key: cord-0932491-ja45g4b0 authors: Yetkin, Ertan; Taylan, Gökay; Yalta, Kenan title: COVID-19 pandemic: a glimpse into newly diagnosed hypertensive patients date: 2020-09-17 journal: Cardiovasc Endocrinol Metab DOI: 10.1097/xce.0000000000000234 sha: 9ea1a89dd79d04cb215c125a0bd618b26cf4b109 doc_id: 932491 cord_uid: ja45g4b0 nan The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as an immediate and global problem just within a few months after its first description in Wuhan-China. Beyond its alarming mortality rate and easily transmissible nature through air droplets, it has also resulted in significant challenges in the cardiovascular area not only due to its higher mortality rates in cardiovascular disease and certain associated conditions, including diabetes mellitus and hypertension, but also due to the theoretically facilitated inoculation of lung tissue by the culprit agent, SARS-CoV-2 in these conditions [1, 2] . This worrisome concern has been largely attributed to the potential upregulation of angiotensin enzyme 2 (ACE2) in hypertensive and diabetic patients, and more interestingly; in those receiving angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) [3] . Fortunately, this clinical confusion has been resolved by successive recommendations of cardiovascular societies [4] . Consistently, all guidelines have advised against discontinuation of ACEIs/ARBs in the context of avoiding or treating COVID-19 infection. More interestingly, use of ACEIs and ARBs has been reported to be protective against lung injury caused by COVID-19 particularly in more severe clinical scenarios [5] . Additionally, these agents might also exert anti-inflammatory and antioxidative effects through a significant reduction in angiotensin II levels (with well known oxidative and inflammatory characteristics) along with potentiation of ACE2 (potentially mediating the synthesis of anti-inflammatory and antioxidative byproducts including angiotensin-1-9) that all prevent or mitigate the course of acute respiratory distress syndrome [6] . Clinical trials evaluating the effects of ACEIs, ARBs, and angiotensins themselves in patients with COVID-19 in outpatient and in-patient settings might help to provide important data on this issue. Several studies are currently being conducted to assess role of ACEIs, ARBs, and angiotensins on the clinical course and pathophysiology of COVID-19 (ClinicalTrials.gov identifiers, NCT04364893, NCT04340557, NCT04322786, and NCT04332666). The clinical impact of continuation versus discontinuation of ACEIs and ARBs on outcomes in patients hospitalized with COVID-19 will also be assessed by a randomized clinical study (NCT04338009) ( Table 1) . Clinicians also need strong recommendations regarding the prescription of these agents for newly diagnosed hypertension cases with or without concomitant conditions, including heart failure (HF), diabetes mellitus, and ischemic heart disease, during the ongoing outbreak of COVID-19. Considering the obscure and multifaceted effects of ACEIs and ARBs in various clinical conditions, it seems plausible to prescribe these agents exclusively for compelling indications (for which these agents are known to be indisputably beneficial), including concomitant heart failure and ischemic heart disease, etc, in the setting of newly diagnosed hypertension. On the other hand, withholding ACEIs or ARBs as the first choice with particular preference of other antihypertensive classes, including calcium antagonist, β-blockers, diuretics, and α-blockers in the absence of compelling indications may eliminate the concerns on the patient's side and thereby may increase the drug compliance in the setting of newly diagnosed hypertension during the spreading outbreak of COVID-19. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention Hypertension and diabetes mellitus in patients with COVID 19 Receptor recognition by novel coronavirus from Wuhan: an analysis based on decade-long structural studies of SARS Coronavirus disease 2019 (COVID-19) infection and Renin Angiotensin system blockers Effect of Renin-Angiotensin system blockage in patients with acute respiratory distress syndrome: a retrospective case control study Angiotensinconverting enzyme 2 protects from severe acute lung failure There are no conflicts of interest.