Lviv clinical bulletin 2021, 1(33)-2(34): 31-36

https://doi.org/10.25040/lkv2021.01-02.031

About the Problem of Arterial Hypertension as a Risk Factor in the COVID-19 Pandemic Conditions and its Treatment (Literature Review)

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І. Dunaieva1, N. Kravchun2

1Kharkiv  National  Medical  University

2Life Park medical center, Kharkiv

Context. In a pandemic caused by a coronavirus infection, a special risk group are the patients with cardiovascular disease, hypertension and diabetes mellitus in particular, which are the most common risk groups among the general population. The spread of coronavirus disease is particularly dangerous in terms of decompensation of chronic complications, specific damage to the cardiovascular system, especially in cases of severe infection and high risk of adverse outcomes in the above cohort of patients. The combination of coronavirus disease and cardiovascular disease poses additional difficulties in diagnosing, identifying, and prescribing appropriate therapy, including antihypertensive therapy. Therefore, it is important to address the possible risks and complications in people with hypertension and diabetes mellitus in the conditions of coronavirus disease COVID-19 and the features of the antihypertensive therapy prescription.

Objective. To investigate the peculiarities of treatment of patients with arterial hypertension in the context of the COVID-19 pandemic, to analyze possible risks and complications based on the results of studying the literature.

Materials and methods. Content analysis, methods of systemic and comparative results, as well as bibliosemantic evaluation of current research in the literature on the prescription of antihypertensive therapy in patients with hypertension and diabetes in the conditions of coronavirus COVID-19 were used. Sources of information were searched in scientometric medical databases, namely PubMedNCBI, Medline, Web of Science and Google Scholar, etc. by keywords: diabetes, hypertension, antihypertensive therapy, COVID-19, complications, cardiovascular risk. 174 scientific works in English, Ukrainian and Russian were analyzed and sources were selected, which contain questions about the risks of patients with hypertension and diabetes in the conditions of coronavirus disease, including those related to the appointment of antihypertensive therapy. 

Results. RAAS inhibitors, which provide better blood pressure control, may partially help to maintain the immune system imbalance in hypertension. In patients with hypertension during a viral infection, blood pressure levels and cardiovascular risk should be monitored.

Conclusions. Constant monitoring of hemodynamic parameters, ECG and ECHO-CG – should be under the control according to the indications. The association of RAAS blockers (ACE inhibitors and ARBs) with an increased risk of infection in patients and worsening of COVID-19 has not been established so far, so patients with CVD should continue to take them. Patients who have survived coronavirus disease should be included in the medical rehabilitation programs for faster and better recovery of various systems, primarily respiratory and cardiovascular, as well as to improve quality of life and reduce the risk of disability.

References

  1. Gychka SG, Horoshchak AY, Nikolaienko SI, Dibrova VA, Dibrova YV, Kuzyk PV, Tovkai OA. Influenza A (H1N1) and COVID-19 features of adrenal gland damage. Clinical Endocrinology and Endocrine Surgery. 2020;2(70):79-85 (Ukrainian) https://doi.org/10.30978/CEES-2020-2-79
  2. Korostovtseva LS, Rotar OP, Konradi AO. COVID-19: what are the risks of patients with arterial hypertension? Arterial Hypertension. 2020;26(2):124-132 (Russian) https://doi.org/10.18705/1607-419X-2020-26-2-124-132
  3. Agabiti E, France MA, Uk AD, Germany FM, Kerins M, Germany RK et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension. Eur Heart J. 2018;39:3021-3104.
  4. Andreeva-Gateva PA, Mihaleva ID, Dimova II. Type 2 diabetes mellitus and cardiovascular risk; what the pharmacotherapy can change through the epigenetics. Postgrad Med. 2020 Mar;132(2):109-125. https://doi.org/10.1080/00325481.2019.1681215
  5. Batlle D, Wysocki J, Satchell K. Soluble angiotensinconverting enzyme 2: a potential approach for coronavirus infection therapy? Clin Sci. 2020;134(5):543-545. https://doi.org/10.1042/CS20200163
  6. Bendersky M, Sánchez R. Arterial hypertension in patients with type 2 diabetes mellitus. Rev Fac Cien Med Univ Nac Cordoba. 2013;70(2):83-90.
  7. Chernatska O, Demikhova N. Improvement of treatment in persons with arterial hypertension and type 2 diabetes mellitus. Georgian Med News. 2018;(284):47-51.
  8. Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. https://doi.org/10.1093/eurheartj/ehz486
  9. Cryer MJ, Horani T, DiPette DJ. Diabetes and Hypertension: A Comparative Review of Current Guidelines. J Clin Hypertens (Greenwich). 2016;18(2):95-100. https://doi.org/10.1111/jch.12638
  10. Danser AHJ, Epstein M, Batlle D. Renin-Angiotensin System Blockers and the COVID 19 Pandemic: at present there is no evidence to abandon renin-angiotensin system blockers. Hypertension. 2020;75(6):1382-1385. https://doi.org/10.1161/HYPERTENSIONAHA.120.15082
  11. Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation. 2005;111(20):2605-2610. https://doi.org/10.1161/CIRCULATIONAHA.104.510461
  12. Galvão RDV, Pereira CS, Freitas EGB, Lima DRART, Santos WAM, Souza DF, Nomelini QSS, Ferreira-Filho SR. Association between diabetes mellitus and central arterial stiffness in elderly patients with systemic arterial hypertension. Clin Exp Hypertens. 2020;42(8):728-732. https://doi.org/10.1080/10641963.2020.1783547
  13. Guo T, Fan Y, Chen M, Wu X, Zhang L, He T et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiology. 2020;5(7):811-818. https://doi.org/10.1001/jamacardio.2020.1017
  14. Gupta R, Ghosh A, Singh AK, Misra A. Clinical considerations for patients with diabetes in times of COVID-19 epidemic. Diabetes Metab Syndr. 2020;14(3):211-212. https://doi.org/10.1016/j.dsx.2020.03.002
  15. Gurwitz D. Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics. Drug Dev Res. 2020;81(5):537-540. https://doi.org/10.1002/ddr.21656
  16. Hartmann-Boyce J, Morris E, Goyder C et al. Managing diabetes during the COVID-19 pandemic. The Oxford CEBM COVID-19 Evidence Service. Available from: https://www.cebm.net/covid-19/managing-diabetes-during-the-covid-19-pandemic/
  17. Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020;14(4):395-403. https://doi.org/10.1016/j.dsx.2020.04.018
  18. Hussain A, Bhowmik B, do Vale Moreira NC. COVID-19 and diabetes: Knowledge in progress. Diabetes Res Clin Pract. 2020;162:108142. https://doi.org/10.1016/j.diabres.2020.108142
  19. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393
  20. Imai Y, Kuba K, Penninger JM. The discovery of angiotensin-converting enzyme 2 and its role in acute lung injury in mice. Exp Physiol. 2008;93(5):543-548. https://doi.org/10.1113/expphysiol.2007.040048
  21. Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature. 2005;436(7047):112-116. https://doi.org/10.1038/nature03712
  22. Knuuti J, Wijns W, Achenbach S, Agewall S, Barbato E, Bax JJ et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407-477. https://doi.org/10.1093/eurheartj/ehz425
  23. Kuster GM, Pfister O, Burkard T, Zhou Q, Twerenbold R, Haaf P et al. SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19? Eur Heart J. 2020;14(19):1801-1803. https://doi.org/10.1093/eurheartj/ehaa235
  24. Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L et al. Analysis of epidemiological and clinical features in older patients with corona virus disease 2019 (COVID-19) out of Wuhan. Clin Infect Dis. 2020;71(15):740-747. https://doi.org/10.1093/cid/ciaa242
  25. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. https://doi.org/10.1093/eurheartj/ehz455
  26. Mamedov MN. Arterial hypertension in diabetes mellitus: classical concepts and modern tendencies. Kardiologiia. 2013;53(1):87-90.
  27. Pashkovska NV, Pankiv VI, Pashkovska OV COVID-19 and diabetes mellitus: management of patients during the pandemic. Int Endocrin J. 2020;16(3):180-184. https://doi.org/10.22141/2224-0721.16.3.2020.205264
  28. Pavlou DI, Paschou SA, Anagnostis P, Spartalis M, Spartalis E, Vryonidou A, Tentolouris N, Siasos G. Hypertension in patients with type 2 diabetes mellitus: Targets and management. Maturitas. 2018;112:71-77. https://doi.org/10.1016/j.maturitas.2018.03.013
  29. Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34(5):575-584. https://doi.org/10.1016/j.cjca.2017.12.005
  30. Puig-Domingo M, Marazuela M, Giustina A. COVID-19 and endocrine diseases. A statement from the European Society of Endocrinology. Endocrine. 2020;68(1):2-5. https://doi.org/10.1007/s12020-020-02294-5
  31. Sommerstein R, Gräni C. Preventing a COVID-19 pandemic: ACE inhibitors as a potential risk factor for fatal COVID-19. Br Med J. 2020;368:m810. https://doi.org/10.1136/bmj.m810
  32. Sparks MA, South A, Welling P, Luther JM, Cohen J, Byrd JB et al. Sound Science before Quick Judgement Regarding RAS Blockade in COVID-19. Clin J Am Soc Nephrol. 2020;15(5):714-716. https://doi.org/10.2215/CJN.03530320
  33. Sternfeld B, Gabriel KP, Jiang SF, Whitaker KM, Jacobs DR, Quesenberry CP et al. Risk Estimates for Diabetes and Hypertension with Different Physical Activity Methods. Med Sci Sports Exerc. 2019;51(12):2498-2505. https://doi.org/10.1249/MSS.0000000000002083
  34. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75(6):1334-1357. https://doi.org/10.1161/HYPERTENSIONAHA.120.15026
  35. Zhang JJ, Dong X, Cao YY et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-1741. https://doi.org/10.1111/all.14238
  36. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
  37. Zou Z, Yan Y, Shu Y, Gao R, Sun Y, Li X et al. Angiotensinconverting enzyme 2 protects from lethal avian influenza A H5N1 infections. Nat Commun. 2014;5:3594. https://doi.org/10.1038/ncomms4594