Currently, the novel coronavirus (COVID-19) has spread to many countries around the world. It has been demonstrated that hypertension, the most common comorbidity in COVID-19 patients, is predisposed to develop severe cases, especially in the older individuals.By above reasons, we enrolled 58 patients over 50 years old in the population. Besides, hypertension may be involved in the pathogenesis of COVID ‑19 either by playing a direct role as a pre-existing clinical predictor of disease severity or by contributing to deterioration in the later course of the disease characterized by acute respiratory distress syndrome (ARDS), systemic inflammatory response syndrome (SIRS), and / or multiple organ failure (MOF) .
anti-hypertensive drugs are ones of the most widely used pharmacologic agents in the world and is they are predominantly used in the elderly subjects. The essential hypertension patients are basically treated with blood pressure lowering drugs including RAS blockers (ACEIs/ARBs), CCBs and so on.
In fact, our team firstly demonstrated that the plasma AngII concentration was significantly elevated after severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection. Lei Fang and his colleagues also showed that coronavirus would probably use angiotensin converting enzyme 2 (ACE2) to target cells on the epithelium of the lungs, intestine, kidneys, and blood vessels.Moreover, circulating amounts of ACE2 increased in patients with hypertension or diabetes, and levels are further increased by different drugs, including ACEIs and ARBs[13–14].It should also be emphasized that specific alleles control ACE2 expression, activity, and response to ACEIs.In addition to animal models, humans given ACEIs, ARBs, or both, had increased ACE2 levels on intestine luminal cells.Nevertheless, it is still controversial about the ACEIs/ARBs as treatment of COVID-19. Besides, whether ACE2 expression is upregulated by either of these drugs in the primary target cells of SARS-CoV-2 in human lungs is not yet known. A number of scientists have showed that ACEI and ARB pharmacotherapy may aggravate SARS-CoV-2-induced lung disease by increasing ACE2 surface expression on airway epithelial cells[12, 16], while it also has been reported that ACEI/ARB exposure was not associated with a higher risk of COVID-19 infection[16–17],or even had the benefit for prognosis.On the other hand, some researchers have recommended CCBs as a suitable alternative treatment to renin-angiotensin-aldosterone system inhibitors, because the CCBs have not been reported to increase the expression of ACE2, Thus, the CCBs are not only used in the clinical management of hypertension, but also utilized in the treatment of various pulmonary disorders with vasoconstriction. The utilization of CCBs rather than RAS blockers is particularly recommended for elderly Chinese hypertensive population to reduce the risk of stroke, which is the major cardiovascular risk threatening the Chinese hypertensive population[19–20].It has also been confirmed that nifedipine and amlodipine were found to be associated with significantly improved mortality and a decreased risk for intubation and mechanical ventilation in elderly patients with COVID-19.
In recent a few months, we have collected the data of patients with COVID-19 and hypertension, and then analyzed clinical characteristics of 58 enrolled patients, we observed that there was no obvious difference in clinical course in ACEIs/ARBs medication, CCBs medication and the drug-usage-combined group (CCBs and ACEI/ARBS) It may be attributed to several factors: First, several works have already stressed the fact that blood pressure control has no effect on susceptibility to the SARS-CoV-2 viral infection.The higher prevalence of hypertension in patients with COVID-19 is more likely due to the fact that the severe patients were significantly older. Besides, the major complications of hypertension such as chronic heart failure, cerebral infarction and chronic renal failure made the patient much more vulnerable to progression to severe infection or death. Second, combined with previous autopsies, it was confirmed that the lungs were the main target organs invaded by novel coronavirus while the structure of cardiomyocytes was often intact. There was only a small amount of monocyte inflammatory infiltration in the interstitium[23–24], indicating that the lung may be the main infection site of COVID-19. Therefore,the outcomes of patients with COVID-19 and hypertension mostly were determined by the functional recovery of the primary underlying disease, especially the pulmonary function. Our preliminary work supported this point.Third, reviewing retrospective research data about the reports associating hypertension with COVID-infection, it has been recognized that the prevalence of hypertension in adults was around that same percentage of the COVID-19 patients.
In addition, there was also significantly difference in the use of non-invasive ventilator treatment at admission with different groups (ACEIs/ARBs group and CCBs + ACEIs/ARBs group). Reviewing retrospective research data, CCBs have been utilized in the treatment of various pulmonary disorders with vasoconstriction as well, while dysregulation or loss of hypoxic pulmonary vasoconstriction is suspected in patients with COVID-19. This could potentially explain the significant difference of clinical data at the use of non-invasive ventilator treatment. But this remains to be validated by more rigorous studies due to the relatively small sample size. Meanwhile, we found that of the usage of non-invasive ventilator treatment was not associated with the final clinical ending of patients. The mortality rate of novel coronavirus in China was much lower than that of other countries[4, 26], so we speculated that it was likely due to the early detection, early treatment, and the use of various adjuvant treatments.
In conclusion, the different use of anti-hypertensive drugs does not affect outcomes of patients with COVID-19 and hypertension, even between single drug regimen and combined therapy (with at least two anti-hypertensive drugs as combined therapy).The use or temporary adjustment of antihypertension drugs during infectious disease could be individualized according to volume status, hemodynamic stability, comorbid cardiovascular disease profiles, and anti-hypertensive drug class. More researches are needed for the use of anti-hypertensive drugs before and during severe infection or epidemics.