血管紧张素转换酶 2 与抗高血压药物(血管紧张素受体阻滞剂和血管紧张素转换酶抑制剂)在 2019 冠状病毒病中的作用。

Angiotensin-Converting Enzyme 2 and Antihypertensives (Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors) in Coronavirus Disease 2019.

机构信息

Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Spain; Division of Cardiovascular Medicine, Stanford University School of Medicine, CA.

John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA.

出版信息

Mayo Clin Proc. 2020 Jun;95(6):1222-1230. doi: 10.1016/j.mayocp.2020.03.026. Epub 2020 Apr 4.

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, is being defined as the worst pandemic disease of modern times. Several professional health organizations have published position papers stating that there is no evidence to change the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in the management of elevated blood pressure in the context of avoiding or treating COVID-19 infection. In this article, we review the evidence on the relationship between the renin-angiotensin-aldosterone system and COVID-19 infection. In agreement with current guidelines, patients with hypertension should continue taking antihypertensive medications as prescribed without interruption. Because ACEIs and ARBs are also used to retard the progression of chronic kidney disease, we suggest that these recommendations also apply to the use of these agents in chronic kidney disease. No differences generally exist between ARBs and ACEIs in terms of efficacy in decreasing blood pressure and improving other outcomes, such as all-cause mortality, cardiovascular mortality, myocardial infarction, heart failure, stroke, and end-stage renal disease. The ACEIs are associated with cough secondary to accumulation of bradykinin and angioedema, and withdrawal rates due to adverse events are lower with ARBs. Given their equal efficacy but fewer adverse events, ARBs could potentially be a more favorable treatment option in patients with COVID-19 at higher risk for severe forms of disease.

摘要

新型冠状病毒病(COVID-19)由严重急性呼吸系统综合征冠状病毒 2 引起,被定义为现代最严重的大流行病。一些专业卫生组织发表了立场文件,指出在避免或治疗 COVID-19 感染的情况下,没有证据表明需要改变血管紧张素转换酶抑制剂(ACEIs)或血管紧张素受体阻滞剂(ARBs)在高血压管理中的应用。本文综述了肾素-血管紧张素-醛固酮系统与 COVID-19 感染之间关系的证据。根据现行指南,高血压患者应继续按规定服用降压药物,不要中断。由于 ACEIs 和 ARBs 也用于延缓慢性肾脏病的进展,我们建议这些建议也适用于慢性肾脏病中这些药物的使用。ARB 和 ACEI 在降低血压和改善其他结局方面(如全因死亡率、心血管死亡率、心肌梗死、心力衰竭、卒中和终末期肾病)的疗效通常没有差异。ACEIs 与缓激肽积累和血管性水肿相关的咳嗽有关,由于不良反应而停药的比率较低的是 ARBs。鉴于其疗效相当,但不良反应较少,在 COVID-19 患者中,ARB 可能是一种更有利的治疗选择,尤其是对于疾病严重形式风险较高的患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14fb/7129862/3758fe1b0d38/gr1_lrg.jpg

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索