**4.3 Anti-hypertensive drugs, cardiovascular system and SARS-CoV-2**

Even at the beginning of the pandemic, a publication suggested that due to hyper expression of ACE2 receptors in DM and hypertension, patients with said condition would be more likely to develop severe manifestations of COVID-19 [6] which was not confirmed with subsequent studies [21, 24, 30, 34]. At the same time, there was a theory that anti-hypertensive drugs could cause more severe cases of COVID-19, however it has been refuted. Meng et al. [27] showed that ACE inhibitors (ACEi) or angiotensin receptor-1 blockers (ARB) therapy increased CD3 and CD8 T cell counts in peripheral blood and decreased the peak viral load compared to other antihypertensive drugs and Rico-Mesa et al. [24] suggest that the effects of these drugs were positive, including ACE2 receptor blockade, disabling viral entry into the heart and lungs, and an overall decrease in inflammation secondary to ACEI/ARB.

Moreover, Societies of Hypertension affirms that in hypertensive patients with COVID-19 or at risk of COVID-19 infection, ACEi and ARBs treatment should be maintained according to the recommendations contained in the 2018 ESC/ESH guidelines [5], because blood pressure control remains an important consideration in order to reduce disease burden, even if it has no effect on susceptibility to the SARS-CoV-2 viral infection [24].
