Treba nastaviti liječenje uobičajenom antihipertenzivnom terapijom u skladu s recentnim smjernicama budući da ne postoje klinički niti znanstveni dokazi koji bi ukazali kako liječenje ACE inhibitorima ili sartanima treba prekinuti zbog COVID-19 infekcije

S obzirom na informacije koje su pojavile u medijima o afinitetu korona virusa COVID-19 na angiotensin konvertirajući enzim -2 (ACE2) i potencijalno povećavanome riziku kod osoba liječenih ACE inhibitorima ili lijekovima koji blokiraju angiotenzin II receptore (sartani ili ARB- ovi), a zbog povećane raspoloživosti navedenoga enzima i time potencijalnoga intenziviranja infekcije korona virusom Hrvatsko društvo za hipertenziju i Radna skupina za arterijsku hipertenziju Hrvatskoga kardiološkog društva donosi sljedeći stav koji je sukladan stavu vodećih i krovnih međunarodnih društava – Europskoga društva za hipertenziju i Europskoga društva za kardiologiju.

Liječnici i bolesnici trebaju nastaviti liječenje svojom uobičajenom antihipertenzivnom terapijom u skladu s recentnim smjernicama budući da ne postoje klinički niti znanstveni dokazi koji bi ukazali kako liječenje ACE inhibitorima ili sartanima treba prekinuti zbog COVID-19 infekcije.

Isto tako, nema dokaza da bi bolesnike inficirane COVID 19 virusom trebalo liječiti drugačije od ostalih bolesnika kojima je nužna blokada renin - angiotenzinskoga sustava.

U nastavku ovoga mišljenja su izvadci stavova međunarodnih i nekih nacionalnih društava.

Molimo da s ovim stavom upoznate kolege, bolesnike i ostale zdravstvene radnike.

prof. dr. sc. Bojan Jelaković

predsjednik Hrvatskoga društva za hipertenziju i Radne skupine za arterijsku hipertenziju Hrvatskoga kardiološkog društva

akademik Davor Miličić 

predsjednik Hrvatskoga kardiološkog društva

Position statement ESC council of Hypertension:

“…Physicians and patients should continue treatment with their usual anti-hypertensive therapy because there is no clinical or scientific evidence to suggest that treatment with ACEi or ARBs should be discontinued because of the COVID-19 infection”.

Statement of the European Society of Hypertension (ESH)

(https://www.eshonline.org/spotlights/esh-statement-on-covid-19/):

“In stable patients with COVID-19 infections or at risk for COVID-19 infections, treatment with ACEIs and ARBs should be executed according to the recommendations in the 2018 ESC/ESH guidelines.”

“The currently available data on COVID-19 infections do not a support a differential use of RAS blockers (ACEI or ARBs) in COVID-19 patients.”

Statement of the Italian Society of Hypertension (SIIA) and Italian Society of GPs (SIMG)

(drugi privitak i https://www.simg.it/supporto-e-condivisione-della-posizione- della-siia-sulluso-degli-ace-inibitori-nella-presente-situazione-epidemica/):

“The society recommends to hypertensive patients not to change the antihypertensive therapy which has proven over time to protect at risk of serious cardiovascular complications, such as myocardial infarction, heart failure, sudden death, brain stroke and kidney failure.”

“The discontinuation of ACE inhibitors and Sartans, as well as not justified by scientific data available to date, would represent a danger both in terms of increased cardiovascular risk and with a view to an infection with COVID-19”.

Statement of the Swiss Society of Cardiology and the Swiss Society of Hypertension

(treći privitak):

“Based on today's data and in view of the clear and well-documented reduction in mortality in heart disease, an ACE inhibitor or Sartan therapy must be continued or should be established according to current guidelines for SARS-Cov2 positive patients with Heart failure, Hypertension or Heart attack. A prophylactic conversion of still healthy patients to other substances is not justified"