RESUMO
Más allá del control de la glucemia existen otros objetivos importantes a la hora de brindar atención integral a pacientes con diabetes mellitus. Se realizó una revisión bibliográfica con el objetivo de identificar el papel que desempeñan los nuevos fármacos antidiabéticos en la prevención cardiovascular y la insuficiencia cardiaca. El uso de SGLT2i y GLP-1a acarrea una disminución significativa de eventos cardiovasculares, sin diferencias entre ambos, exceptuando las hospitalizaciones por insuficiencia cardiaca, en donde es evidente la superioridad de estos últimos (en especial dapaglifozina y empaglifozina). La evidencia actual respecto al efecto de los DPP-4i es diversa, aunque se observa un aumento del riesgo de hospitalizaciones por insuficiencia cardiaca con el consumo de algunos fármacos de esta clase (saxagliptina).(AU)
Beyond glucemic control there are other important goals when it comes to providing integral care to patients with diabetes mellitus. A bibliographic review was made in order to identify the role played by new antidiabetic drugs in cardiovascular prevention and heart failure. The use of SLGT2i and GLP1a leads to a significant decrease in cardiovascular events, with no difference between the two, except when it comes to hospitalizations for heart failure, where the superiority of the last ones (especially dapaglifozin and empaglifozin) is evident. The current evidence regarding the effect of dpp-4i is diverse, although an increased risk of hospitalizations for heart failure is observed with the use of some drugs of this class (saxagliptin).(AU)
Assuntos
Humanos , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/prevenção & controle , Hipoglicemiantes , Diabetes Mellitus Tipo 2 , Isquemia Miocárdica , Inibidores do Transportador 2 de Sódio-Glicose , Peptídeo 1 Semelhante ao GlucagonRESUMO
Beyond glucemic control there are other important goals when it comes to providing integral care to patients with diabetes mellitus. A bibliographic review was made in order to identify the role played by new antidiabetic drugs in cardiovascular prevention and heart failure. The use of SLGT2i and GLP1a leads to a significant decrease in cardiovascular events, with no difference between the two, except when it comes to hospitalizations for heart failure, where the superiority of the last ones (especially dapaglifozin and empaglifozin) is evident. The current evidence regarding the effect of dpp-4i is diverse, although an increased risk of hospitalizations for heart failure is observed with the use of some drugs of this class (saxagliptin).
Assuntos
Doenças Cardiovasculares , Sistema Cardiovascular , Diabetes Mellitus Tipo 2 , Insuficiência Cardíaca , Hipoglicemiantes , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipoglicemiantes/efeitos adversosRESUMO
RESUMEN Introducción: El primer trimestre de 2020 se ha visto influenciado por la propagación de una pandemia ocasionada por el virus SARS coronavirus 2, el cual origina una afección (COVID-19) que en algunos casos llega al Síndrome de Distress Respiratorio Agudo. Objetivo: Identificar la relación existente entre COVID-19 y la Hipertensión Arterial. Material y métodos: Se realizó una revisión, utilizando bases de datos bibliográficas y buscadores. Además, se utilizó literatura de consulta obligada en Cardiología e información de sitios web oficiales gubernamentales, de la OMS/OPS y sociedades científicas. Desarrollo: Los coronavirus se unen a sus células diana a través de una proteína espícula (S), cuya unidad de superficie S1 se acopla a la enzima conversora de angiotensina 2 como receptor. En las diferentes series revisadas se observa la clara relación entre el antecedente de Hipertensión Arterial y el curso evolutivo desfavorable en pacientes con COVID-19. Al realizar una búsqueda extensa de la bibliografía no se encuentra evidencia científica que ampare la suspensión del tratamiento con inhibidores de la enzima conversora de angiotensina/ antagonistas de los receptores de angiotensina en pacientes hipertensos con COVID-19. Conclusiones: La enzima conversora de angiotensina actúa como receptor del SARS-CoV 2. Los individuos hipertensos presentan un curso evolutivo menos favorable de la afección por este virus. No es aconsejable la suspensión del tratamiento con inhibidores de la enzima conversora de angiotensina o antagonistas del receptor de angiotensina en pacientes hipertensos afectados con COVID-19.
ABSTRACT Introduction: The first three months of 2020 have been influenced by the spreading of a pandemic caused by the SARS-coronavirus 2, which causes COVID-19 infection that in some cases is associated with acute respiratory distress syndrome. Objective: To identify the relationship between COVID-19 and hypertension. Material and Methods: A bibliographic review was carried out using database search engines. In addition, reference literature in Cardiology was used as well as information from official government websites such as WHO/PAHO and other scientific societies. Development: Coronaviruses enter into target cells through a spike S protein, whose S1 surface unit is coupled to the angiotensin-converting enzyme 2 as a receptor. In the different revised series, the clear relationship between the history of arterial hypertension and the unfavorable evolution is observed in patients with COVID-19. In an extensive literature search, there is no scientific evidence for discontinuation of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in hypertensive patients with COVID-19. Conclusions: The angiotensin-converting enzyme acts as a SARS-CoV2 receptor. Hypertensive individuals have a less favorable evolution course of the condition caused by this virus. Discontinuation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers is not advisable in hypertensive patients with COVID-19.
