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COVID-19: Does existing hypertension go hand in hand with immune failure?
The majority of infections with the SARS-CoV-2 coronavirus are mild or have no symptoms at all. However, some infected people become seriously ill. According to experts, there are certain risk groups in which the risk of a severe COVID-19 course is increased. The risk is also said to be higher for people with high blood pressure. In addition, the risk of infection is higher in hypertension. Is that correct?
According to a message, the German high-pressure league is increasingly asked the question of the extent to which an existing hypertension is associated with an immune insufficiency, i.e. increases the risk of infection with SARS-CoV-2 or a severe course of COVID-19 disease. The experts therefore provide information on the current state of knowledge.
Groups of people with an increased risk of serious illness
According to experts, the disease COVID-19, which is triggered by an infection with the novel coronavirus SARS-CoV-2, is mild to moderate in most cases (80 percent).
However, among other things, older people from around 50-60 years of age as well as people who suffer from previous diseases such as lung diseases or other chronic diseases such as cardiovascular diseases are at increased risk of a severe COVID-19 course.
But does this also apply to hypertension patients? And is hypertension really an increased risk of infection with SARS-CoV-2?
The Hypertension League explains that the "European Society of Hypertension" (ESH) writes in a statement that there is currently no evidence that hypertension per se increases the risk of becoming infected with SARS-CoV-2.
According to researchers who have compiled a comprehensive review of COVID risk factors in the cardiovascular system, the data currently available show a proportion of hypertension sufferers among COVID 19 patients of 15-40 percent (depending on the study).
This rate roughly corresponds to the proportion of people in the general population who suffer from high blood pressure (around 30 percent). This suggests that high blood pressure per se does not increase the risk of infection.
Hypertension is closely associated with age
The same applies to the question of whether hypertension aggravates the risk of a severe course of the disease from COVID-19. At first glance, it is said in the review of the scientists, it looks like this, since many patients with severe courses of the new infectious disease have a history of high blood pressure.
For this reason, hypertension was listed early on after the outbreak of the corona pandemic as a risk factor in addition to other diseases such as diabetes mellitus, cardiovascular diseases, COPD and cancer.
The problem with this classification, however, is that high blood pressure is closely associated with age, so it occurs more often in older people. In Germany, about one in three people aged 50 and over are affected, and one in two among those over 60.
It is also known that older COVID-19 patients in particular have a severe course with intensive care, ventilation or death.
In this respect, it is not surprising, according to the Hypertension League, that the rate of existing hypertension is also high in these, usually older patients with severe COVID-19 courses.
According to the experts, there is currently no clarity as to whether there is a direct association between high blood pressure and severe illnesses, or whether age as a “confounder” makes a significant contribution to this connection.
Setting blood pressure as an essential preventive measure
However, the current data situation shows very impressively that high-pressure patients who take ACEI (ACE inhibitors) or ARB (angiotensin receptor blockers) do not have a higher "COVID risk".
To this end, three major observational studies were published in the specialist journal “The New England Journal of Medicine” (NEJM) at the beginning of May, from which it can be concluded that drug-controlled high blood pressure in patients without hypertension-related end organ damage per se does not pose the risk of COVID -19, the risk of developing a severe course of the disease is increased.
On the contrary: In the publication, the authors of the above-mentioned review emphasize the adjustment of blood pressure as an essential preventive measure in the context of the corona pandemic.
Patients with arterial hypertension should therefore continue to take their high-pressure medication and ensure good blood pressure control, this is also the ESH recommendation, which the German Hypertension League joins.
People with hypertension need no more protection than others
According to the Hypertension League, there is currently no evidence that hypertension patients without severe end organ damage / hypertension-related complications need more protection (e.g. through a ban on employment) than the general population of the same age if blood pressure is well adjusted.
The general recommendations of the Robert Koch Institute (RKI) such as hygiene measures, distance requirements and vaccination recommendations apply to them. (ad)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- German Hypertension League: Recommendations for the risk classification of hypertensives in the context of the SARS-CoV-2 pandemic, (accessed: June 21, 2020), Deutsche Hypertension League
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