COVID and Hypertension Treatment

By Garnet R. Chaney

Is there a link betwen COVID-19 and high blood pressure, and the drugs used to treat hypertension?
I am not the only one wondering about this connection.
In this article I will keep track of the latest research I have found on this issue.

A question that I have been watching concerns the link between high blood pressure and COVID-19. One reason is that I have hypertension, and another reason is that recent attempts to treat my hypertension with Lisinopril were unsuccessful because I was among the group of individuals who experienced the severe dry hacking cough side effect. This cough appears to be caused by a genetic issue in the metabolism of lisinopril in certain individuals. There appear to be certain genetic markers associated with this symptom which causes accumulation of a certain substance in the lungs. I discontinued my Lisinopril treatment approximately 6 months ago, and it took more than 3 months for the cough to clear up.

Since COVID-19 causes death thru its affect on the lungs, I have been watching for any literature that might show this side effect being associated with more severe encounters with COVID.

NephJC is a nephrology journal club using Twitter to to discuss the research, guidelines, and editorials that drive nephrology. This is the NephJC position on the use of ACEi and ARB given the current COVID19 pandemic. As of April 20, their position is that "Patients who are taking ACE inhibitors or ARBs are not advised to change their therapy unless advised to do so by their physician". The list the current positions of several major organizations.

However according Dr. Kevin Kavanagh, MD, has an article at Infection Control Today, "Evidence Continues to Link ACE Inhibitors to Severe COVID-19 Symptoms"

He writes:

"Why is hypertension appearing to be a primary driver of COVID-19?

"The incidence of hypertension is noticeably high in patients with COVID-19 and the high degree of targeting of older individuals is very unusual. A recent study by the US Centers for Disease Control and Prevention regarding the Kirkland Nursing home observed: “The most common chronic underlying conditions among facility residents were hypertension (69.1%), cardiac disease (56.8%), renal disease (43.2%), diabetes (37.0%), obesity (33.3%), and pulmonary disease (32.1%).”1

"Thus, hypertension may be a primary risk factor and driver of the severe symptoms of COVID-19. The ACE2 Receptor is used by the coronavirus (SARS-CoV-2) to enter cells. A protease, TMPRSS2, is also required to prime the virus for cellular entry. Data suggests that serum of patients which have recovered from infection blocks this entry mechanism.2

"In a recent blog, the director of the National Institutes of Health, Francis S. Collins, stated:“The genomic data of the new coronavirus responsible for COVID-19 show that its spike protein contains some unique adaptations. One of these adaptations provides special ability of this coronavirus to bind to a specific protein on human cells called angiotensin converting enzyme (ACE2).”3

"Other researchers have observed that lisinopril and losartan can increase (or upregulate) the ACE2 Receptor mRNA cellular expression by five and three-fold, respectively.4 This has given rise to concerns that these inhibitors may increase ACE2 Receptor cellular surface expression leading to exacerbated viral load in cells.

"There has been at least 1 review article which discusses this concern which recommended staying the course with ACE inhibitor therapy of hypertension, since it has also been observed to be protective of pulmonary damage in mice.5 The authors also appear to have a large number of declared conflicts-of-Interest with the drug industry. The laboratory research in mice used losartan (angiotensin II receptor antagonist) with an acute exposure not specified, and may not be adequate time for upregulation of ACE-2 receptor.6 In a prior publication, only a 30 minute pre-treatment of the inhibitor was used and the effect on ACE-2 receptor expression is unknown and therefore long-term viral effect on the lung cannot be determined.7

"There is mounting consensus that ACE inhibitors may be a primary driver of the severe symptoms. The concerns have been raised in the Lancet8 and most recently in Medscape.9

If you are using ACE related hypertension control drugs, this article may be a starting point for discussion with your physician. 

Comments on researching this article

These google queries were helpful in finding information in this article:
* lisinopril cough mechanism covid
* lisinopril cough mechanism
    * The mechanism of ACE inhibitor-induced cough remains unresolved, but likely involves the protussive mediators bradykinin and substance P, agents that are degraded by ACE and therefore accumulate in the upper respiratory tract or lung when the enzyme is inhibited, and prostaglandins, the production of which may be ...  Site: Title: Angiotensin-Converting Enzyme Inhibitor-Induced Cough ...
* lisinopril allergic reactions
* lisinopril ACE2  
    * ACE2 and HYPERTENSION — › news › covidace2  Mar 14, 2020 - ACE2, coronavirus, COVID19, SARS, hypertension. ... in the left ventricle of normotensive Lewis rats after 12 days of lisinopril and losartan.

Do you have more information on the connection between Coronavirus, COVID-19, hypertension, high blood pressure, and ACE drugs used for its treatment such as lisinopril and losartan?  Please let me know in the feedback section below.  Thank you.

by garnet r. chaney

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I have been watching closely for articles on any link between the lisonopril side effect of dry hacking cough, and COVID mechanism of attack on the lungs.

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