{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T02:00:19Z","timestamp":1769824819841,"version":"3.49.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T00:00:00Z","timestamp":1619568000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81670304"],"award-info":[{"award-number":["81670304"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>COVID-19 is a respiratory infectious disease caused by SARS-CoV-2, and cardiovascular damage is commonly observed in affected patients. We sought to investigate the effect of SARS-CoV-2 infection on cardiac injury and hypertension during the current coronavirus pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Study design and methods<\/jats:title>\n<jats:p>The clinical data of 366 hospitalized COVID-19-confirmed patients were analyzed. The clinical signs and laboratory findings were extracted from electronic medical records. Two independent, experienced clinicians reviewed and analyzed the data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Cardiac injury was found in 11.19% (30\/268) of enrolled patients. 93.33% (28\/30) of cardiac injury cases were in the severe group. The laboratory findings indicated that white blood cells, neutrophils, procalcitonin, C-reactive protein, lactate, and lactic dehydrogenase were positively associated with cardiac injury marker. Compared with healthy controls, the 190 patients without prior hypertension have higher Ang\u2161 level, of which 16 (8.42%) patients had a rise in blood pressure to the diagnostic criteria of hypertension during hospitalization, with a significantly increased level of the cTnI, procalcitonin, angiotensin-II (Ang\u2161) than those normal blood pressure ones. Multivariate analysis indicated that elevated age, cTnI, the history of hypertension, and diabetes were independent predictors for illness severity. The predictive model, based on the four parameters and gender, has a good ability to identify the clinical severity of COVID-19 in hospitalized patients (area under the curve: 0.932, sensitivity: 98.67%, specificity: 75.68%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Hypertension, sometimes accompanied by elevated cTnI, may occur in COVID-19 patients and become a sequela. Enhancing Ang II signaling, driven by SARS-CoV-2 infection, might play an important role in the renin-angiotensin system, and consequently lead to the development of hypertension in COVID-19.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0250815","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T19:59:05Z","timestamp":1619639945000},"page":"e0250815","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":57,"title":["Hypertension as a sequela in patients of SARS-CoV-2 infection"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0163-4139","authenticated-orcid":true,"given":"Ganxiao","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xun","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zuojiong","family":"Gong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Xia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuefen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector","family":"Barajas-Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0994-8434","authenticated-orcid":true,"given":"Dan","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,4,28]]},"reference":[{"key":"pone.0250815.ref001","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1002\/jmv.25678","article-title":"Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle","volume":"92","author":"H Lu","year":"2020","journal-title":"J Med Virol"},{"key":"pone.0250815.ref002","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.ijid.2020.01.009","article-title":"The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health\u2013The latest 2019 novel coronavirus outbreak in Wuhan, China","volume":"91","author":"DS Hui","year":"2020","journal-title":"Int J Infect Dis"},{"key":"pone.0250815.ref003","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A Novel Coronavirus from Patients with Pneumonia in China, 2019","volume":"382","author":"N Zhu","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0250815.ref004","doi-asserted-by":"crossref","first-page":"3085","DOI":"10.1016\/j.jacc.2020.04.028","article-title":"Clinical Implications of SARS-CoV-2 Interaction With Renin Angiotensin System: JACC Review Topic of the Week","volume":"75","author":"A Brojakowska","year":"2020","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"pone.0250815.ref005","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.bbrc.2020.02.071","article-title":"Structure analysis of the receptor binding of 2019-nCoV","volume":"525","author":"Y Chen","year":"2020","journal-title":"Biochem Biophys Res Commun"},{"key":"pone.0250815.ref006","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1161\/CIRCRESAHA.120.317015","article-title":"Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2","volume":"126","author":"M Gheblawi","year":"2020","journal-title":"Circ Res"},{"key":"pone.0250815.ref007","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.cardiores.2006.09.006","article-title":"ACE2 of the heart: From angiotensin I to angiotensin (1\u20137)","volume":"73","author":"S Keidar","year":"2007","journal-title":"Cardiovasc Res"},{"key":"pone.0250815.ref008","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China","volume":"395","author":"C Huang","year":"2020","journal-title":"Lancet"},{"issue":"32","key":"pone.0250815.ref009","doi-asserted-by":"crossref","first-page":"3104","DOI":"10.1093\/eurheartj\/ehaa524","article-title":"Large Intra-cardiac Thrombus in a COVID-19 Patient Treated with Prolonged Extracorporeal Membrane Oxygenation Implantation","volume":"41","author":"D Hu","year":"2020","journal-title":"Eur Heart J"},{"key":"pone.0250815.ref010","first-page":"136","article-title":"Diagnosis and treatment of pneumonia caused by new coronavirus infection(Trial version 5[J\/OL])","volume":"40","author":"National Health and Health Commission and State Administration of traditional Chinese medicine","year":"2020","journal-title":"Chinese J Integrated Traditional Western Edicine"},{"key":"pone.0250815.ref011","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1016\/j.jacc.2010.01.044","article-title":"Prospective evaluation of the prognostic implications of improved assay performance with a sensitive assay for cardiac troponin I","volume":"55","author":"M Bonaca","year":"2010","journal-title":"J Am Coll Cardiol"},{"key":"pone.0250815.ref012","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1038\/s41586-020-2012-7","article-title":"A pneumonia outbreak associated with a new coronavirus of probable bat origin","volume":"579","author":"P Zhou","year":"2020","journal-title":"Nature"},{"key":"pone.0250815.ref013","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.tips.2004.04.001","article-title":"ACE2: from vasopeptidase to SARS virus receptor","volume":"25","author":"AJ Turner","year":"2004","journal-title":"Trends Pharmacol Sci"},{"key":"pone.0250815.ref014","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/path.2162","article-title":"The emerging role of ACE2 in physiology and disease","volume":"212","author":"I Hamming","year":"2007","journal-title":"J Pathol"},{"key":"pone.0250815.ref015","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1016\/j.jacc.2009.05.051","article-title":"Normal plasma levels of cardiac troponin I measured by the high-sensitivity cardiac troponin I access prototype assay and the impact on the diagnosis of myocardial ischemia","volume":"54","author":"P Venge","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"pone.0250815.ref016","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1001\/jamacardio.2020.0950","article-title":"Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China","volume":"5","author":"S Shi","year":"2020","journal-title":"JAMA Cardiol"},{"key":"pone.0250815.ref017","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.jacc.2020.06.068","article-title":"Cardiac Troponin for Assessment of Myocardial Injury in COVID-19: JACC Review Topic of the Week","volume":"76","author":"Y Sandoval","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"pone.0250815.ref018","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1001\/jamacardio.2020.1096","article-title":"Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)","volume":"5","author":"RM Inciardi","year":"2020","journal-title":"JAMA Cardiol"},{"key":"pone.0250815.ref019","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.pcad.2020.03.001","article-title":"Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis","volume":"63","author":"G Lippi","year":"2020","journal-title":"Prog Cardiovasc Dis"},{"key":"pone.0250815.ref020","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1038\/s41569-019-0244-8","article-title":"Counter-regulatory renin-angiotensin system in cardiovascular disease","volume":"17","author":"M Paz Ocaranza","year":"2020","journal-title":"Nat Rev Cardiol"},{"key":"pone.0250815.ref021","doi-asserted-by":"crossref","first-page":"960","DOI":"10.1161\/CIRCRESAHA.116.303587","article-title":"Hypertension: renin-angiotensin-aldosterone system alterations","volume":"116","author":"L Te Riet","year":"2015","journal-title":"Circ Res"},{"key":"pone.0250815.ref022","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1161\/CIRCULATIONAHA.120.047049","article-title":"Angiotensin Converting Enzyme 2: A Double-Edged Sword","volume":"142","author":"K Wang","year":"2020","journal-title":"Circulation"},{"key":"pone.0250815.ref023","doi-asserted-by":"crossref","first-page":"201","DOI":"10.3389\/fendo.2013.00201","article-title":"Update on the Angiotensin converting enzyme 2-Angiotensin (1\u20137)-MAS receptor axis: fetal programing, sex differences, and intracellular pathways","volume":"4","author":"MC Chappell","year":"2014","journal-title":"Front Endocrinol (Lausanne)"},{"key":"pone.0250815.ref024","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1093\/ndt\/gfl632","article-title":"ACE2 activity is increased in monocyte-derived macrophages from prehypertensive subjects","volume":"22","author":"S Keidar","year":"2007","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0250815.ref025","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/S0140-6736(20)32656-8","article-title":"6-month consequences of COVID-19 in patients discharged from hospital: a cohort study","volume":"397","author":"C Huang","year":"2021","journal-title":"Lancet"},{"key":"pone.0250815.ref026","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.1152\/physrev.00038.2017","article-title":"Angiotensin II Signal Transduction: An Update on Mechanisms of Physiology and Pathophysiology","volume":"98","author":"SJ Forrester","year":"2018","journal-title":"Physiol Rev"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250815","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T19:59:32Z","timestamp":1619639972000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0250815"}},"subtitle":[],"editor":[{"given":"Bhagwan","family":"Dass","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,4,28]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0250815","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,28]]}}}