Hypertension & diabetes mellitus linked to Coronavirus infection

In an article written by Lei Fang, George Karakiulakis, Michael Roth published in The Lancet on March 11, the authors have found links of COVID-19 infection with cerebrovascular diseases, diabetes, hypertension and coronary heart diseases.

In the article titled ‘Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?’ the authors state that the most distinctive comorbidities of 32 non-survivors from a group of 52 intensive care unit patients with novel coronavirus disease 2019 (COVID-19) in the study by Xiaobo Yang and colleagues were cerebrovascular diseases (22%) and diabetes (22%).

Citing another study which included 1099 patients with confirmed COVID-19, they asserted that 173 of them had severe disease with comorbidities of hypertension (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), and cerebrovascular disease (2·3%).

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They cited a third study which was conducted on 140 patients who were admitted to hospital with COVID-19, of them 30% had hypertension and 12% had diabetes.

Based on their study the authors hypothesise that diabetes and hypertension treatment with angiotensin-converting enzyme 2 (ACE2)-stimulating drugs increases the risk of developing severe and fatal COVID-19.

Concluding that the sensitivity of an individual might result from a combination of both therapy and ACE2 polymorphism, the authors suggested that patients with cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, are at higher risk for severe COVID-19 infection and, therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs.

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They further suggested that based on a PubMed search on Feb 28, 2020, they did not find any evidence to suggest that antihypertensive calcium channel blockers increased ACE2 expression or activity, therefore these could be a suitable alternative treatment in these patients.

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