scholarly journals Treatment of hypertension during the COVID-19 pandemic: questions about the blockade of the renin-angiotensin-aldosterone system

2021 ◽  
pp. 59-67
Author(s):  
S. G. Kanorskiy
Keyword(s):  
Clinical Trials ◽  
Ace Inhibitors ◽  
Randomized Clinical Trials ◽  
Enzyme Inhibitors ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin Aldosterone System ◽  
Uncomplicated Hypertension ◽  
Renin Angiotensin ◽  
Risk Of Death

Arterial hypertension was one of the most common comorbidities associated with a high risk of death in hospitalized patients with COVID-19. Patients with hypertension are routinely and according to standards treated with angiotensinconverting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARB) II. ACE inhibitors or ARB II are included in fixed combinations of antihypertensive drugs recommended for patients with uncomplicated hypertension, as well as when combined with various comorbidities. During the COVID-19 pandemic, there were suggestions about the potential for a negative effect of drugs of these classes on the course and outcomes of a new coronavirus infection. There was a need for a quick response from the most reputable medical organizations to the question of the use of ACE inhibitors and ARB II during the COVID-19 pandemic. The expert position was soon published despite the lack of evidence from randomized clinical trials. Was there any reason for concern about the treatment of ACE inhibitors and ARB II for COVID-19? What are the relationships between the renin-angiotensin-aldosterone system (RAAS) and COVID-19? Is there any new data from clinical trials that can confirm or deny the previously presented position of professional societies regarding the use of RAAS blockers in COVID-19? What is the role of the difference in the mechanism of action of an ACE inhibitor and ARB II in COVID-19? Is it possible that RAAS blockers will be helpful in treating COVID-19? Will the tactics of hypertension pharmacotherapy change in the near future? In this review article, modern concepts on this problem are discussed and answers to the listed questions reflecting the achieved level of knowledge are formulated.

scholarly journals Cardiorenal disease development under chronic renin–angiotensin–aldosterone system suppression

2012 ◽  
Vol 13 (1) ◽  
pp. 217-219 ◽  
Author(s):  
Pantelis A Sarafidis ◽  
Luis M Ruilope
Keyword(s):  
Arterial Hypertension ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Disease Development ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Receptor Blockers

Drugs suppressing the renin-angiotensin-aldosterone system (RAAS) are now widely used to treat patients all along the cardiorenal continuum. It supposes that many patients, in particular those with arterial hypertension are treated with converting-enzyme inhibitors and angiotensin receptor blockers for years during which the development and prograssion of cardiorenal disease can be observed. The meaning of this progression in the presence of RAAS suppression requires to be clarified and to be treated in order to diminish the velocity of progression of cardiorenal disease.

scholarly journals Expert consensus. Effect of antihypertensive therapy on cognitive functions

2021 ◽  
Vol 18 (1) ◽  
pp. 5-12
Author(s):  
Olga D. Ostroumova ◽  
Vladimir A. Parfenov ◽  
Tatiana M. Ostroumova ◽  
Nikolay N. Yakhno ◽  
Irina E. Chazova ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Antihypertensive Therapy ◽  
Randomized Clinical Trials ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Drug Prevention ◽  
Expert Consensus ◽  
Alzheimers Disease ◽  
People With Dementia ◽  
Receptor Blockers

Arterial hypertension (AH) is the major modifiable risk factor for cognitive impairment (CI), including dementia, CI in cerebrovascular and neurodegenerative diseases, including Alzheimers disease. By 2050, the number of people with dementia will approximately 3 times increase due to the aging population and limited opportunities for drug prevention and treatment of severe CI. In connection with the above, it seems necessary to create an expert consensus, which would summarize the evidence-based medicine data available to date on the effect of antihypertensive therapy (AHT) on cognitive function (CF). In the expert consensus, the data of prospective randomized clinical trials, observational and population studies, meta-analyzes on the effect of AHT on the risk of dementia and CI progression, including certain CF, were summarized and analyzed. The consensus considers the effect of antihypertensive drugs (AHD) on various cognitive domains. Literature data give evidence that AHT reduces the risk for dementia, including vascular dementia, reduces the risk of for dementia in Alzheimers disease, as well as reduces the risk and can prevent the progression of non-dementia CI. The effect of AHT on various CF has been little studied. Most meta-analyzes did not reveal the benefits of any class of AHD; however, one study demonstrated the advantage of angiotensin receptor blockers, while another study diuretics. The consensus emphasizes that, given the high incidence of AH in the general population, AHT may be one of the most effective ways to prevent CI or delay CI progression. The effect of different classes of AHD on CF requires further study. It is necessary to conduct a larger number of well-designed randomized clinical trials that would assess the state of executive functions in patients with AH.

scholarly journals Cardiovascular Damage in COVID-19: Therapeutic Approaches Targeting the Renin-Angiotensin-Aldosterone System

2020 ◽  
Vol 21 (18) ◽  
pp. 6471 ◽  
Author(s):  
Jairo Lumpuy-Castillo ◽  
Ana Lorenzo-Almorós ◽  
Ana María Pello-Lázaro ◽  
Carlos Sánchez-Ferrer ◽  
Jesús Egido ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Dependent Manner ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Viral Propagation ◽  
Cardiovascular Damage ◽  
Receptor Blockers

Coronavirus disease 2019 (COVID-19) is usually more severe and associated with worst outcomes in individuals with pre-existing cardiovascular pathologies, including hypertension or atherothrombosis. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can differentially infect multiple tissues (i.e., lung, vessel, heart, liver) in different stages of disease, and in an age- and sex-dependent manner. In particular, cardiovascular (CV) cells (e.g., endothelial cells, cardiomyocytes) could be directly infected and indirectly disturbed by systemic alterations, leading to hyperinflammatory, apoptotic, thrombotic, and vasoconstrictive responses. Until now, hundreds of clinical trials are testing antivirals and immunomodulators to decrease SARS-CoV-2 infection or related systemic anomalies. However, new therapies targeting the CV system might reduce the severity and lethality of disease. In this line, activation of the non-canonical pathway of the renin-angiotensin-aldosterone system (RAAS) could improve CV homeostasis under COVID-19. In particular, treatments with angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) may help to reduce hyperinflammation and viral propagation, while infusion of soluble ACE2 may trap plasma viral particles and increase cardioprotective Ang-(1–9) and Ang-(1–7) peptides. The association of specific ACE2 polymorphisms with increased susceptibility of infection and related CV pathologies suggests potential genetic therapies. Moreover, specific agonists of Ang-(1–7) receptor could counter-regulate the hypertensive, hyperinflammatory, and hypercoagulable responses. Interestingly, sex hormones could also regulate all these RAAS components. Therefore, while waiting for an efficient vaccine, we suggest further investigations on the non-canonical RAAS pathway to reduce cardiovascular damage and mortality in COVID-19 patients.

scholarly journals Clinical Outcome of Renin-Angiotensin-Aldosterone System Blockers in Treatment of Hypertensive Patients with COVID-19:  A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Andrea Laurentius ◽  
Brian Mendel ◽  
Radityo Prakoso
Keyword(s):  
Clinical Outcome ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Heart Association ◽  
Hospital Treatment ◽  
Converting Enzyme Inhibitors ◽  
Renin Angiotensin Aldosterone System ◽  
Hypertensive Patients ◽  
Renin Angiotensin

Abstract Background: Novel coronavirus disease 2019 has been stated as global disease pandemic due to its rapid spread worldwide. Up to 30% of Coronavirus Disease 2019 patients with hypertension are more susceptible to death. Angiotensin converting enzyme inhibitors and angiotensin receptor blockers has been used as primary line of medication for hypertension; nonetheless, conflicting data arises as numerous studies showed contradictory results. Methods: Aiming to show clinical outcome of renin-angiotensin-aldosterone system blockers in hospital treatment of hypertensive patients with Coronavirus Disease 2019, systematically searched literatures through eight databases were intensively appraised using Strengthening the Reporting of Observational Studies in Epidemiology checklists for cohort studies. Results: Six encompassed studies in this meta-review showed in-hospital hypertensive Coronavirus Disease 2019 patients receiving antihypertensive drugs were associated to overall risk reduction of all-cause mortalities (hazard ratio = 0.54, confidence interval 95% = 0.33 – 0.86). Conclusion: Therefore, the results support recommendation by American Heart Association not to discontinue antihypertension regimens in Coronavirus Disease 2019 patients with hypertension. Further researches are required as that majority of the studies are originated from Asian countries along with comprehensive standardization of baseline characteristics.

scholarly journals Clinical outcome of renin-angiotensin-aldosterone system blockers in treatment of hypertensive patients with COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Andrea Laurentius ◽  
Brian Mendel ◽  
Radityo Prakoso
Keyword(s):  
Clinical Outcome ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Receptor Blockers ◽  
Hospital Treatment ◽  
Main Body ◽  
Converting Enzyme ◽  
Angiotensin Receptor ◽  
Renin Angiotensin Aldosterone System ◽  
Hypertensive Patients ◽  
Renin Angiotensin

Abstract Background Novel coronavirus disease 2019 has been stated as global disease pandemic due to its rapid spread worldwide. Up to 30% of coronavirus disease 2019 patients with hypertension are more susceptible to death. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been used as primary line of medication for hypertension; nonetheless, conflicting data arises as numerous studies showed contradictory results. Main body Aiming to show clinical outcome of renin-angiotensin-aldosterone system blockers in hospital treatment of hypertensive patients with coronavirus disease 2019, systematically searched literatures through five databases were intensively appraised using The Grading of Recommendations Assessment, Development and Evaluation checklists for cohort studies. Based on the result evaluation from retrospective cohorts involving more than 15,000 patients across Asia and other regions of the world, ten encompassed studies divided into two subgroups in this meta-review showed that in-hospital hypertensive coronavirus disease 2019 patients receiving antihypertensive drugs were associated with overall risk reduction in subgroup 1 (hazard ratio, HR = 0.96, 95% CI = 0.82–1.12) to no outcome association of all-cause mortalities in subgroup 2 (HR = 0.26, 95% CI = 0.19–0.34). All appraised studies in synergism showed that mortality outcomes were not augmented with the employment of either ACE inhibitor or ARB in subjects. Conclusion Therefore, the results support recommendation by the American Heart Association not to discontinue angiotensin-converting enzyme inhibitor or angiotensin receptor blocker regimens in coronavirus disease 2019 patients with hypertension.

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