The mainstream (& the sidestream) medical media have already named one culprit ie hypertension (HT) as a significant comorbid entity in the current Corona pandemic. But, If we ask one direct question, how Corona and HT are linked ? , the answer is not forthcoming fluently.
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Some of the thought process about the Issue.
1. Does Coronavirus relish high blood pressure on its journey to attack lungs ?
Funny question you may think. The virus primarily lives and tracts through the respiratory tract to reach lungs. Viral load in the bloodstream is nil or minuscule till late stages. BP is nothing to do with what is happening in pulmonocytes . BP doesn’t influence the viremia in any significant way.
2. Does HT related pulmonary endothelial dysfunction facilitate and accelerate viral injury?
We don’t know. If at all, this is true, we have to worry about pulmonary hypertension (PH) and not SHT . PAH and SHT have absolutely no relation as far as I know.
3. Is concomitant anti-HT drugs cause relative hypotension and cause morbidity?
Maybe. We don’t know. Hypotension should be avoided at all costs.
4. Is there a conflict between Antihypertemive agents and Corona?
We don’t know.(Much has been written about the ACEI genetic susceptibility Here is a current reference South, A.M., Tomlinson, L., Edmonston, D. et al. Controversies of renin–angiotensin system inhibition during the COVID-19 pandemic. Nat Rev Nephrol 16, 305–307 (2020).)
5. Does Corona precipitate LV dysfunction in patients with corona infection?
Possible. Very rare (We haven’t seen much of uncontrollable HT causing afterload mismatch in corona setting as of now)
6. Do silent or manifest Coronary artery disease (CAD) and diabetes (The close buddy of HT) add up the risk?
Yes.definitely is possible. (No doubt, DM confers definite additional risk in Corona)
7. Is preexisting HT cause CKD and argument the morbidity?
Yes. This happens only if HT has damaged the target organs sufficiently. Here the outcome of Corona infection might have an aggressive course.
Final message
So what exactly is the relationship between HT and Corona?
(Actually, this question was asked not in a cardiology academic meet. It was a casual query from one of my studious patients. I think nowadays we learn cardiology more from them than textbooks)
I guess, there is no direct, meaningful link in most people who just have isolated HT without any target organ damage. It is more of perceived risk, and views are speculative and conjectural (Including what is written here) Corona affects the elderly and HT is also common in the elderly (30% of all elders) that’s it.
The estimated 300 million people who are labeled as hypertension around the globe need not panic. Just because you are having high BP, corona doesn’t have any special attraction to you.
Dr.S.Venkatesan MD 