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Published on: January 4, 2018
Inflammation and immunity connect hypertension with adverse COVID-19 outcomes
Lei Cai1, Chuan He1, Yonglin Liu2
1Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Collaborative Innovation Center for Genetics and Development, Shanghai Mental Health Center, Shanghai Jiaotong University, Shanghai, China.
Insights
Hypertension significantly increases the risk of severe COVID-19 outcomes and mortality. Genetic links, particularly involving inflammation and immunity genes in the lungs, may explain this connection.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Genetics
Background:
- Hypertension is a prevalent comorbidity globally.
- The association between hypertension and severe COVID-19 outcomes requires further investigation.
- Understanding shared genetic factors may elucidate disease mechanisms.
Purpose of the Study:
- To investigate the link between hypertension and severe COVID-19 outcomes.
- To analyze the relationship between blood pressure levels and COVID-19 severity.
- To identify shared genes and molecular pathways connecting hypertension and severe COVID-19.
Main Methods:
- Meta-analysis of 68 observational studies on COVID-19 mortality and severity.
- Genome-wide cross-trait meta-analysis (GWCTM) to identify shared genetic factors.
- Subgroup analysis of European cohorts to assess blood pressure differences.
Main Results:
- Hypertension was associated with a 1.80-fold increased risk of COVID-19 mortality and 1.78-fold increased risk of severe outcomes.
- Significant differences in blood pressure were observed between severe and mild COVID-19 patients in European cohorts.
- Shared genes between hypertension and severe COVID-19 were predominantly expressed in the lungs, implicating inflammatory and immune pathways.
Conclusions:
- Hypertension is a significant risk factor for severe COVID-19.
- Genetic variants in inflammation- and immunity-related genes may contribute to both hypertension and severe COVID-19.
- Shared molecular pathways, including CCR1/CCR5 and IL10RB signaling, are implicated.
Abstract:
Objectives: To explore the connection of hypertension and severe COVID-19 outcomes. Methods: A total of 68 observational studies recording mortality and/or general severity of COVID-19 were pooled for meta-analyses of the relationship of severe COVID-19 outcomes with hypertension as well as systolic and diastolic blood pressure. Genome-wide cross-trait meta-analysis (GWCTM) was performed to explore the genes linking between hypertension and COVID-19 severity. Results: The results of meta-analysis with the random effect model indicated that pooled risk ratios of hypertension on mortality and severity of COVID-19 were 1.80 [95% confidence interval (CI) 1.54-2.1] and 1.78 (95% confidence interval 1.56-2.04), respectively, although the apparent heterogeneity of the included studies was detected. In subgroup analysis, cohorts of severe and mild patients of COVID-19 assessed in Europe had a significant pooled weighted mean difference of 6.61 mmHg (95% CI 3.66-9.55) with no heterogeneity found (p = 0.26). The genes in the shared signature of hypertension and the COVID-19 severity were mostly expressed in lungs. Analysis of molecular networks commonly affected both by hypertension and by severe COVID-19 highlighted CCR1/CCR5 and IL10RB signaling, as well as Th1 and Th2 activation pathways, and also a potential for a shared regulation with multiple sclerosis. Conclusion: Hypertension is significantly associated with the severe course of COVID-19. Genetic variants within inflammation- and immunity-related genes may affect their expression in lungs and confer liability to both elevated blood pressure and to severe COVID-19.
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