Тактика антигипертензивной терапии в период пандемии COVID-19 - Журнал Терапевтический архив №9 Вопросы кардиологии 2021

Тактика антигипертензивной терапии в период пандемии COVID-19

Подзолков В.И., Брагина А.Е., Родионова Ю.Н., Брагина Г.И., Быкова Е.Е. Тактика антигипертензивной терапии в период пандемии COVID-19. Терапевтический архив. 2021; 93 (9): 1125–1131. DOI: 10.26442/00403660.2021.09.201015

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Podzolkov VI, Bragina AЕ, Rodionova YuN, Bragina GI, Bykova EE. Tactics of antihypertensive therapy during COVID-19 pandemic. Terapevticheskii Arkhiv (Ter. Arkh.). 2021; 93 (9): 1125–1131. DOI: 10.26442/00403660.2021.09.201015

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Аннотация

Данные зарубежных и российских исследований свидетельствуют о более высокой смертности пациентов с сопутствующими сердечно-сосудистыми заболеваниями вследствие новой коронавирусной инфекции COVID-19. Доказано, что артериальная гипертензия как один из значимых факторов риска развития сердечно-сосудистых заболеваний связана с более тяжелым прогнозом COVID-19.
В статье представлены результаты современных исследований и крупных метаанализов о необходимости и безопасности применения блокаторов ренин-ангиотензин-альдостероновой системы у пациентов с артериальной гипертензией и COVID-19. Приведены данные, свидетельствующие о том, что патогенетически оправданной рациональной комбинацией является сочетание ингибитора ангиотензинпревращающего фермента (ИАПФ) и тиазидоподобного диуретика. Данная комбинация препаратов реализует различные пути снижения артериального давления посредством уменьшения активности ренин-ангиотензин-альдостероновой системы, которое достигается применением ИАПФ, и натриуреза за счет диуретиков. В качестве примера рассматривается высокоэффективная фиксированная комбинация препаратов, характеризующаяся хорошей переносимостью, которая состоит из ИАПФ лизиноприла и тиазидоподобного диуретика индапамида пролонгированного действия. Авторами высказано мнение, что назначение фиксированного комбинированного препарата Диротон® Плюс (компания «Гедеон Рихтер») будет способствовать эффективному контролю уровня артериального давления и органопротекции в условиях повышения тромбогенного и прооксидативного потенциала, свойственного COVID-19 как в острой стадии, так и в рамках постковидного синдрома.

Ключевые слова: COVID-19, сердечно-сосудистые заболевания, артериальная гипертензия, ингибиторы ангиотензинпревращающего фермента, лизиноприл, диуретики, индапамид, ренин-ангиотензин-альдостероновая система.

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Results of foreign and Russian studies indicate a higher mortality rate of patients with concomitant cardiovascular diseases (CVD) due to the new coronavirus infection COVID-19. It has been proven that arterial hypertension, as one of the significant risk factors for the development of concomitant cardiovascular diseases, is associated with a more severe prognosis of COVID-19. This article presents the results of modern studies and large meta-analyzes of necessity and safety of the use of blockers of the renin-angiotensin-aldosterone system in patients with arterial hypertension and COVID-19. The data of studies show that an angiotensin-converting enzyme inhibitor (ACE inhibitor) and a thiazide-like diuretic is a pathogenetically rational combination. It realizes various ways of lowering blood pressure by reducing the activity of the renin-angiotensin-aldosterone system, which is achieved by using an ACE inhibitor, and natriuresis due to diuretics. As an example, a highly effective fixed combination of drugs is considered, characterized by good tolerance, which consists of an ACE inhibitor lisinopril and a thiazide-like diuretic indapamide of prolonged action. The authors expressed the opinion that the appointment of the fixed combination drug Diroton® Plus (Gedeon Richter) will contribute to effective control of blood pressure and organoprotection in conditions of increased thrombogenic and prooxidative potential, characteristic of COVID-19 both in the acute stage and within the post-COVID Syndrome.

Keywords: COVID-19, cardiovascular diseases, hypertension, angiotensin-converting enzyme inhibitors, lisinopril, diuretics, indapamide, renin-angiotensin-aldosterone system

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1. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;2:e16-e25. DOI:10.1016/j.jinf.2020.04.021
2. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81. DOI:10.1001/jama.2020.5394
3. Mehra MR, Desai SS, Kuy SR, et al. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. N Eng J Med. 2020;382:e102. DOI:10.1056/NEJMoa2007621
4. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI:10.1001/jama.2020.6775
5. Lippi G, Wong J, Henry BM. Hypertension in patients with coronavirus disease 2019 (COVID-19): a pooledanalysis. Pol Arch Intern Med. 2020;130(4):304-9. DOI:10.20452/pamw.15272
6. Zhou Y, Yang Q, Chi J, et al. Comorbidities and the risk of severe or fatal out comes associated with coronavirus disease 2019: A systematic review and meta-analysis. Int J Infect Dis. 2020;99:47-56. DOI:10.1016/j.ijid.2020.07.029
7. COVID-19. Clinical management. Living guidelines 25 January 2021. World Health Organization. Available at: https://app.magicapp.org/#/guideline/j1WBYn. Accessed: 09.06.2021.
8. Flacco ME, Acuti Martellucci C, Bravi F, et al. Treatment with ACE inhibitors or ARBs and risk of severe/lethal COVID-19: a meta-analysis. Heart. 2020;106:1519-24.
9. Baral R, Tsampasian V, Debski M, et al. Association Between Renin-Angiotensin-Aldosterone System Inhibitors and Clinical Outcomes in Patients With COVID-19: A Systematic Review and Meta-analysis. JAMA Network. 2021;4(3):e213594. DOI:10.1001/jamanetworkopen.2021.3594
10. Liu PP, Blet A, Smyth D, et al. The Science Underlying COVID-19 Implications for the Cardiovascular System. Circulation. 2020;142(1):68-78. DOI:10.1161/CIRCULATIONAHA.120.047549
11. Yang G, Tan Z, Zhou L, et al. Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors Usage is Associated with Improved Inflammatory Status and Clinical Outcomes in COVID-19 Patients With Hypertension. MedRxiv. 2020. DOI:10.1101/2020.03.31.20038935
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14. Arterial hypertension in adults. Clinical recommendations. Available at: http://cr.rosminzdrav.ru/#!/recomend/687. Accessed: 24.08.2021 (in Russian).
15. Leonova MV, Steinberg LL, Belousov YB, et al. Results of pharmacoepidemiologic study of arterial hypertension PIFAGOR IV: physicians compliance. Russian Journal of Cardiology. 2015;1:59-66 (in Russian). DOI:10.15829/1560-4071-2015-1-59-66
16. Rotar OP, Libis RA, Isaeva EN, et al. Metabolic syndrome prevalence in Russian cities. Russian Journal of Cardiology. 2012;2:55-62 (in Russian). DOI:10.15829/1560-4071-2012-2-55-62
17. Burniera M, Bakris G, Williams B. Redefining diuretics use in hypertension: why sel ect a thiazide-like diuretic? J Hypertens. 2019;37:1574-86. DOI:10.1097/HJH.0000000000002088
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19. Podzolkov VI, Tarzimanova AI, Georgadze ZO. Modern Principles of Treatment of Uncontrolled Hypertension. Rational Pharmacotherapy in Cardiology. 2019;15(5):736-41 (in Russian). DOI:10.20996/1819-6446-2019-15-5-736-741
20. Qi H, Liu Z, Cao H, et al. Comparative efficacy of antihypertensive agents in salt-sensitive hypertensive patients: a network meta-analysis. Am J Hypertens. 2018;31:835-46. DOI:10.1093/ajh/hpy027
21. Rogowski O, Steinvil A, Berliner S, et al. Elevated resting heart rate is associated with the metabolic syndrome. Cardiovasc Diabet. 2009;8:55. DOI:10.1186/1475-2840-8-55
22. Palatini P, Dorigatti F, Zaetta V, et al. Heart rate as a predictor of development of sustained hypertension in subjects screened for stage 1 hypertension: the HARVEST Study. J Hypertens. 2006;24(9):1873-80. DOI:10.1097/01.hjh.0000242413.96277.5b
23. Podzolkov VI, Bragina AE, Tarzimanova AI, et al. Post-COVID Syndrome and Tachycardia: Theoretical Base and Treatment Experience. Rational Pharmacotherapy in Cardiology. 2021;17(2):256-62 (in Russian). DOI:10.20996/1819-6446-2021-04-08
24. WHO. Emergency use ICD codes for COVID-19 disease outbreak. Available at: https://www.who.int/standards/classifications/classification-of-diseases/emergency-use-icd-codes-for.... Accessed: 24.08.2021.
25. Nalbandian A, Sehgal K, Gupta A, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601-15. DOI:10.1038/s41591-021-01283-z
26. Makani H, Bangalore S, Romero J, et al. Peripheral edema associated with calcium channel blockers: incidence and withdrawal rate – a meta-analysis of randomized trials. J Hypertens. 2011;29(7):1270-80. DOI:10.1097/HJH.0b013e3283472643
27. Cavalieri L, Cremonesi G. Delapril plus Indapamide: A Review of the Combination in the Treatment of Hypertension. Clin Drug Invest. 2007;27(6):367-80. DOI:10.2165/00044011-200727060-00001
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Авторы

В.И. Подзолков, А.Е. Брагина*, Ю.Н. Родионова, Г.И. Брагина, Е.Е. Быкова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*anna.bragina@mail.ru

________________________________________________

Valery I. Podzolkov, Anna Е. Bragina*, Yulia N. Rodionova, Galina I. Bragina, Ekaterina E. Bykova

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*anna.bragina@mail.ru

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