COVID-19 e hipertensión arterial: ¿existe evidencia para suspender antagonistas del sistema renina-angiotensina-aldosterona?

Palabras clave: COVID-19, enzima convertidora de angiotensina, inhibidores de la enzima convertidora de angiotensina, sistema renina-angiotensina-aldosterona

Resumen

El nuevo coronavirus SARS-CoV-2, causante de la enfermedad COVID-19, presenta una alta mortalidad en pacientes con enferme- dades cardiovasculares, diabetes e hipertensión, trastornos que comparten la fisiopatología subyacente relacionada con el sistema renina-angiotensina (RAS). El SARS-CoV-2 utiliza la proteína de la membrana angiotensina I y convierte a la enzima convertidora de angiotensina tipo 2 (ACE2) en un receptor de entrada celular; por tanto, el RAS, regulado por ACE y ACE2, puede verse alterado en pacientes con COVID-19. Sin embargo, aún no es claro si el uso de fármacos antihipertensivos inhibidores de la ACE2 y bloqueadores del receptor de angiotensina II podría potencializar el daño ocasionado por el virus o contrarrestar su efecto, sobre todo a nivel pulmonar. El desafío se ve agravado por la información exagerada publicada en diferentes revistas científicas, la cual podría llevar a acciones inapropiadas, por lo que es importante diferenciar rápidamente la verdadera epidemia de hipótesis falsas, que podría llevar a conductas medicas potencialmente dañinas.

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Referencias

Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol . 2020;5(7):831-40. http://dx.doi.org/10.1001/jamacardio.2020.1286

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus- Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. http://dx.doi.org/10.1001/jama.2020.1585

Onder G, Rezza G, Brusaferro S. Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. Jama. 2020;323(18):1775-6. http://dx.doi.org/10.1001/jama.2020.4683

Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. Jama. 2020323(14):1334. http://dx.doi.org/10.1001/jama.2020.4344

Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3. https://doi.org/10.1016/S0140-6736(20)30185-9

Adams JG, Walls RM. Supporting the Health Care Workforce during the COVID-19 Global Epidemic. JAMA. 2020;323(15):1439-1440. http://dx.doi.org/10.1001/jama.2020.3972

Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA. 2020;323(8):709-10. http://dx.doi.org/10.1001/jama.2020.1097

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81. http://dx.doi.org/10.1016/ S2213-2600(20)30079-5

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708-20. http://dx.doi.org/10.1056/NEJMoa2002032

Zhang J, Dong X, Cao Y, Yuan Y, Yang Yn, Yan Yn, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;57(7):1730-41.

The novel Coronavirus Pneumonia Emergency Response Epidemiological Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID 19) - China, 2020. China CDC Weekly. 2020;2(8):113-22.

Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-5. http://dx.doi.org/10.1016/j.ijid.2020.03.017

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019(COVID-19) outbreak in China : Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020. http://dx.doi.org/10.1001/jama.2020.2648

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. http://dx.doi.org/10.1016/S0140-6736(20)30566-3

Fauci AS, Lane HC, Redfield RR. Covid-19 - Navigating the Uncharted. N Engl J Med. 2020;382(13):1268-9 http://dx.doi.org/10.1056/NEJMe2002387

Kuster GM, Pfister O, Burkard T, Zhou Q, Twerenbold R, Haaf P, et al. SARS-CoV2: should inhibitors of the renin-angiotensin system be withdrawn in patients with COVID-19? Eur Heart J. 2020;41(19):1801-3.

http://dx.doi.org/10.1093/eurheartj/ehaa235.

Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109:531-8. http://dx.doi.org/10.1007/s00392-020-01626-9

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-8. http://dx.doi.org/10.1001

/jamacardio.2020.1017

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. http://dx.doi.org/10.1001/jamainternmed.2020.0994

Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21. http://dx.doi.org/10.1016/S2213-2600(20)30116-8

Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3. http://dx.doi.org/10.1038/s41586-020-2012-7

Harmer D, Gilbert M, Borman R, Clark KL. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett. 2002;532(1-2):107-10. http://dx.doi.org/10.1016/s0014-5793(02)03640-2

Lo KB, McCullough PA, Rangaswami J. Antihypertensive drugs and risk of COVID-19? Lancet Respir Med. 2020;8(5):30156-9. https://doi.org/10.1016/S2213-2600(20)30156-9

Imai Y, Kuba K, Rao S, Huan Y, Guo F, Guan B, et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature. 2005;436:112-6. https://doi.org/10.1038/nature03712

Rice GI, Thomas DA, Grant PJ, Turner AJ, Hooper NM. Evaluation of angiotensin-converting enzyme (ACE), its homologue ACE2 and neprilysin in angiotensin peptide metabolism. Biochem J. 2004;383(Pt 1):45-51. http://dx.doi.org/10.1042/BJ20040634

Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus- induced lung injury. Nat Med. 2005;11(8):875-9. http://dx.doi.org/10.1038/nm1267

Burrell LM, Johnston CI, Tikellis C, Cooper ME. ACE2, a new regulator of the renin-angiotensin system. Trends Endocrinol Metab. 2004;15(4):166-9. https://doi.org/10.1016/j.tem.2004.03.001

Vaduganathan M, Vardeny O, Michel T, McMurray J, Pfeffer M, Solomon SD. Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. N Engl J Med. 2020;382(17):1653-9. https://doi.org/10.1056/NEJMsr2005760

Khan A, Benthin C, Zeno B, Albertson TE, Boyd J, Christie JD, et al. A pilot clinical trial of recombinant human angiotensin- converting enzyme 2 in acute respiratory distress syndrome. Crit Care. 2017;21(1):234. https://doi.org/10.1186/s13054-017-1823-x

Liu Y, Huang F, Xu J, Yang P, Qin Y, Cao M, et al. Anti-hypertensive Angiotensin II receptor blockers associated to mitigation of disease severity in elderly COVID-19 patients. medRxiv. 2020. https://doi.org/10.1101/2020.03.20.20039586

Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020;46(4):586-90. https://doi.org/10.1007/s00134-020-05985-9

Sociedad Europea de Cardiología. Declaración de posición del Consejo ESC sobre Hipertensión en inhibidores de la ECA y bloqueadores de los receptores de angiotensina. 2020 [citado marzo 20 2020]. Disponible en: https://www.dicardiology.com/content/esc-council- hypertension-says-ace-i-and-arbs-do-not-increase-covid-19-mortality.

Asociación americana del corazón. La declaración HFSA/ACC/AHA aborda las preocupaciones relacionadas con el uso de antagonistas de RAAS en COVID-19. 2020 [citado marzo 20 2020]. Disponible en: https://newsroom.heart.org/news/patients-taking-ace-i-and- arbs-who-contract-covid-19-should-continue-treatment-unless-otherwise-advised-by-their-physician.

Sociedad Española de Cardiologia. No hay evidencia clínica ni científica para suspender tratamientos de IECA y ARA debido a la infección por COVID-19. https://secardiologia.es/institucional/socios/comunicados comunicados-oficiales/11446-no-hay-evidencia- clinica-ni-cientifica-para-suspender-tratamientos-de-ieca-y-ara-debido-a-la-infeccion-por-covid-19

World Health Organization (WHO). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Geneva: WHO; 2020 [consultado marzo 10 2020] Disponible en https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission- on-covid-19-final-report.pdf.

Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, et al. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) Asthma Consortium. J Thorac Dis. 2018;10(11):6314-51. http://dx.doi.org/10.21037/jtd.2018.09.153

Dykewicz MS. Cough and angioedema from angiotensin-converting enzyme inhibitors: New insights into mechanisms and management. Curr Opin Allergy Clin Immunol. 2004;4(4):267-70. http://dx.doi.org/10.1097/01.all.0000136759.43571.7f

Irwin RS, Madison JM. The diagnosis and treatment of cough. N Engl J Med. 2000;343(23):1715-21. http://dx.doi.org/10.1056/ NEJM200012073432308

Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, et al. Diagnosis and Management of Cough Executive Summary: ACCP Evidence-Based Clinical Practice Guidelines. Chest. 2006;129(Suppl 1):1S-23S. http://dx.doi.org/10.1378/ chest.129.1_suppl.1S

Epstein M, Reaven NL, Funk SE, McGaughey KJ, Oestreicher N, Knispel J. Evaluation of the Treatment Gap Between Clinical Guidelines and the Utilization of Renin-Angiotensin-Aldosterone System Inhibitors. Am J Manag Care. 2015;21(Suppl 11):S212-20.

Publicado
2020-04-24
Cómo citar
1.
Villanueva Bendek I, Ramírez Marmolejo R, Montejo JD, Rodelo Ceballos J, Puello González L, Vélez Verbel M, Gómez Franco L. COVID-19 e hipertensión arterial: ¿existe evidencia para suspender antagonistas del sistema renina-angiotensina-aldosterona?. Rev. Colomb. Nefrol. [Internet]. 24 de abril de 2020 [citado 1 de octubre de 2020];7(Supl.2). Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/405