Devyani Goswami, Amity University Kolkata
Hypertension and cardiovascular diseases are considered as vital risk factors for critical disease progression for COVID-19 contracted patients. 1 out of every 5 individual suffers from hypertension. Hypertension is observed to develop serious problems in the later stage of the infection, as these patients are more likely to develop pneumonia more quickly than the rest and ultimately leading to multiple organ failure.
After combining clinical data and single-cell sequencing data of airway samples with in-vitro experiments; it was observed that a distinct inflammatory predisposition of immune cells for hypertension patients as the viral disease progressed. COVID-19 virus exploits the ACE2 receptor on epithelial cells of the lungs, which is a part of the renin-angiotensin-aldosterone system (RAAS), whose major function is to regulate blood pressure homeostasis and vascular repair responses. Various anti-hypertensive treatment by ACEIs or ARBs is observed to modulate ACE2 expression hence altering the susceptibility for COVID-19.
ACEI treatment dampened SARS-CoV-19 related airway hyper-inflammation along with increased cell-intrinsic antiviral responses. On the other hand, ARB treatment enhanced epithelial immune cell interactions along with a higher expression of the pro-inflammatory cytokines CCL3, CCL4 and chemokine receptor CCR1. The study concluded that ACEI treatment can reduce critical disease progression more prominently than ARB treatment.
Although testing positive for COVID-19 does not mean that it could be treated with ACEI or ARB treatments. As no difference was observed in ACE2 expression and initial viral concentration among patients; because ACE2 expression after COVID-19 contraction is not changed by ACEI or ARB treatments. Although viral clearance was delayed by ARB treatment, which can be due to defects in the immunity.
Due to the smaller size of the cohort, clinical efficacy was not established for this study and it requires further studies are required on this field.
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Source: Hypertension delays viral clearance and exacerbates airway hyper-inflammation in patients with COVID-19 https://doi.org/10.1038/s41587-020-00796-1
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