Clinical features of coronavirus infection COVID-19 in patients with arterial hypertension

The COVID-19 coronavirus pandemic is significant for modern medical science and practice. Patients with concomitant pathology during the COVID-19 pandemic, in particular arterial hypertension, require special attention, as they are among the most vulnerable groups to this infection. This requires optimization of diagnostic and clinical approaches to helping patients with this pathology. In this regard, the study of the course of the infectious process COVID-19 in patients with hypertension is of scientific and practical interest. On the basis of the State Budgetary Healthcare Institution S. P. Botkin City Clinical Hospital of the Moscow Department of Health 145 patients with COVID-19 were under observation, 91 of whom had a coronavirus infection combined with arterial hypertension, 54 patients had no arterial hypertension. All patients underwent a comprehensive clinical and laboratory examination and clinical follow-up in dynamics. The course of COVID-19 coronavirus infection in patients with arterial hypertension is characterized by the development of more severe pneumonia (in 5,5% of patients with hypertension, lung lesions are diagnosed with computed tomography of more than 3 degrees) and more pronounced respiratory failure in a larger number of patients (in 8,8% with hypertension, infection was accompanied by the development of respiratory failure of 2 or more degrees). Patients with hypertension had higher rates of CRP, ferritin and glucose, while changes in the leukocyte formula were comparable between the groups. The dynamics of the level of postinfectious IgG class antibodies was characterized by a gradual decrease in their level during the year, while in patients with COVID-19 occurring against the background of hypertension, higher rates of postinfectious IgG class antibodies were observed on average in the first months after infection. The development of coronavirus infection COVID-19 in patients with particular arterial hypertension requires special attention from the doctor, due to the risk of developing a severe form of infection.

1. Li W., Moore M., Vasilieva N., et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus // Nature. 2003; 426: 450-454. DOI: https://doi.org/10.1038/nature02145.

2. Lan J., Ge J., Yu J., et al. Structure of the SARS-CoV-2 spike receptorbinding domain bound to the ACE2 receptor // Nature. 2020; 581: 215-220. DOI: https://doi.org/10.1038/s41586-020-2180-5.

3. Walls A. C., et al. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein // Cell. 2020; 181: 281-292. DOI: https://doi.org/10.1016/j.cell.2020.02.058.

4. Li F., Li W., Farzan M., Harrison S. C. Structure of SARS coronavirus spike receptor-binding domain complexed with receptor // Science. 2005; 309: 1864-1868. DOI: https://doi.org/10.1126/science.1116480.

5. Wang Q., Zhang Y., Wu L., Niu S., et al. Structural and functional basis of SARS-CoV-2 entry by using human ACE2 // Cell. 2020; 181 (4): 894-904. DOI: https://doi.org/10.1016/j.cell.2020.03.045.

6. Lei C., Qian K., Li T., Zhang S., et al. Neutralization of SARS-CoV-2 spike pseudotyped virus by recombinant ACE2-Ig // Nat Commun. 2020; 11 (1): 2070. DOI: https://doi.org/10.1038/s41467-020-16048-4.

7. Donoghue M., Hsieh F., Baronas E., et al. A novel angiotensin-converting enzyme-relatedcarboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9 // Circ Res. 2000; 87: E1-9. DOI: 10.1161/01.res.87.5.e1.

8. Santos R. A. S., Sampaio W. O., Alzamora A. C., Motta-Santos D., Alenina N., Bader M., et al. The ACE2/Angiotensin-(1-7)/MAS Axis of the Renin-Angiotensin System: Focus on Angiotensin-(1-7) // Physiological Reviews. 2018; 98 (1): 505-553. DOI: 10.1152/physrev.00023.2016.

9. Golukhova Ye. Z., Slivneva I. V., Rybka M. M., Mamalyga M. L., Alekhin M. N., Klyuchnikov I. V. i dr. Pulmonary hypertension as a risk factor for adverse outcomes in patients with COVID -19 // Rossiyskiy kardiologicheskiy zhurnal. 2020. T. 25, № 12. P. 121-133.

10. Samsonova M. V., Mikhaleva L. M., Zayrat'yants O. V., Varyasin V. V., Bykanova A. V., Mishnev O. D. i dr. Pulmonary pathology in COVID-19 in Moscow // Arkhiv patologii. 2020. T. 82, № 4. P. 32-40.] DOI: https://doi.org/10.17116/patol20208204132

11. Wu Y. Compensation of ACE2 Function for Possible Clinical Management of 2019-nCoV-Induced Acute Lung Injury // Virologica Sinica. 2020; 35 (3): 256-258. DOI: 10.1007/s12250-020-00205-6.

12. Hamming I., Timens W., Bulthuis M., Lely A., Navis G., van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis // The Journal of Pathology. 2004; 203 (2): 631-637. DOI: 10.1002/path.1570.

13. Alcocer-Díaz-Barreiro L., Cossio-Aranda J., Verdejo-Paris J., Odinde-Los-Ríos M., Galván-Oseguera H., Álvarez-López H. et al. COVID-19 and the renin, angiotensin, aldosterone system. A complex relationship // Arch. Cardiol. Mex. 2020. Vol. 90, suppl. P. 19-25. DOI: https://doi.org/10.24875/ACM.M20000063.

14. Shi S., Qin M., Cai Y., Liu T., Shen B., Yang F. et al. Characteristics and clinical significance of myocardial injury in patients with severe coronavirus disease 2019 // European Heart Journal. 2020; 41 (22): 2070-2079. DOI: 10.1093/eurheartj/ehaa408.

15. Sala S., Peretto G., Gramegna M., Palmisano A., Villatore A., Vignale D. et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection // European Heart Journal. 2020; 41 (19): 1861-1862. DOI: 10.1093/eurheartj/ehaa286.

16. Ueki Y., Otsuka T., Windecker S., Räber L. ST-elevation myocardial infarction and pulmonary embolism in a patient with COVID-19 acute respiratory distress syndrome // European Heart Journal. 2020; 41 (22): 2134. DOI: 10.1093/eurheartj/ehaa399.

17. Dominguez-Erquicia P., Dobarro D., Raposeiras-Roubín S., Bastos Fernandez G., Iñiguez-Romo A. Multivessel coronary thrombosis in a patient with COVID-19 pneumonia // European Heart Journal. 2020; 41 (22): 2132. DOI: 10.1093/eurheartj/ehaa393.

18. Fernandez Gasso L., Maneiro Melon N. M., Sarnago Cebada F., Solis J., Garcia Tejada J. Multivessel spontaneous coronary artery dissection presenting in a patient with severe acute SARS-CoV-2 respiratory infection // European Heart Journal. 2020; 41 (32): 3100-3101. DOI: 10.1093/eurheartj/ehaa400.

19. Zhou F., Yu T., Du R., Fan G., Liu Y., Liu Z. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study // The Lancet. 2020; 395 (10229): 1054-1062. DOI: 10.1016/S0140-6736(20)30566-3.

20. Dong E., Du H., Gardner L. An interactive web-based dashboard to track COVID-19 in real time // The Lancet Infectious Diseases. 2020; 20 (5): 533-534. DOI: 10.1016/S1473-3099(20)30120-1.

21. Clerkin K. J., Fried J. A., Raikhelkar J., Sayer G., Griffin J. M., Masoumi A. et al. COVID-19 and Cardiovascular Disease // Circulation. 2020; 141 (20): 1648-1655. DOI: 10.1161/CIRCULATIONAHA.120.04694.

22. Li X., Xu S., Yu M., Wang K., Tao Y., Zhou Y. et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan // Journal of Allergy and Clinical Immunology. 2020; 146 (1): 110-118. DOI: 10.1016/j.jaci.2020.04.006.

23. Cai Q., Chen F., Wang T., Luo F., Liu X., Wu Q. et al. Obesity and CO-VID-19 Severity in a Designated Hospital in Shenzhen, China // Diabetes Care. 2020; 43 (7): 1392-1398. DOI: 10.2337/dc20-0576.

24. Simonnet A., Chetboun M., Poissy J., Raverdy V., Noulette J., Duhamel A. et al. High Prevalence of Obesity in Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Requiring Invasive Mechanical Ventilation // Obesity. 2020; 28 (7): 1195-1199. DOI: 10.1002/oby.22831.

25. Shi Y., Yu X., Zhao H., Wang H., Zhao R., Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: findings of 487 cases outside Wuhan // Critical Care. 2020; 24 (1): 108. DOI: 10.1186/s13054-020-2833-7.

26. Wu C., Chen X., Cai Y., Xia J., Zhou X., Xu S. et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China // JAMA Internal Medicine. 2020; 180 (7): 934-43. DOI: 10.1001/jamainternmed.2020.0994.

27. European Society of Cardiology. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. Last updated on 10 June 2020. URL: https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19-Guidance (дата обращения: 18.02.2022).

28. Centers for Disease Control and Prevention. People at Increased Risk for Severe Illness. 2020. URL: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/index.html (дата обращения: 18.02.2022).

29. Shibata S., Arima H., Asayama K., Hoshide S., Ichihara A., Ishimitsu T. et al. Hypertension and related diseases in the era of COVID-19: are port from the Japanese Society of Hypertension Task Force on COVID-19 // Hypertension Research. 2020; 43 (10): 1028-1046. DOI: 10.1038/s41440-020-0515-0.

30. A. Petri, K. Sebin. Visual medical statistics. M.: GEOTAR-MED, 2010. P. 16.

31. Al-Swiahb J. N., Motiwala M. A. Upper respiratory tract and otolaryngological manifestations of coronavirus disease 2019 (COVID-19): A systemic review // SAGE Open Med. 2021 May 20; 9: 20503121211016965. DOI: 10.1177/20503121211016965. PMID: 34094558; PMCID: PMC8141987.