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Why Heart Disease and Hypertension Put Patients at Greater Risk of Contracting COVID-19

HIGHLIGHTS:

  • The overall global mortality rate for those affected by COVID-19 is currently approximately 2-3% among average adults, while older adults aged ≥60 years and persons with serious underlying health conditions, such as diabetes, hypertension, and heart disease, have seen mortality rates as high as 14-20%.
  • Symptoms of COVID-19 range from mild to severe, and include nasal congestion, sore throat, coughing, and fever. In more severe cases, it can result in pneumonia, shortness of breath and difficulty breathing.
  • Those with underlying medical conditions should take their medications regularly, wear protective face masks without exception every time they go out, wash their hands frequently, refrain from eating together with others, and avoid going to crowded places.

 

Coronaviruses (CoVs) are a large family of viruses that cause a variety of diseases in both animals and humans, and belong to the same virus group as MERS and SARS. However, the novel (new) coronavirus strain appears to be less deadly than both MERS and SARS. The overall global mortality rate for MERS is 30%, and about 10% for SARS, while the novel coronavirus strain mortality rate is currently under 3%. The World Health Organization (WHO) has now announced an official name for the novel coronavirus: SARS-CoV-2

Which diseases should cause us to be especially careful of COVID-19?

According to information published in The Lancet Medical Journal, COVID-19 is often particularly harmful to a number of systems in the body, especially in elderly patients over 60 years of age and people with certain underlying diseases, such as hypertension (high blood pressure), heart disease, diabetes, and cancer. If patients in these categories are infected and do not receive immediate treatment, they may be at risk of eventual heart attack and even death. It has been found that in at-risk patients, SARS-CoV-2 infection leads to cardiac arrhythmia or abnormal heartbeat (17%), myocardial infarction (7%), and circulatory failure (9%). Because of this, those with hypertension and heart disease must be especially careful, even while there is, as of yet, no clear and significant conclusion to this regard with differing results in many studies.

Fake news or real—increase risk of COVID-19?

Currently, COVID-19 has spread to almost every continent throughout the world and scientists everywhere are working to understand the mechanisms of infection by the virus. Once the virus enters the body, its goal is to reach the lungs thanks to a receptor in the human lungs known as angiotensin-converting enzyme 2 (ACE ll). ACE ll can be compared to a lock that, when opened, allows the virus to enter the cells of the body. As the virus travels through the body with its “keys” or what we see as spiky projections that resemble a crown on the surface of the virus, those spiky projections meet with the receptors, which is the moment that the infection begins.
There has been speculation that ACE-inhibitor drugs, or drugs that help to control or inhibit ACE ll functions (used primarily for the treatment of high blood pressure, heart disease, and kidney disease in diabetes patients), result in a higher risk of contracting SARS-CoV-2 because they cause cells in the body to have more receptors, or “locks,” allowing the virus access into the body, thus increasing the binding target of SARS-CoV-2 infection.

For patients who need to take ACE-inhibitors, such as patients with hypertension or heart disease, whether they have been infected with the virus or not, is it necessary to discontinue, reduce, or change ACE-i or ARB medications?

As of March 17, 2020, several medical journals (The Position Statement of the European Society of Cardiology Council on Hypertension, Hypertension Canada, The Canadian Cardiovascular Society, and the Canadian Heart Failure Society) have clearly stated that speculation about the safety of ACE-i or ARB treatment in relation to COVID-19 does not yet have enough sound scientific basis or evidence to support either discontinuing, reducing, or changing these anti-hypertensive medications within this or any group. They recommend that physicians and patients continue treatment with their usual anti-hypertensive therapy, and they have stated that discontinuation could cause more harm to patients than any speculated benefits.

In summary, how should patients with these conditions deal with the current situation?

If you have any of these underlying conditions, you should receive regular health checkups, get enough exercise, and closely follow the advice of your doctor. As a matter of fact, everyone of all ages should work to prevent infection through good hygiene practices. If you have a history of direct or close contact with any suspected COVID-19 patients within the past 14 days and you experience symptoms of a fever, cough, runny nose, and difficulty breathing, you should see a doctor for screening and early diagnosis, as this can help to prevent any lung, heart, and kidney complications that might occur. In the case of any indications in elderly patients with underlying lung or heart conditions, patients should also receive influenza and pneumococcal vaccines in order to build up the body’s immunity. These patients should take extra care of their health during this time.

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References
  • Zhou F et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet Published: March 11, 2020
  • Wang D et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA Published online February 7, 2020
  • Guan W et al. Clinical Characteristics of Coronavirus Disease 2019 in China NEJM Published online at February 28, 2020
  • Wu C et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. Published online March 13, 2020
  • Huang C et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet Published: January 24, 2020
  • Deshotels M et al. Angiotensin II Mediates Angiotensin Converting Enzyme Type 2 Internalization and Degradation Through an Angiotensin II Type I Receptor–Dependent Mechanism. Hypertension. 2014;64:1368–1375
  • Heurich A et al. TMPRSS2 and ADAM17 Cleave ACE2 Differentially and Only Proteolysis by TMPRSS2 Augments Entry Driven by the Severe Acute Respiratory Syndrome Coronavirus Spike Protein. Journal of Virology 2014;88(2):1293-1307
  • Walters TE et al. Angiotensin converting enzyme 2 activity and human atrial fibrillation: increased plasma angiotensin converting enzyme 2 activity is associated with atrial fibrillation and more advanced left atrial structural remodelling. EP Europace, Volume 19, Issue 8, August 2017, Pages 1280–1287
  • https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext

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Krisda Vilaiwatanakorn, M.D. Summary: Internal Medicine Cardiology