COVID-19 Disrupts the Body’s Blood Pressure Control System and Amplifies Health Risks in Hypertensive Patients
Nikhil Prasad Fact checked by:Thailand Medical News Team May 21, 2025 1 week, 6 days, 6 hours, 44 minutes ago
Medical News: COVID and Hypertension - A Dangerous Connection Hidden in the Body’s Pressure Regulator
In a major review conducted by researchers from Aarhus University in Denmark and Otto von Guericke University in Magdeburg, Germany, the link between COVID-19 and hypertension was explored in depth, revealing how the virus behind the pandemic, SARS-CoV-2, can disrupt the body’s blood pressure control system and amplify health risks in hypertensive patients.
Schematic diagram of the RAAS, its protective effects on organs and its interactions with the SARS-CoV-2 viral entry mechanism. The protease renin cleaves angiotensinogen to generate angiotensin I. ACE plays an important role in converting angiotensin I into angiotensin II. Angiotensin II may exert some biological functions through angiotensin II receptor type 1 and 2 receptors (AT1R and AT2R), leading to potent vasoconstriction in several organs. ACE2 hydrolyses angiotensin II to the Angiotensin 1-7, which binds the Mas receptor playing a protective role in several organs. ACE2 also hydrolyses angiotensin I to the Angiotensin 1-9, which can be further converted to Angiotensin 1-7 by ACE. The balance between ACE/Ang II/AT1R and ACE2/Ang 1-7/MasR axes is a prerequisite for maintaining normal health. In addition, ADAM17 can cleave the extracellular juxta-membrane region of ACE2. Soluble ACE2 can bind to the receptor-binding domain of the spike protein of SARS-CoV-2 thus blocking further binding to ACE2 and host cell infection. (Small insert) Illustration of the viral entry of SARS-CoV-2. The receptor-binding domain of the spike protein from SARS-CoV-2 binds to ACE2, allowing host cell entry and infection.
The study reveals that hypertension, already a widespread health threat affecting more than 31 percent of the global adult population, becomes even more dangerous when coupled with COVID-19. This
Medical News report explains that the virus directly interferes with the renin-angiotensin-aldosterone system (RAAS)—the hormonal system responsible for regulating blood pressure, fluid balance, and vascular tone.
The Viral Gateway That Hijacks a Crucial Enzyme
SARS-CoV-2 gains entry into human cells by binding to a protein on the cell surface known as angiotensin-converting enzyme 2 (ACE2). While ACE2 normally plays a protective role in lowering blood pressure and reducing inflammation, the virus effectively “hijacks” this enzyme to infect cells. This not only allows the virus to spread but also reduces ACE2 availability, disturbing the balance of RAAS.
The RAAS is made up of two major axes. The first, known as the ACE/Angiotensin II/AT1R pathway, raises blood pressure and promotes inflammation. The second, the ACE2/Angiotensin-(1-7)/Mas receptor axis, counterbalances the first by lowering blood pressure and calming inflammation. By binding to and depleting ACE2, the virus tips the scales toward the more dangerous, pro-inflammatory side, leading to lung injury, vascular damage, and possibly multi-organ failure.
Hypertensive Patients at Greater Risk
The rese
arch team highlighted multiple studies showing that individuals with high blood pressure are significantly more likely to experience severe or fatal outcomes from COVID-19. For example, a meta-analysis cited in the review found that hypertensive patients have over three times the risk of dying from COVID-19 compared to those without hypertension.
Further, elevated levels of angiotensin II—a potent vasoconstrictor—were observed in COVID-19 patients, correlating directly with the severity of lung damage. This reinforces the theory that the virus-induced suppression of ACE2 leads to an uncontrolled rise in angiotensin II, pushing already vulnerable hypertensive patients into critical conditions.
RAAS Medications and the Debate Over Safety
One important issue addressed in the review was whether common hypertension drugs that target the RAAS—like ACE inhibitors and angiotensin receptor blockers (ARBs)—make patients more susceptible to COVID-19. Since these drugs may increase ACE2 expression, some feared they could enhance viral entry.
However, the review concludes that these concerns are largely unfounded. Not only is there no solid evidence that these drugs increase infection risk, but several studies actually suggest they may be protective. In one retrospective study of over 1,100 hypertensive COVID-19 patients, those on ARBs or ACE inhibitors had significantly lower mortality and fewer complications like septic shock.
These medications may help restore balance to the RAAS, counteracting the harmful effects of the virus. As a result, major health bodies now recommend that patients continue their antihypertensive medications unless advised otherwise by their doctors.
Potential New Treatments and Future Directions
Given how critical ACE2 is in this process, scientists are investigating novel therapies that enhance the ACE2/Ang-(1-7)/Mas receptor pathway. One promising approach is the use of human recombinant soluble ACE2 (hrsACE2), which can act as a decoy to bind the virus, preventing it from entering cells, while simultaneously restoring the RAAS balance.
Other potential treatments include Ang-(1-7) analogues, which mimic the protective effects of the ACE2 pathway. Clinical trials are ongoing to assess the safety and efficacy of these therapies in COVID-19 patients.
Why This Matters for the Future
Hypertension is a complex, multifactorial disease that requires careful management. The discovery that SARS-CoV-2 can exploit this condition to worsen patient outcomes emphasizes the urgent need for integrated treatment strategies. Understanding how COVID-19 disturbs the RAAS provides critical insights into why hypertensive patients are more vulnerable and highlights potential targets for treatment that may save lives.
The conclusions from this extensive review make it clear: patients with hypertension must be considered high-risk during the ongoing pandemic, and preserving RAAS balance is a key therapeutic goal. Emerging evidence supports the continued use of RAAS-modulating medications like ACE inhibitors and ARBs, while innovative therapies that enhance the protective arm of the RAAS are showing real promise. In the fight against COVID-19, targeting the body’s own hormonal systems may be just as crucial as attacking the virus directly.
The study findings were published in the peer-reviewed journal: Physiological Reports.
https://physoc.onlinelibrary.wiley.com/doi/10.14814/phy2.14800
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https://www.thailandmedical.news/news/long-term-risk-of-hypertension-up-to-three-years-after-covid-19-infection
https://www.thailandmedical.news/news/breaking-covid-19-news-italian-study-shows-that-about-9-percent-of-all-exposed-to-sars-cov-2-will-develop-new-onset-hypertension
https://www.thailandmedical.news/news/new-insights-from-an-experimental-study-on-the-hypertension-drug-lisinopril-and-covid-19
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