Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19
Identifieur interne : 000E04 ( Ncbi/Merge ); précédent : 000E03; suivant : 000E05Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19
Auteurs : Reinhold Kreutz [Allemagne] ; Engi Abd El-Hady Algharably [Allemagne] ; Michel Azizi [France] ; Piotr Dobrowolski [Pologne] ; Tomasz Guzik [Pologne] ; Andrzej Januszewicz [Pologne] ; Alexandre Persu [Belgique] ; Aleksander Prejbisz [Pologne] ; Thomas Günther Riemer [Allemagne] ; Ji-Guang Wang [République populaire de Chine] ; Michel Burnier [Suisse]Source :
- Cardiovascular Research [ 0008-6363 ] ; 2020.
Abstract
Systemic arterial hypertension (referred to as hypertension herein) is a major risk factor of mortality worldwide, and its importance is further emphasized in the context of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection referred to as COVID-19. Patients with severe COVID-19 infections commonly are older and have a history of hypertension. Almost 75% of patients who have died in the pandemic in Italy had hypertension. This raised multiple questions regarding a more severe course of COVID-19 in relation to hypertension itself as well as its treatment with renin–angiotensin system (RAS) blockers, e.g. angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We provide a critical review on the relationship of hypertension, RAS, and risk of lung injury. We demonstrate lack of sound evidence that hypertension
Url:
DOI: 10.1093/cvr/cvaa097
PubMed: 32293003
PubMed Central: 7184480
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<author><name sortKey="Wang, Ji Guang" sort="Wang, Ji Guang" uniqKey="Wang J" first="Ji-Guang" last="Wang">Ji-Guang Wang</name>
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, Shanghai, China</nlm:aff>
<country xml:lang="fr">République populaire de Chine</country>
<wicri:regionArea>, Shanghai</wicri:regionArea>
<wicri:noRegion>Shanghai</wicri:noRegion>
</affiliation>
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<author><name sortKey="Burnier, Michel" sort="Burnier, Michel" uniqKey="Burnier M" first="Michel" last="Burnier">Michel Burnier</name>
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, Lausanne, Switzerland</nlm:aff>
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<series><title level="j">Cardiovascular Research</title>
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<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<p>Systemic arterial hypertension (referred to as hypertension herein) is a major risk factor of mortality worldwide, and its importance is further emphasized in the context of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection referred to as COVID-19. Patients with severe COVID-19 infections commonly are older and have a history of hypertension. Almost 75% of patients who have died in the pandemic in Italy had hypertension. This raised multiple questions regarding a more severe course of COVID-19 in relation to hypertension itself as well as its treatment with renin–angiotensin system (RAS) blockers, e.g. angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We provide a critical review on the relationship of hypertension, RAS, and risk of lung injury. We demonstrate lack of sound evidence that hypertension <italic>per se</italic>
is an independent risk factor for COVID-19. Interestingly, ACEIs and ARBs may be associated with lower incidence and/or improved outcome in patients with lower respiratory tract infections. We also review in detail the molecular mechanisms linking the RAS to lung damage and the potential clinical impact of treatment with RAS blockers in patients with COVID-19 and a high cardiovascular and renal risk. This is related to the role of angiotensin-converting enzyme 2 (ACE2) for SARS-CoV-2 entry into cells, and expression of ACE2 in the lung, cardiovascular system, kidney, and other tissues. In summary, a critical review of available evidence does not support a deleterious effect of RAS blockers in COVID-19 infections. Therefore, there is currently no reason to discontinue RAS blockers in stable patients facing the COVID-19 pandemic. </p>
</div>
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<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Cardiovasc Res</journal-id>
<journal-id journal-id-type="iso-abbrev">Cardiovasc. Res</journal-id>
<journal-id journal-id-type="publisher-id">cardiovascres</journal-id>
<journal-title-group><journal-title>Cardiovascular Research</journal-title>
</journal-title-group>
<issn pub-type="ppub">0008-6363</issn>
<issn pub-type="epub">1755-3245</issn>
<publisher><publisher-name>Oxford University Press</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">32293003</article-id>
<article-id pub-id-type="pmc">7184480</article-id>
<article-id pub-id-type="doi">10.1093/cvr/cvaa097</article-id>
<article-id pub-id-type="publisher-id">cvaa097</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review</subject>
</subj-group>
</article-categories>
<title-group><article-title>Hypertension, the renin–angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19</article-title>
<subtitle>European Society of Hypertension COVID-19 Task Force Review of Evidence</subtitle>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-4818-211X</contrib-id>
<name><surname>Kreutz</surname>
<given-names>Reinhold</given-names>
</name>
<xref ref-type="corresp" rid="cvaa097-cor1"></xref>
<xref ref-type="aff" rid="cvaa097-aff1">c1</xref>
<pmc-comment>reinhold.kreutz@charite.de </pmc-comment>
</contrib>
<contrib contrib-type="author"><name><surname>Algharably</surname>
<given-names>Engi Abd El-Hady</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff1">c1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Azizi</surname>
<given-names>Michel</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff2">c2</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-8919-1661</contrib-id>
<name><surname>Dobrowolski</surname>
<given-names>Piotr</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff3">c3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Guzik</surname>
<given-names>Tomasz</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff4">c4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Januszewicz</surname>
<given-names>Andrzej</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff3">c3</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-4007-9695</contrib-id>
<name><surname>Persu</surname>
<given-names>Alexandre</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff5">c5</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-7085-0244</contrib-id>
<name><surname>Prejbisz</surname>
<given-names>Aleksander</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff3">c3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Riemer</surname>
<given-names>Thomas Günther</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff1">c1</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0001-8511-1524</contrib-id>
<name><surname>Wang</surname>
<given-names>Ji-Guang</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff6">c6</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-1283-8487</contrib-id>
<name><surname>Burnier</surname>
<given-names>Michel</given-names>
</name>
<xref ref-type="aff" rid="cvaa097-aff7">c7</xref>
</contrib>
</contrib-group>
<aff id="cvaa097-aff1"><label>c1</label>
<institution>Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie</institution>
, Germany</aff>
<aff id="cvaa097-aff2"><label>c2</label>
<institution>Université Paris-Descartes; AP-HP, Hôpital Européen Georges-Pompidou</institution>
, Hypertension Department and DMU CARTE; INSERM, CIC1418, Paris, France</aff>
<aff id="cvaa097-aff3"><label>c3</label>
<institution>Department of Hypertension, National Institute of Cardiology</institution>
, Warsaw, Poland</aff>
<aff id="cvaa097-aff4"><label>c4</label>
<institution>Institute of Cardiovascular & Medical Sciences BHF Glasgow Cardiovascular Research Centre</institution>
; Glasgow, UK and Jagiellonian University, Collegium Medicum, Krakow, Poland</aff>
<aff id="cvaa097-aff5"><label>c5</label>
<institution>Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain</institution>
, Brussels, Belgium</aff>
<aff id="cvaa097-aff6"><label>c6</label>
<institution>The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine</institution>
, Shanghai, China</aff>
<aff id="cvaa097-aff7"><label>c7</label>
<institution>Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois</institution>
, Lausanne, Switzerland</aff>
<author-notes><corresp id="cvaa097-cor1">Corresponding author. Institute of Clinical Pharmacology and Toxicology, Charitéplatz 1, D-10117 Berlin, Germany. Tel: +49 30 450 525 112, Fax: +49 30 450 7 525 112, Email: <email>reinhold.kreutz@charite.de</email>
</corresp>
</author-notes>
<pub-date pub-type="epub" iso-8601-date="2020-04-15"><day>15</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>15</day>
<month>4</month>
<year>2020</year>
</pub-date>
<pmc-comment> PMC Release delay is 0 months and 0 days and was based on the . </pmc-comment>
<elocation-id>cvaa097</elocation-id>
<history><date date-type="received"><day>31</day>
<month>3</month>
<year>2020</year>
</date>
<date date-type="rev-recd"><day>01</day>
<month>4</month>
<year>2020</year>
</date>
<date date-type="accepted"><day>06</day>
<month>4</month>
<year>2020</year>
</date>
</history>
<permissions><copyright-statement>Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.</copyright-statement>
<copyright-year>2020</copyright-year>
<license license-type="publisher-standard" xlink:href="https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model"><license-p>This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (<ext-link ext-link-type="uri" xlink:href="https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model">https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model</ext-link>
)</license-p>
</license>
<license><license-p>This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.</license-p>
</license>
</permissions>
<self-uri xlink:href="cvaa097.pdf"></self-uri>
<abstract><title>Abstract</title>
<p>Systemic arterial hypertension (referred to as hypertension herein) is a major risk factor of mortality worldwide, and its importance is further emphasized in the context of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection referred to as COVID-19. Patients with severe COVID-19 infections commonly are older and have a history of hypertension. Almost 75% of patients who have died in the pandemic in Italy had hypertension. This raised multiple questions regarding a more severe course of COVID-19 in relation to hypertension itself as well as its treatment with renin–angiotensin system (RAS) blockers, e.g. angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We provide a critical review on the relationship of hypertension, RAS, and risk of lung injury. We demonstrate lack of sound evidence that hypertension <italic>per se</italic>
is an independent risk factor for COVID-19. Interestingly, ACEIs and ARBs may be associated with lower incidence and/or improved outcome in patients with lower respiratory tract infections. We also review in detail the molecular mechanisms linking the RAS to lung damage and the potential clinical impact of treatment with RAS blockers in patients with COVID-19 and a high cardiovascular and renal risk. This is related to the role of angiotensin-converting enzyme 2 (ACE2) for SARS-CoV-2 entry into cells, and expression of ACE2 in the lung, cardiovascular system, kidney, and other tissues. In summary, a critical review of available evidence does not support a deleterious effect of RAS blockers in COVID-19 infections. Therefore, there is currently no reason to discontinue RAS blockers in stable patients facing the COVID-19 pandemic. </p>
</abstract>
<abstract abstract-type="graphical"><title>Graphical Abstract</title>
<p><fig id="cvaa097-ga1" orientation="portrait" position="float"><label>Graphical Abstract</label>
<graphic xlink:href="cvaa097f4"></graphic>
</fig>
</p>
</abstract>
<kwd-group><kwd>Hypertension</kwd>
<kwd>Angiotensin</kwd>
<kwd>COVID-19</kwd>
<kwd>Cardiovascular</kwd>
<kwd>Lung</kwd>
</kwd-group>
<funding-group><award-group award-type="grant"><funding-source><institution-wrap><institution>DFG</institution>
<institution-id institution-id-type="DOI">10.13039/100004807</institution-id>
</institution-wrap>
</funding-source>
</award-group>
</funding-group>
<counts><page-count count="12"></page-count>
</counts>
<custom-meta-group><custom-meta><meta-name>article-lifecycle</meta-name>
<meta-value>PAP</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Allemagne</li>
<li>Belgique</li>
<li>France</li>
<li>Pologne</li>
<li>République populaire de Chine</li>
<li>Suisse</li>
</country>
<region><li>Canton de Vaud</li>
<li>Région de Bruxelles-Capitale</li>
<li>Île-de-France</li>
</region>
<settlement><li>Bruxelles</li>
<li>Lausanne</li>
<li>Paris</li>
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<tree><country name="Allemagne"><noRegion><name sortKey="Kreutz, Reinhold" sort="Kreutz, Reinhold" uniqKey="Kreutz R" first="Reinhold" last="Kreutz">Reinhold Kreutz</name>
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<name sortKey="Algharably, Engi Abd El Hady" sort="Algharably, Engi Abd El Hady" uniqKey="Algharably E" first="Engi Abd El-Hady" last="Algharably">Engi Abd El-Hady Algharably</name>
<name sortKey="Riemer, Thomas Gunther" sort="Riemer, Thomas Gunther" uniqKey="Riemer T" first="Thomas Günther" last="Riemer">Thomas Günther Riemer</name>
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<country name="France"><region name="Île-de-France"><name sortKey="Azizi, Michel" sort="Azizi, Michel" uniqKey="Azizi M" first="Michel" last="Azizi">Michel Azizi</name>
</region>
</country>
<country name="Pologne"><noRegion><name sortKey="Dobrowolski, Piotr" sort="Dobrowolski, Piotr" uniqKey="Dobrowolski P" first="Piotr" last="Dobrowolski">Piotr Dobrowolski</name>
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<name sortKey="Guzik, Tomasz" sort="Guzik, Tomasz" uniqKey="Guzik T" first="Tomasz" last="Guzik">Tomasz Guzik</name>
<name sortKey="Januszewicz, Andrzej" sort="Januszewicz, Andrzej" uniqKey="Januszewicz A" first="Andrzej" last="Januszewicz">Andrzej Januszewicz</name>
<name sortKey="Prejbisz, Aleksander" sort="Prejbisz, Aleksander" uniqKey="Prejbisz A" first="Aleksander" last="Prejbisz">Aleksander Prejbisz</name>
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<country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Persu, Alexandre" sort="Persu, Alexandre" uniqKey="Persu A" first="Alexandre" last="Persu">Alexandre Persu</name>
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</country>
<country name="République populaire de Chine"><noRegion><name sortKey="Wang, Ji Guang" sort="Wang, Ji Guang" uniqKey="Wang J" first="Ji-Guang" last="Wang">Ji-Guang Wang</name>
</noRegion>
</country>
<country name="Suisse"><region name="Canton de Vaud"><name sortKey="Burnier, Michel" sort="Burnier, Michel" uniqKey="Burnier M" first="Michel" last="Burnier">Michel Burnier</name>
</region>
</country>
</tree>
</affiliations>
</record>
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