Management of patients with hypertension, coronary heart disease and chronic heart failure during the COVID-19 pandemic in the primary care setting

On December 1, 2021, a meeting of the Council of experts on the treatment of hypertension, coronary heart disease, and chronic heart failure during the COVID-19 pandemic was held remotely to adjust and adapt current approaches to outpatient treatment of the above pathologies under the current epidemiological situation. The meeting was attended by leading Russian specialists from federal medical research centers of cardiology and therapy.

1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017

2. Task Force for the management of COVID-19 of the European Society of Cardiology. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1 — epidemiology, pathophysiology, and diagnosis. Eur Heart J. 2021;43(11):1033-1058. doi:10.1093/eurheartj/ehab696

3. Figliozzi S, Masci PG, Navid Ahmadi N, Tondi L, Koutli E, Aimo A et al. Predictors of adverse prognosis in COVID-19: a systematic review and meta-analysis. Eur J Clin Invest. 2020;50(10): e13362. doi:10.1111/eci.13362

4. Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: a systematic review and meta-analysis. PLoS One. 2020;15(8):e0238215. doi:10.1371/journal.pone.0238215

5. Barron E, Bakhai C, Kar P, Weaver A, Bradley D, Ismail H et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol. 2020;8(10):813-822. doi:10.1016/S22138587(20)30272-2

6. Popkin BM, Du S, Green WD, Beck MA, Algaith T, Herbst CH et al. Individuals with obesity and COVID-19: a global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21(11):e13128. doi:10.1111/obr.13128

7. Del Sole F, Farcomeni A, Loffredo L, Carneval R, Menichelli D, Vicario T et al. Features of severe COVID-19: a systematic review and meta-analysis. Eur J Clin Invest. 2020;50(10):e13378. doi:10.1111/eci.13378.

8. Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE et al. Factors associated with COVID-19-related death using Open SAFELY Nature. 2020;584(7821):430-436. doi:10.1038/s41586-020-2521-4

9. Wang T, Tang R, Ruan H, Chen R, Zhang Z, Sang L et al. China Medical Treatment Expert Group for COVID-19. Predictors of fatal outcomes among hospitalized COVID-19 patients with preexisting hypertension in China. Clin Respir J. 2021;15(8):915-924. doi:10.1111/crj.13382

10. Gao C, Cai Y, Zhang K, Zhou L, Zhang Y, Zhang X et al. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur Heart J. 2020;41(22):2058-2066. doi:10.1093/eurheartj/ehaa433

11. Martmez-Botfa P, Bernardo A, Acebes-Huerta A, Caro A, Leoz B, Martmez-Carballeira D et al. Clinical management of hypertension, inflammation and thrombosis in hospitalized COVID-19 patients: impact on survival and concerns. J Clin Med. 2021;10(5):1073. doi:10.3390/jcm10051073

12. Arutyunov GP, Tarlovskaya EI, Arutyunov AG, Belenkov YN, Konradi AO, Lopatin YM et al. International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of predictors of short-term adverse outcomes in COVID-19. Russian Journal of Cardiology. 2021;26(4):4470. doi: 10.15829/1560-4071-2021-447. In Russian.

13. Drummond GR, Vinh A, Guzik TJ, Sobey CG. Immune mechanisms of hypertension. Nat Rev Immunol. 2019;19(8):517-532. doi:10.1038/s41577-019-0160-5

14. Bojkova D, Wagner JUG, Shumliakivska M, Aslan GS, Umber Saleem U, Arne Hansen A et al. SARS-CoV-2 infects and induces cytotoxic effects in human cardiomyocytes. Cardiovasc Res. 2020;116(14):2207-2215. doi:10.1093/cvr/cvaa267

15. Bartoloni E, Perricone C, Cafaro G, Gerli R. Hypertension and SARS-CoV-2 infection: is inflammation the missing link? Cardiovasc Res. 2020;116(13):e193-e194. doi:10.1093/cvr/cvaa273

16. Smeda M, Chlopicki S. Endothelial barrier integrity in COVID-19-dependent hyperinflammation: does the protective facet of platelet function matter? Cardiovasc Res. 2020;116(10): e118-e121. doi:10.1093/cvr/cvaa190

17. Huang C, Wang Y, Li X, Re L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S01406736(20)30183-5

18. Chen L, Li X, Chen M, Feng Y, Xiong C. The ACE 2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV-2. Cardiovasc Res. 2020;116(6):1097-1100.

19. 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):811-818. doi:10.1001/jamacardio.2020.1017

20. Meizlish ML, Pine AB, Goshua G, C-Hong C, Hanming Z, Jason B et al. Circulating markers of angiogenesis and endotheliopathy in COVID-19. Pulm Circ. 2020;10(4):2045894020966547. doi:10.1101/2020.06.29.20140376

21. Invernizzi A, Schiuma M, Parrulli S, Torre A, Zicarelli F, Colombo V et al. Retinal vessels modifications in acute and post-COVID-19. Sci Rep. 2021;11(1):19373. doi:10.1038/s41598-021-98873-1

22. Kassir R. Risk of COVID-19 for patients with obesity. Obes Rev. 2020;21(6):e13034. doi:10.1111/obr.13034

23. Wright FL, Vogler TO, Moore EE, Moore HB, Wohlauer MV, Urban S et al. Fibrinolysis shutdown correlation with thromboembolic events in severe COVID-19 infection. J Am Coll Surg. 2020;231(2):193-203.e1. doi:10.1016/j.jamcollsurg.2020.05.007

24. Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28(3):583-590. doi:10.1038/s41591-022-01689-3

25. Yan R, Zhang Y, Li Y, Xia L, Guo Y, Zhou Q. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE 2. Science. 2020;367(6485):1444-1448. doi:10.1126/science.abb2762

26. South AM, Diz DI, Chappell MC. COVID-19, ACE 2, and the cardiovascular consequences. Am J Physiol Heart Circ Physiol. 2020;318(5):H1084-H1090. doi:10.1152/ajpheart.00217.2020

27. Jessup JA, Gallagher PE, Averill DB, Brosnihan KB, Tallant EA, Chappell MC. Effect of angiotensin II blockade on a new congenic model of hypertension derived from transgenic Ren-2 rats. Circulation. 2006;291(5):H2166-72. doi:10.1152/ajpheart.00061.2006.

28. Sommerstein R, Grani C. Rapid response: preventing a COVID-19 pandemic: ACE inhibitors as a potential risk factor for fatal Covid-19. Br Med J. 2020;368: m810. doi:10.1136/bmj.m810

29. Gurwitz D. Angiotensin receptor blockers as tentative SARS-CoV-2 therapeutics. Drug Dev Res. 2020;81(5):537-540. doi:10.1002/ddr.21656

30. Cohen JB, Hanff TC, William P, Sweitzer N, Rosado-Santander NR, Medina C et al. Continuation versus discontinuation of renin-angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial. Lancet Respir Med. 2021;9(3):275-284. doi:10.1016/S22132600(20)30558-0

31. Chen R, Yang J, Gao X, Ding X, Yang Y, Shen Y et al. Influence of blood pressure control and application of renin-angiotensin-aldosterone system inhibitors on the outcomes in COVID-19 patients with hypertension. J Clin Hypertens (Greenwich). 2020;22(11):1974-1983. doi:10.1111/jch.14038

32. Cremer S, Pilgram L, Berkowitsch A, Stecher M, Rieg S, Shumliakivska M et al. LEOSS study group (2021). Angiotensin II receptor blocker intake associates with reduced markers of inflammatory activation and decreased mortality in patients with cardiovascular comorbidities and COVID-19 disease. PLoS One. 2021;16(10):e0258684. doi:10.1371/journal.pone.0258684

33. Najmeddin F, Solhjoo M, Ashraf H, Salehi M, Rasooli F, Ghoghaei M et al. Effects of renin-angiotensin-aldosterone inhibitors on early outcomes of hypertensive COVID-19 patients: A Randomized Triple-Blind Clinical Trial. Am J Hypertens. 2021: hpab111. doi:10.1093/ajh/hpab111

34. Cremer S, Pilgram L, Berkowitsch A, Stecher M, Rieg S, Shumliakivska M et al. Discontinuation of antihypertensive medications on the outcome of hospitalized patients with severe acute respiratory syndrome-coronavirus 2. Hypertension. 2021;78(1):165-173. doi:10.1161/HYPERTENSIONAHA.121.17328

35. Yan F, Huang F, Xu J, Yang P, Qin Y, Lv J et al. Antihypertensive drugs are associated with reduced fatal outcomes and improved clinical characteristics in elderly COVID-19 patients. Cell Discov. 2020;6(1):77. doi:10.1038/s41421-020-00221-6

36. Oh TK, Cho HW, Suh JW, Song IA. Incidence and mortality associated with cardiovascular medication among hypertensive COVID-19 patients in South Korea. Yonsei Med J. 2021;62(7):577-583. doi:10.3349/ymj.2021.62.7.577

37. Gao P, Wu W, Tian R, Yan X, Qian H, Guo F et al. Association between tachyarrhythmia and mortality in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). Ann Transl Med. 2021;9(10):883. doi:10.21037/atm-21-2282

38. Kow CS, Ramachandram DS, Hasan SS. Clinical outcomes of hypertensive patients with COVID-19 receiving calcium channel blockers: a systematic review and meta-analysis. Hypertens Res. 2021;45(2):360-363. doi:10.1038/s41440-021-00786-z

39. Mareev VYu, Orlova YaA, Plisyk AG, Pavlikova EP, Matskeplishvili ST, Akopyan ZA et al. Results of open-label non-randomized comparative clinical trial: “Bromhexine and Spironolactone for CoronаvirUs Infection requiring hospitalization (BISCUIT)”. Kardiologiia = Cardiology. 2020;60(10):4-15. In Russian.

40. Kreutz R, Haas S, Holberg G, Lassen MR, Mantovani LG, Schmidt A et al. Rivaroxaban compared with standard thromboprophylaxis after major orthopaedic surgery: co-medication interactions. Br J Clin Pharmacol. 2016;81(4):724-734. doi:10.1111/bcp.12836

41. Holt A, Blanche P, Zareini B, Rasmussen PV, Strange JE, Rajan D et al. Gastrointestinal bleeding risk following concomitant treatment with oral glucocorticoids in patients on non-vitamin K oral anticoagulants. Heart. doi:10.1136/heartjnl-2021-319503

42. Golukhova EZ, Arslanbekova SM, Sychev DA, Kuznetsova EV. Peculiarities of dosing of warfarin under conditions of polypharmacotherapy in patients after implantation of artificial heart valves. Creative Cardiology. 2013;1:58-65. In Russian.

43. Zhang J, Chen W, Qian J, Fu J, Wu T, Lv M et al. Changes in the gut microbiota may affect the clinical efficacy of oral anticoagulants. Front Pharmacol. doi:10.3389/fphar.2022.860237

44. Ashcraft K, Moretz C, Schenning C, Rojahn S, Vines Tanudtanud K, Magoncia GO et al. Unmanaged pharmacogenomic and drug interaction risk associations with hospital length of stay among Medicare advantage members with COVID-19: A Retrospective Cohort Study. J Pers Med. 2021;11(11):1192. doi:10.3390/jpm11111192

45. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2 — care pathways, treatment, and follow-up. Eur Heart J. 2022;43(11):1059-1103. doi:10.1093/eurheartj/ehab697

46. Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of postacute covid-19 in primary care. Br Med J. 2020;370:m3026. doi:10.1136/bmj.m3026

47. Amenta EM, Spallone A, Rodriguez-Barradas MC, El Sahly HM, Atmar RL, Kulkarni PA. Postacute COVID-19: an overview and approach to classification. Open Forum Infect Dis. 2020;7(12):ofaa509. doi:10.1093/ofid/ofaa509

48. Pavli A, Theodoridou M, Maltezou HC. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res. 2021;52(6):575-581. doi:10.1016/j.arcmed.2021.03.010

49. Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021;53(10):737-754. doi:10.1080/23744235.2021.1924397

50. Arutyunov GP, Tarlovskaya EI, Arutyunov AG on behalf of co-authors. Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up. Russian Journal of Cardiology. 2021; 26(10):4708. doi:10.15829/1560-4071-2021-4708. In Russian.

51. Government of the Russian Federation, Decree of June 18, 2021 No. 927 “On amendments to the program of state guarantees of free medical care for citizens for 2021 and for the planning period of 2022 and 2023”. In Russian.

52. Ministry of health of the Russian Federation, Order No. 404n dated April 27, 2021 “On approval of the Procedure for conducting a preventive medical examination and medical examination of certain groups of the adult population”. In Russian.

53. Ministry of Health of the Russian Federation, Order No. 698n dated July 1, 2021 “On approval of the procedure for sending citizens to undergo in-depth medical examination, including categories of citizens undergoing in-depth medical examination as a matter of priority”. In Russian.

54. Methodological guide for conducting preventive medical examination and medical examination of certain groups of the adult population, in-depth medical examination for citizens who have had a new coronavirus infection (COVID-19), Moscow, 2021. In Russian.

55. Richter D, Guasti L, Koehler F, Squizzato A, Nistri S, Christodorescu R et al. Late phase of COVID-19 pandemic in General Cardiology. A position paper of the ESC Council for Cardiology Practice. ESC Heart Failure. 2021;8(5):3483-3494. doi:10.1002/ehf2.13466