Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?

Fang L, Karakiulakis G2, Roth M3. Lancet Respir Med. 2020 Mar 11. pii: S2213-2600(20)30116-8. [CrossRef] [PubMed]

The most distinctive comorbidities of severe 32 novel coronavirus disease 2019 (COVID-19) hypertension, diabetes mellitus, coronary heart diseases, and cerebrovascular disease. Human pathogenic coronaviruses (severe acute respiratory syndrome coronavirus [SARS-CoV] and SARSCoV-2) bind to their target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. The expression of ACE2 is substantially increased in patients with type 1 or type 2 diabetes, who are treated with ACE inhibitors and angiotensin II type-I receptor blockers (ARBs). Hypertension is also treated with ACE inhibitors and ARBs, which results in an upregulation of ACE2. The authors hypothesize that the increased expression of ACE2 would facilitate infection with COVID-19 and that diabetes and hypertension treatment with ACE2-stimulating drugs would increase the risk of developing severe and fatal COVID-19.