ArticleCardiovascular research2020
Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19.
Article in Cardiovascular research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT05167240 (European Society of Hypertension Ambulatory Blood Pressure Monitoring COVID-19 Study), which is not on this map. Cited by 187 papers, 11 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
European Society of Hypertension Ambulatory Blood Pressure Monitoring COVID-19 Study
Who cites it
187 citing papers in PubMed, 11 syntheses or guidelines pooled it, 370 citations in OpenAlex.
- Prevalence of NSAID use among people with COVID-19 and the association with COVID-19-related outcomes: Systematic review and meta-analysis.British journal of clinical pharmacology · 2022Pooled it
- The impact of systemic hypertension on outcomes in hospitalized COVID-19 patients - a systematic review.African health sciences · 2022Pooled it
- Overexpression of angiotensin-converting enzyme 2 by renin-angiotensin system inhibitors. Truth or myth? A systematic review of animal studies.Hypertension research : official journal of the Japanese Society of Hypertension · 2021Pooled it
- Pooled it
- Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19: A Systematic Review and Meta-analysis.JAMA network open · 2021Pooled it
- Associations Between the Use of Renin-Angiotensin System Inhibitors and the Risks of Severe COVID-19 and Mortality in COVID-19 Patients With Hypertension: A Meta-Analysis of Observational Studies.Frontiers in cardiovascular medicine · 2021Pooled it
- Severe acute respiratory syndrome coronavirus 2 and renin-angiotensin system blockers: A review and pooled analysis.Archives of cardiovascular diseases · 2020Pooled it
- A systematic review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 clinical outcomes: What is the evidence so far?Pharmacology research & perspectives · 2020Pooled it
- A comparison of mortality-related risk factors of COVID-19, SARS, and MERS: A systematic review and meta-analysis.The Journal of infection · 2020Pooled it
- COVID-19 and thalassaemia: A position statement of the Thalassaemia International Federation.European journal of haematology · 2020Guideline
- Pooled it
- The impact of COVID-19 on mortality among diabetic and hypertensive individuals in coastal communities in Bangladesh: evidence from chakaria health and demographic surveillance system.Population health metrics · 2026Article
- Life's Essential 8 and Risk of Severe COVID-19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study.Journal of the American Heart Association · 2026Article
- Risk factors for severe COVID-19 and development of a predictive model.BMC pulmonary medicine · 2025Article
- Findings and outcomes of hospitalized unvaccinated patients during the COVID-19 pandemic: impact of comorbidities on clinical, laboratory, and immunological parameters.Revista do Instituto de Medicina Tropical de Sao Paulo · 2025Article
- Infection to hypertension: a review of post-COVID-19 new-onset hypertension prevalence and potential underlying mechanisms.Frontiers in cardiovascular medicine · 2025Review
- Clinical and epidemiological profile of pregnant and postpartum women affected by COVID-19 who required respiratory support.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2025Observational
- Diesel exhaust particle inhalation in conjunction with high-fat diet consumption alters the expression of pulmonary SARS-COV-2 infection pathways, which is mitigated by probiotic treatment in C57BL/6 male mice.Particle and fibre toxicology · 2024Article
- Pathogenic mechanisms of cardiovascular damage in COVID-19.Molecular medicine (Cambridge, Mass.) · 2024Review
- Role of the RAAS in mediating the pathophysiology of COVID-19.Pharmacological reports : PR · 2024Review
127 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
Authors and funding
11 authors at 7 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Systemic arterial hypertension (referred to as hypertension herein) is a major risk factor of mortality worldwide, and its importance is further emphasized in the context of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection referred to as COVID-19. Patients with severe COVID-19 infections commonly are older and have a history of hypertension. Almost 75% of patients who have died in the pandemic in Italy had hypertension. This raised multiple questions regarding a more severe course of COVID-19 in relation to hypertension itself as well as its treatment with renin-angiotensin system (RAS) blockers, e.g. angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We provide a critical review on the relationship of hypertension, RAS, and risk of lung injury. We demonstrate lack of sound evidence that hypertension per se is an independent risk factor for COVID-19. Interestingly, ACEIs and ARBs may be associated with lower incidence and/or improved outcome in patients with lower respiratory tract infections. We also review in detail the molecular mechanisms linking the RAS to lung damage and the potential clinical impact of treatment with RAS blockers in patients with COVID-19 and a high cardiovascular and renal risk. This is related to the role of angiotensin-converting enzyme 2 (ACE2) for SARS-CoV-2 entry into cells, and expression of ACE2 in the lung, cardiovascular system, kidney, and other tissues. In summary, a critical review of available evidence does not support a deleterious effect of RAS blockers in COVID-19 infections. Therefore, there is currently no reason to discontinue RAS blockers in stable patients facing the COVID-19 pandemic.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.