Hypertension Unit, Renal Division, University of São Paulo Medical School, Sao Paulo, Brazil.
Hypertension Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Avenida Dr Eneas de Carvalho Aguiar, 44, Sao Paulo, 05403-900, Brazil.
Curr Hypertens Rep. 2020 Jun 13;22(6):43. doi: 10.1007/s11906-020-01057-x.
There is increasing evidence indicating an association between several risk factors and worse prognosis in patients with coronavirus disease 2019 (COVID-19), including older age, hypertension, heart failure, diabetes, and pulmonary disease. Hypertension is of particular interest because it is common in adults and there are concerns related to the use of renin-angiotensin system (RAS) inhibitors in patients with hypertension infected with COVID-19. Levels of angiotensin-converting enzyme 2 (ACE2), a protein that facilitates entry of coronavirus into cells, may increase in patients using RAS inhibitors. Thus, chronic use of RAS inhibition could potentially lead to a more severe and fatal form of COVID-19. In this review, we provide a critical review to the following questions: (1) Does hypertension influence immunity or ACE2 expression favoring viral infections? (2) Are the risks of complications in hypertension mediated by its treatment? (3) Is aging a major factor associated with worse prognosis in patients with COVID-19 and hypertension?
Despite the potential involvement of immune responses in the pathogenesis of hypertension, there is no evidence supporting that hypothesis that hypertension or RAS inhibitors contributes to unfavorable outcomes in viral infections. Future investigations adopting a strict protocol for confirming hypertension status as well as assessing associated comorbidities that may influence outcomes are necessary. From the therapeutic perspective, recombinant ACE2 may serve as a potential therapy, but relevant studies in humans are lacking. Definitive evidence regarding the use of RAS inhibitors in patients with COVID-19 is needed; 5 randomized trials examining this issue are currently underway. There is no current scientific support for claiming that hypertension or its treatment with RAS inhibitors contribute to unfavorable outcomes in COVID-19.
越来越多的证据表明，几种危险因素与 2019 冠状病毒病（COVID-19）患者的预后较差有关，包括年龄较大、高血压、心力衰竭、糖尿病和肺部疾病。高血压尤其值得关注，因为它在成年人中很常见，而且人们担心 COVID-19 感染的高血压患者使用肾素-血管紧张素系统（RAS）抑制剂。血管紧张素转换酶 2（ACE2）的水平可能会在使用 RAS 抑制剂的患者中增加，ACE2 是一种促进冠状病毒进入细胞的蛋白质。因此，慢性使用 RAS 抑制可能导致 COVID-19 更严重和致命的形式。在这篇综述中，我们对以下问题进行了批判性的回顾：（1）高血压是否影响免疫或 ACE2 表达，有利于病毒感染？（2）高血压的并发症风险是否与其治疗有关？（3）年龄是 COVID-19 合并高血压患者预后不良的主要因素吗？
尽管免疫反应可能参与高血压的发病机制，但没有证据支持高血压或 RAS 抑制剂会导致病毒感染不良结局的假说。未来的研究需要采用严格的方案来确认高血压的状态，并评估可能影响结局的相关合并症。从治疗的角度来看，重组 ACE2 可能是一种潜在的治疗方法，但缺乏相关的人体研究。需要明确 COVID-19 患者使用 RAS 抑制剂的证据；目前正在进行 5 项关于这个问题的随机试验。目前没有科学证据支持高血压或其使用 RAS 抑制剂会导致 COVID-19 不良结局的说法。
