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Review
. 2020 Jun 13;22(6):43.
doi: 10.1007/s11906-020-01057-x.

Is Hypertension a Real Risk Factor for Poor Prognosis in the COVID-19 Pandemic?

Luciano F Drager  1   2 , Andrea Pio-Abreu  3 , Renato D Lopes  4 , Luiz A Bortolotto  5
Affiliations
Review

Is Hypertension a Real Risk Factor for Poor Prognosis in the COVID-19 Pandemic?

Luciano F Drager et al. Curr Hypertens Rep. .

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 renin-angiotensin 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. There is no current scientific support for claiming that hypertension or its treatment with RAS inhibitors contribute to unfavorable outcomes in COVID-19.

Keywords: COVID-19; Hypertension; Outcomes; Prognosis; RAS inhibition; Treatment.

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Conflict of interest statement

The authors declare no conflicts of interest relevant to this manuscript.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for the cumulative probability of COVID-19 mortality during 28-day follow-up in ACEI/ARB or non-ACEI/ARB cohort among patients with hypertension in a unmatched model and b propensity score matched model. Reproduced with permission from Zhang et al. Circ Res Apr 17:2020 [•]. doi/10.1161/CIRCRESAHA.120.317134
Fig. 2
Fig. 2
Predictors of composite endpoints in hospitalized patients with COVID-19 in 575 hospitals in China. Comorbidities were determined based on the patient’s self-reported on admission. Reproduced with permission from Guan et al. Eur Resp J 2020 DOI: 10.1183/13993003.00547-2020. [36] COPD: Chronic obstructive pulmonary disease
See this image and copyright information in PMC

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