Tactics of antihypertensive therapy during COVID-19 pandemic

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Abstract

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.

About the authors

Valery I. Podzolkov

Sechenov First Moscow State Medical University (Sechenov University)

Email: anna.bragina@mail.ru
ORCID iD: 0000-0002-0758-5609

д-р мед. наук, проф., зав. каф. факультетской терапии №2 лечебного фак-та, дир. факультетской терапевтической клиники

Russian Federation, Moscow

Anna Е. Bragina

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: anna.bragina@mail.ru
ORCID iD: 0000-0002-2699-1610

д-р мед. наук, проф. каф. факультетской терапии №2 лечебного фак-та

Russian Federation, Moscow

Yulia N. Rodionova

Sechenov First Moscow State Medical University (Sechenov University)

Email: anna.bragina@mail.ru
ORCID iD: 0000-0003-3461-6703

канд. мед. наук, доц. каф. факультетской терапии №2 лечебного фак-та

Russian Federation, Moscow

Galina I. Bragina

Sechenov First Moscow State Medical University (Sechenov University)

Email: anna.bragina@mail.ru
ORCID iD: 0000-0002-0558-7096

канд. мед. наук, доц. каф. поликлинической терапии

Russian Federation, Moscow

Ekaterina E. Bykova

Sechenov First Moscow State Medical University (Sechenov University)

Email: anna.bragina@mail.ru
ORCID iD: 0000-0002-4830-624X

аспирант каф. факультетской терапии №2 лечебного факт-та

Russian Federation, Moscow

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2. Fig. 1. Cochrane database meta-analysis data: 10 studies, 2075 people, baseline BP 161/98 mm Hg, mean follow-up 10 weeks (adapted from [32]).

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3. Fig. 2. Increasing the number of antihypertensive drugs decreases adherence to therapy (adapted from [41]).

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4. Fig. 3. Pharmacokinetics of components in a fixed combination of lisinopril with indapamide.

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