While there is an overrepresentation of hypertension among hospitalized and critically ill COVID-19 patients, it is uncertain whether this relationship is causal or confounded by age and other co-morbidities associated with hypertension including obesity, diabetes mellitus, and chronic kidney disease.
The median age of hospitalized patients in Lombardy and New York City was 63 years old 9,10 and the percentage with a hypertension diagnosis is consistent with the percentage observed in the general population. Severity of COVID-19 illness is skewed towards the elderly population who have a higher prevalence of hypertension. Despite these observations, the link between hypertension and COVID-19 is unclear. A large US study of 5,700 hospitalized patients revealed an overall hypertension rate of 56%, 10 similar to hypertension rates reported from China 11 and Italy 9 (50% and 49%, respectively). Initial reports from COVID-19 hot spots, including Wuhan, 6,7 Lombardy, 8,9 and New York City, 10 identified higher rates of hypertension among severely ill, hospitalized COVID-19 patients.
Approximately 50% of US patients with hypertension are prescribed angiotensin converting enzyme inhibitors (ACE-I), aldosterone receptor blockers (ARB) and aldosterone antagonists, collectively called RAAS inhibitors, and are among the most frequently prescribed anti-hypertensive medications. 3 According to the Centers for Disease Control (CDC), 63% of adults over the age of 60 are hypertensive, 4 a number that will continue to rise as our population ages. 3 The prevalence of hypertension in US adults is around 50% and higher rates correlate directly with advancing age. Hypertension, defined by the American College of Cardiology (ACC) and American Heart Association (AHA) as a systolic blood pressure (BP) ≥130 or diastolic BP ≥80 mm 3, is a primary modifiable risk factor associated with atherosclerotic cardiovascular disease. This paper will explore the current state of our understanding of this association and review recently published studies evaluating outcomes of hypertensive COVID-19 patients treated with RAAS inhibitors. Since SARS-CoV-2 infects human cells via the angiotensin-converting enzyme II (ACE2) receptor that acts on the renin-angiotensin-aldosterone system (RAAS), a key regular of blood pressure, questions have been raised about a possible link between hypertension and severe COVID-19 infection. 2Įarly reports from major COVID-19 epicenters including Wuhan and Lombardy, Italy revealed higher morbidity and mortality rates among patients with a history of hypertension, coronary artery disease, diabetes mellitus, chronic kidney disease, and obesity.
As of Jthere were over 8 million documented cases and 450,000 deaths worldwide, including more than 2 million cases and 118,000 deaths in the United States (US). Due to its high transmissibility, COVID-19 spread quickly and escalated into a global pandemic. 1 The responsible virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 is a novel coronavirus that belongs to the same family as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Coronavirus disease 2019 (COVID-19) emerged in December 2019 likely as a result of zoonotic transmission from wild animals linked to a large wet market in Wuhan, China.