Arterial Hypertension as a Risk Comorbidity Associated with COVID-19 Pathology

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.

Nomograma de predicción para la estratificación del riesgo en pacientes con COVID-19

“…Las estadísticas actuales en la COVID-19 refieren que la hipertensión arterial es una de las comorbilidades más comunes en los pacientes. Kamyshnyi et al, (2020) argumenta que el hecho de padecer esta enfermedad puede empeorar la evolución y aumentar el riesgo de progresión e ingreso en la unidad de cuidados intensivos. Se han estudiado los mecanismos por los cuales la HTA contribuye al mal pronóstico de la COVID-19, y aún no están claros.…”

Risk Factors and Blood Pressure Control Targets Associated With the Clinical Outcome of Elderly COVID-19 Patients With Hypertension: a Retrospective Cohort Study

“…Our study shows that the percentage of good outcomes in hypertension decreases 50% and the risk of adverse outcomes increases more than 3 times. COVID-19 patients with hypertension should be given additional attention to prevent worsening of their clinical outcomes (4,18). Instruction of blood pressure control in hypertensive patients is very important for clinical treatment of COVID-19.…”

“…It has been previously reported that patients with older age and chronic underlying conditions might have a high risk of experiencing intensive care and death. Moreover, current clinical data suggest that, in COVID-19 patients, hypertension can worsen outcomes and increase the risk of admission to intensive care unit (ICU) (4). Previous clinical trials showed that SARSCoV-2 enters cells through angiotensinconverting enzyme 2(ACE2) receptors (5); high blood pressure is likely to increase COVID-19 mortality by affecting lung function and impairing oxygen delivery(6).…”

Survival Analysis of Covid 19 Patients from Two Hospitals in Cimahi, Indonesia

“…The risk of death in covid patients with hypertension is 3,36 times higher. Based on the analysis derived from a backward stepwise logistic regression analysis it was obtained: male; age ≥60 years; smoking history; hypertension; lymphocyte≤ 0.8 * 109/L; PO2/FiO2≤ 260; logistic regression analysis: male; age ≥60 years; smoking history; hypertension; lymphocyte≤ 0.8 * 109/L; PO2/FiO2≤ 260; IL-6 ≥ 13pg/ml; IL-2R ≥ 1000pg/ml; positive sputum or sanguine culture for bacteria; fungi infection; multilobular infiltration [31,32]. Pneumonia is reported to be the most frequent cause of death in Covid 19 disease both for adults and children [33].…”