Hypertension and SARS-CoV2 coronavirus (COVID-19): data do not show a direct association.

WHAT ARE THE DEVELOPMENTS IN RELATION TO ANTIHYPERTENSIVE THERAPY?

The data so far on the viral pandemic COVID-19 confirm that it is a multisystemic disease, as it affects more than one organic system. The clinical picture that accompanies it, its possible complications, its progression and the prognosis of the disease are the subject of much research. Among the patients who contracted the virus, the majority of those who developed severe clinical symptoms and complications were elderly and patients with underlying diseases such as diabetes mellitus, coronary artery disease, chronic obstructive pulmonary disease and arterial hypertension (CAD).

The possible association between AF and coronavirus disease has been largely studied, for two reasons. On the one hand, due to the finding that the new cortovirus binds to and uses during the progression of the disease the angiotensin converting enzyme (ACE-2), which is expressed in the lung and other tissues, and plays a catalytic role in the neurohormonal system (renin-angiotensin-aldosterone system or RAAS system) that regulates blood pressure in the human body. In hypertensive patients this system often suffers. On the other hand, due to the increased incidence of AF in patients who developed COVID-19. However, ultimately the association between AF and coronavirus disease seems to be due to the fact that it is a common comorbidity in the elderly and often co-exists with conditions such as coronary heart disease and diabetes mellitus. The scientific data so far, according to the European Society of Hypertension (ESH), do not indicate a predisposition to the disease in hypertensive patients, and AF does not seem to be a risk factor for a more severe clinical picture. However, it has been shown that in hypertensive patients, particularly those with dysregulated blood pressure, the disease is associated with an increased risk of complications and mortality rates.

Because of the tendency of the virus to bind to the ACE-2 enzyme, there has been considerable concern about the use of antihypertensive drugs that act by inhibiting the RAAS system, such as the converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), drugs that are widely used in hypertensive patients. The concern about their use was based on their mechanism of action, which is thought to induce and/or increase the levels of the enzyme ACE2, so the theory that they increase the risk of disease and the severity of the disease was considered. However, this theory was not supported by scientific evidence. According to ESH, the available data do not support a causal relationship between RAAS inhibitors and novel coronavirus. The ESH guidelines recommend that antihypertensive treatment should be continued as received, in stable hypertensive patients, and in the absence of other indications for discontinuation.

In conclusion, the guidelines of both the European and the Hellenic Society of Hypertension, as well as the Hellenic Society of Cardiology, recommend the continuation of medication in stable patients with AF, which follows the guidelines for the treatment of hypertension. At the same time, they advise hypertensive patients to respectfully follow the protection guidelines suggested for the age group and comorbidity profile to which they belong. Undoubtedly, the research process is in constant evolution, especially in this period of pandemic, and the results and data obtained from it are integrated into the guidelines in a modern way, with the aim of safety and protection of patients.

References
1. ESH Statement on COVID-19. April 15th, 2020. https://www.eshonline.org/spotlights/esh-statement-covid-19/
2. hypertension, renin-angiotensin-aldosterone system inhibition, and COVID-19. lancet. 2020 May 30;395(10238):1671-1673
3. SARS-CoV2(COVID-19) coronavirus. Hellenic Society of Hypertension. https://hypertasi.gr/UsersFiles/Documents/tomos29_1o_2020/8284_ENHMEROSH_COVID19_L.pdf
4. SARS-CoV2 ( COVID-19) coronavirus , Hypertension and Use of Renin-angiotensin system inhibitors (αMEA and angiotensin receptor blockers ). What is in force today. Hellenic Cardiology Society. https://www.hcs.gr/default.aspx?pageid=1069
5. high blood pressure linked to increased risk of dying from COVID-19. June 5th, 2020. European Society of Cardiology. https://www.escardio.org/The-ESC/Press-Office/Press-releases/High-blood-pressure-linked-to-increased-risk-of-dying-from-COVID-19