Correction of cardiovascular risk factors in patients with arterial hypertension and diabetes mellitus in a time of COVID-19 pandemic

Arterial hypertension and diabetes mellitus established large risk factors for cardiovascular diseases associated with atherosclerosis are among the most common comorbidities in patients with coronavirus infection. Each of the pathologies, and especially their combination increases the cardiovascular risk, and in case of SARS-Cov-2 infection, the risk of severe course of infection and mortality. The article discusses the mechanisms of mutual burden of coronavirus infection, arterial hypertension and diabetes mellitus, provides a new concept of activating the immune system in hypertension, considers modern approaches to antihypertensive therapy in patients with diabetes mellitus.

1. Vremennye metodicheskie rekomendacii «Profilaktika, diagnostika i lechenie novoj koronavirusnoj infekcii (COVID-19), versiya 15 (22.02.2022)», utv. MZ RF.

2. Klinicheskie rekomendacii RKO Arterial‘naya gipertenziya u vzroslyh, 2020. – 136 s.

3. Shestakova M.V., Vikulova O.K., Isakov M.A., Dedov I.I. Saharnyj diabet i COVID-19: analiz klinicheskih iskhodov po dannym registra saharnogo diabeta Rossijskoj Federacii. Problemy endokrinologii. – 2020;66(1):35-46. doi: doi.org/10.14341/probl12458

4. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart Journal, Volume 39, Issue 33, 01 September 2018, Pages 3021–3104, doi.org/10.1093/eurheartj/ehy339

5. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. European Heart Journal (2020) 41, 255323. doi:10.1093/eurheartj/ehz486

6. ADVANCE Management Committee. Study rationale and design of ADVANCE: action in diabetes and vascular disease – preterax and diamicron MR controlled evaluation. Diabetologia. 2001; 44: 1118-20.

7. Bornstein SR, Rubino F., Khunti K. et al. Practical recommendations for the management of diabetes in patients with COVID-19. http://www.thelancet.com/diabetes-endocrinology Vol 8 June 2020. – P. 546–550.

8. Caillon A., Zhao K., Klein KO et al. Systolic Blood Pressure at Hospital Admission Is an Important Risk Factor in Models Predicting Outcome of COVID-19 Patients. Am J Hypertens 2021 Apr 2;34(3):282-290. doi: 10.1093/ajh/hpaa225.

9. Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. www.thelancet.com. Published Online March 10, 2022 https://doi.org/10.1016/S0140-6736(21)02796-3

10. Nilsson PM. ACCORD and Risk-Factor Control in Type 2 Diabetes. N Engl J Med 2010; 362:1575- 1585. DOI: 10.1056/NEJMoa1001286.

11. Patrick DM, Van Beusecum JP, Kirabo A. et al. The role of inflammation in hypertension: novel concepts. Curr Opin Physiol. 2021 Feb; 19:92-98. doi: 10.1016/j.cophys.2020.09.016. Epub 2020 Oct 13.

12. Thakur B., Pallavi Dubey P., Joseph Benitez J. et al. A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19. Sci Rep 11, 8562 (2021). doi.org/10.1038/s41598-021-88130-w.

13. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2022 Feb 5;399(10324):520. doi: 10.1016/S0140-6736(22)00061-7.