COVID-19 and hypertension
Author: Dr Kieran Walsh
The pace of scientific discovery in COVID-19 has been unprecedented. There have been rapid advances in our knowledge of the epidemiology, diagnosis, and management of the infection. We have also made rapid progress in our knowledge of how best to manage conditions that might co-exist alongside COVID-19.
The management of hypertension is a good case in point. This is a common illness and so it is vital that patients with hypertension receive the correct advice about how to manage their condition. However, the path of scientific discovery has not always been smooth and there are lessons that we can learn from the journey to our current state of knowledge.
In the first few months of the outbreak, the use of certain antihypertensives was a cause for concern. The ACE2 receptor is also the receptor for SARS-CoV-2, the coronavirus which causes COVID-19. Thus there were concerns that ACE inhibitors and angiotensin receptor blockers would increase the risk of morbidity and mortality associated with the infection.
However, the evidence from trials has largely refuted these concerns. Indeed one study showed that renin-angiotensin system inhibitors might improve clinical outcomes of COVID- 19 infection in patients with hypertension. (1) Thus the current advice is that patients already taking these drugs should continue on them. This is true regardless of whether patients are taking these drugs for hypertension or another condition.
Some people have questioned the role of evidence-based medicine in the COVID-19 pandemic. Certainly the process of developing evidence-based medicine has been accelerated during the pandemic. But the principles of evidence-based medicine – combining sound research with professional expertise and patient needs and desires – have remained intact. And they have allowed us to move from seemingly plausible pathophysiological rationale to solid evidence-based decision making.
These principles can also enable us to prioritise recommendations. One priority recommendation for patients with hypertension in the midst of the pandemic is offering smoking cessation advice. Smoking cessation will reduce overall cardiovascular risk but also reduce the risk of a severe episode of COVID-19. It is a straightforward intervention – but one that can lead to many worthwhile outcomes.
BMJ Best Practice has covered COVID-19 from the start of the pandemic. The BMJ Best Practice Comorbidities tool now covers the management of COVID-19 and other common and important comorbidities – including hypertension. We hope you find it useful. Please do get in touch if you feel there are other conditions that we should cover. Please email on kmwalsh@bmj.com.
References
1. Meng J, Xiao G, Zhang J, He X, Ou M, Bi J, Yang R, Di W, Wang Z, Li Z, Gao H, Liu L, Zhang G. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microbes Infect. 2020 Dec;9(1):757-760
Competing interests
KW works for BMJ which produces the BMJ Best Practice Comorbidities tool.