Toward the start of the pandemic, some scientists were concerned that high blood pressure might be a risk factor for COVID-19. Some experts also wondered whether antihypertensive medication might increase the risk of contracting SARS-CoV-2. Understanding whether hypertension is a risk factor for COVID-19 or for developing severe COVID-19 is challenging. Because both COVID-19 and hypertension are more common in older adults, it is difficult to tease the two apart.
As the authors of the editorial explain, “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.” More than 7 months on, it is still unclear whether hypertension increases the risk of developing COVID-19 or the risk of poorer outcomes. The Centers for Disease Control and Prevention (CDC) state that “Having other cardiovascular or cerebrovascular diseases, such as hypertension might increase your risk of severe illness from COVID-19.”
Some people with hypertension take renin-angiotensin-aldosterone system (RAAS) inhibitors, such as an angiotensin converting enzyme (ACE). These drugs may potentially affect the activity of ACE2 receptors, which are also the point where SARS-CoV-2 enters the cells. Scientists wondered whether these drugs might, therefore, influence infection risk. There is some evidence that RAAS inhibitors increase the number of ACE2 receptors. As the authors explain, this “could theoretically increase the binding of SARS-CoV-2 to the lung and its pathophysiological effects, leading to greater lung injury.”
Conversely, some research indicates that RAAS inhibitors might protect the lungs from damage and could, therefore, protect against the lung injuries that occur during COVID-19. Although the discussion is ongoing, at this stage, there does not appear to be a significant link between antihypertensive medication and COVID-19 risk. A large study published in June “found no substantial increase in the likelihood of a positive test for Covid-19 or in the risk of severe Covid-19 among patients who tested positive in association with five common classes of antihypertensive medications.”