Inverse association between hypertension treatment and COVID-19 prevalence in Japan

Kinoshita, Masako; Sato, Kazuaki; Vellingiri, Balachandar; Green, Shawn J.; Tanaka, Masami

OBJECTIVES: Cell entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) depends on angiotensin-converting enzyme II (ACE2). ACE2 is homologous with, but acts antagonistically to, angiotensin-converting enzyme (ACE), and has the critical function of protecting the lungs. ACE inhibitors are major antihypertensive agents. Thus, we aimed to analyze the impact of the prevalence of preexisting hypertension on the local spread of coronavirus disease 2019. METHODS: Data on SARS-CoV-2 infection and the estimated number of patients who received medical treatment based on disease classification using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, in each prefecture were obtained from the official Japanese notifications database. We analyzed the association between the proportion of patients with each disease and SARS-CoV-2-infection prevalence. RESULTS: The ratio of patients treated for diseases of the circulatory system, especially hypertensive disorders, per population demonstrated the most significant negative correlation with SARS-CoV-2-infection prevalence (Spearman’s rank correlation, p < 0.01). Age group analysis revealed a significant negative correlation in age groups 35–44, 45–54, 55–64, 75–84, and ≥85. CONCLUSIONS: Our findings suggest that hypertension treatment may play a protective role against the local spread of SARS-CoV-2 infection.