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COVID-19 in Patients with Hypertension
Thiago Quinaglia1, Mahsima Shabani2,3, Nima Rezaei4,5,6
1Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA.
Advances in Experimental Medicine and Biology
|May 11, 2021
Summary
Hypertension may increase COVID-19 severity, but renin-angiotensin-aldosterone system inhibitors might offer protection. More research is needed to clarify the complex relationship between these conditions and treatments.
Area of Science:
- Cardiology
- Infectious Diseases
- Pharmacology
Background:
- Hypertension is a prevalent global condition affecting nearly one billion people.
- Hypertension is a potential risk factor for COVID-19 incidence and severity.
- Antihypertensive drugs, particularly RAAS inhibitors, may influence COVID-19 outcomes.
Purpose of the Study:
- To explore the intricate relationship between hypertension, COVID-19, and antihypertensive medications.
- To investigate the potential mechanisms linking ACE-2 receptor expression to SARS-CoV-2 infection.
- To summarize current evidence regarding mortality risk and protective effects in hypertensive COVID-19 patients.
Main Methods:
- Review of case series and retrospective cohort studies on hypertension and COVID-19.
- Analysis of potential mechanistic pathways involving ACE-2 receptors.
- Examination of observational data and limited randomized trial findings.
Main Results:
- Observational studies suggest a twofold increased mortality risk for hypertensive COVID-19 patients.
- Previous or continued use of RAAS inhibitors may be protective in this subgroup.
- A single randomized study sub-analysis found no link between ACE inhibitors and COVID-19 incidence or severity.
Conclusions:
- The interaction between hypertension, COVID-19, and RAAS inhibitors is complex and not fully understood.
- Current guidelines recommend continuing antihypertensive medications, especially RAAS inhibitors, unless clinically indicated otherwise.
- Further randomized clinical trials are essential for evidence-based decision-making.
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