ABSTRACT
From the end of 2019 to the beginning of 2020, the scientific community has confronted a pandemic by a new coronavirus, referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The related dis-ease, termed coronavirus disease 2019 (COVID-19), is a widely variable entity which displays worse prognoses in subjects with comorbidities. This is due to chronic diseases like hypertension and diabetes mellitus that share several features with infections, such as the proinflammatory en-vironment and the increased adaptive immune response. These processes may be augmented in the infection, in cor-relation with worse clinical courses. In the specific case of hypertensive patients with COVID-19, susceptibility may be attributed to the preexisting inflammatory state and the altered immune response, as well as the role of the angio-tensin-converting enzyme 2 (ACE2), a key element in the renin-angiotensin-aldosterone system, which intervenes in the pathophysiology of both conditions. Given the novelty of the virus and the high worldwide prevalence of hyperten-sion, it is necessary to study and comprehend the impact of this disease in the infection by SARS-CoV-2 in order to of-fer improved management. The objective of this review is to summarize some clinical aspects on COVID-19 in patients with hypertension.
ABSTRACT
The pandemic of coronavirus disease 2019 (COVID-19) has become a genuine public health problem. The largestproportion of cases appears to occur in elder subjects, which may be more likely to develop severe cases. Like- wise, older age has been positively correlated with the presence of comorbidities such as hypertension, diabetes mellitus, and cardiovascular disease, which in turn have been related to worse prognosis in patients with COVID-19. Upon this outlook, polypharmacy represents an added risk factor. In these patients, some of the most used drugs include the modulators of the renin-angiotensin-aldosterone system (RAAS), such as the angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (ARA). These modulators generate special attention in patients with COVID-19, as angiotensin-converting enzyme 2 (ACE2) can act as an entry point for SARS-CoV-2 into human cells. Interference of the RAAS with ACEi or ARA has been proposed to possibly modify the susceptibility to infection by coronavirus. Nevertheless, in the clinical setting, opposing opinions contrasts the risks of maintaining or discontinuing antihypertensive treatment with these drugs. The objective of this review is to evaluate the molecular mechanisms regulating ACE2 and its relationship with COVID-19, and revise the current recommendations regarding the use of ACEi and ARA in patients with this disease. Keywords: COVID-19, coronavirus, hypertension, renin- angiotensin-aldosterone, angiotensin-converting enzyme 2.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has become an emerging pandemic, dominating the current outlook in pub- lic health. The typical clinical picture of COVID-19 encom- passes flu-like symptoms;including fever predominantly dry cough, dyspnea, asthenia, odynophagia, rhinorrhea, and headache. However, some patients may also develop cardiovascular manifestations, such as acute cardiac injury, heart failure, shock, and arrhythmias, among others. The pa- thogeny underlying this link has not been clarified;however, SARS-CoV-2 has been observed to penetrate cells via the angiotensin-converting enzyme 2, an important participant in the renin-angiotensin-aldosterone systemand the regulation of the cardiovascular system. The use of angiotensin-con- verting enzymeinhibitors and angiotensin II receptor antago- nistsmay cause upregulation of ACE2 and facilitate viral en- try. COVID-19 has also been related to various forms of co- agulopathy, with a tendency to favor pro-thrombotic states, increasing cardiovascular risk. The objective of this article is to explore the link between COVID-19 and cardiovascular disease, and its repercussions in clinical management.