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Лечение артериальной гипертензии в период пандемии COVID-19: вопросы блокады ренин-ангиотензин-альдостероновой системы

https://doi.org/10.21518/2079-701X2021-4-59-67

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Аннотация

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.

Об авторе

С. Г. Канорский
Кубанский государственный медицинский университет
Россия

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



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Для цитирования:


Канорский С.Г. Лечение артериальной гипертензии в период пандемии COVID-19: вопросы блокады ренин-ангиотензин-альдостероновой системы. Медицинский Совет. 2021;(4):59-67. https://doi.org/10.21518/2079-701X2021-4-59-67

For citation:


Kanorskiy S.G. Treatment of hypertension during the COVID-19 pandemic: questions about the blockade of the renin-angiotensin-aldosterone system. Meditsinskiy sovet = Medical Council. 2021;(4):59-67. (In Russ.) https://doi.org/10.21518/2079-701X2021-4-59-67

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ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)