On “All you need is lab” radio show on Tuesday, July 21, Dr. María Paz Ocaranza referred to the relationship between high blood pressure and coronavirus, in light of the statistics: “those patients who respond with greater severity against SARS-CoV-2 infection, the highest proportion have hypertension, therefore there is a fairly direct relationship regarding coronavirus and how hypertensive patients respond”.

The CENDHY principal researcher was invited to the Radio USACH 94.5 FM program “All you need is lab” , led by journalist Iveliz Martel and whose editor is science journalist Nadia Politis, to discuss the fundamentals of the relationship between hypertension and COVID-19, as an expert with extensive experience in preclinical studies on hypertension and cardiovascular damage.

“Hypertension is a chronic disease that has a high prevalence in Chile, of the order of 27.6%, making it a fairly frequent disease in the population”, established the researcher from the Division of Cardiovascular Disease of the School of Medicine of the Pontificia Universidad Católica de Chile (PUC), alluding to the data from the last National Health Survey 2016/2017. She explained that “hypertension is related to an increased proportion of the immune response and therefore a significant number of hypertensive patients have an inflammatory cause”.

When asked by  Iveliz Martel about the risk factors for hypertension and the effects it has on the body, the PhD. in biochemistry pointed out that “from a physiological point of view, hypertension has several mechanisms and one of the most fundamental is the renin-angiotensin system, which is the focus of most of the drugs available today to treat hypertension”. Current treatment of hypertension consists, among other elements, in the permanent consumption of antihypertensive drugs that, for the most part, aim to inhibit the classic pathway of the renin-angiotensin system and which are part of the therapy basis with which to start the treatment of hypertensive patients, as indicated by the researcher.

On the connection between hypertension and coronavirus, Dr. Ocaranza explained that “the concrete link is precisely the renin-angiotensin system, which physiologically is in a balance between a “bad” or deleterious pathway and a positive pathway, and it is in this positive pathway that the ECA-2 receptor participates, which allows the entry of the coronavirus into the body and produces COVID-19”. The researcher participated in a special article in the Chilean Journal of Cardiology where, talong researchers from the Advanced Center for Chronic Diseases (ACCDiS), PUC School of Medicine and the University of Texas Southwestern Medical Center, they described the relationship between the positive or “canonical” pathway of the renin-angiotensin system and coronavirus infection [1].

Specifically, as the researcher illustrated: “This is a key and lock concept, in which the virus is the key, and the lock is this ECA-2 protein” . The coronavirus enters the body through the ECA-2 receptor and begins to replicate inside infected cells, that is, it produces copies of itself and expands through the body, infecting other organs; and this is how the virus is self-supporting. “The ECA-2 enzyme is abundant in some tissues and therefore they will be more damaged as a result of the action of this virus.” Adding that “mainly this protein is present in the upper airway and in the lungs fundamentally, but it is also in the heart, blood vessels, liver and intestine, and therefore there are some episodes of diarrhea in patients”.

Interviewer Iveliz Martel asked the specialist about the abundance of ACE-2 in people with arterial hypertension, to which she replied that “what has been seen is that hypertensive patients have the pathway where ACE-2 is altered and what happens is that the deleterious route is activated, which favors the pathogenicity of the virus”.

The journalist then consulted for recommendations to hypertensive patients and patients with chronic diseases about continuing their treatment with medications, to which Dr. Ocaranza clarified based on scientific evidence that “the recommendation is to continue the therapy proposed by your treating physician, in no case stop taking your medications. The big controversy stemmed from reported data on antihypertensive drugs that block the damaging pathway, which were seen to increase the proportion of the ECA-2 protein”. However, she clarified that “what happens is that in addition to producing this increase, they also generate an increase in the production of molecules with a positive and protective effect, which counteract the action of the virus and decrease its pathogenicity, therefore from that point of view, it is even more advisable to maintain therapy”.

CENDHY principal researcher was asked about the cardiovascular consequences of COVID-19 and symptoms other than respiratory, following hypotheses that propose that this is a virus that affects blood vessels, to which she replied that “this ECA-2 protein is importantly present in the heart and it has been seen in those who are infected with this virus they present tachycardia and could also have hypertension pictures because it generates the contraction of the blood vessels and therefore an increase in pressure arterial”.

To conclude, and in relation to symptoms such as migraines and headaches, Dr. Ocaranza explained that “the receptor is also present at the central nervous system level, and we could say then that in fact multi-damage-organ occurs” and reiterated that “that is why it is important to be emphatic that patients, whether with hypertension, diabetes or basic cardiovascular diseases, which are the main cause of death worldwide, should not abandon your therapy”.

References:

[1] Ramírez-Sagredo, A. et al (2020). Antihipertensivos en pacientes con COVID-19. Rev Chil Cardiol vol. 39 no.1. Accede a esta publicación en nuestra sección de Publicaciones [enlazar].