A weaker immune system, according to medical experts, is one reason people with high blood pressure, and other health problems are at higher risk for Coronavirus. Longterm health conditions and aging, they also said, weaken the immune system and makes it less able to fight off the virus. In this report, ISIOMA MADIKE, also tries to find out from medical practitioners if, indeed, the prevalence of hypertension increases risk of mortality in COVID-19
Gabriel Okuose returned from a business trip out of Lagos where he had spent two weeks to the warm embrace of his loving family and swiftly settled down for a sumptuous meal from his wife, Joy, since he was famished. He was not the type that eats on the way when travelling.
Just the first cut of the saved Eba, Okuose slowly lost balance and slumped. The joyous mood of his family quickly transmuted to confusion and then mourning. “We were all confused because he didn’t show any sign of ill health when he returned.
In fact, he was in his jolly mood hugging everyone and seemed to be happy to have met us all in good health. How could we have known that was the last for the family? He just slumped and died instantly, turning me into unprepared widowhood, and making our two children fatherless. Till date we couldn’t find an explanation to that tragic end,” recalled Joy with tears rolling down her youthful cheeks. Okuose was 39 years old at the time of his death.
He lived with his young family in Ikorodu area of Lagos State. But a further inquiry reviewed that he was hypertensive. This may be why medical experts often refer to hypertension as a silent killer. It usually does not give notice and there is hardly any symptom to suggest its onset.
Like Okuose, Adiniyi Wahab, was also in a church service somewhere in Ketu, Lagos, when he suddenly slumped and died. Though he was rushed to a nearby private hospital, the doctor on duty simply pronounced him “dead on arrival”.
This may be the reason why many who have raised blood pressure became apprehensive when COVID-19 birthed with its devastating consequences. The fears may not have been misplaced after all. This is because the prevalence of hypertension, according to medical doctors, is high in patients affected by Coronavirus disease, and it appears to be related to an increased risk of mortality in COVID-19 circle.
Health policy analyst and Managing Director, Solomon Jayden Medical Centre, Dr. Akin Oyejoko, noted that “hypertensive patients have poor treatment outcomes from COVID-19”. Oyejoko, whose sojourn in medical practice spans many years at both public and private hospitals in Nigeria and abroad, dissected the relationship between HBP and COVID-19 when he spoke with one of our reporters.
He said that clinically, it is true that COVID-19 is usually more potent when contracted by someone with hypertension than someone with no such precondition because, according to him, many people are usually not aware that they were hypertensive. “Some may be aware but were poorly managed. Most of these people already had complications that were unattended and with the viral attack, the system breaks down.
“Let me quickly try to explain something about how the body works. The heart, the blood vessels, the kidneys, the liver and the lungs, influence the blood pressure. Whenever there is a problem they try collectively to solve it and they also compensate for each other. So, and insult to one is physiologically an insult to all. “It is difficult to find an isolated organ failure without some degree of damage to some other organs.
The first thing is to make sure they keep themselves safe, and secondly, make sure their blood pressure is controlled. By regularly checking it and taking their medications as prescribed. Also stay away from selfacclaimed cures and remedies.”
He said that recent studies, mostly from the United States, shows that people with hypertension tend to be at a higher risk of getting the virus and need intensive care. “What we see in Africa is not exactly the same. We see a situation where anybody can get the virus, and an obviously higher survival rate. I think as more African studies are made available the pattern will become more obvious,” he added.
However, a public health physician, Prof. Bayo Onajole, told this reporter that HBP does not predispose anyone to have COVID-19, but that having the virus while one is hypertensive may make the outcome worse. This is so, he said, because “basically, it is due to the effect of hypertension on several organs and systems of the body that worsens COVID-19.” Another public health physician, Dr. Doyin Odubanjo, appears to agree with Onajole when he stated that so far, it is not proven that those with underlying conditions, such as HBP, have a greater chance of being infected with COVID-19 but may have a more serious disease course if the get it.
He said: “This is also probably due to the fact that COVID-19 apparently has cardiovascular effects just as HBP does, and HBP might even have already caused some damage to other organs before COVID-19 comes in to further complicate it all.” A multiple award-winning medical practitioner, Dr. Adegboyega Oderinde, also said that long term health conditions such as hypertension and diabetes, for instance, may weaken the immune system as much as aging. Viewed in that light, he said, those having such medical conditions may predispose to higher risk of infection for Coronavirus, “though a lot of research still needs to be done in this regard.
“The virus symptom is more severe in hypertension because it is a long term illness, which weakens the immune system over time. Hypertension affects more of the old age bracket whose immune system would have naturally gone down.
“And the side effects of some antihypertensive medications like ACE inhibitors such as Lisinopril, Captopril, Enalapril and Perindopril include cough, which when added to the cough of COVID, worsen the symptoms.”
For a Professor of Veterinary Medicine and Clinical Virology at Michael Okpara University of Agriculture in Umudike, Prof. Maduike Ezeibe, “COVID-19 kills mainly those with underlying illnesses such as hypertension. But if patients are treated with effective anti-viral medicines such as Antivirt which mops viruses by attaching one of its two electrically charged ends to any of the charges a virus has, even those patients can survive.
“Nigeria should help the world by inviting the World Health Organisation (WHO) to accredit the Antivirt. Or are we shy to tell the world we have achieved the cure they are looking for? Proving this to be true will save our economy.” The prevalence of hypertension, according to the aggregate opinion of these medical experts, is high in patients affected by Coronavirus disease, and it appears to be related to an increased risk of mortality.
To them, if one has high blood pressure, it’s a good idea to take extra care to protect oneself during any virus outbreak. Early research shows that people with the condition may be more likely to: Get COVID-19, have worse symptoms, and die from the infection.
High Blood Pressure Risks
Growing data shows a higher risk of COVID-19 infections and complications in people with high blood pressure. Analysis of early data from both China and the U.S. shows that high blood pressure is the most commonly shared pre-existing condition among those hospitalised, affecting between 30 per cent and 50 per cent of the patients. Other health conditions included cancer, diabetes, or lung disease. In Italy, a report said that more than 99 percent of people, who had died from the virus, had one of these conditions, and 76 per cent of them had high blood pressure. Other research shows that people with high blood pressure are also slightly more likely to die from Coronavirus. Their risk is about twice as high as that of the overall population.
What’s the Link?
A weaker immune system, doctors said, is one reason people with high blood pressure and other health problems are at higher risk for Coronavirus. They have also said that long-term health conditions and aging further weaken the immune system which makes it less able to fight off the virus. Nearly two-thirds of people over 60 are likely to have high blood pressure, which is the precursor for hypertension. Another possibility is that the higher risk comes not from high blood pressure itself, but from certain drugs used to treat it – ACE inhibitors and Angiotensin Receptor Blockers (ARBs).
The theory is based on the fact that ACE inhibitors and ARBs raise levels of an enzyme called ACE2 in the body. And to infect cells, the COVID-19 virus must attach itself to ACE2. Some large studies, however, found no ties between the use of these drugs and how severe COVID-19 is. Other research suggests that they may make COVID-19 less severe. There’s also no proof that people have less severe illness after stopping them.
Stopping these medications may make heart and kidney disease worse. It can also raise a risk of death. The American College of Cardiology and American Heart Association recommend that one keep taking one’s high blood pressure medicine as prescribed. If one doesn’t, it could raise a risk for a heart attack or stroke, they added.
Hypertension and COVID-19
The world is currently suffering from the outbreak of a pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus SARS-CoV-2 that causes the disease called COVID-19. It was first reported in Wuhan, Hubei Province, China on December 31, 2019. As of September 31, there have been 58,848 confirmed cases of COVID-19 reported in Nigeria, with 1,112 deaths and 50,358 recoveries. While the world figure stands at 34 million cases and 1.024 million deaths, 23.7 million recoveries for the same period in question.
The clinical and epidemiological features of COVID-19 have been repeatedly published in the last few weeks. Interestingly, specific comorbidities associated with increased risk of infection and worse outcomes with development of increased severity of lung injury and mortality have been reported. The most common comorbidities in one report were hypertension (30%), diabetes (19%), and coronary heart disease (8%). Another report showed that the most frequent comorbidities in patients with COVID-19, who developed the acute respiratory distress syndrome, were hypertension (27%), diabetes (19%), and cardiovascular disease (6%).
The frequency with which COVID-19 patients are hypertensive is not entirely surprising nor does it necessarily imply a causal relationship between hypertension and COVID-19 or its severity, since hypertension is exceedingly frequent in the elderly, and older people appear to be particular at risk of being infected with SARS-CoV-2 virus and of experiencing severe forms and complications of COVID- 19.
It is, however, unclear whether uncontrolled blood pressure is a risk factor for acquiring COVID-19, or whether controlled blood pressure among patients with hypertension is or is not less of a risk factor. Several organisations have already stressed the fact that blood pressure control remains an important consideration in order to reduce disease burden, even if it has no effect on susceptibility to the SARS-CoV-2 viral infection.
Nevertheless, the fact that hypertension, and other forms of cardiovascular disease also found frequently in COVID- 19 patients, are often treated with Angiotensin-Converting Enzyme (ACE) inhibitors, Angiotensin Receptor Blockers (ARBs), and that SARS-CoV-2, the virus causing COVID-19.
It binds to ACE2 in the lung to enter cells, but has raised questions regarding the possibility that these agents could either be beneficial or actually nefarious in patients treated with them. This is with respect to susceptibility to acquire COVID-19 or in relation to its outcome.
Position of International Society of Hypertension on COVID-19
The International Society of Hypertension (ISH) has said that to date, there is no evidence that people with hypertension are over-represented among those seriously infected by COVID-19. Indeed, the opposite, according to it, is true given that most such cases occur in those over 60 years in whom hypertension usually affects the majority. It also said that there is also no clinical data in humans to show that ACEInhibitors or ARBs neither improve or worsen susceptibility to COVID-19 infection nor do they affect the outcomes of those infected. In the absence of any such compelling data the ISH strongly recommend that the routine use of ACEinhibitors or ARBs to treat raised blood pressure should continue and should not be influenced by concerns about COVID-19 infection.
High blood pressure (hypertension)
Hypertension, according to WHO, is when blood pressure is too high. Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.
Main cause of hypertension
Common factors that can lead to high blood pressure include: A diet high in salt, fat, and/or cholesterol. Chronic conditions such as kidney and hormone problems, diabetes, and high cholesterol. Family history, especially if your parents or other close relatives have high blood pressure.
To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers.
The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure). Blood pressure measurements fall into four general categories: Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg. Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Stage 1 hypertension.
Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher. Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more significant.
Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a common type of high blood pressure among people older than 65. Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure.
This is because blood pressure normally varies throughout the day, and it may be elevated during visits to the doctor (white coat hypertension). Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff.
Changing your lifestyle can go a long way toward controlling high blood pressure. Your doctor may recommend you make lifestyle changes including: Eating a heart-healthy diet with less salt; getting regular physical activity; maintaining a healthy weight or losing weight if you’re overweight or obese and limiting the amount of alcohol you drink. But sometimes lifestyle changes aren’t enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.