Abstract
Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is an ongoing global public health challenge. Current clinical data suggest that, in COVID-19 patients, arterial hypertension (AH) is one of the most common cardiovascular comorbidities; it can worsen outcomes and increase the risk of admission to intensive care unit (ICU). The exact mechanisms through which AH contributes to the poor prognosis in COVID-19 are not yet clear. The putative relationship between AH and COVID-19 may be linked to the role of angiotensin-converting enzyme 2 (ACE2), a key element of the AH pathophysiology. Another mechanism connecting AH and COVID-19 is the dysregulation of the immune system resulting in a cytokine storm, mediated by an imbalanced response of T helper cells subtypes. Therefore, it is essential to optimize blood pressure control in hypertensive patients and monitor them carefully for cardiovascular and other complications for the duration of COVID-19 infection. The question whether AH-linked ACE2 gene polymorphisms increase the risk and/or worsen the course of SARS-CoV-2 infection should also receive further consideration.
Highlights
Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus severe acute respiratory syndrome-coronavirus-2 (SARSCoV-2), is an ongoing global public health challenge
Current clinical data suggest that, in COVID-19 patients, arterial hypertension (AH) is one of the most common cardiovascular comorbidities; it can worsen outcomes and increase the risk of admission to intensive care unit (ICU). e exact mechanisms through which AH contributes to the poor prognosis in COVID-19 are not yet clear. e putative relationship between AH and COVID-19 may be linked to the role of angiotensin-converting enzyme 2 (ACE2), a key element of the AH pathophysiology
Available data supports that the number of CVDs in infected patients correlates with mortality [25]. e overall case fatality rate (CFR) was 2.3% in the entire cohort but significantly higher in patients with AH, DM, and CVD (6%, 7.3%, and 10.5%, respectively). e Chinese Center for Disease Control (CDC) has reviewed 72,314 confirmed, suspected, and asymptomatic COVID-19 cases to conclude that CFR was 0.9% in the patients with no comorbid medical conditions. e majority of patients among the confirmed cases were 30–79 years old (86.6%), and preexisting diseases increased the risk of COVID-19 mortality. e death rate increased to 10.5% in patients with CVD, 7.3% in diabetic patients, 6.3% in patients with chronic respiratory disease, 6.0% in patients with AH, and 5.6% in patients with cancer [26]
Summary
Current clinical data suggest that, in COVID-19 patients, arterial hypertension (AH) is one of the most common cardiovascular comorbidities; it can worsen outcomes and increase the risk of admission to intensive care unit (ICU). E putative relationship between AH and COVID-19 may be linked to the role of angiotensin-converting enzyme 2 (ACE2), a key element of the AH pathophysiology Another mechanism connecting AH and COVID-19 is the dysregulation of the immune system resulting in a cytokine storm, mediated by an imbalanced response of T helper cells subtypes. We highlighted the mechanisms of immune response to SARS-CoV-2, a factor that can increase the risk of hospitalization and mortality under infection. About 15% had AH (36% among those requiring intubation or resulting in death) and 2.5% had CHD
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