"1. Introduction
...The most frequent comorbidity in patients with coronavirus disease 2019 (COVID-19) is hypertension...the exact mechanisms explaining the development of severe forms of COVID-19 among hypertensive patients remain undefined.
... The main aim of our narrative review was to summarize available evidences on the effect of SARS-CoV-2 infection and COVID-19 vaccines on BP [blood pressure].
4. Mechanisms
4.1. The role of ACE2: The failure of the counter-regulatory RAS [renin-angiotensin-system] axis...appears to be the most relevant causative mechanism implicated in the raise of BP and worse outcome of COVID-19. Indeed, recent investigations demonstrated the development of an 'Angiotensin II storm' or 'Angiotensin II intoxication' during the acute phase of SARs-CoV-2 infection.
5. Conclusions
Recent clinical and experimental advances in the pathophysiology of SARS-CoV-2 infection support the notion that the interaction of the virus...with ACE2 receptors exerts a pivotal role in the development of severe disease.
... Downregulation and internalization of ACE2 receptors (due to viral occupation), and malfunction of other angiotensinases, dysregulates the protective RAS axis with increased generation and activity of Ang II and reduced formation of Ang1,7.
... Ang II plays key roles in BP homeostasis, including the heart, kidney, blood vessels, adrenal glands, and cardiovascular control centres in the brain. Thus, the negative effect of SARS-CoV-2 on BP during and after the acute phase of infection is not entirely unexpected.
... Uncontrolled hypertension during the course of the disease can acutely worsen hypertension-mediated organ damage and adverse outcomes.
A similar mechanism has been recently proposed to explain the raise in BP following COVID-19 vaccination...the resulting features of COVID-19 vaccination resemble those of active COVID-19 disease."
https://pmc.ncbi.nlm.nih.gov/articles/PMC9744686/
© 2022 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.