The COVID-19 and Hypertension

Öz

On 31 December 2019, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in China, caused COVID-19 infection and a pandemic. Hypertension (HT) appeared as an important comorbidity affecting prognosis in COVID-19 infection. SARSCoV-2’s use of angiotensin converting enzyme 2 (‘angiotensin converting enzyme-2’, ACE2) as viral entry receptor in the lung has caused concern in patients diagnosed with hypertension and receiving ACEI / ARB therapy in COVID-19 infection. Studies show that the disease is more serious and more mortal in HT patients diagnosed with COVID-19. Taking ACEI / ARB, does not differ prognosis and mortality in many studies and even has positive effects in some studies. In addition, it seems that other antihypertensive treatments do not make a significant difference in terms of prognosis or mortality. Blood pressure of hypertensive patients must be kept under control. If there is no other reason, antihypertensive treatments of patients should not be changed.

Anahtar Kelimeler

• COVID-19
• Hypertension,
• Prognosis
• Mortality

COVID-19 ve Hipertansiyon

Öz

Çin’de, ilk kez 31 Aralık 2019’da, yeni bir ciddi akut solunum sendromu koronavirüs 2 (SARS-CoV-2)’nin neden olduğu COVID-19 enfeksiyonu tespit edildi ve pandemiye sebep oldu. Hipertansiyon (HT), COVID-19 enfeksiyonunda prognozu etkileyen önemli bir komorbidite olarak karşımıza çıkmaktadır. SARS-CoV-2’nin akciğerde viral giriş reseptörü olarak anjiyotensin dönüştürücü enzim 2’yi (‘angiotensin converting enzyme-2’, ACE2) kullanması, COVID-19 enfeksiyonunda hipertansiyon tanısı olan ve ACEI/ARB tedavisi alan hastalar açısından endişe yaratmıştır. Yapılan çalışmalarda HT tanısı olan COVID-19 hastalarında hastalığın daha ciddi ve daha mortal seyrettiği görülmektedir. ACEI/ARB kullanım gruplarında birçok çalışmada prognoz açısından farklılık oluşturmadığı hatta bazı çalışmalarda olumlu etki oluşturduğu izlenmektedir. Ayrıca diğer antihipertansif tedavilerin de prognoz veya mortalite açısından anlamlı farklılık yaratmadığı görülmektedir. Hipertansif hastaların kan basıncı mutlaka kontrol altında tutulmalıdır. Başka bir neden yoksa hastaların antihipertansif tedavileri değiştirilmemelidir.

Anahtar Kelimeler

• hipertansiyon
• covid 19
• Prognoz
• Mortalite

Kaynakça

1. REFERANSLAR:
2. 1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020; 382:727–733.
3. 2. http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/ news/news/2020/3/who-announces-covid-19-outbreak-a-pandemic. (30 March 2020)
4. 3. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579:270.
5. 4. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395:1054.
6. 5. Kreutz R, Algharably EAE, Azizi M, et al. Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19 [published online ahead of print, 2020 Apr 15]. Cardiovasc Res. 2020;cvaa097. doi:10.1093/cvr/cvaa097
7. 6. Gutierrez F, Masia M, Mirete C, Soldan B, Rodriguez JC, Padilla S, Hernandez I, Royo G, Martin-Hidalgo A. The influence of age and gender on the populationbased incidence of community-acquired pneumonia caused by different microbial pathogens. J Infect 2006;53:166–174.
8. 7. Koivula I, Sten M, Makela PH. Risk factors for pneumonia in the elderly. Am J Med 1994;96:313–320.

9. 8. Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, Shao L, Tian Y, Dong Y, Zheng C, Wang J, Zhu M, Weintraub WS, Gao R. Status of hypertension in China: results from the China Hypertension Survey, 2012–2015. Circulation 2018;137:2344–2356.
10. 9. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:145–151.
11. 10. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy [published online ahead of print, 2020 Apr 6]. JAMA. 2020;323(16):1574‐1581. doi:10.1001/jama.2020.5394.
12. 11. Guan WJ, Liang WH, Zhao Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547. Published 2020 May 14. doi:10.1183/13993003.00547-2020.
13. 12. Kreutz R, Algharably EAE, Azizi M, et al. Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19 [published online ahead of print, 2020 Apr 15]. Cardiovasc Res. 2020;cvaa097. doi:10.1093/cvr/cvaa097
14. 13. Hampl V, Herget J, Bíbová J, et al. Intrapulmonary activation of the angiotensin-converting enzyme type 2/angiotensin 1-7/G-protein-coupled Mas receptor axis attenuates pulmonary hypertension in Ren-2 transgenic rats exposed to chronic hypoxia. Physiol Res. 2015;64(1):25–38.
15. 14. Imai Y, Kuba K, Ohto-Nakanishi T, Penninger JM. Angiotensin-converting enzyme 2 (ACE2) in disease pathogenesis. Circ J. 2010;74(3):405‐410. doi:10.1253/circj.cj-10-0045.
16. 15. Santos RAS, Sampaio WO, Alzamora AC, Motta-Santos D, Alenina N, Bader M, Campagnole-Santos MJ. The ACE2/angiotensin-(1-7)/MAS axis of the renin–angiotensin system: focus on angiotensin-(1-7). Physiol Rev 2018;98:505–553.
17. 16. Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B, Yang P, Sarao R, Wada T, Leong-Poi H, Crackower MA, Fukamizu A, Hui CC, Hein L, Uhlig S, Slutsky AS, Jiang C, Penninger JM. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature 2005;436:112–116.
18. 17. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531‐538. doi:10.1007/s00392-020-01626-9.
19. 18. Gao C, Cai Y, Zhang K, et al. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur Heart J. 2020;41(22):2058‐2066. doi:10.1093/eurheartj/ehaa433.
20. 19. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMP, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020. 10.1016/j.thromres.2020.04.013.
21. 20. Nadar S, Lip GY. Hypertension and the prothrombotic state. J Am Coll Cardiol. 2003;41:1847. doi: 10.1016/S0735-1097(03)00337-1).
22. 21. Meng J, Xiao G, Zhang J, et al. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microbes Infect. 2020;9(1):757‐760. doi:10.1080/22221751.2020.1746200
23. 22. Zhang P, Zhu L, Cai J, et al. Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients With Hypertension Hospitalized With COVID-19 [published online ahead of print, 2020 Apr 17]. Circ Res. 2020;10.1161/CIRCRESAHA.120.317134.
24. 23. Li J, Wang X, Chen J, Zhang H, Deng A. Association of Renin-Angiotensin System Inhibitors With Severity or Risk of Death in Patients With Hypertension Hospitalized for Coronavirus Disease 2019 (COVID-19) Infection in Wuhan, China [published online ahead of print, 2020 Apr 23]. JAMA Cardiol. 2020;e201624. doi:10.1001/jamacardio.2020.1624.
25. 24. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area [published online ahead of print, 2020 Apr 22] [published correction appears in doi: 10.1001/jama.2020.7681]. JAMA. 2020;323(20):2052‐2059. doi:10.1001/jama.2020.6775
26. 25. Pirola CJ, Sookoian S. Estimation of Renin-Angiotensin-Aldosterone-System (RAAS)-Inhibitor effect on COVID-19 outcome: A Meta-analysis [published online ahead of print, 2020 May 28]. J Infect. 2020;S0163-4453(20)30329-7. doi:10.1016/j.jinf.2020.05.052
27. 26. Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G. Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19 [published online ahead of print, 2020 May 1]. N Engl J Med. 2020;NEJMoa2006923. doi:10.1056/NEJMoa2006923
28. 27. Tadic M, Cuspidi C, Mancia G, Dell'Oro R, Grassi G. COVID-19, hypertension and cardiovascular diseases: Should we change the therapy? [published online ahead of print, 2020 May 13]. Pharmacol Res. 2020;158:104906. doi:10.1016/j.phrs.2020.104906).
29. 28. Hypertension ECo. Position Statement of the ESC Council on Hypertension on ACEInhibitors and Angiotensin Receptor Blockers. https://www.escardio.org/Councils/ Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-councilon-hypertension-on-ace-inhibitors-and-ang).