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COVID-19 and hypertension-evidence and practical management: Guidance from the HOPE Asia Network
Kazuomi Kario1, Yuji Morisawa2, Apichard Sukonthasarn3
1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
Insights
Patients with hypertension face worse outcomes with COVID-19, but their medications are safe. Multidisciplinary care, including telemedicine for blood pressure monitoring, is key for managing hypertension during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Nephrology
Background:
- Hypertension is a risk factor for severe COVID-19 outcomes.
- Concerns exist regarding renin-angiotensin system (RAS) inhibitors due to SARS-CoV-2 viral entry mechanisms.
- Evidence does not support increased risk of SARS-CoV-2 infection or worse COVID-19 course with RAS inhibitor use.
Purpose of the Study:
- To review the role of hypertension in COVID-19 prognosis.
- To evaluate the safety of RAS inhibitors in COVID-19 patients.
- To outline comprehensive management strategies for hypertensive patients during the pandemic.
Main Methods:
- Literature review and synthesis of current evidence on COVID-19, hypertension, and RAS inhibitors.
- Identification of biomarkers for COVID-19 complications.
- Discussion of management strategies including telemedicine and lifestyle factors.
Main Results:
- Hypertension is associated with poorer COVID-19 prognosis, but not necessarily increased infection risk independently.
- RAS inhibitors are safe and should be continued for hypertensive patients.
- Biomarkers like troponin, NT-proBNP, D-dimer, and creatinine aid in monitoring and risk stratification for complications such as myocardial injury, heart failure, thrombosis, and kidney injury.
Conclusions:
- Antihypertensive therapy, including RAS inhibitors, should be maintained in patients with hypertension and COVID-19.
- Multidisciplinary management incorporating telemedicine, lifestyle modifications, and psychological well-being is crucial for optimal patient outcomes.
- Continued monitoring of cardiac, thrombotic, and renal biomarkers is essential for managing severe COVID-19 cases.
Abstract:
There are several risk factors for worse outcomes in patients with coronavirus 2019 disease (COVID-19). Patients with hypertension appear to have a poor prognosis, but there is no direct evidence that hypertension increases the risk of new infection or adverse outcomes independent of age and other risk factors. There is also concern about use of renin-angiotensin system (RAS) inhibitors due to a key role of angiotensin-converting enzyme 2 receptors in the entry of the SARS-CoV-2 virus into cells. However, there is little evidence that use of RAS inhibitors increases the risk of SARS-CoV-2 virus infection or worsens the course of COVID-19. Therefore, antihypertensive therapy with these agents should be continued. In addition to acute respiratory distress syndrome, patients with severe COVID-19 can develop myocardial injury and cytokine storm, resulting in heart failure, arteriovenous thrombosis, and kidney injury. Troponin, N-terminal pro-B-type natriuretic peptide, D-dimer, and serum creatinine are biomarkers for these complications and can be used to monitor patients with COVID-19 and for risk stratification. Other factors that need to be incorporated into patient management strategies during the pandemic include regular exercise to maintain good health status and monitoring of psychological well-being. For the ongoing management of patients with hypertension, telemedicine-based home blood pressure monitoring strategies can facilitate maintenance of good blood pressure control while social distancing is maintained. Overall, multidisciplinary management of COVID-19 based on a rapidly growing body of evidence will help ensure the best possible outcomes for patients, including those with risk factors such as hypertension.