Since the first outbreak of COVID-19 in China at the end of 2019, it has been established that older adults and patients with chronic diseases belong to the group with the highest risk of mortality due to the disease triggered by the spread of the virus. People with chronic pathologies such as high blood pressure, coronary heart disease, heart failure, cancer, chronic obstructive pulmonary disease (COPD), chronic kidney disease and diabetes, must take extreme care as the complications associated with COVID-19 disease can be fatal.
Among the chronic diseases with the highest prevalence in patients with COVID-19 is hypertension (approximately 17% [Yang J et al., 2020]) , a condition that affects 27.3% of the Chilean population (GES 2018 Guide ). In our country, close to 90% of the population consumes at least one medication on a regular basis, and almost 40% take 5 or more a day according to the 2016/2017 National Health Survey, among them the medications to control the hypertension.
Concerning the population of hypertensive patients, concerns have been raised within this risk group as to whether or not to continue with antihypertensive drugs, as scientific studies early indicated that these drugs were harmful in patients affected by the new coronavirus, increasing the susceptibility of contagion and aggravating the disease.
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The reason is that the virus triggers its respiratory infection by anchoring itself to a protein on the surface of the pulmonary alveoli [Ralph R et al., 2020], which is the same protein that is modified by the drugs that are prescribed for hypertension. This protein molecule corresponds to the “angiotensin-converting enzyme-2” (ACE-2) and allows the virus to enter the body.
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Faced with the controversy, a group of researchers from Spain, Italy and the United States carried out a review of more than 60 published scientific studies, concluding that there is no robust evidence to link the consumption of antihypertensive drugs and increased risk. of coronavirus infection or disease severity. The main author, Dr. Fabián Sanchis-Gomar, an academic at the University of Valencia (Spain) and Stanford University (USA), and his colleagues, highlight that “in accordance with current indications, we recommend hypertensive patients to continue taking your medicines without interruption. “
This comprehensive review was published by the scientific editorial Elsevier in the monthly issue of the medical journal “Mayo Clinic Proceedings” and investigated the effects on COVID-19 of drugs from the family of angiotensin-converting enzyme inhibitors ( ACE inhibitors) such as Losartan, Valsartan, Candesartan and Olmesartan, and those of the angiotensin receptor blocker (BRA) type such as Enalapril, Lisinopril and Captopril.
Experts conclude that “the drugs used decrease mortality in cardiac pathologies and, with respect to COVID-19, are a good option for patients at high risk of developing severe forms of the disease.” The hypothesis that these drugs provide a protective effect in hypertensive patients is supported by other research [South AM et al. , 2020].
Dr. Jorge E. Jalil, cardiologist specializing in Internal Medicine at the Pontificia Universidad Católica de Chile, and principal investigator at CENDHY (Center for New Drugs for Hypertension) agrees, noting that “there is no clinical evidence to suggest a modification of treatment with these drugs in hypertensive patients or in patients with heart failure, which is where drugs such as Losartan, Valsartan, Enalapril or Lisinopril, or the like are used, or the like. “
393/5000 The doctor emphasizes that “on the contrary, what clinical trials have shown with many patients and with rigor is that these patients prevent complications and decrease mortality. Different is the case of a patient with COVID-19 disease with complications and low blood pressure, a situation where all antihypertensive drugs must be discontinued. “
As Dr. Jalil indicates, the international consensus between doctors and the scientific community dedicated to fighting the COVID-19 pandemic, is clear about not abandoning medical treatments and respecting social isolation measures. decreed by health authorities, particularly risk groups such as patients with at least one chronic disease.
On the other hand, Dr. Sergio Lavandero, Director of the Advanced Center for Chronic Diseases (ACCDiS) shares what was sustained by Dr. Jalil, who also reported that according to two recent investigations (COVID-19 with different severity: a multicenter study of clinical characteristics / Renin-angiotensin system inhibitors improve the clinical results of patients with arterial hypertension COVID -19) show that virus positive patients with moderate symptoms use antihypertensive drugs such as Losartan, Valsartan, Candesartan, Olmesartan and Enalapril, Lisinopril and Captopril, with few patients with severe symptoms. In addition, it was reported that its administration improves the clinical results of hypertensive patients with COVID-19.
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