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COVID-19 and Antihypertensive Treatment

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Book cover Cardiovascular Complications of COVID-19

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

This chapter reviews the evidence that hypertension increases the risk of severe COVID-19 infection and argues in favor of the possibility that this is due to the high prevalence of hypertension-related organ damage in the population. It also reports the results of large-scale observational studies and of the available small trials that pretreatment with or intra-infection use of blockers of the renin-angiotensin system does not modify the risk and severity of COVID-19 and that this is likely to be true also for other antihypertensive drugs. Finally, the chapter addresses the multiple factors that during the COVID-19 pandemic and related lockdowns may have increased blood pressure and reduced blood pressure control of hypertensive patients, including disruption of healthcare systems’ ability to cope with diseases other than COVID-19. Some suggestions for hypertension guidelines modifications are issued.

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References

  1. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, Brown TS, Der Nigoghossian C, Zidar DA, Haythe J, Brodie D, Beckman JA, Kirtane AJ, Stone GW, Krumholz HM, Parikh SA. Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 2020 May;12(75):2352–71.

    Article  Google Scholar 

  2. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, the Northwell COVID-19 Research Consortium, Barnaby DP, Becker LB, Chelico JD, Cohen SL, Cookingham J, Coppa K, Diefenbach MA, Dominello AJ, Duer-Hefele J, Falzon L, Gitlin J, Hajizadeh N, Harvin TG, Hirschwerk DA, Kim EJ, Kozel ZM, Marrast LM, Mogavero JN, Osorio GA, Qiu M, Zanos TP. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–9.

    Article  CAS  Google Scholar 

  3. Rodilla E, Saura A, Jiménez I, Mendisabal A, Pineda-Cantero A, Lorenzo-Hernandez E, Fidalgo-Montero MP, et al. Association of hypertension with all-cause mortality among hospitalized patients with COVID-19. J Clin Med. 2020;9:3136.

    Article  CAS  Google Scholar 

  4. Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M, Investigators SARS-RAS. Age and multimorbidity predict death among COVID-19 patients: results of the SARS-RAS study of the Italian Society of Hypertension. Hypertension. 2020;76:366–72.

    Article  CAS  Google Scholar 

  5. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS, China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.

    Article  CAS  Google Scholar 

  6. Mancusi C. Aortic strain in hypertensive patients, are we ready for it? J Hypertens. 2021;39:1314–5.

    Article  CAS  Google Scholar 

  7. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020;12:6049–57.

    Article  CAS  Google Scholar 

  8. Sun Y, Guan X, Jia L, Xing N, Cheng L, Liu B, Zhang S, He K. Independent and combined effects of hypertension and diabetes on clinical outcomes in patients with COVID-19: a retrospective cohort study of Huoshen Mountain Hospital and Guanggu Fangcang Shelter Hospital. J Clin Hypertens (Greenwich). 2021;23:218–31.

    Article  CAS  Google Scholar 

  9. Mirani M, Favacchio G, Carrone F, Betella N, Biamonte E, Morenghi E, Mazziotti G, Lania AG. Impact of comorbidities and glycemia at admission and dipeptidyl peptidase 4 inhibitors in patients with type 2 diabetes with COVID-19: a case series from an academic Hospital in Lombardy, Italy. Diabetes Care. 2020;43:3042–9.

    Article  CAS  Google Scholar 

  10. de Almeida-Pititto B, Dualib PM, Zajdenverg L, Dantas JR, de Souza FD, Rodacki M, Bertoluci MC, Brazilian Diabetes Society Study Group (SBD). Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis. Diabetol Metab Syndr. 2020;12:75.

    Article  Google Scholar 

  11. Ram VS, Babu GR, Prabhakaran D. COVID-19 pandemic in India. Eur Heart J. 2020;41:3874–6.

    Article  CAS  Google Scholar 

  12. Ran J, Song Y, Zhuang Z, Han L, Zhao S, Cao P, Geng Y, Xu L, Qin J, He D, Wu F, Yang L. Blood pressure control and adverse outcomes of COVID-19 infection in patients with concomitant hypertension in Wuhan, China. Hypertens Res. 2020;43:1267–76.

    Article  CAS  Google Scholar 

  13. Chen R, Yang J, Gao X, Ding X, Yang Y, Shen Y, He C, Xiang H, Ke J, Yuan F, Cheng R, Lv H, Li P, Zhang L, Liu C, Tan H, Huang L. Influence of blood pressure control and application of renin-angiotensin-aldosterone system inhibitors on the outcomes in COVID-19 patients with hypertension. J Clin Hypertens (Greenwich). 2020;22:1974–83.

    Article  CAS  Google Scholar 

  14. Corrao G, Rea F, Carle F, Scondotto S, Allotta A, Lepore V, D'Ettorre A, Tanzarella C, Vittori P, Abena S, Iommi M, Spazzafumo L, Ercolanoni M, Blaco R, Carbone S, Giordani C, Manfellotto D, Galli M, Mancia G. On behalf of the ‘Monitoring and assessing care pathways (MAP)’ working group of the Italian Ministry of Health. Stratification of the risk of developing severe or lethal Covid-19 using a new score from a large Italian population: a population-based cohort study. BJM Open. 2021;11:e053281. https://doi.org/10.1136/bmjopen-2021-053281.

    Article  Google Scholar 

  15. Kreutz R, Algharably EAE, Azizi M, Dobrowolski P, Guzik T, Januszewicz A, Persu A, Prejbisz A, Riemer TG, Wang JG, Burnier M. Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19. Cardiovasc Res. 2020;116:1688–99.

    Article  CAS  Google Scholar 

  16. Mancia G, Facchetti R, Vanoli J, Dell’Oro R, Seravalle G, Grassi G. White coat hypertension without organ damage: impact on long-term mortality, new hypertension and new organ damage. Hypertension. 2022;79:1057. https://doi.org/10.1161/HYPERTENSIONAHA.121.18792.

    Article  CAS  Google Scholar 

  17. Panza JA, Quyyumi AA, Brush JE Jr, Epstein SE. Abnormal endothelium-dependent vascular relaxation in patients with essential hypertension. N Engl J Med. 1990;323(1):22–7.

    Article  CAS  Google Scholar 

  18. Libby P, Lüscher T. COVID-19 is, in the end, an endothelial disease. Eur Heart J. 2020;41:3038–44.

    Article  CAS  Google Scholar 

  19. Kumar A, Arora A, Sharma P, Anikhindi SA, Bansal N, Singla V, Khare S, Srivvastava A. Is diabetes mellitus associated with mortality and severity of COVID-10? A meta-analysis. Diabetes Metabol Syndr. 2020;14:535–45.

    Article  Google Scholar 

  20. Atmosudigdo IS, Lin MA, Radi B, Henrina J, Yonas E, Vania R, Pranata R. Dyslipidemia increases the risk of severe COVID-19: a systematic review, meta-analysis and meta-regression. Clin Med Insights Endocrinol Diabetes. 2021;14:1179551421990675. https://doi.org/10.1177/1179551421990675.

    Article  Google Scholar 

  21. Gheblawi M, Wang K, Viveiros A, Nguyen Q, Zhong JC, Turner AJ, Raizada MK, Grant MB, Oudit GY. Angiotensin-converting enzyme 2: SARS-CoV-2 receptor and regulator of the renin-angiotensin system: celebrating the 20th anniversary of the discovery of ACE2. Circ Res. 2020;126:1456–74.

    Article  CAS  Google Scholar 

  22. Kai H, Kai M. Interactions of coronaviruses with ACE2, angiotensin II, and RAS inhibitors—lessons from available evidence and insights into COVID-19. Hypertens Res. 2020;43:648–54.

    Article  CAS  Google Scholar 

  23. Esler M, Esler D. Can angiotensin receptor-blocking drugs perhaps be harmful in the COVID-19 pandemic? J Hypertens. 2020;38:781–2.

    Article  CAS  Google Scholar 

  24. Medicines taken by 6.6million people with high blood pressure and diabetes could raise the risk of deadly coronavirus symptoms, scientists claim. By Sam Blanchard for: Mailonline. Published: 11:53 GMT, 13 March 2020.

    Google Scholar 

  25. Hirakawa Y, Arima H, Webster R, Zoungas S, Li Q, Harrap S, Lisheng L, Hamet P, Mancia G, Poulter N, Neal B, Williams B, Rogers A, Woodward M, Chalmers J. Risks associated with permanent discontinuation of blood pressure-lowering medications in patients with type 2 diabetes. J Hypertens. 2016;34:781–7.

    Article  CAS  Google Scholar 

  26. Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G. Renin-angiotensin-aldosterone system blockers and the risk of Covid-19. N Engl J Med. 2020;382:2431–40.

    Article  CAS  Google Scholar 

  27. Rea F, Corrao G, Ludergnani M, Caiazzo I, Merlino L. A new population-based risk stratification tool was developed and validated for predicticting mortality, hospital admission, and health care costs. J Clin Epidemiol. 2019;116:62–71.

    Article  Google Scholar 

  28. Reynolds HR, Adhikari S, Pulgarin C, Troxel AB, Iturrate E, Johnson SB, Hausvater A, Newman JD, Berger JS, Bangalore S, Katz SD, Fishman GI, Kunichoff D, Chen Y, Ogedegbe G, Hochman JS. Renin-angiotensin-aldosterone system inhibitors and risk of Covid-19. N Engl J Med. 2020;382:2441–8.

    Article  CAS  Google Scholar 

  29. Bavishi C, Whelton PK, Mancia G, Corrao G, Messerli FH. Renin-angiotensin-system inhibitors and all-cause mortality in patients with COVID-19: a systematic review and meta-analysis of observational studies. J Hypertens. 2021;39:784–94.

    Article  CAS  Google Scholar 

  30. Fosbøl EL, Butt JH, Østergaard L, Andersson C, Selmer C, Kragholm K, Schou M, Phelps M, Gislason GH, Gerds TA, Torp-Pedersen C, Køber L. Association of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use with COVID-19 diagnosis and mortality. JAMA. 2020;324(2):168–77.

    Article  Google Scholar 

  31. EMA, Latest data support continued use of ACE inhibitors and ARB medicines during COVID-19 pandemic European Medicine Agency, EMA/284513/2020. 2020.

    Google Scholar 

  32. Lopes RD, Macedo AVS, de Barros E, Silva PGM, Moll-Bernardes RJ, Dos Santos TM, Mazza L, Feldman A, D'Andréa Saba Arruda G, de Albuquerque DC, Camiletti AS, de Sousa AS, de Paula TC, Giusti KGD, Domiciano RAM, Noya-Rabelo MM, Hamilton AM, Loures VA, Dionísio RM, Furquim TAB, De Luca FA, Dos Santos Sousa ÍB, Bandeira BS, Zukowski CN, de Oliveira RGG, Ribeiro NB, de Moraes JL, Petriz JLF, Pimentel AM, Miranda JS, de Jesus Abufaiad BE, Gibson CM, Granger CB, Alexander JH, de Souza OF, BRACE CORONA Investigators. Effect of discontinuing vs continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on days alive and out of the hospital in patients admitted with COVID-19: a randomized clinical trial. JAMA. 2021;325:254–64.

    Article  CAS  Google Scholar 

  33. Bauer A, Schreinlechner M, Sappler N, Dolejsi T, Tilg H, Aulinger BA, Weiss G, Bellmann-Weiler R, Adolf C, Wolf D, Pirklbauer M, Graziadei I, Gänzer H, von Bary C, May AE, Wöll E, von Scheidt W, Rassaf T, Duerschmied D, Brenner C, Kääb S, Metzler B, Joannidis M, Kain HU, Kaiser N, Schwinger R, Witzenbichler B, Alber H, Straube F, Hartmann N, Achenbach S, von Bergwelt-Baildon M, von Stülpnagel L, Schoenherr S, Forer L, Embacher-Aichhorn S, Mansmann U, Rizas KD, Massberg S, ACEI-COVID investigators. Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial. Lancet Respir Med. 2021;9:863–72.

    Article  CAS  Google Scholar 

  34. Cohen JB, Hanff TC, William P, Sweitzer N, Rosado-Santander NR, Medina C, Rodriguez-Mori JE, Renna N, Chang TI, Corrales-Medina V, Andrade-Villanueva JF, Barbagelata A, Cristodulo-Cortez R, Díaz-Cucho OA, Spaak J, Alfonso CE, Valdivia-Vega R, Villavicencio-Carranza M, Ayala-García RJ, Castro-Callirgos CA, González-Hernández LA, Bernales-Salas EF, Coacalla-Guerra JC, Salinas-Herrera CD, Nicolosi L, Basconcel M, Byrd JB, Sharkoski T, Bendezú-Huasasquiche LE, Chittams J, Edmonston DL, Vasquez CR, Chirinos JA. Continuation versus discontinuation of renin-angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial. Lancet Respir Med. 2021;9:275–84.

    Article  CAS  Google Scholar 

  35. Mancia G. COVID-19, Hypertension and RAAS blockers: the BRACE-CORONA trial. Cardiovasc Res. 2020;116(14):e198–9.

    Article  CAS  Google Scholar 

  36. Clemente-Moragón A, Martínez-Milla J, Oliver E, Santos A, Flandes J, Fernández I, Rodríguez-González L, Serrano Del Castillo C, Ioan AM, López-Álvarez M, Gómez-Talavera S, Galán-Arriola C, Fuster V, Pérez-Calvo C, Ibáñez B. Metoprolol in critically ill patients with COVID-19. J Am Coll Cardiol. 2021;78:1001–11.

    Article  Google Scholar 

  37. Kjeldsen SE, Narkiewicz K, Burnier M, Oparil S. Potential protective effects of antihypertensive treatments during the Covid-19 pandemic: from inhibitors of the renin-angiotensin system to beta-adrenergic receptor blockers. Blood Press. 2021;30(1):1–3.

    Article  CAS  Google Scholar 

  38. Vasanthakumar N. Beta-adrenergic blockers as a potential treatment for COVID-19 patients. BioEssays. 2020;42(11):e2000094. https://doi.org/10.1002/bies.202000094.

    Article  CAS  Google Scholar 

  39. Gao C, Cai Y, Zhang K, Zhou L, Zhang Y, Zhang X, Li Q, Li W, Yang S, Zhao X, Zhao Y, Wang H, Liu Y, Yin Z, Zhang R, Wang R, Yang M, Hui C, Wijns W, McEvoy JW, Soliman O, Onuma Y, Serruys PW, Tao L, Li F. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur Heart J. 2020;41:2058–66.

    Article  CAS  Google Scholar 

  40. Singh S, Offringa-Hup AK, Logtenberg SJJ, Van der Linden PD, Janssen WMT, Klein H, Waanders F, Simsek S, de Jager CPC, Smits P, van der Feltz M, Jan Beumer G, Widrich C, Nap M, Pinto-Sietsma SJ. Discontinuation of antihypertensive medications on the outcome of hospitalized patients with severe acute respiratory syndrome-coronavirus 2. Hypertension. 2021;78:165–73.

    Article  CAS  Google Scholar 

  41. Zhang P, Zhu L, Cai J, Lei F, Qin JJ, Xie J, Liu YM, Zhao YC, Huang X, Lin L, Xia M, Chen MM, Cheng X, Zhang X, Guo D, Peng Y, Ji YX, Chen J, She ZG, Wang Y, Xu Q, Tan R, Wang H, Lin J, Luo P, Fu S, Cai H, Ye P, Xiao B, Mao W, Liu L, Yan Y, Liu M, Chen M, Zhang XJ, Wang X, Touyz RM, Xia J, Zhang BH, Huang X, Yuan Y, Loomba R, Liu PP, Li H. Association of inpatient use of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circ Res. 2020;126:1671–81.

    Article  CAS  Google Scholar 

  42. Kreutz R, Dobrowolski P, Prejbisz A, Algharably EAE, Bilo G, Creutzig F, Grassi G, Kotsis V, Lovic D, Lurbe E, Modesti PA, Pappaccogli M, Parati G, Persu A, Polonia J, Rajzer M, de Timary P, Weber T, Weisser B, Tsioufis K, Mancia G, Januszewicz A, European Society of Hypertension COVID-19 Task Force Review. Lifestyle, psychological, socioeconomic and environmental factors and their impact on hypertension during the coronavirus disease 2019 pandemic. J Hypertens. 2021;39:1077–89.

    Article  CAS  Google Scholar 

  43. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, De Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). 2018 ESC/ESH guidelines for the Management of Arterial Hypertension. J Hypertens. 2018;36:1953–2041.

    Article  CAS  Google Scholar 

  44. Laffin LJ, Kaufman HW, Chen Z, Niles JK, Arellano AR, Bare LA, Hazen SL. Rise in blood pressure observed among US adults during the COVID-19 pandemic. Circulation. 2022;145:235–7.

    Article  CAS  Google Scholar 

  45. Einstein AJ, Shaw LJ, Hirschfeld C, Williams MC, Villines TC, Better N, Vitola JV, Cerci R, Dorbala S, Raggi P, Choi AD, Lu B, Sinitsyn V, Sergienko V, Kudo T, Nørgaard BL, Maurovich-Horvat P, Campisi R, Milan E, Louw L, Allam AH, Bhatia M, Malkovskiy E, Goebel B, Cohen Y, Randazzo M, Narula J, Pascual TNB, Pynda Y, Dondi M, Paez D, the INCAPS COVID Investigators Group. International impact of COVID-19 on the diagnosis of heart disease. J Am Coll Cardiol. 2021;77:173–85.

    Article  CAS  Google Scholar 

  46. The corona-virus disease 2019 pandemic compromised routine care for hypertension: a survey conducted among excellence centers of the European Society of Hypertension. J Hypertens. 2021;39:190–5.

    Google Scholar 

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Authors and Affiliations

  1. Università Milano-Bicocca, Milan, Italy

    Giuseppe Mancia

  2. Department of Statistics and Quantitative Methods, National Center for Health Care Research & Pharmacoepidemiology, University Milano-Bicocca, Milan, Italy

    Federico Rea & Giovanni Corrao

  3. Clinica Medica, University Milano-Bicocca, Milan, Italy

    Guido Grassi

  4. Medical Faculty, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

    Sverre E. Kjeldsen

  5. Charitè, Universitaetsmedizin, Institute of Clinical Pharmacology and Toxicology, Berlin, Germany

    Reinhold Kreutz

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  1. Giuseppe Mancia
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  2. Federico Rea
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  3. Guido Grassi
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  4. Sverre E. Kjeldsen
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  5. Reinhold Kreutz
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  6. Giovanni Corrao
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Correspondence to Giuseppe Mancia .

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Editors and Affiliations

  1. Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łódź, Poland

    Maciej Banach

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Mancia, G., Rea, F., Grassi, G., Kjeldsen, S.E., Kreutz, R., Corrao, G. (2022). COVID-19 and Antihypertensive Treatment. In: Banach, M. (eds) Cardiovascular Complications of COVID-19. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-15478-2_18

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