Is Hypertension a Real Risk Factor for Poor Prognosis in the COVID-19 Pandemic?
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RESISTANT HYPERTENSION (L DRAGER, SECTION EDITOR)
Is Hypertension a Real Risk Factor for Poor Prognosis in the COVID-19 Pandemic? Luciano F. Drager 1,2 & Andrea Pio-Abreu 1 & Renato D. Lopes 3 & Luiz A. Bortolotto 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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 reninangiotensin 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. Keywords Hypertension . COVID-19 . Prognosis . Treatment . Outcomes . RAS inhibition
Introduction Coronavirus disease 2019 (COVID-19), a systemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), is quickly becoming one of the biggest This article is part of the Topical Collection on Resistant Hypertension * Luciano F. Drager [email protected] 1
Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil
2
Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Avenida Dr Eneas de Carvalho Aguiar, 44, Sao Paulo 05403-900, Brazil
3
Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
challenges the global population has faced since World War II [1]. As of May 12, 2020, 4,215,514 ca
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