Scientific evidence suggests hypertensive patients maintain drug treatment during COVID-19 pandemic
Since the first outbreak of COVID-19 in China at the end of 2019 it was established that older adults and patients with chronic diseases belong to the group with the highest risk of mortality from the disease triggered by 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, should be extremely careful as complications associated with COVID-19 disease can be fatal.
Chronic diseases with the highest prevalence in COVID-19 patients include high blood pressure (approximately 17% [Yang J et al., 2020]), a condition affecting 27,3% of Chile's population (GES Guide 2018). In our country, about 90% of the population regularly consumes one drug, and almost 40% take 5 or more a day according to the 2016/2017 National Health Survey, these include medicines to control hypertension.
With regard to the hypertensive patient population, within this risk group, concerns have arisen whether or not to continue with antihypertensive drugs, scientific studies indicated early that these drugs were harmful in patients affected by the new coronavirus, increasing the susceptibility of contagion and aggravating the disease.
The reason is that the virus triggers its respiratory infection by anchoring to a protein on the surface of the pulmonary alveoli [Ralph R and cabbage., 2020], which is the same protein that is modified by drugs prescribed for hypertension. This protein molecule corresponds to the "angiotensin-2 converting enzyme" (ECA-2) and allows the virus to enter the body.
Faced with controversy, a group of researchers from Spain, Italy and the United States conducted a review of more than 60 scientific studies published, concluding that there is no robust evidence to link the use of antihypertensive drugs and an increased risk of coronavirus infection or disease severity. The lead author, Dr. Fabian Sanchis-Gomar, Academics from the University of Valencia (Spain) and Stanford University (USA), and his colleagues, emphasize that "in corcondancia with current indications, we recommend hypertensive patients to continue taking their medicines without interruption".
This comprehensive review was published by the scientific publisher Elsevier in the monthly edition of the medical journal "Mayo Clinic Proceedings" and investigated the effects on COVID-19 of drugs in the angiotensin-converting enzyme inhibitors family (Acei) like Losartan, Valsartan, Candesartan and Olmesartan, and those of type angiotensin receptor blockers (Bra) like Enalapril, Lisinopril and Captopril.
Experts conclude that "the drugs used decrease mortality in heart disease 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 and cabbage., 2020].
Dr. Jorge E. Jalil, cardiologist specializing in Internal Medicine of the Pontifical Catholic University of 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 patients with heart failure, which is where mostly drugs like Losartan are used, Valsartan, Enalapril or Lisinopril, or similar".
The doctor emphasizes that "on the contrary, what clinical trials with many patients have shown and with strictness 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, situation where all antihypertensive drugs should be discontinued".
As Dr.. Jalil, international consensus among doctors and the scientific community aimed at combating the COVID-19 pandemic, is clear that it does not abandon medical treatments and respect the social isolation measures decreed by health authorities, particularly at-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 Dr.. Jalil, who also reported, that according to two recent research (COVID-19 with different gravity: a multicenter study of clinical characteristics / Renin-angiotensin system inhibitors improve clinical outcomes in patients with COVID-19 high blood pressure) test patients positive for the virus with moderate symptomatology use antihypertensives such as Losartan, Valsartan, Candesartan, Olmesartan and Enalapril, Lisinopril and Captopril, few patients with severe symptomatology. In addition, reported that its administration improves the clinical outcomes of hypertensive patients with COVID-19.