Hypertension, or high blood pressure, is highly prevalent across the globe. As the COVID-19 pandemic continues, researchers are keen to understand whether hypertension or the drugs that treat it might interact with the virus. The American Heart Association (AHA), said there is no firm evidence that hypertension or blood pressure drugs will increase a person’s risk of contracting SARS-CoV-2:
“Similarly, current evidence does not support the theory that individuals with hypertension are more likely to experience worse symptoms of COVID-19 should they contract the virus. However, those with a chronic condition such as high blood pressure reading above 130/80 may face an increased risk for severe complications if they get the virus.”
The World Health Organisation (WHO), been termed hypertension “a silent killer” and a “global public health issue” because most affected individuals show no symptoms. It is also said that hypertension is the “most important preventable cause of heart disease and stroke worldwide.”
A Consultant Physician and Cardiologist at Lagos, Dr Folasade Adeola Daniel of the Lagos State University Teaching Hospital (LASUTH) and Senior Lecturer, Lagos State University College of Medicine (LASUCOM), explained: “If you know your blood pressure then you could tell when it is abnormal, higher or lower, then appropriate medical attention could be quickly sought. Awareness can help people modify their lifestyle to correct the elevated blood pressure if that be the case.
“A person would know if his or her blood pressure is at the target for those who need to be on treatment for hypertension. It is also better one knows his or her actual blood pressure reading whenever it is done rather than accept a normal verdict from whoever is doing it.
“Despite the social distancing restrictions that led to a drastic reduction in the contact we should have with patients. The home blood pressure monitor is recognised as a tool in the diagnosis and monitoring of elevated blood pressure.”
To stay healthy, he added that WHO recommended healthy diet, no alcohol, physical activity and no tobacco and stress management as steps to minimise the odds of developing high blood pressure and its adverse consequences.
Blood pressure-lowering medicines and COVID-19 patients
AHA, Heart Failure Society of America and American College of Cardiology, said medications for high blood pressure, heart failure or heart disease do not increase one’s risk of contracting COVID-19: “They are vital to maintaining blood pressure levels to reduce the risk of heart attack, stroke and worsening heart disease.
“If you are a cardiovascular disease patient with COVID-19, your health care provider should evaluate you before adding or removing treatments. Changes should be based on the latest scientific evidence and shared decision-making.
“Some common habits or over-the-counter medicines and supplements can be BP raisers. Common pain medicines called nonsteroidal anti-inflammatory drugs (NSAIDs) like; naproxen and ibuprofen can increase the blood pressure. Decongestants are also known BP-raisers. People with heart concerns should limit or avoid them, especially if their blood pressure is uncontrolled. Drugs such as acetaminophen are less likely to increase blood pressure.
“People should ask their doctors about OTC medicines.
Some prescription medicines; people taking medication for mental health, corticosteroids, oral birth control, immunosuppressants and some cancer medications, should monitor blood pressure to make sure it’s under control.
“People should limit alcohol and caffeine, because too much can raise blood pressure. Caffeine should be capped at three cups per day in general, and most people with high blood pressure should avoid it. Herbs and food combinations, such as natural supplements and home remedies may not be safe. Some herbal supplements can raise blood pressure.”
Existing conditions and COVID-19
JAMA Internal Medicine study demonstrated that certain existing conditions are associated with an increased risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and with more severe symptoms of COVID-19.
The study investigated 41 patients in Wuhan, China, where the COVID-19 outbreak started. It found that 32 per cent had underlying health conditions most commonly, diabetes, hypertension, and cardiovascular disease. Another followed 201 people with COVID-19. Of these individuals, 84 developed acute respiratory distress syndrome (ARDS). Of the 84 who developed ARDS, 27.4 per cent had hypertension. In comparison, 13.7 per cent of those who did not develop ARDS had hypertension.
However, these associations between hypertension and COVID-19 are not necessarily causal. Hypertension is exceedingly frequent in the elderly, and older people appear to be at particular risk of being infected with SARS-CoV-2 virus and of experiencing severe forms and complications of COVID-19. Meanwhile, in the JAMA study, the average age of individuals who developed ARDS was 58 years compared with 48 years in those who did not develop ARDS.
The AHA revealed that for people with hypertension, doctors sometimes prescribe angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs): “These medications, it is said belong to a group of drugs called renin-angiotensin-aldosterone system (RAAS) antagonists. These drugs inhibit the RAAS and interrupt activity at a receptor called ACE2.
“Scientists have shown that SARS-CoV-2 binds to ACE2 receptors to facilitate its entry into lung cells.” The association disclosed that “there is some evidence that ACE inhibitors and ARBs increase the number of ACE2 receptors.
“This could theoretically increase the binding of SARS-CoV-2 to the lung and its pathophysiological effects, leading to greater lung injury. In other words, if these drugs increase the number of entry points for the virus, they might cause more severe symptoms.
“However, other theory, some research indicates that ACE2 can protect against severe lung injury as this is due to interactions with the RAAS, both ACE inhibitors and ARBs might contribute to reduce inflammation systemically and particularly in the lung, heart, and kidney.
“If this is the case, the drugs “could diminish the potential for development of acute respiratory distress syndrome, myocarditis, or acute kidney injury, which can occur in COVID-19 patients.”