A recent article titled “Pulmonary arterial hypertension and COVID-19: piecing the puzzle”, published in Respiratory Medicine and Research, summarises the existing literature on the clinical presentation of COVID-19 in patients with pulmonary arterial hypertension, focusing on shared pathobiology, clinical outcomes, potential treatment strategies, and the need for further research in understanding and managing these conditions.
This article outlines the different aspects that both diseases – surprisingly – have in common, including:
Pathobiology of pulmonary arterial hypertension and COVID-19: pulmonary arterial hypertension is a rare and progressive vascular disease, characterised by remodeling of pulmonary arteries, leading to increased pressure and resistance. A key aspect of the disease’s pathobiology is the role of angiotensin converting enzyme 2 (ACE2), which is down-regulated in pulmonary arterial hypertension and affects the body’s response to COVID-19 .
Endothelial Dysfunction in pulmonary arterial hypertension and COVID-19: Both pulmonary arterial hypertension and COVID-19 share endothelial dysfunction, a condition where the lining of blood vessels is compromised. This dysfunction contributes to the severity of COVID-19 in pulmonary arterial hypertension patients. The article proposes a “double hit” model, where pulmonary arterial hypertension is the first hit causing chronic damage and COVID-19 is the second hit exacerbating the condition.
Clinical Outcomes of COVID-19 in pulmonary arterial hypertension patients: Various studies have shown different outcomes for pulmonary arterial hypertension patients with COVID-19. Some early studies suggested favourable outcomes, but larger, more robust studies indicated higher mortality and hospitalisation rates in pulmonary arterial hypertension patients with COVID-19 compared to those without. Treatments and management strategies for PAH patients with COVID-19 are also discussed.
Long-Term Effects of COVID-19 on Pulmonary Vasculature: COVID-19 can cause long-term effects on the pulmonary vasculature, including pulmonary embolism and changes in the pulmonary vascular wall. These effects can resemble those seen in pulmonary arterial hypertension, suggesting a potential link between post- COVID-19 complications and the development of pulmonary arterial hypertension.
Repurposing pulmonary arterial hypertension-approved Therapy for COVID-19 Treatment: The article explores the potential of using pulmonary arterial hypertension-approved therapies (like endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and prostacyclins) in treating COVID-19. Results from clinical trials have been mixed, indicating the need for further research in this area .
Conclusions and Recommendations: The pandemic has negatively impacted pulmonary arterial hypertension patients, with high-risk groups experiencing worse outcomes. The article suggests a multidisciplinary approach to treating pulmonary arterial hypertension patients with COVID-19 and emphasises the need for prospective studies to assess the long-term impact of COVID-19 on PAH patients .
Fida Charif, Fatima Dakroub, Imad Bou Akl, Mithum Kularatne, David Montani, “Pulmonary arterial hypertension and COVID-19: Piecing the puzzle”, Respiratory Medicine and Research, Volume 84, 2023, 101053, ISSN 2590-0412, https://doi.org/10.1016/j.resmer.2023.101053.
You can find the article at this link on the Science Direct web page
Summary written by Alena Adarbehova, volunteer for the Alliance for Pulmonary Hypertension
The opinions expressed in this article are those of the author only and do not necessarily reflect the views or positions of any entities they represent, or of the Alliance for Pulmonary Hypertension.