SARS-CoV-2 binds to the target cells through angiotensin-converting enzyme 2 (ACE2), which is expressed by epithelial cells of the lung, intestine, kidney, and blood vessels. ACE inhibitors, angiotensin II type-I receptor blockers (ARBs), thiazolidinediones, and ibuprofen (anti-inflammatory drug) can substantially increase the expression of ACE2. These drugs are used to treat type 1 or type 2 diabetes, and hypertension.
Therefore, the hypothesis is that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.