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Reviews in Cardiovascular Medicine  2020, Vol. 21 Issue (3): 385-397     DOI: 10.31083/j.rcm.2020.03.78
Systematic Review Previous articles | Next articles
SARS-CoV-2 infection in patients with diabetes mellitus and hypertension: a systematic review
Niloofar Deravi1, *(), Mobina Fathi1, Kimia Vakili1, Shirin Yaghoobpoor1, Marzieh Pirzadeh2, Melika Mokhtari3, Tara Fazel4, Elahe Ahsan1, Samad Ghaffari5, *()
1Student Research committee, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran 1983969411, Iran
2Student Research Committee, Babol University of Medical Sciences, Babol 4717647745, Iran
3Student Research Committee, Dental Faculty, Tehran Medical sciences, Islamic Azad University, Tehran 1946853314, Iran
4Student Research Committee, School of International Campus, Guilan University of Medical Sciences, Rasht 4199613776, Iran
5Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz 5166616471, Iran
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After the emergence of the novel 2019 coronavirus disease in P. R. China, this highly contagious disease has been currently spread out to almost all countries, worldwide. Novel 2019 coronavirus disease, Middle East respiratory syndrome, and severe acute respiratory syndrome are reported to cause a higher risk for severe infections in patients with chronic comorbidities, such as hypertension and diabetes. These severe infections can contribute to higher rates of morbidity and mortality in these patients. In the present review, we discussed the role and underlying mechanisms of the two most common chronic diseases, type-2 diabetes mellitus and hypertension, in clinical manifestations and disease severity of novel 2019 coronavirus disease, Middle East respiratory syndrome and severe acute respiratory syndrome, with the hope to provide evidence for better decision-making in the treatment of this vulnerable population.

Key words:  Diabetes mellitus      hypertension      SARS-CoV-2      COVID-19      MERS      SARS     
Submitted:  30 April 2020      Revised:  02 September 2020      Accepted:  07 September 2020      Published:  30 September 2020     
*Corresponding Author(s):  Niloofar Deravi Email:; Samad Ghaffari Email:   

Cite this article: 

Niloofar Deravi, Mobina Fathi, Kimia Vakili, Shirin Yaghoobpoor, Marzieh Pirzadeh, Melika Mokhtari, Tara Fazel, Elahe Ahsan, Samad Ghaffari. SARS-CoV-2 infection in patients with diabetes mellitus and hypertension: a systematic review. Reviews in Cardiovascular Medicine, 2020, 21(3): 385-397.

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Fig. 1.  The role of diabetes mellitus in vulnerability to acute viral infections. Both types of diabetes mellitus (T2D and T1D) are accompanied by hyperglycemia and obesity. Obesity, is defined by hypertrophy of adipose tissue that can lead to production of some pro-inflammatory mediators. This adipose tissue induced mediators, alongside with inflammation caused by hyperglycemia, can lead to altered immune profile that can put patients at higher risk of acute viral infections.

Fig. 2.  Angiotensin I is converted to angiotensin II by ACE enzyme. Angiotensin II a vasoconstrictor agent causing hypertension, inflammation and acute lung injury. Moreover, angiotensin II induces the inflammatory pathway through activating NFκβ. It also stimulates monocytes to secrete IL-1β. ACE2, the receptor of SARS-COV2 converts angiotensin I and angiotensin II to angiotensin 1-9 and angiotensin 1-7, respectively. ACE2 also counter regulates ACE enzyme activation. Hypertension and diabetes induce an inflammatory state in the body. Furthermore, diabetes mellitus (DM) results in more ACE2 and spike protein glycosylation which helps viral entry. DM patients also have elevated levels of furin protease which cleavage spike protein and helps viral entry. Anti-hypertensive and hypoglycemic drugs that block the ACE enzyme pathway upregulate the expression of ACE2 and could facilitate virus entry.

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