КЛИНИЧЕСКИЕ АССОЦИАЦИИ КОРОНАВИРУСНОЙ ИНФЕКЦИИ COVID-19 И АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ: ПАТОГЕНЕТИЧЕСКИЕ МЕХАНИЗМЫ И ДИСКУССИОННЫЕ ВОПРОСЫ ПРИМЕНЕНИЯ ИНГИБИТОРОВ РЕНИН-АНГИОТЕНЗИН-АЛЬДОСТЕРОНОВОЙ СИСТЕМЫ
Аннотация
Обзор современных публикаций свидетельствует, что у пациентов с артериальной гипертензией (АГ) повышен риск тяжелого течения и смертельного исхода COVID-19. К основным патогенетическим механизмам, объясняющим ассоциацию АГ с COVID-19, относят влияние коронавируса на работу ренин-ангиотензин-альдостероновой системы (РААС), которая участвует в развитии и прогрессировании АГ. В обзоре представлены результаты ряда исследований с оценкой влияния применения иАПФ/БРА у пациентов с сердечно-сосудистыми заболеваниями на развитие и течение COVID-19. Результаты международного анализа данных показали, что использование иАПФ/БРА у пациентов с АГ и COVID-19 ассоциированы с меньшими показателями общей смертности, а использование иАПФ, статинов и женский пол связаны с большей вероятностью выживания пациентов. Представлены данные по перспективным разработкам новых лекарственных средств, влияющих на работу РААС.
Литература
Stanaway JD, Afshin A, Gakidou E, Lim SS, Abate D, Abate KH, Abbafati C, Abbasi N, Abbastabar H, Abd-Allah F, Abdela J, Abdelalim A, Abdollahpour L, Abdulkader RS, Abebe M, Abebe Z, Abera SF, Abil OZ, Abraha HN, Abrham AR, Abu-Raddad LJ, Abu-Rmeileh NM, Accrombessi MMK, Acharya D, Acharya P, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923-1994. https://doi.org/10.1016/S0140-6736(18)32225-6.8.
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-based Studies from 90 Countries. Circulation. 2016. 134(6):441-450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912.
Adhikari SP, Meng S, Wu Y-J, Mao Y-P, Ye R-X, Wang Q-Z, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infectious Diseases of Poverty. 2020;9(1):29. https://doi.org/10.1186/s40249-020-00646-x.
Sifuentes-Rodríguez E, Palacios-Reyes D. COVID-19: The outbreak caused by a new coronavirus. Boletin medico del Hospital Infantil de Mexico. 2020;77(2):47-53.https://doi.org/10.24875/BMHIM.20000039.
Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: what we know. International Journal of Infectious Diseases. 2020;94:44-48. https://doi.org/10.1016/j.ijid.2020.03.004.
Kreutz R, El-Hady Algharably EA, Azizi M, Dobrowolski P, Guzik T, Januszewicz A, Persu A, Prejbisz A, Riemer TG, Wang J-G, Burnie M. Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19. Cardiovascular Research. 2020;cvaa097. https://doi.org/10.1093/cvr/cvaa097.
Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiology. 2020. https://doi.org/10.1001/jamacardio.2020.1286.
Wang Z, Chen Z, Zhang L, Wang X, Hao G, Zhang Z, Shao L, Tian Y, Dong Y, Zheng C, Wang J, Zhu M, Weintraub WS, Gao R. Status of hypertension in China: results from the China Hypertension Survey. 2012-2015. Circulation. 2018;137(22):2344-2356. https://doi.org/10.1161/CIRCULATIONAHA.117.032380.
Bai SL, Wang JY, Zhou YQ, Yu DS, Gao XM, Li LL, Yang F. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-151. https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003.
Singh AK, Gupta R, Misra A. Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin angiotensin system blockers. Diabetology & Metabolic Syndrome. 2020;14(4):283-287. https://doi.org/10.1016/j.dsx.2020.03.016.
Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, Liu L, Shan H, Lei C-l, Hui DSC, Du B, Li L-j, Zeng G, Yuen K-Y, Chen R-c, Tang C-l, Wang T, Chen P-y, Xiang J, Li S-y, Wang J-l, Liang Z-j, Peng Y-x, Wei L, Liu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020;382:17081720. https://doi.org/10.1056/NEJMoa2002032.
Zhang J-j, Dong X, Cao YY, Yuan Y-D, Yang Y-B, Yan Y-Q, Akdis CA, Gao Y-D. Clinical characteristics of 140 patients infected by SARS-CoV-2 in Wuhan, China. Allergy. 2020 Jul;75(7):1730-1741. https://doi.org/10.1111/all.14238.
Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, Anderson EJ, Openo KP, Weigel A, Monroe ML, Ryan P, Henderson J, Kim S, Como-Sabetti K, Lynfield R, Sosin D, Torres S, Muse A, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 – COVID-NET, 14 States, March 1-30, 2020. Morbidity and Mortality Weekly Report. 2020;69(15):458-464. https://doi.org/10.15585/mmwr.mm6915e3.
Tocci G, Nati G, Cricelli C, Parretti D, Lapi F, Ferrucci A, Borghi C, Volpe M. Prevalence and control of hypertension in the general practice in Italy: updated analysis of a large database. Journal of Human Hypertension. 2017;31(4):258-262. https://doi.org/10.1038/jhh.2016.71.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-2059. https://doi.org/10.1001/jama.2020.6775.
Paul M, Mehr AR, Kreutz R. Physiology of local renin-angiotensin systems. Physiological Reviews. 2006;86(3):747803. https://doi.org/10.1152/physrev.00036.2005.
Romero C, Orias M, Weir M. Novel RAAS agonists and antagonists: clinical applications and controversies. Nature Reviews Endocrinology. 2015;11(4):242-252. https://doi.org/10.1038/nrendo.2015.6.
Ferrario CM, Mullick AE. Renin angiotensin aldosterone inhibition in the treatment of cardiovascular disease. Pharmacology Research. 2017;125(Pt A):57-71. https://doi.org/10.1016/j.phrs.2017.05.020.
Jakubova LV, Kezhun LV, Semyachkina-Glushkovskaya OV. Izmenenie aktivnosti renina plazmyi funkcii jendotelija u lic s arterialnoj gipertenziej pri terapii s vkljucheniem ingibitora angiotenzinprevrashhajushhego fermenta i holekalciferola [Changes in plasma renin activity and endothelial function in patients with arterial hypertension with inclusion in therapy inhibitor of angiotensin-converting enzyme and cholecalciferol]. Recept [Recipe]. 2017;20(6):568-577. (Russian).
Kezhun LV, Yankovskaya LV. Rol renin-angiotenzin-aldosteronovoj sistemy i vitamina D v razvitii arterialnoj gipertenzii u zhenshhin v perimenopauzalnom periode [Role of renin-angiotensin-aldosterone system and vitamin D in development of arterial hypertension in perimenopausal women]. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta [Journal of the Grodno State Medical University]. 2013;1(41):14-17. (Russian).
Kezhun LV, Yankouskaya LV. Aktivnost renina plazmy funkcii jendotelija i status vitamina D zhenshhin s arterialnoj gipertenziej v premenopauzalnom i rannem postmenopauzalnom periodah [Plasma renin activity endothelial function and vitamin D status in women with hypertension in the premenopausal and early postmenopausal periods]. Zhurnal Grodnenskogo gosudarstvennogo medicinskogo universiteta [Journal of the Grodno State Medical University]. 2014;4(48):37-42. (Russian).
Dinh DT, Frauman AG, Johnston CI, Fabiani ME. Angiotensin receptors: distribution, signaling and function. Clinical Science. 2001;100(5):481-492.
Ferrario CM, Jessup JA, Chappell MC, Averill DB, Brosnihan KB, Tallant EA, Diz DI, Gallagher PE. Effect of angiotensin-converting enzyme inhibition and angiotensin II receptor blockers on cardiac angiotensin-converting enzyme 2. Circulation. 2005;111(20):2605-2610. https://doi.org/10.116/CIRCULATIONAHA.104.510461.
Zhuo JL, Ferrao FM, Zheng Y, Li XC. New frontiers in the intrarenal Renin-Angiotensin system: a critical review of classical and new paradigms. Frontiers in Endocrinology (Lausanne). 2013;4:166. https://doi.org/10.3389/fendo.2013.00166.
Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor recognition by novel coronavirus from Wuhan: An analysis based on decade-long structural studies of SARS. Journal of Virology. 2020. https://doi.org/10.1128/JVI.00127-20.
Kuba K, Imai Y, Rao S, Gao H, Guo F, Guan B, Huan Y, Yang P, Zhang Y, Deng W, Bao L, Zhang B, Liu G, Wang Z, Chappell M, Liu Y, Zheng D, Leibbrandt A, Wada T, Slutsky AS, Liu D, Qin C, Jiang C, Penninger JM. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nature Medicine. 2005;11(8):875-879. https://doi.org/10.1038/nm1267.
Imai Y, Kuba K, Penninger JM. The discovery of angiotensin-converting enzyme 2 and its role in acute lung injury in mice. Experimental physiology. 2008;93(5):543-548. https://doi.org/10.1113/expphysiol.2007.040048.
Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Seminars in Immunopathology. 2017;39(5):529-539.https://doi.org/10.1007/s00281-017-0629-x.
Tveito K. Cytokine storms in COVID-19 cases? Tidsskrift for den Norske Legeforening. 2020 Mar 23;140. https://doi.org/10.4045/tidsskr.20.0239.
Itani HA, McMaster WG, Saleh MA, Nazarewicz RR, Mikolajczyk TP, Kaszuba AM, Konior A, Prejbisz A, Januszewicz A, Norlander AE, ChenW, Bonami RH, Marshall AP, Poffenberger G, Weyand CM, Madhur MS, Moore DJ, Harrison DG, Guzik TJ. Activation of human T cells in hypertension: studies of humanized mice and hypertensive humans. Hypertension. 2016;68(1):123-132. https://doi.org/10.1161/HYPERTENSIONAHA.116.07237.
Loperena R, Van Beusecum JP, Itani HA, Engel N, Laroumanie F, Xiao L, Elijovich F, Laffer CL, Gnecco JS, Noonan J, Maffia P, Jasiewicz-Honkisz B, CześnikiewiczGuzik M, Mikolajczyk TP, Śliwa T, Dikalov S, Weyand CM, Guzik TJ, Harrison DG. Hypertension and increased endothelial mechanical stretch promote monocyte differentiation and activation: roles of STAT3, interleukin 6 and hydrogen peroxide. Cardiovascular Research. 2018;114(11):1547-1563. https://doi.org/10.1093/cvr/cvy112.
Drummond GR, Vinh A, Guzik TJ, Sobey CG. Immune mechanisms of hypertension. Nature Reviews Immunology. 2019;19(8):517-532. https://doi.org/10.1038/s41577-019-0160-5.
China NHCotPsRo. Chinese Clinical Guidance for COVID-19 Pneumonia Diagnosis and Treatment [Internet]. 7th ed. 2020. Available from: http://kjfy.meetingchina.org/msite/news/show/cn/3337.html.
Chou C-H, Hung C-S, Liao C-W, Wei L-H, Chen C-W, Shun C-T, Wen W-F, Wan C-H, Wu X-M, Chang Y-Y, Wu V-C, Wu K-D, Lin Y-H. IL-6 trans-signalling contributes to aldosterone-induced cardiac fibrosis. Cardiovascular Research. 2018;114(5):690-702. https://doi.org/10.1093/cvr/cvy013.
Diao B, Wang C, Tan Y, Chen X, Liu Y, Ning L, Chen L, Li M, Liu Y, Wang G, Yuan Z, Feng Z, Wu Y, Chen Y. Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (covid-19) [Internet]. MedRxiv. 2020. Available from: www.medrxiv.org/conte nt/10.1101/2020.02.18.20024364v1. https://doi.org/10.1101/2020.02.18.20024364.
Siedliński M, Józefczuk E, Xu X, Teumer A, Evangelou E, Schnabel RB, Welsh P, Maffia P, Erdmann J, Tomaszewski M, Caulfield MJ, Sattar N, Holmes MV, Guzik TJ. White blood cells and blood pressure: A Mendelian Randomization Study. Circulation. 2020;141(16):13071317. https://doi.org/10.1161/CIRCULATIONAHA.119.045102.
American Heart Association, Heart Failure Society of America, American College of Cardiology. Patients taking ACE-i and ARBs who contract COVID-19 should continue treatment, unless otherwise advised by their physician: Statement. [Internet]. Newsroom. Available from: https:// newsroom.heart.org/news/patients-taking-ace-i-and-arbswho-contract-covid-19-should-continue-treatment-unlessotherwise-advised-by-their-physician.
Vaduganathan M, Vardeny O, Pharm D, Michel T, McMurray JJ, Pfeffer MA, Solomon SD. Renin-Angiotensin-Aldosterone System Inhibitors in Patients with Covid 19. New England Journal of Medicine. 2020;382(17):1653-1659. https://doi.org/10.1056/NEJMsr2005760.
Yang G, Tan Z, Zhou L, Yang M, Peng L, Liu J, Cai J, Yang R, Han J, Huang Y, He S. Angiotensin II Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors Usage is Associated with Improved Inflammatory Status and Clinical Outcomes in COVID-19 Patients with Hypertension [Internet]. MedRxiv. 2020. Available from: https://www. medrxiv.org/content/10.1101/2020.03.31.20038935v1. full.pdf+html. https://doi.org/10.1101/2020.03.31.20038935.
Zhang P, Zhu L, Cai J, Lei F, Qin Z, Xie J, Liu EM, KiZhao Y, Huang X, Lin L, Xia M, Chen MM, Cheng X, Zhang X, Guo D, Peng Y, Xiao-Ji , Chen J, She ZG, Wang Y, Xu Q, Tan R, Wang H, Ling J, Luo P, et al. Association of inpatient use of angiotensin converting enzyme inhib-itors and angiotensin II receptor blockers with mortality among patients with hypertension hospitalized with COVID-19. Circulation Research. 2020;126(12):16711681. https://doi.org/10.1161/CIRCRESAHA.120.317134.
Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G. Renin-Angiotensin-Aldosterone System Blockers and the Risk of Covid-19. New England Journal of Medicine. 2020;382:2431-2440. https://doi.org/10.1056/NEJMoa2006923.
Reynolds HR, Adhikari S, Pulgarin C, Troxel AB, Iturrate E, Johnson SB, Hausvater A, Newman JD, Berger JS, Bangalore S, Katz SD, Fishman GI, Kunichoff D, Chen Y, Ogedegbe G, Hochman JS. Renin-AngiotensinAldosterone System Inhibitors and Risk of Covid-19. New England Journal of Medicine. 2020;382:2441-2448. https://doi.org/10.1056/NEJMoa2008975.
Mehra MR, Desai SS, Kuy SR, Henry TD, Patel AN. Cardiovascular Disease, Drug Therapy, and Mortality in Covid-19. New England Journal of Medicine. 2020;382:e102. https://doi.org/10.1056/NEJMoa2007621.
Goulter AB, Goddard MJ, Allen JS, Kenneth CL. ACE2 gene expression is activated in human heart failure. BMC. Medicine. 2004;2:19. https://doi.org/10.1186/1741-7015-2-19.
Sama IE, Ravera A, Santema BT, van Goor H, ter Maaten JM, Cleland JGF, Rienstra M, Friedrich AW, Samani NJ, Ng LL, Dickstein K, Lang CC, Filippatos G, Anker SD, Ponikowski P, Metra M, van Veldhuisen D, Voors AA. Circulating plasma concentrations of angiotensinconverting enzyme 2 in men and women with heart failure and effects of renin angiotensin-aldosterone inhibitors. European Heart Journal. 2020;41(19):1810-1817. https://doi.org/10.1093/eurheartj/ehaa373.
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):1775-1776. https://doi.org/10.1001/jama.2020.4683.
Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme2 (ACE2) as a SARSCoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Medicine. 2020;46(4):586590. https://doi.org/10.1007/s00134-020-05985-9.
Sommerstein R, Michael MK, Franz HM, Christoph G. Coronavirus disease 2019 (COVID-19): do angiotensin-converting enzyme inhibitors/angiotensin receptor blockers have a biphasic effect? Journal of the American Heart Association. 2020;9(7):e016509. https://doi.org/10.1161/JAHA.120.016509.
Monteil V, Kwon H, Prado P, Hagelkrüys A, Wimmer RA, Stahl M, Leopoldi A, Garreta E, Hurtado C, del Pozo CH, Prosper F, Romero JP, Wirnsberger G, Zhang H, Slutsky AS, Conder R, Montserrat N, Mirazimi A, Penninger JM. Inhibition of SARS-CoV-2 Infections in Engineered Human Tissues Using Clinical-Grade Soluble Human ACE2. Cell. 2020;181(4):905-913. https://doi.org/10.1016/j.cell.2020.04.004.
Arendse LB, Jan Danser AH, Poglitsch M, Touyz RM, Burnett JC, Llorens-Cortes C, Ehlers M, Sturrock ED. Novel therapeutic approaches targeting the renin–angiotensin system and associated peptides in hypertension and heart failure. Pharmacological Reviews. 2019;71(4):539-570. https://doi.org/10.1124/pr.118.017129.