key: cord-0767918-hg34wsj0 authors: Itoh, Hiroshi title: A new normal for hypertension medicine with coronavirus disease-2019 (COVID-19): proposal from the president of the Japanese Society of Hypertension date: 2020-06-18 journal: Hypertens Res DOI: 10.1038/s41440-020-0497-y sha: 01ced51e119048ca9745c25780e5b6926cc7955b doc_id: 767918 cord_uid: hg34wsj0 nan two years after the disaster, their blood pressure remained significantly elevated by~4-5 mmHg on average, and the incidence rates of obesity, diabetes and dyslipidemia, as well as hypertension, remained 1.2-1.5 times higher than those before the disaster [3] . The current situations in 2020 under the policy of social distancing and "stay at home" with self-restraint from going out are similar to those of the evacuation in 2011: sudden death of familiar persons, fear for death of ourselves, stresses produced due to family members being in the house all day long, feeling of detachment from friends and others, job loss and economic difficulties and so on. 2020 is the year of the 20th anniversary of the discovery of ACE 2 (angiotensin-converting enzyme 2) [4] . It is a mystery why this molecule, which cleaves angiotensin II, one of the central players of blood pressure and cardiovascular homeostasis, into angiotensin (1-7), is used for the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into host target cells [5] . The reninangiotensin system is a relatively new endocrine system in phyletic evolution that produces high blood pressure to deliver adequate oxygen and nutrients throughout the body for survival. ACE2 is expressed not only on pulmonary cells but also on intestinal and renal epithelial cells, cardiomyocytes and vascular endothelial cells [6] . Vascular endothelial cells are infected by SARS-CoV-2, resulting in the occurrence of systemic vasculitis and severe thromboembolism in relation to the "cytokine storm". Chromosome X harbors the gene coding for ACE-2, and the activity of transmembrane protease serine 2 (TMPRSS2), which facilitates the fusion of viral and cellular membranes, is androgen dependent [7] . These facts might be related to the sex preference of this disease [8] . Regulation of ACE2 expression by SARS-CoV-2 infection or by the administration of ACE inhibitors or angiotensin receptor blockers has been reported in in vitro cultured cells and in vivo animal models, and its clinical implication for COVID-19 has been argued [9] . Along with the observation that underlying cardiovascular diseases that are often caused by or complicated with hypertension are associated with an increased risk of severity of the disease [10] , we should constantly attempt to discover and investigate the true picture of COVID-19 in relation to hypertension that has so far been delineated, that is, what is known and what is not yet known, to be well prepared for a possible pandemic of NCDs, including hypertension. Our sincere scientific approach to cope with the reality of hypertension with COVID-19 would yield a New Normal hypertension medicine. This perspective opens up a new field of hypertension research to produce a concept of combined disease types of communicable and noncommunicable diseases, specific to each person's particular lifestyle and life environment. This new disease entity would include a new type of physical-mental stress-induced hypertension, a new type of vasculitis with hypertension, diseases evoked by lung-mediated organ miscommunication, or cardiovascular dysregulation produced by discordance between the human host and microorganisms. Facing the difficulty of frequent face-to-face examination of the patients performed in Old Normal medical practice, the New Normal of hypertension medicine also prompts us to cultivate the digital transformation of the medical practice of hypertension management to realize life-long care to naturally maintain a happy and healthy life, respecting the diversity of each person with hypertension. The establishment of a medical care system with constant connection to each person with hypertension by various IoT (Internet of Things) technologies and a medical advisory system to give personalized proper advice at the appropriate time according to the lifelog data of each person and the construction of a dynamic community remodeled with mutual dependence on each person's diverse quality of life are expected. Among them, the most important requirement is a "redesign" of the image of medical doctors being engaged in hypertension medicine to welcome the New Normal of hypertension medicine. Conflict of interest The author declares that they have no conflicts of interest. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Homo deus: a brief history of tomorrow A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? Prog Cardiovasc Dis Changes in cardiovascular risk factors after the great east Japan earthquake A human homolog of angiotensin-converting enzyme. Cloning and functional expression as a captopril-insensitive carboxypeptidase SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis Prostate-localized and androgen-regulated expression of the membrane-bound serine protease TMPRSS2 Androgen sensitivity gateway to COVID-19 disease severity Interactions of coronaviruses with ACE2, angiotensin II, and RAS inhibitors-lessons from available evidence and insights into COVID-19 Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York city area