critical review to the following questions: (1) Does hypertension influence immunity or ACE2 expression favoring viral infections? (2) Are the risks of complications in hypertension mediated by its treatment? (3) Is aging a major factor associated with worse prognosis in patients with COVID-19 and hypertension? Recent Findings Despite the potential involvement of immune responses in the pathogenesis of hypertension, there is no evidence supporting that hypothesis that hypertension or RAS inhibitors contributes to unfavorable outcomes in viral infections. Future investigations adopting a strict protocol for confirming hypertension status as well as assessing associated comorbidities that may influence outcomes are necessary. From the therapeutic perspective, recombinant ACE2 may serve as a potential therapy, but relevant studies in humans are lacking. Definitive evidence regarding the use of RAS inhibitors in patients with COVID-19 is needed; 5 randomized trials examining this issue are currently underway. Summary There is no current scientific support for claiming that hypertension or its treatment with RAS inhibitors contribute to unfavorable outcomes in COVID-19.
ISSN:1522-6417
1534-3111
1534-3111
DOI:10.1007/s11906-020-01057-x