Overview of COVID19 In Hypertension Patients

Introduction: The coronavirus disease 2019 (COVID-19) is worldwide outbreak. Globally there are 21,159,730 reported confirmed cases and there is almost no country in the world that is not affected by COVID-19 (3). It is caused by severe acute respiratory syndrome coronavirus 2 respiratory syndrome coronavirus 2 (SARS-CoV-2) enter the cells through angiotensin converting enzyme 2 (ACE2) receptor that act as key regulator of blood pressure. Objective: To summarize the most updated data on COVID-19 and hypertension Methodology: A PubMed and UpToDate search was completed in Clinical Queries using the key terms ‘COVID-19 in hypertension patients ‘and ‘COVID-19 ‘. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews Result: 1099 patients with confirmed COVID-19, of which the single highest risk factor of infection was hypertension reported in 15% of patients. Meta-analysis of six studies (1527) patients, hypertension was present in 17.1% of patients with the infection. The median age of SARS-CoV-2–positive patients who died was 78.5 years. significantly higher usage of ARBs in hypertensive patients with moderate COVID-19 disease than those with a severe and critical course of disease. There is no advantage to any group of medications within RAAS inhibitors. There are no data regarding the association between RAAS inhibitors and the outcome. Conclusion: There is a relation between COVID-19 and HTN and need more data to be clarify weather HTN is isolated risk factor or as a reflection of ACEI or ARB. Age is associated with COVID19.


Introduction
The coronavirus disease 2019 (COVID-19) is worldwide outbreak (1). Globally there are 21,159,730 reported confirmed cases (2) and there is almost no country in the world that is not affected by COVID-19 (3). It is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (4) a positive stranded RNA virus (5). It transmitted animal to person and person to person. During this outbreak person to person is the main mode of transmission. The transmission occurs through respiratory droplets; when a person with infection coughs or sneezes he or she can infect another close-range contact person (5) respiratory syndrome coronavirus 2 (SARS-CoV-2) enter the cells through angiotensin converting enzyme 2 (ACE2) receptor (6). It catalyzes the conversion of angiotensin II to angiotensin I (7) ACE2 receptor act as key regulator of blood pressure. High or uncontrolled blood pressure cause the patient a preventable cardiovascular disease witch is a leading cause of morbidity and mortality globally (8) Alot of studies have been raising the question about the relation between COVID-19 and hypertension. A lot of published article reviews, retrospectives and metaanalysis regard the association between COVID 19 and hypertension. Here, we summarize the most updated data on COVID-19 and hypertension. minute at least apart (10). Globally, 1 in 4 men and 1 in 5 women diagnosed with chronic HTN (11.12). Raised blood pressure is a major risk factor for chronic heart disease, stroke, and coronary heart disease. It is a global cause of mortality (13) (Table1).

The association of HTN and COVID-19
The concern about the relationship between hypertension and COVID19 was the concern of many studies. Since the pathogenesis of COVID19 interact with ACE2 receptors a one of the components of the renin-angiotensin system (RAS) (

The association of age and COVID-19
Is the association of hypertension with covid-19 anything more than a reflection of the age of hypertensive patients? Because HTN prevalence increases in parallel with aging, this pattern may represent the expected prevalence for the given age group (23) There is lack of data in age group and association with COVID19 The most common comorbidities in one report were hypertension (30%), diabetes (19%), and coronary heart disease (8%) Huang et al.
-113 patients with hypertension -Elderly with comorbidities -multivariate analysis (adjusted for age and sex) failed to show that hypertension was an independent risk factor for COVID-19 mortality or severity.
-observed that hypertension carries a nearly 2.5-fold higher risk of developing severe disease or dying from SARS-CoV-2 infection h -risk of dying with odd ratio ( 2.42) ic-significant odds of COVID-19 severity associated with tension was only seen in those over age 60 Fang L et al.
Feng Yet al.
The critical group had a higher percentage of patients aged >75 years than the moderate group  Table 3.

Study Results
Sanchis-Gomar et al. (30) suggested that ARBs might be a better treatment option in COVID-19 patients at higher risk of severe forms of disease due to the equal efficacy but fewer side effects than ACEIs Marijana Tadic et al. (3) -There is no advantage to any group of medications within RAAS inhibitors. -Withdrawing these medications or switching therapy would have uncertain benefits, but definitely many disadvantages such as uncontrolled hypertension, cardiac decompensation and renal function impairment, which could potentially induce more complications in patients with COVID-19 than the infection of SARS-CoV-2 itself.

Feng et al. (29)
-investigated 476 patients with COVID-19 and reported a significantly higher usage of ARBs in hypertensive patients with moderate COVID-19 disease than those with a severe and critical course of disease -There are no data regarding the association between RAAS inhibitors and the outcome.
Li, B et al. (20) included 1178 patients with COVID-19, out of which 362 had hypertension and reported that ACEIs/ARBs are not associated with the severity or mortality of COVID-19 patients Mancia G et a. (34) there was no association between ACEI/ARB use and the risk of COVID-19