{"id":7086,"date":"2020-09-20T19:55:41","date_gmt":"2020-09-20T22:55:41","guid":{"rendered":"https:\/\/cendhy.cl\/most-recent-evidence-on-the-use-of-ace-inhibitors-and-arbs-on-covid-19-patients\/"},"modified":"2020-09-20T19:55:41","modified_gmt":"2020-09-20T22:55:41","slug":"most-recent-evidence-on-the-use-of-ace-inhibitors-and-arbs-on-covid-19-patients","status":"publish","type":"post","link":"https:\/\/cendhy.cl\/en\/most-recent-evidence-on-the-use-of-ace-inhibitors-and-arbs-on-covid-19-patients\/","title":{"rendered":"Most recent evidence on the use of ACE Inhibitors and ARBs on COVID-19 patients"},"content":{"rendered":"\n

On the recent study titled “Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients<\/em>“<\/a><\/strong>, published on August, 24th, on Current Atherosclerosis Reports, CENDHY principal researchers Dra. Mar\u00eda Paz Ocaranza and Dr. Jorge E. Jalil<\/a>, in collaboration with researchers Jackeline Moya and Mar\u00eda Alejandra Lonis from the Divisi\u00f3n de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, have prepared the following material:<\/p><\/p>\n\n

<\/p>\n\n

Mar\u00eda Paz Ocaranza, Jackeline Moya, Mar\u00eda Alejandra Lonis, Jorge Jalil<\/strong><\/p>\n\n

Divisi\u00f3n de Enfermedades Cardivasculares, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile<\/strong><\/p>\n\n

Center of New Drugs for Hypertension (CENDHY)<\/strong><\/p>\n\n

Universidad de Chile & Pontificia Universidad Cat\u00f3lica de Chile\u00a0<\/strong><\/p>\n\n

<\/p>\n\n

Gran controversia ha surgido respecto al uso de medicamentos antihipertensivos en pacientes con COVID-19. Estos cuestionamientos surgieron de un comentario publicado en Lancet Respiratory Medicine<\/em> que plante\u00f3 la hip\u00f3tesis de que pacientes con hipertensi\u00f3n arterial pudieran estar expuestos a un mayor riesgo de mortalidad por COVID-19, debido probablemente a mayor susceptibilidad gen\u00e9tica y\/o por el uso de ciertos f\u00e1rmacos antihipertensivos bloqueadores del sistema renina-angiotensina como inhibidores de la enzima convertidora de angiotensina I (IECA)<\/strong> y antagonistas de receptor de angiotensina II tipo 1 (ARAII)<\/strong>.1\u00a0<\/sup><\/p>\n\n

Es conocido que la enzima convertidora de angiotensina I hom\u00f3loga\u00a0 (ECA2) es el receptor para el virus SARS-CoV-2, lo cual le permite al virus entrar en la c\u00e9lula hu\u00e9sped e infectarla2<\/sup>. Al estar la ECA2 presente no solo en el sistema respiratorio, sino que tambi\u00e9n en el sistema cardiovascular, entre otros,\u00a0 su interacci\u00f3n con este virus causa un gran da\u00f1o respiratorio, cardiovascular y sist\u00e9mico 3<\/sup>.\u00a0<\/p>\n\n

En modelos precl\u00ednicos, se ha observado que los f\u00e1rmacos ARAII e IECA aumentan la expresi\u00f3n y\/o actividad de la ECA2, por lo cual se ha se ha especulado que el uso de los IECA y ARAII potencialmente aumentar\u00edan el riesgo a COVID-19<\/strong>2<\/sup>.<\/p>\n\n

Los IECA y ARAII son medicamentos ampliamente usados ya que son f\u00e1rmacos de elecci\u00f3n inicial para el tratamiento de la hipertensi\u00f3n arterial. Sin embargo, tambi\u00e9n son usados en pacientes con infarto al miocardio, insuficiencia card\u00edaca, enfermedad cerebro-vascular y enfermedad renal cr\u00f3nica4<\/sup>. Por tanto, surge la necesidad de disponer de estudios cl\u00ednicos sistem\u00e1ticos y robustos que abarquen un n\u00famero significativo de pacientes en tratamiento con estos antihipertensivos y analizar su relaci\u00f3n con mayor riesgo a COVID-19<\/strong>. Al respecto, existen varios estudios cl\u00ednicos disponibles, pero su principal limitaci\u00f3n es su bajo tama\u00f1o muestral<\/strong>5,6<\/sup>.\u00a0<\/p>\n\n

Recientemente, Baral et al<\/em>. (2020)7<\/sup>\u00a0 han publicado una revisi\u00f3n sistem\u00e1tica y el meta-an\u00e1lisis m\u00e1s grande y detallado a la fecha en relaci\u00f3n al riesgo asociado al uso de IECA\/ARAII en pacientes con COVID-19<\/strong>.\u00a0\u00a0<\/p>\n\n

Se incluyeron 20 estudios realizados principalmente en China en un total de 28.872 pacientes con COVID-19 (la mayor\u00eda fueron estudios retrospectivos). Los criterios de inclusi\u00f3n fueron pacientes \u2265 18 a\u00f1os con infecci\u00f3n por COVID19 positivos por PCR, con y sin tratamiento con IECA\/ARAII. Se evalu\u00f3 mortalidad y eventos cr\u00edticos (definidos como\u00a0 admisi\u00f3n a UTI o necesidad de ventilaci\u00f3n mec\u00e1nica). Se excluyeron pacientes con sintomatolog\u00eda de COVID-19 sin test de PCR confirmatorio. La calidad de los estudios seleccionados se evalu\u00f3 con la escala de Newcastle-Ottawa de nueve puntos, que eval\u00faa la calidad de los casos y controles. En base a esto, se incluyeron en el meta-an\u00e1lisis 19 estudios, de los cuales muchos de ellos incluyeron datos de mortalidad para un subgrupo de pacientes hipertensos, adem\u00e1s de pacientes con patolog\u00eda cardiovascular y pacientes hipertensos con diabetes.<\/p>\n\n

Los resultados mostraron que un 27.9% (8041\/28872) de los pacientes estaba recibiendo IECA\/ARAII. De los pacientes hipertensos con COVID 19 un 32.3% de ellos (3140\/9706) estaba recibiendo IECA y ARAII. Del total de pacientes incluidos, aquellos que recibieron IECA \/ARAII mostraron una tendencia a un menor riesgo de muerte y\/o eventos cr\u00edticos<\/strong> (OR 0,671; IC: 0,435 a 1,034; p \u2009= 0,071). De manera importante, en pacientes hipertensos bajo tratamiento con IECA\/ARAII se observ\u00f3 un menor riesgo de mortalidad y\/o de eventos cr\u00edticos de 33%<\/strong> (OR 0,670, IC 0,495 a 0,908, p = 0,010).\u00a0 En los pacientes hipertensos que estaban recibiendo IECA\/ARAII versus<\/em> los que estaban recibiendo otros antihipertensivos se observ\u00f3 un menor riesgo de mortalidad y\/o de eventos cr\u00edticos de 33,6%<\/strong> (OR 0,664, IC 0,458 a 0,964, p = 0,031). No se encontraron diferencias de mortalidad\/eventos cr\u00edticos en pacientes que usaron IECA versus los que usaron ARAII.\u00a0<\/p>\n\n

Las principales limitantes de este estudio<\/strong> fueron haber incluido en el meta-an\u00e1lisis estudios con pacientes de diferentes patolog\u00edas cardiovasculares y, por tanto, con diferente severidad, adem\u00e1s de no incluir un grupo control<\/strong>.\u00a0<\/p>\n\n

En conclusi\u00f3n, los resultados de este estudio muestran que el uso de IECA\/ARAII no aumenta la gravedad y mortalidad de pacientes con COVID-19<\/strong>. En particular, los pacientes hipertensos\u00a0 bajo tratamiento con IECA\/ARAII\u00a0 tienen menor riesgo de presentar la enfermedad COVID-19 grave y letal<\/strong>, y por lo tanto, debieran mantener el tratamiento salvo contraindicaciones espec\u00edficas durante la infecci\u00f3n viral como hipotensi\u00f3n, shock o falla renal aguda.<\/strong><\/p>\n\n

<\/p>\n\n

Referencias<\/strong><\/p>\n\n

1. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?<\/em>. Lancet Respir Med. 2020;8:e21<\/p>\n\n

2. Feng Y, Ling Y, Bai T, et al. COVID-19 with Different Severities: A Multicenter Study of Clinical Features<\/em>. Am J Respir Crit Care Med. 2020;201:1380.<\/p>\n\n

3. Wang Y, Roever L, Tse G, Liu T. 2019-novel coronavirus-related acute cardiac injury cannot be ignored<\/em>. Curr Atheroscler Rep. 2020;22:14.<\/p>\n\n

4. Kow CS, Zaidi STR, Hasan SS. Cardiovascular disease and use of renin-angiotensin system inhibitors in COVID-19<\/em>. Am J Cardiovasc Drugs. 2020;20:217.<\/p>\n\n

5. Barochiner J, Mart\u00ednez R. Use of inhibitors of the renin-angiotensin system in hypertensive patients and COVID-19 severity: A systematic review and meta-analysis<\/em>. J Clin Pharm Ther. 2020;10.1111\/jcpt.13246. <\/p>\n\n

6. Zhang X, Yu J, Pan LY, Jiang HY. ACEI\/ARB use and risk of infection or severity or mortality of COVID-19: A systematic review and meta-analysis<\/em>. Pharmacol Res. 2020;158:104927. <\/p>\n\n

7. Baral R, White M, Vassiliou VS. Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients<\/em>. Curr Atheroscler Rep. 2020;22:61.<\/p>\n","protected":false},"excerpt":{"rendered":"

On the recent study titled “Effect of Renin-Angiotensin-Aldosterone System Inhibitors in Patients with COVID-19: a Systematic Review and Meta-analysis of 28,872 Patients“, published on August, 24th, on Current Atherosclerosis Reports, […]<\/p>\n","protected":false},"author":2,"featured_media":7056,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[21],"tags":[],"class_list":["post-7086","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-press"],"yoast_head":"\nMost recent evidence on the uso on antihypertensive medication and COVID-19<\/title>\n<meta name=\"description\" content=\"The ir controversy on the use on medication for hypertension on COVID-19 patientes. 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