Korona Virus u Srbiji i Antihipertenzivi 2020 (COVID-19) - Ordinacija "Dr Milićević" Novi Sad

Želim da obavestim pacijente koji uzimaju antihipertenzive tipa ace inhibitora:

Zorkaptil

Katopil

Ampril

Tritace

Prilindu

Preksanil

Prenesu

Hemokvin

Itd.

Da prethodno navedeni lekovi ne povećavaju rizik od infekcije Korona Virusom – Covid-19.

U nastavku je zvaničan email eksperata Evropskog Uduruzenja Kardiologa (ESC)

Stav ESC eksperata o primeni ACE inhibitora/ARB tokom COVID-19 pandemije

Nema naučnih i kliničkih dokaza da primena ACEi/ARB povećava rizik od COVID-19 infekcije. Zbog toga ne treba obustavljati redovnu antihipertenzivnu terapiju, stav je ESC eksperata.

Među lekarima i u opštoj javnosti brzo se proširila vest da primena ACE inhibitora i blokatora angiotenzinskih receptora (ARB) povećava rizik od infekcije novim koronavirusom, a da kod inficiranih dodatno komplikuje kliničku sliku. Zbog toga su pojedini lekari isključivali ove efikasne lekove iz terapije, dok su pacijenti sami obustavljali antihipertenzivnu terapiju ukoliko je sadržala neki ACEi/ARB. Na ovo su morali da odreaguju eksperti Evropskog udruženja kardiologa (ESC).

Dosadašnje analize osoba obolelih i umrlih od COVID-19 ukazuju na to da se radi o starijim osobama koje često imaju udružena hronična oboljenja. Od komorbiditeta svojom učestalošću su se izdvojili arterijska hipertenzija, dijabetes i cerebrovaskularna oboljenja. Kako su lekovi koji inhibiraju RAAS među najefikasnijim i najpropisivanijim lekovima za terapiju hipertenzije, logično je pretpostaviti da su osobe preminule usled COVID-19, sa češćom pojavom hipertenzije – češće bili na ACEi/ARB terapiji. Bez ikakve uzorčno-posledične veze, kreirana je konekcija ACEi/ARB sa većim mortalitetom kod SARS-CoV-2 infekcije, koja se širila društvenim mrežama i izazvala paniku među lekarima i kardiovaskularnim bolesnicima.

Glavni argument koji se mogao naći jeste mehanizam kojim deluju svi koronavirusi (SARS, MERS, pa i novi koronavirus). Naime, ovi virusi se vezuju za svoj receptor na površini ćelija u koje planiraju da uđu (prevashodno za ćelije respiratornog, potom i digestivnog trakta). Receptor za koronaviruse je ACE2 enzim. S druge strane, poznato je da primena ACEi/ARB povećava ekspresiju ovog receptora na ćelijama.

Međutim, postoje i potpuno drugačiji podaci. U eksperimentalnim studijama je čak uočeno da ACEi/ARB mogu imati protektivan efekat od pojave ozbiljnih plućnih komplikacija kod infekcije COVID-19. Ali ovo nije još uvek potvrđeno kod ljudi.

Ipak, stav ESC eksperata po ovom pitanju je jasan: lekarima i pacijentima se snažno savetuje da nastave sa uobičajenom antihipertenzivnom terapijom, jer ne postoje klinički ili naučni dokazi koji bi podržali obustavljanje ACEi/ARB terapije kod postojanja COVID-19 infekcije.

Izvor:

https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang

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Korona Virus u Srbiji i Antihipertenzivi 2020 (COVID-19) – Ordinacija “Dr Milićević” Novi Sad

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