Résumé. La pandémie COVID-19 représente un problème de santé publique majeur. Une partie de la population est à risque accru de développer des complications de cette maladie, en particulier les ...personnes âgées ainsi que les malades diabétiques, les obèses et, possiblement, les malades hypertendus. Pour ces derniers, cela reste à être confirmé dans des études contrôlées de grande envergure. Les connaissances accumulées à ce jour sont rassurantes, que les malades soient traités ou non. Il n’y a pas de crainte à avoir en ce qui concerne la prise de médicaments antihypertenseurs, y compris les bloqueurs du système rénine-angiotensine. Les premières observations indiquent que le vaccin anti-COVID-19 peut être administré chez le malade hypertendu avec la meme efficacité que le normotendu. En conclusion il n’y a pas de raison de prendre en charge le malade hypertendu autrement qu’avant l’apparition de la pandémie.
Zusammenfassung. Die COVID-19-Pandemie stellt ein grosses Problem für die öffentliche Gesundheit dar. Ein Teil der Bevölkerung hat ein erhöhtes Risiko, im Rahmen dieser Erkrankung vermehrt ...Komplikationen zu entwickeln, insbesondere ältere Menschen sowie Diabetiker, adipöse und möglicherweise hypertensive Patientinnen und Patienten. Für Letztere muss dies noch in gross angelegten kontrollierten Studien bestätigt werden. Die bisher gesammelten Erkenntnisse beruhigen, egal ob die Betroffenen behandelt sind oder nicht. Bei der Einnahme von blutdrucksenkenden Medikamenten, einschliesslich Blockern des Renin-Angiotensin-Systems, besteht kein Grund zur Besorgnis. Erste Beobachtungen deuten darauf hin, dass der COVID-19-Impfstoff ohne besondere Probleme bei Hypertoniepatientinnen und -patienten verabreicht werden kann. Zusammenfassend lässt sich sagen, dass es keinen Grund gibt, hypertensive Patientinnen und Patienten anders zu behandeln als vor dem Ausbruch der Pandemie.
CME/Answers: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice
The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased ...risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.
CME/Answers: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice
The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased ...risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.
Endothelial dysfunction might be an important and early event in the pathogenesis of major cardiovascular diseases. Therefore, the evaluation of endothelial function in humans may be of great ...clinical relevance. Usual methods for that purpose are either invasive and/or technically demanding. In the dermal microcirculation, endothelial function may be assessed noninvasively from the laser Doppler measurement of increases in blood flow after either the transdermal application of acetylcholine by iontophoresis, or the release of transient arterial occlusion (reactive hyperemia). An endothelium-independent response may be provided by the iontophoresis of sodium nitroprusside. This approach is notable for technical simplicity, but of uncertain reproducibility. Sixteen young, healthy, nonsmoking males were examined in the fasting state. Changes in skin blood flow were measured with a laser Doppler imager during the iontophoresis of acetylcholine and sodium nitroprusside, as well as during reactive hyperemia, on two different days, at each of two different sites on the volar face of the forearm. Nonspecific effects related to the stimulation of terminal nerve fibers by the iontophoretic current were suppressed by prior surface anesthesia. The iontophoresis of acetylcholine and sodium nitroprusside induced a seven- to eightfold increase in dermal blood flow. The corresponding figure for peak reactive hyperemia was approximately fourfold. The mean coefficients of variation of responses recorded on different days, on the same site, in the same individual were <10% for iontophoresis of acetylcholine and for peak reactive hyperemia, and between 10 and 20% for iontophoresis of sodium nitroprusside. This day-to-day variation was significantly smaller than the site-to-site variation (p < 0.01 for all three responses). Endothelium-dependent and -independent responses of dermal blood flow evaluated with laser Doppler imaging are highly reproducible from day to day, at least in healthy nonsmoking young male subjects, and provided some simple precautions are observed, foremost among which is the strict standardization of the recording site. These observations may have implications for the testing of endothelial function in clinical studies.
The contribution of neuropeptide Y (NPY), deriving from adrenal medulla, to the adrenosympathetic tone is unknown. We found that in response to NPY, primary cultures of mouse adrenal chromaffin cells ...secreted catecholamine, and that this effect was abolished in cultures from NPY Y₁ receptor knockout mice (Y₁-/-). Compared with wild-type mice (Y₁+/+), the adrenal content and constitutive release of catecholamine were increased in chromaffin cells from Y₁-/- mice. In resting animals, catecholamine plasma concentrations were higher in Y₁-/- mice. Comparing the adrenal glands of both genotypes, no differences were observed in the area of the medulla, cortex, and X zone. The high turnover of adrenal catecholamine in Y₁-/- mice was explained by the enhancement of tyrosine hydroxylase (TH) activity, although no change in the affinity of the enzyme was observed. The molecular interaction between the Y₁ receptor and TH was demonstrated by the fact that NPY markedly inhibited the forskolin-induced luciferin activity in Y₁ receptor-expressing SK-N-MC cells transfected with a TH promoter sequence. We propose that NPY controls the release and synthesis of catecholamine from the adrenal medulla and consequently contributes to the sympathoadrenal tone.
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