COVID-19 patients who also suffer from high blood pressure are more likely to fall ill with the disease, which also leaves them at increased risk of death.
Scientists from the Berlin Institute of Health (BIH) and Charité – Universitätsmedizin Berlin, in collaboration with partners in Heidelberg and Leipzig, have now discovered that the immune cells of patients with hypertension are too already active and that this pre-activation has significantly increased under COVID-19.
This most likely explains the improved immune response and progression of a more severe disease. However, some hip-strain-reducing drugs called ACE inhibitors can have specific effects.
They not only lower blood pressure but also counteract immune depression. The scientists have now published their findings in the journal Nature’s biotechnology.
More than a billion people worldwide suffer from high blood pressure or hypertension. Of the more than 75 million people worldwide infected with the SARS-CoV-2 virus worldwide to date, more than 16 million are also severely infected .
These patients are more likely to become seriously ill, and as a result there is an increased risk of death. It was previously unclear to what extent treatment with antihypertensive drugs could be followed during SARS-CoV-2 infection – and whether patients were more likely to benefit or harm.
This is because antihypertensives inhibit the same regulatory mechanism used by the novel coronavirus SARS-CoV-2 to enter the host cell and stimulate COVID-19.
Professor Ulf Landmesser is Medical Director of CharitéCenter 11 for Cardiovascular Diseases, Director of the Medical Department of Cardiology, and BIH Professor of Cardiology at the Charité Benjamin Franklin Campus in Berlin. He identified early on that patient with heart disease or cardiovascular disease often had a very important disease progression with COVID-19.
The virus uses the ACE2 receptor as a gateway into the cells, and the formation of this receptor may be affected by the administration of antihypertensive drugs. So we were initially afraid that patients receiving ACE receptors or angiotensin receptor blockers may have more on the surface of their cells and thus be more susceptible to infection. “
Ulf Landmesser, Professor, Medical Director of the CharitéCenter, Director of the Medical Department of Cardiology, BIH at Charité
Some drugs that lower blood pressure may help with COVID-19
To clarify this suspicion, the scientists analyzed individual cells from the respiratory systems of COVID-19 patients who were also taking medication for high blood pressure.
Dr Sören Lukassen, a scientist in Professor Christian Conrad ‘s group at BIH Digital Health Center, explains that they were then able to provide: “We found that the drugs do not appear to causing more receptors to form on the cells, as a result we do not think they make it easier for the virus to enter the cells in this way and thus causing a harder course of COVID. -19. “
On the other hand, cardiovascular patients taking ACE inhibitors did in fact show a lower risk for becoming very ill with COVID-19. In fact, they exhibited almost the same level of risk as COVID-19 patients without cardiovascular complications.
A severe course of COVID-19 linked to pre-activation of the immune system
The blood of hip-tolerant patients usually shows high levels of inflammation, which can be fatal in the case of SARS-CoV-2 infection. “Elevated swelling levels are always a warning sign that COVID-19 will be more potent, regardless of any cardiovascular issues,” Landmesser explains.
Therefore, the scientists used single-cell sequencing techniques to study the immune response of hip-tolerant patients with COVID-19.
“We analyzed a total of 114,761 cells from the nasopharynx of 32 COVID-19 patients and 16 non-infected control patients, with both groups including cardiovascular patients as well as those without cardiovascular problems,” he said. reported by Dr. Saskia Trump, director of a research group in the laboratory Irina Lehmann, who is BIH Professor of Environmental Epigenetics and Lung Research.
“We found that the immune cells of the cardiovascular patients showed strong preactivation even before infection with the novel coronavirus,” Lehmann explains.
“After exposure to the virus, these patients were more likely to develop an enhanced immune response, which was associated with a real progression of COVID-19 disease. However, our results also showed that they were treated with immunosuppressants. ACE, although not with angiotensin receptor blockers, may inhibit this enhanced immune response after coronavirus infection, so ACE inhibitors may increase the risk of patients with severe myocardial infarction. -release tolerance from major disease progression. “
Reduction of delay in viral loading
In addition, the scientists found that the anti-hypertensive drugs can affect the speed at which the immune system can reduce the viruses, i.e., the concentration of the virus in the body. “Here, we saw a clear distinction between the different treatments for high blood pressure,” notes Roland Eils, Director of the BIH Digital Health Center.
“In patients treated with angiotensin II receptor blockers, the reduction in viral loading was significantly delayed, which may also contribute to a more severe course of COVID-19. We did not observe of this delay in the patients receiving ACE inhibitors for the treatment of .the hip tolerance. “
Interdisciplinary collaboration accelerates research
More than 40 scientists have been working at a rapid pace on this extensive study. “The ability to provide rapid responses to urgent questions during the pandemic requires interdisciplinary collaboration among many enthusiasts,” Eils explains.
“COVID-19 is such a complex disease that we brought together experts from cardiology, immunology, virology, lung medicine, intensive care and computer science for this study. Our goal was to provide a strong scientific response. to address as soon as possible the question of whether simultaneous treatment with ACE inhibitors or angiotensin receptor blockers may have adverse effects or even adverse effects through COVID – 19 epidemic. “
No evidence of increased risk of disease
Thanks to the study, the teams from the BIH, Charité, and Collaborating Centers in Leipzig and Heidelberg can now reassure both patients and the physicians who treat them: “Our study does not provide evidence that treatment with anti – hypertensive drugs increases the risk of infection with the novel coronavirus, “says Ulf Landmesser, summarizing the results.
“However, treating hip tolerance with ACE inhibitors may be more beneficial for patients with COVID-19 than treatment with angiotensin II receptor blockers – a hypothesis that is ‘further research currently in randomized trials. “
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Magazine Reference:
Trump, S., et al. (2020) Diabetes delays viral clearance and exacerbates airway hyperinflammation in patients with COVID-19. Naure Biotechnology. doi.org/10.1038/s41587-020-00796-1.