SARS-CoV-2 and Hypertension: Evidence Supporting Invasion into the Brain Via Baroreflex Circuitry and the Role of Imbalanced Renin-Angiotensin-Aldosterone-System.
SARS-CoV-2 and Hypertension: Evidence Supporting Invasion into the Brain Via Baroreflex Circuitry and the Role of Imbalanced Renin-Angiotensin-Aldosterone-System.
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DOI：
10.1177/26331055231151926
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发表时间：
2023
影响因子：
3.6
通讯作者：
de Castro, Olagide Wagner
中科院分区：
文献类型：
--
作者：
Oliveira, Kellysson Bruno;de Melo, Igor Santana;da Silva, Bianca Rodrigues Melo;Oliveira, Keylla Lavinia da Silva;Sabino-Silva, Robinson;Anhezini, Lucas;Katayama, Pedro Lourenco;Santos, Victor Rodrigues;Shetty, Ashok K.;de Castro, Olagide Wagner
高血压被认为是新冠肺炎最关键的风险因素之一。有证据表明，SARS-CoV-2感染通过血管削弱大血管的管壁，从而对心血管系统产生强烈的影响。在本文中，我们认为SARS-CoV-2侵入颈动脉和主动脉压力感受器，导致孤束核(NTS)和下丘脑室旁核(PVN)感染，这种感染后NTS和PVN的失调导致中枢水平的血压变化。此外，我们还探讨了SARS-CoV-2有利于膜ACE2受体内化的假说，产生肾素-血管紧张素-醛固酮系统(RAAS)的失衡，增加血管紧张素II(Ang-II)、去整合素和金属蛋白酶17结构域(ADAM17/TACE)的活性，最终调节从压力感受器到NTS的传入信号的整合，促进血压升高。这些机制与交感神经活性增加有关，从而导致与SARS-CoV-2入侵相关的一过性或永久性高血压，导致因心血管疾病而死亡的人数较多。
Hypertension is considered one of the most critical risk factors for COVID-19. Evidence suggests that SARS-CoV-2 infection produces intense effects on the cardiovascular system by weakening the wall of large vessels via vasa-vasorum. In this commentary, we propose that SARS-CoV-2 invades carotid and aortic baroreceptors, leading to infection of the nucleus tractus solitari (NTS) and paraventricular hypothalamic nucleus (PVN), and such dysregulation of NTS and PVN following infection causes blood pressure alteration at the central level. We additionally explored the hypothesis that SARS-CoV-2 favors the internalization of membrane ACE2 receptors generating an imbalance of the renin-angiotensin-aldosterone system (RAAS), increasing the activity of angiotensin II (ANG-II), disintegrin, and metalloproteinase 17 domain (ADAM17/TACE), eventually modulating the integration of afferents reaching the NTS from baroreceptors and promoting increased blood pressure. These mechanisms are related to the increased sympathetic activity, which leads to transient or permanent hypertension associated with SARS-CoV-2 invasion, contributing to the high number of deaths by cardiovascular implications.
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