Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

Preliminary evidence shows that patients with diabetes and/or hypertension are more likely to develop a severe infection from the novel coronavirus. Could a common drug used to treat both be the reason? HGHI’s Anders Gundersen reviews a new Lancet paper.

The Lancet Respiratory Medicine | Fang et al. | Mar. 11, 2020

Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

Examining previous publications about the clinical characteristics of patients infected with COVID-19, this research group developed a hypothesis about why hypertension and diabetes seem to be the most prevalent comorbidities among infected patients and why those with either or both of these two comorbidities appear to be more likely to develop a severe infection from SARS-CoV-2.

What the authors realized was that these comorbidities are often treated with angiotensin-converting enzyme (ACE) inhibitors. It just so happens that both SARS-CoV and SARS-CoV-2 bind to their target cells through the enzyme ACE2.

In patients on ACE inhibitors, there is a greater amount of ACE2 in the body. ACE2 can also be increased with use of thiazolidinediones (a drug to treat diabetes) and ibuprofen.

Increased ACE2 expression would in theory more readily allow COVID-19 infection to occur.

While not confirmed, this hypothesis would lead to a conflict in treatment prioritization for patients with these comorbidities, and whether a patient uses ACE inhibitors should be determined prior to treatment for COVID-19 infection.

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