Hypertension and its role in COVID-19-related cerebrovascular disease

Cerebrovascular disorders such as stroke and intracerebral hemorrhage (ICH) occur in COVID-19 patients with pre-existing hypertension. Elevated blood pressure increases the risk of COVID-19-related morbidity and mortality. Although, the exact mechanisms of action are not well understood, pre-existing imbalance in the renin-angiotensin-aldosterone system (RAAS), and hypertension-induced cerebrovascular abnormalities can facilitate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infiltration into the central nervous system (CNS) leading to severe tissue damage and cerebrovascular insults. Alternatively, SARS-CoV-2 can independently affect blood flow regulation and induce cerebrovascular disease (CeVD) via binding to its receptor angiotensin converting enzyme 2 (ACE2) and modulation of RAAS. The present review systemically discusses published clinical reports and provides an overview of the potential associations between pre-existing hypertension, SARS-CoV-2 infection, and the occurrence of COVID-19-related CeVD. Early identification of high-risk patients is crucial for better point of care and prevention of COVID-19-related CeVD, morbidity and mortality.