HIPERTENSI DAN PENYEBAB GAGAL GINJAL

SEHUBUNGAN DENGAN COVID 19

ENITA R. KURNIAATMAJA
 INTRODUCTION

Coronavirus disease (COVID-19) is

a new highly infectious and life-
threatening disease from severe
acute respiratory syndrome
(SARS)–coronavirus (CoV)-2 virus
WHO COVID-19

Indonesia
1.386.556 confirmed case
37.547 Deaths
Hypertension in US
Which Underlying Conditions Do COVID-19 patients
Have?
 CHRONIC KIDNEY DISEASE AND HYPERTENSION
Among patients with COVID-19, both chronic kidney disease (CKD) and hypertension
are risk factors for more severe disease
A. In a meta-analysis of four studies and 1389 infected patients (including 273 patients with severe
disease), the prevalence of underlying CKD was more frequent among those with severe disease
(3.3 versus 0.4 percent; OR 3.03, 95% CI 1.09-8.47)
B. Cohort of 1590 hospitalized patients in China, underlying hypertension was independently
associated with severe COVID-19 (HR 1.58, 95% CI 1.07-2.32)
A B

Hery BM & Lippi G, International Urology and Nephrology. doi.org/10.1007/s11255-020-02451-9

Guan W-jie, et al. Eur Respir J 2020
Hypertension. 2020;75:1334-1357.
DOI: 10.1161/HYPERTENSIONAHA.120.15026
Classification of Hypertension Based on Office Blood
Pressure (BP) Measurement

2020 ISH Global Hypertension Practice Guidelines

Pharmacological treatment of hypertension: general scheme

2020 ISH Global Hypertension Practice Guidelines

2020 ISH Global Hypertension Practice Guidelines
ISH core drugs treatment Strategy

2020 ISH Global Hypertension Practice Guidelines

 Drug treatment strategy for hypertension and CKD

Williams B et al. 2018 ESC/ESH Guidelines. DOI:10.1714/3026.30245

Nephrology volume 16, June 2020.doi.org/10.1038/ s41581-020-0279-
4
 Hypertension and Covid-19

• The COVID-19 epidemic is caused by an infection with a

novel coronavirus, officially named severe acute respiratory
syndrome coronavirus 2 (SARS-COV-2)
• Among patients with COVID-19 admitted to a hospital,
emerging data suggest that hypertension may be associated
with an increased risk of mortality due to COVID-19

Zhang P, et al. Circ Res.2020 Apr 17

 Hypertension and Covid-19
• ACEIs and ARBs are part of RAAS inhibiting agents and considered as
one of the first-line medications for the management of a large
proportion of patients with hypertension
• However, continued use of ACEI/ARB has become controversial in the
setting of COVID-19
• The reason for this controversy stems from the fact that ACEIs and
ARBs use may increase the expression of ACE2 receptor in animal-
based studies, which is the known cellular receptor and a necessary
entry point for SARS-COV-2 infection

Zhang P, et al. Circ Res.2020 Apr 17

ACEIs and ARBs in COVID-19  HARMFUL OR USEFUL ?
 Understanding ACE2 Receptor,
How Covid-19 Virus Enter the Human Body

• Virus SARS-CoV (penyebab SARS) dapat masuk ke dalam sel inangnya berikatan dengan ACE2 sebagai reseptornya
• Afinitas SARS-CoV-2 pada ACE2 adalah 10-20 kali lipat lebih tinggi dari SARS-CoV, yang dapat menjelaskan
transmisibilitasnya yang lebih tinggi
Ikawati Z, April 2020
 Hubungan ACE2
dengan SARS-CoV2
RAAS System Inhibitors in
COVID-19

Viruses 2020, 12, 491; doi:10.3390/v12050491

Diagram RAAS yang menunjukkan peran ACE dan ACE2 dalam metabolisme
berbagai peptida angiotensin dan akibat gangguan keseimbangan ACE2
Components of Renin-Angiotensin System pathway and
possible interaction of ACE-I, ARB and COVID-19.
RAAS System Inhibitors in COVID-19

Vaduganathan M, et al. N ENGL J MED 382;17.April 23, 2020

CONCLUSIONS : This study provides clinical data on the association between
ACEIs/ARBs and outcomes in patients with hypertension hospitalized with
COVID-19 infections, suggesting that ACEIs/ARBs are not associated with the
severity or mortality of COVID-19 in such patients. These data support current
guidelines and societal recommendations for treating hypertension during the
COVID-19 pandemic

JAMA Cardiol. doi:10.1001/jamacardio.2020.1624

CONCLUSIONS : Among hospitalized patients with COVID-19 and coexisting
hypertension, inpatient use of ACEI/ARB was associated with lower risk of
all-cause mortality compared with ACEI/ARB nonusers. While study
interpretation needs to consider the potential for residual confounders, it is
unlikely that in-hospital use of ACEI/ARB was associated with an increased
mortality risk.
Zhang P, et al. Circulation Research. 2020;126:1671–1681
Among patients hospitalized with mild to moderate COVID-19 and who were
taking ACEIs or ARBs before hospital admission, there was no significant
difference in the mean number of days alive and out of the hospital for those
assigned to discontinue vs continue these medications. These findings do not
support routinely discontinuing ACEIs or ARBs among patients hospitalized
with mild to moderate COVID-19 if there is an indication for treatment.

Lopes DR, et al. JAMA. 2021;325(3):254-264

The Council on Hypertension strongly recommend that
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.
Could blood pressure-lowering medicines make people
with COVID-19 sicker?
According to the latest guidance from the American Heart
Association, Heart Failure Society of America and the
American College of Cardiology, issued March 17,2020:
• Do not stop taking prescribed angiotensin converting
enzyme inhibitors (ACE-i) or angiotensin receptor
blocker (ARB) medications for high blood pressure, heart
failure or heart disease.
• These medications don’t increase your risk of
contracting COVID-19. They are vital to maintaining your
blood pressure levels to reduce your risk of heart attack,
stroke and worsening heart disease.
• If you’re a cardiovascular disease patient with COVID-19,
your health care provider should evaluate you before
adding or removing treatments. Changes should be
based on the latest scientific evidence and shared
decision-making.
 Hypertension
Management in the
Covid-19 Context