Investigating link to hypertension
Note that back in 2006, it was suggested that ACE inhibitors might be BENEFICIAL in treating ARDS (Acute Respiratory Distress Syndrome -- which is how it kills you, suffocating you in your own lung exudate).
https://www.medscape.com/viewarticle/926665
News > Medscape Medical News > Conference News > CROI 2020
Scientists Seek Answers to Hypertension–COVID-19 Link
Heather Boerner
March 11, 2020
SNIP
...
data showing that more than 40% of people with severe infection had baseline hypertension. Among those with severe illness, the next most common comorbidity was diabetes, at about half that rate. Similar data have been described elsewhere, as reported by Medscape Medical News.
SARS-CoV-2 and ACE2
It turns out that SARS-CoV-2 was nearly tailor made for the human body. Although it seems to have emerged from bats or species that bats feed on, current thinking is that there are a number of these "SARS-like" viruses already in bat communities that use ACE2 receptors to invade cells. The receptors exist in multiple species, and in humans they dot the hearts and lungs.
In addition, they play a role in the development of hypertension and diabetes, and are present in greater numbers in people with cardiovascular disease.
snip
The fact that SARS-CoV-2 targets ACE2 receptors could be significant, Baric said. For instance, ACE2 is on a sex-linked chromosome, meaning that women express the receptor at higher levels than men. But according to Wu's data, men have worse COVID-19 outcomes than women.
And then there's the issue of ACE inhibitors. Reinin–angiotensin–aldosterone system inhibitors, which include ACE inhibitors,
cause an increase in the expression of ACE2 receptors, according to a recent comment in Nature Reviews Cardiology.
"The safety and potential effects of antihypertension therapy with ACE inhibitors or angiotensin-receptor blockers in patients with COVID-19 should be carefully considered," write the Chinese researchers. "Whether patients with COVID-19 and hypertension who are taking an ACE inhibitor or angiotensin-receptor blocker should switch to another antihypertensive drug remains controversial, and further evidence is required."
This increased expression of ACE2 receptors was discussed in a recent BMJ letter, in which Swiss researchers point out that "we need rapid epidemiological and preclinical studies to clarify this relationship."
If there is an association between ACE inhibitors and the virus, "we might be able to reduce the risk of fatal COVID-19 courses in many patients by temporarily replacing these drugs," they write.
However, ACE2 has been shown to play a protective role in influenza-induced acute respiratory distress syndrome and, with age, ACE2 expression drops, said Baric, who agrees that more research is needed.
"There is probably some direct relationship to the level of ACE2 expression and disease severity," he said. "And it probably plays some role in the age-related" severity trends we've seen in COVID-19.
