medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X2021-4-59-67medsovet-6091Research ArticleКАРДИОЛОГИЯCARDIOLOGYЛечение артериальной гипертензии в период пандемии COVID-19: вопросы блокады ренин-ангиотензин-альдостероновой системыTreatment of hypertension during the COVID-19 pandemic: questions about the blockade of the renin-angiotensin-aldosterone systemhttps://orcid.org/0000-0003-1510-9204КанорскийС. Г.KanorskiyS. G.

Канорский Сергей Григорьевич, доктор медицинских наук, профессор, заведующий кафедрой терапии № 2 факультета повышения квалификации и профессиональной переподготовки специалистов

350063, Краснодар, ул. Митрофана Седина, д. 4

Sergey G. Kanorskiy, Dr. Sci. (Med.), Professor, Head of Chair of Therapy № 2

4, Mitrofan Sedin St., Krasnodar, 350063

kanorskysg@mail.ruКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian Federation202118042021045967Copyright © Канорский С.Г., 20212021Канорский С.Г.Kanorskiy S.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6091

Артериальная гипертензия (АГ) является одним из наиболее часто сопутствующих заболеваний, ассоциирующихся с высоким риском смерти у госпитализированных пациентов с COVID-19. Больных с АГ привычно и согласно стандартам лечат с помощью ингибиторов ангиотензинпревращающего фермента (ИАПФ) или блокаторов рецепторов ангиотензина (БРА) II. ИАПФ или БРА II входят в состав фиксированных комбинаций антигипертензивных препаратов, рекомендованных больным с неосложненной АГ, а также при ее сочетании с различной сопутствующей патологией. В период пандемии COVID-19 появились предположения о потенциальной возможности негативного влияния препаратов этих классов на течение и исходы новой коронавирусной инфекции. Возникла необходимость быстрого ответа наиболее авторитетных медицинских организаций на вопрос о применении ИАПФ и БРА II в период пандемии COVID-19. Позиция экспертов вскоре была опубликована, несмотря на отсутствие доказательств, полученных в рандомизированных клинических исследованиях. Имелись ли основания для тревоги в отношении лечения ИАПФ и БРА II при COVID-19? Каковы взаимосвязи между ренин-ангиотензин-альдостероновой системой (РААС) и COVID-19? Появились ли новые данные клинических исследований, способные подтвердить либо опровергнуть представленную ранее позицию профессиональных обществ в отношении применения блокаторов РААС при COVID-19? Какова роль различия механизма действия ИАПФ и БРА II при COVID-19? Возможно ли, что блокаторы РААС окажутся полезными при лечении COVID-19? Изменится ли тактика фармакотерапии АГ в ближайшем будущем? В настоящей обзорной статье обсуждены современные представления по данной проблеме и сформулированы отражающие достигнутый уровень знаний ответы на перечисленные вопросы.

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.

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The authors declare that there are no conflicts of interest present.