Management of hypertension in patients with COVID-19: Implication of angiotensin-converting enzyme 2.

The global coronavirus disease-19 (COVID-19) pandemic, caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has created an unprecedented, global public health crisis. Epidemiological studies showed that hypertension is a frequent comorbidity, as well as an independent prognostic risk factor in patients with COVID-19. Angiotensin-converting enzyme-2 (ACE-2) is a receptor for SARS-CoV-2, and thus essential for viral entry into human cells. This review summarizes the recent findings of epidemiology of hypertension in COVID-19 patients and highlights the critical role of ACE2. We also review the impact of endothelial dysfunction, inflammation, and arterial stiffness in promoting hypertension and cardiovascular disease in COVID-19 patients. This review also discusses therapeutic strategies for managing hypertension in patients with COVID-19, with particular emphasis on ACE inhibitors, angiotensin receptor blockers, and calcium channel blockers.

Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications.

The prevalence of heart failure is on the rise and imposes a major health threat, in part, due to the rapidly increased prevalence of overweight and obesity. To this point, epidemiological, clinical, and experimental evidence supports the existence of a unique disease entity termed "obesity cardiomyopathy," which develops independent of hypertension, coronary heart disease, and other heart diseases. Our contemporary review evaluates the evidence for this pathological condition, examines putative responsible mechanisms, and discusses therapeutic options for this disorder. Clinical findings have consolidated the presence of left ventricular dysfunction in obesity. Experimental investigations have uncovered pathophysiological changes in myocardial structure and function in genetically predisposed and diet-induced obesity. Indeed, contemporary evidence consolidates a wide array of cellular and molecular mechanisms underlying the etiology of obesity cardiomyopathy including adipose tissue dysfunction, systemic inflammation, metabolic disturbances (insulin resistance, abnormal glucose transport, spillover of free fatty acids, lipotoxicity, and amino acid derangement), altered intracellular especially mitochondrial Ca2+ homeostasis, oxidative stress, autophagy/mitophagy defect, myocardial fibrosis, dampened coronary flow reserve, coronary microvascular disease (microangiopathy), and endothelial impairment. Given the important role of obesity in the increased risk of heart failure, especially that with preserved systolic function and the recent rises in COVID-19-associated cardiovascular mortality, this review should provide compelling evidence for the presence of obesity cardiomyopathy, independent of various comorbid conditions, underlying mechanisms, and offer new insights into potential therapeutic approaches (pharmacological and lifestyle modification) for the clinical management of obesity cardiomyopathy.

Commentary: COVID-19 and obesity pandemics converge into a syndemic requiring urgent and multidisciplinary action.

While substantial evidence points towards obesity and associated cardiometabolic disorders being a major factor for poor outcomes in SARS-CoV2 infections (COVID-19), the complexity of the interplay between these two pandemics is becoming apparent. Indeed, as previously defined, this interaction between obesity and COVID-19 represents a 'syndemic' that requires both current and ongoing attention. At a mechanistic level the chronic inflammatory environment of obesity predisposes to life threatening events such as cytokine storm and enhanced coagulopathy. Obesity and its management are affected by diverse factors manifested at societal, educational, racial, and nutritional levels. A multidisciplinary approach is required to manage obese and type 2 diabetic patients, not only during the current COVID-19 crisis, but to decrease the growing burden of cardiometabolic disease and associated cardiovascular complications impacting future viral pandemics. Further, this syndemic has highlighted disparities in healthcare which need to be addressed to achieve equality in health outcomes in patients infected with COVID-19.