Ever since the first outbreak in Wuhan China December 2019, novel coronavirus disease (COVID19) has rapidly spread to many other regions and become a global health threat. So far, COVID-19 has affected over 200 countries and the mortality rate reached as high as 8% in Italy. The novel pathological agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), uses angiotensin-converting enzyme 2 (ACE2) during transmission. One important epidemiological clinical characteristic of COVID-19 is the enrichment of severe patients with cardiovascular disease carriers especially hypertension.
Hypertension is the global leading cause of mortality and represents the most important factor predisposing the risk of developing cardiovascular diseases. Hypertensive patients typically have over-elevated ACE/ANGII axis, in which ACE positively regulates the level of angiotensin II (ANGII) in the renin–angiotensin–aldosterone system (RAS). Drugs that inhibit the RAS, namely ACE inhibitors and angiotensin receptor antagonists (ARAs), are common medications for hypertension management. While ACE is hypertension promoting, ACE2 counterbalances the effects of ACE and delivers many beneficial effects to human health including attenuating inflammatory response and redox stress.
It was reported that the ABO blood group is associated with ACE activity and ACE inhibitor-induced cough among Chinese patients with essential hypertension.