La COVID-19 en personas hipertensas
Palabras clave:
COVID-19, coronavirus SARS–CoV-2, hipertensión arterial, tratamiento antihipertensivo.Resumen
La COVID-19 es una enfermedad infecciosa causada por el coronavirus SARS–CoV-2, que afecta de forma más grave a personas en edades avanzadas de la vida y a pacientes con inmunodepresión y/o afecciones crónicas, como la hipertensión arterial, de gran significación en la mortalidad por enfermedades cardiovasculares y cerebrovasculares. Con este artículo se buscó actualizar los conocimientos sobre el nivel de gravedad de la COVID-19 en pacientes hipertensos y su asociación con el consumo de fármacos antihipertensivos de los grupos de los inhibidores de la enzima convertidora de la angiotensina y los antagonistas de los receptores de la angiotensina II. Asimismo, se ofrecen evidencias científicas acerca de que la hipertensión arterial es un predictor clínico de gravedad en pacientes con dicha enfermedad infecciosa, lo cual se manifiesta sobre todo en las edades mayores de 60 años, y de que la suspensión de forma preventiva de los mencionados tratamientos antihipertensivos puede conducir a inestabilidad clínica y a resultados desfavorables.
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17. Danser AJ, Epstein M, Batlle D. Renin-angiotensin system blockers and the COVID-19 pandemic: at present there is no evidence to abandon Renin-Angiotensin system blockers. Hypertension. 2020 [citado 24/04/2020];75:1382-5. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.120.15082
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19. Zheng Y, Ma Y, Zhang J. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17:259-60.
20. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507-13.
21. Chen X, Hu W, Ling J, Mo P, Zhang Y, Jiang Q, et al. Hypertension and Diabetes Delay the Viral Clearance in COVID-19 Patients. medRxiv. 2020 [citado 24/04/2020]. Disponible en: https://www.medrxiv.org/content/10.1101/2020.03.22.20040774v1.full.pdf
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23. Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus Disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. Journal of Infection. 2020;80(6):639-45.
24. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020 [citado 24/04/2020];17(5):259-60. Disponible en: https://www.nature.com/articles/s41569-020-0360-5.pdf
25. 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 [citado 24/04/2020];382:1708-20. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
26. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA Network. 2020 Mar [citado 24/04/2020]. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2763667
27. Boehm M, Nabel EG. Angiotensin-Converting Enzyme 2 — A New Cardiac Regulator. N Engl J Med. 2002; 347(22):1795-7.
28. Wösten-van Asperen RM, Bos AP, Bem RA, Dierdorp BS, Dekker T, van Goor H. et al. Imbalance between pulmonary angiotensin-converting enzyme and angiotensin-converting enzyme 2 activity in acute respiratory distress syndrome. Ped Crit Care Med. 2013;14(9):438-41.
29. Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation. 2005;111(20):2605-10.
30. 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. Natmed. 2005 [citado 24/04/2020];11(8):875-9. Disponible en: https://www.nature.com/articles/nm1267.pdf
31. Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003 [citado 24/04/2020];426(6965):450-4. Disponible en: https://www.nature.com/articles/nature02145.pdf
32. Lukassen S, Chua RL, Trefzer T, Kahn NC, Schneider MA, Muley T, et al. SARS-CoV-2 receptor ACE2 and TMPRSS2 are predominantly expressed in a transient secretory cell type in subsegmental bronchial branches. bioRxiv. 2020 Mar [citado 24/04/2020]. Disponible en: https://www.biorxiv.org/content/10.1101/2020.03.13.991455v2.full.pdf
33. Rao S, Lau A, So HC. Exploring diseases/traits and blood proteins causally related to expression of ACE2, the putative receptor of 2019-nCov: A Mendelian Randomization analysis highlights tentative relevance of diabetes-related traits. medRxiv. 2020 May [citado 24/04/2020]. Disponible en: https://www.medrxiv.org/content/10.1101/2020.03.04.20031237v2.full.pdf
34. Romaní-Pérez M, Outeiriño-Iglesias V, Moya CM, Santisteban P, González-Matías LC, Vigo E, et al. Activation of the GLP-1 receptor by liraglutide increases ACE2 expression, reversing right ventricle hypertrophy, and improving the production of SP-A and SP-B in the lungs of type 1 diabetes rats. Endocrinology. 2015;156(10):3559-69.
35. Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020;180:281-92.
36. Wösten‐van Asperen RM, Lutter R, Specht PA, Moll GN, van Woensel JB, van der Loos CM, et al. Acute respiratory distress syndrome leads to reduced ratio of ACE/ACE2 activities and is prevented by angiotensin‐(1–7) or an angiotensin II receptor antagonist. Journal of Pathology. 2011;225(4):618-27.
37. Roca-Ho H, Riera M, Palau V, Pascual J, Soler MJ. Characterization of ACE and ACE2 expression within different organs of the NOD mouse. Int J Mol Sci. 2017;18(3):563.
2. Moreno-Montoya J. El desafío de comunicar y controlar la epidemia por coronavirus. Biomédica. 2020 [citado 23/04/2020];40(1):11-3. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-41572020000100011&lng=en
3. Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nature Medicine. 2020 [citado 24/04/2020];26:450–2. Disponible en: https://www.nature.com/articles/s41591-020-0820-9.pdf
4. Cui J, Li F, Shi LS. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019 [citado 24/04/2020];17:181-92. Disponible en: https://www.nature.com/articles/s41579-018-0118-9.pdf
5. Diao B, Feng Z, Wang C, Wang H, Liu L, Wang C, et al. Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. medRxiv. 2020 [citado 24/04/2020]:1-17. Disponible en: https://www.medrxiv.org/content/medrxiv/early/2020/04/10/2020.03.04.20031120.full.pdf
6. Drosten C, Günther S, Preiser W, van der Werf S, Brodt HR, Becker S, et al. Identification of a novel coronavirus in patients with severe acute respiratory syndrome. N Engl J Med. 2003 [citado 24/04/2020];348(20):1967-76. Disponible en: https://www.nejm.org/doi/pdf/10.1056/NEJMoa030747?articleTools=true
7. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020 [citado 24/04/2020];395(10223):497-506. Disponible en: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930183-5
8. World Health Organization. Coronavirus disease 2019 (COVID-19). Situation Report–66. Geneva: WHO; 2020 [citado 03/05/2020]. Disponible en: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200326-sitrep-66-covid-19.pdf?sfvrsn=9e5b8b48_2
9. Portal Web Oficial Ministerio de Salud Pública. Coronavirus en Cuba. Parte del cierre del día 26 de abril a las 12 de la noche. La Habana. Cuba: MINSAP; 2020 [actualizado 27/04/2020; citado 02/05/2020]. Disponible en: https://salud.msp.gob.cu/?p=4970
10. 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. Inter J Infect Dis. 2020 [citado 24/02/2020];94(2020):2132-9. Disponible en: https://cuidemonoscusco.com/wp-content/uploads/2020/03/10.1016@j.ijid_.2020.03.017.pdf
11. 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. The Lancet. 2020 [citado 24/04/2020];395:1054-62. Disponible en: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930566-3
12. Pérez Caballero MD, León Álvarez JL, Dueñas Herrera A, Alfonzo Guerra JP, Navarro Despaigne DA, de la Noval García R, et al. Guía Cubana de diagnóstico, evaluación y tratamiento de la hipertensión arterial. Rev Cubana Med. 2017 [citado 19/04/2020];56(Sup.). Disponible en: http://bvs.sld.cu/revistas/med/vol56_sup_17/sumario.htm
13. Wang TJ, Gona P, Larson MG, Levy D, Benjamín EJ, Tofler GH, et al. Multiple biomarkers and the risk of incident hypertension. Hypertension. 2007;49(3):432-8.
14. León Álvarez JL, Guerra Ibáñez G, Yanes Quesada M Á, Calderín Bouza RO, Gutiérrez Rojas A. Disfunción endotelial en hipertensos de reciente diagnóstico. Rev Cubana Med. 2014 [citado 27/04/2020];53(4):417-29. Disponible en: http://scielo.sld.cu/pdf/med/v53n4/med06414.pdf
15. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. The Lancet. 2020;395(10224):565-74.
16. Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S. et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271-80.
17. Danser AJ, Epstein M, Batlle D. Renin-angiotensin system blockers and the COVID-19 pandemic: at present there is no evidence to abandon Renin-Angiotensin system blockers. Hypertension. 2020 [citado 24/04/2020];75:1382-5. Disponible en: https://www.ahajournals.org/doi/pdf/10.1161/HYPERTENSIONAHA.120.15082
18. Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential effects of coronaviruses on the cardiovascular system: A review. JAMA Cardiology. 2020 Mar [citado 23/04/2020]. Disponible en: https://jamanetwork.com/journals/jamacardiology/fullarticle/2763846
19. Zheng Y, Ma Y, Zhang J. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020;17:259-60.
20. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020;395(10223):507-13.
21. Chen X, Hu W, Ling J, Mo P, Zhang Y, Jiang Q, et al. Hypertension and Diabetes Delay the Viral Clearance in COVID-19 Patients. medRxiv. 2020 [citado 24/04/2020]. Disponible en: https://www.medrxiv.org/content/10.1101/2020.03.22.20040774v1.full.pdf
22. Du RH, Liang LR, Yang CQ, Wan W, Cao TZ, Li M, et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J. 2020 [citado 03/05/2020];55(6). Disponible en: https://erj.ersjournals.com/content/erj/early/2020/04/01/13993003.00524-2020.full.pdf
23. Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus Disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. Journal of Infection. 2020;80(6):639-45.
24. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020 [citado 24/04/2020];17(5):259-60. Disponible en: https://www.nature.com/articles/s41569-020-0360-5.pdf
25. 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 [citado 24/04/2020];382:1708-20. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
26. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA Network. 2020 Mar [citado 24/04/2020]. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2763667
27. Boehm M, Nabel EG. Angiotensin-Converting Enzyme 2 — A New Cardiac Regulator. N Engl J Med. 2002; 347(22):1795-7.
28. Wösten-van Asperen RM, Bos AP, Bem RA, Dierdorp BS, Dekker T, van Goor H. et al. Imbalance between pulmonary angiotensin-converting enzyme and angiotensin-converting enzyme 2 activity in acute respiratory distress syndrome. Ped Crit Care Med. 2013;14(9):438-41.
29. Ferrario CM, Jessup J, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, et al. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation. 2005;111(20):2605-10.
30. 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. Natmed. 2005 [citado 24/04/2020];11(8):875-9. Disponible en: https://www.nature.com/articles/nm1267.pdf
31. Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003 [citado 24/04/2020];426(6965):450-4. Disponible en: https://www.nature.com/articles/nature02145.pdf
32. Lukassen S, Chua RL, Trefzer T, Kahn NC, Schneider MA, Muley T, et al. SARS-CoV-2 receptor ACE2 and TMPRSS2 are predominantly expressed in a transient secretory cell type in subsegmental bronchial branches. bioRxiv. 2020 Mar [citado 24/04/2020]. Disponible en: https://www.biorxiv.org/content/10.1101/2020.03.13.991455v2.full.pdf
33. Rao S, Lau A, So HC. Exploring diseases/traits and blood proteins causally related to expression of ACE2, the putative receptor of 2019-nCov: A Mendelian Randomization analysis highlights tentative relevance of diabetes-related traits. medRxiv. 2020 May [citado 24/04/2020]. Disponible en: https://www.medrxiv.org/content/10.1101/2020.03.04.20031237v2.full.pdf
34. Romaní-Pérez M, Outeiriño-Iglesias V, Moya CM, Santisteban P, González-Matías LC, Vigo E, et al. Activation of the GLP-1 receptor by liraglutide increases ACE2 expression, reversing right ventricle hypertrophy, and improving the production of SP-A and SP-B in the lungs of type 1 diabetes rats. Endocrinology. 2015;156(10):3559-69.
35. Walls AC, Park YJ, Tortorici MA, Wall A, McGuire AT, Veesler D. Structure, function, and antigenicity of the SARS-CoV-2 spike glycoprotein. Cell. 2020;180:281-92.
36. Wösten‐van Asperen RM, Lutter R, Specht PA, Moll GN, van Woensel JB, van der Loos CM, et al. Acute respiratory distress syndrome leads to reduced ratio of ACE/ACE2 activities and is prevented by angiotensin‐(1–7) or an angiotensin II receptor antagonist. Journal of Pathology. 2011;225(4):618-27.
37. Roca-Ho H, Riera M, Palau V, Pascual J, Soler MJ. Characterization of ACE and ACE2 expression within different organs of the NOD mouse. Int J Mol Sci. 2017;18(3):563.
Publicado
2020-06-12
Cómo citar
1.
García Céspedes ME, Bell Castillo J, Romero Calzado DE, Ferrales Biset N. La COVID-19 en personas hipertensas. MEDISAN [Internet]. 12 de junio de 2020 [citado 1 de junio de 2025];24(3):501-14. Disponible en: https://medisan.sld.cu/index.php/san/article/view/3107
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