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. 2020 Jul-Aug;14(4):283-287.
doi: 10.1016/j.dsx.2020.03.016. Epub 2020 Apr 9.

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Awadhesh Kumar Singh  1 , Ritesh Gupta  2 , Anoop Misra  3
Affiliations

Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers

Awadhesh Kumar Singh et al. Diabetes Metab Syndr. 2020 Jul-Aug.

Abstract

Background and aims: COVID-19 is already a pandemic. Emerging data suggest an increased association and a heightened mortality in patients of COVID-19 with comorbidities. We aimed to evaluate the outcome in hypertensive patients with COVID-19 and its relation to the use of renin-angiotensin system blockers (RASB).

Methods: We have systematically searched the medical database up to March 27, 2020 and retrieved all the published articles in English language related to our topic using MeSH key words.

Results: From the pooled data of all ten available Chinese studies (n = 2209) that have reported the characteristics of comorbidities in patients with COVID-19, hypertension was present in nearly 21%, followed by diabetes in nearly 11%, and established cardiovascular disease (CVD) in approximately 7% of patients. Although the emerging data hints to an increase in mortality in COVID-19 patients with known hypertension, diabetes and CVD, it should be noted that it was not adjusted for multiple confounding factors. Harm or benefit in COVID-19 patients receiving RASB has not been typically assessed in these studies yet, although mechanistically and plausibly both, benefit and harm is possible with these agents, given that COVID-19 expresses to tissues through the receptor of angiotensin converting enzyme-2.

Conclusion: Special attention is definitely required in patients with COVID-19 with associated comorbidities including hypertension, diabetes and established CVD. Although the role of RASB has a mechanistic equipoise, patients with COVID-19 should not stop these drugs at this point of time, as recommended by various world organizations and without the advice of health care provider.

Keywords: Angiotensin-converting enzyme inhibitors; Angiotensin-receptor blockers; COVID-19; Comorbidities; Hypertension.

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Conflict of interest statement

Declaration of competing interest We hereby declare that we have no conflict of interest related to this article.

Figures

Fig. 1
Fig. 1
Components of Renin-Angiotensin System pathway and possible interaction of Angiotensin Converting Enzyme inhibitors (ACE-I), Angiotensin-Receptor Blockers (ARB) and COVID-19.
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