Clinical and Molecular Medicine Department, Division of Cardiology, Sant' Andrea Hospital, Sapienza University of Rome, Rome, Italy (C.S., M.V.).
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie (R.K.).
Circ Res. 2021 Apr 2;128(7):1062-1079. doi: 10.1161/CIRCRESAHA.121.318054. Epub 2021 Apr 1.
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associates with a considerable high rate of mortality and represents currently the most important concern in global health. The risk of more severe clinical manifestation of COVID-19 is higher in males and steeply raised with age but also increased by the presence of chronic comorbidities. Among the latter, early reports suggested that arterial hypertension associates with higher susceptibility to SARS-CoV-2 infection, more severe course and increased COVID-19-related deaths. Furthermore, experimental studies suggested that key pathophysiological hypertension mechanisms, such as activation of the renin-angiotensin system (RAS), may play a role in COVID-19. In fact, ACE2 (angiotensin-converting-enzyme 2) is the pivotal receptor for SARS-CoV-2 to enter host cells and provides thus a link between COVID-19 and RAS. It was thus anticipated that drugs modulating the RAS including an upregulation of ACE2 may increase the risk for infection with SARS-CoV-2 and poorer outcomes in COVID-19. Since the use of RAS-blockers, ACE inhibitors or angiotensin receptor blockers, represents the backbone of recommended antihypertensive therapy and intense debate about their use in the COVID-19 pandemic has developed. Currently, a direct role of hypertension, independent of age and other comorbidities, as a risk factor for the SARS-COV-2 infection and COVID-19 outcome, particularly death, has not been established. Similarly, both current experimental and clinical studies do not support an unfavorable effect of RAS-blockers or other classes of first line blood pressure lowering drugs in COVID-19. Here, we review available data on the role of hypertension and its management on COVID-19. Conversely, some aspects as to how the COVID-19 affects hypertension management and impacts on future developments are also briefly discussed. COVID-19 has and continues to proof the critical importance of hypertension research to address questions that are important for global health.
由严重急性呼吸系统综合症冠状病毒 2 型（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）死亡率相当高，目前是全球健康的头等大事。男性患 COVID-19 的临床症状更为严重，且随着年龄的增长而急剧上升，而患有慢性合并症的患者，其风险也会增加。在这些合并症中，早期报告表明，高血压与 SARS-CoV-2 感染的易感性增加、病情更为严重以及 COVID-19 相关死亡率增加有关。此外，实验研究表明，高血压的关键病理生理学机制，如肾素-血管紧张素系统（RAS）的激活，可能在 COVID-19 中发挥作用。事实上，ACE2（血管紧张素转换酶 2）是 SARS-CoV-2 进入宿主细胞的关键受体，因此为 COVID-19 与 RAS 之间提供了联系。因此，预计调节 RAS 的药物（包括 ACE2 的上调）可能会增加感染 SARS-CoV-2 的风险，并使 COVID-19 的结果恶化。由于 RAS 阻滞剂、ACE 抑制剂或血管紧张素受体阻滞剂的使用是推荐的抗高血压治疗的基础，因此在 COVID-19 大流行期间，人们对其使用产生了激烈的争论。目前，高血压作为 SARS-CoV-2 感染和 COVID-19 结局（特别是死亡）的一个风险因素，其独立于年龄和其他合并症的直接作用尚未得到确定。同样，目前的实验和临床研究也不支持 RAS 阻滞剂或其他一线降压药物在 COVID-19 中的不良作用。在这里，我们回顾了有关高血压及其对 COVID-19 影响的现有数据。相反，我们还简要讨论了 COVID-19 如何影响高血压的管理以及对未来发展的影响的一些方面。COVID-19 已经并将继续证明高血压研究对解决全球健康重要问题的重要性。
