PEMILIHAN TERAPI YANG TEPAT UNTUK PASIEN

HIPERTENSI DI MASA PANDEMI COVID-19

apt. Fajar Prasetya, M.Si., Ph.D

 Hypertension
• Systemic arterial hypertension (hereafter referred to as hypertension) is
characterized by persistently high blood pressure (BP) in the systemic arteries.
• BP is commonly expressed as the ratio of the systolic BP (that is, the pressure
that the blood exerts on the arterial walls when the heart contracts) and the
diastolic BP (the pressure when the heart relaxes).

Category Subtype Systolic BP Diastolic BP

(mmHg) (mmHg)

Office BP NA ≥140 ≥90

Ambulatory BP Daytime ≥135 ≥85
(awake)

Night-time ≥120 ≥70

(asleep)

24 h ≥130 ≥80
Home BP NA ≥135 ≥85
https://www.nature.com/art
icles/nrdp201814#citeas
Covid-19
Structure of the SARS-CoV-2 spike
glycoprotein (closed state)
•Method: ELECTRON MICROSCOPY
•Resolution: 2.80 Å
 ACE2 Is an Entry Receptor for SARS-CoV-2
• An enzyme attached to the cell membranes of cells located in the lungs, arteries, heart, kidney, and intestines.
• SARS-CoV-2 S uses ACE2 to enter cells and that the receptor-binding domains of SARS-CoV-2 S and SARS-
CoV S bind with similar affinities to human ACE2, correlating with the efficient spread of SARS-CoV-2 among
humans
Spike glycoprotein

ACE2 ACE2

Spike glycoprotein
Sequence Length: 218
Sequence Length: 606
Sequence Length: 606
• Angiotensin-converting enzyme (ACE) cleaves angiotensin I to form angiotensin II.
Angiotensin II enhances sodium reabsorption in the proximal tubule.

• Angiotensin II is also associated with endothelial dysfunction and has profibrotic and
proinflammatory effects, mediated in large part by increased oxidative stress, resulting
in renal, cardiac and vascular injury. Angiotensin II is tightly linked to target-organ
damage in hypertension via these mechanisms.

• ACE2 has emerged as an important modulator in the pathophysiology of hypertension, CVD

and renal disease, owing to its role in metabolizing angiotensin II into angiotensin (1–7).

• Angiotensin (1–7) induces systemic and regional vasodilation, diuresis and natriuresis
and exerts antiproliferative and antigrowth effects on vascular smooth muscle cells,
cardiac myocytes and fibroblasts as well as on glomerular and proximal tubular cells.

• Angiotensin (1–7) also has cardiorenal protective effects.

 Management of hypertension in COVID-19
• Verapamil or carvedilol should be considered for the
management of hypertension in patients at risk of
COVID-19.

• In agreement with the recommendation of major medical

societies to maintain ACEI or ARB therapy in
individuals who are already receiving treatment.

• However, patients with a new diagnosis of hypertension

who are at risk of COVID-19 would likely benefit from
verapamil or carvedilol, as these agents effectively
control blood pressure and may conceivably attenuate
inflammation and necrosis in SARS-CoV-2 myocarditis.
 Verapamil
• Verapamil's mechanism in all cases is to block voltage-dependent calcium
channels

Voltage-Gated Ca2+Channel

PDB: 6JPA
 Verapamil (cont.)
• Verapamil, a phenylalkylamine, also has antiinflammatory properties
• L-type Ca2+ channel (LTCC) blockers, represented by amlodipine and verapamil, are widely
used antihypertensive drugs that also have antiinflammatory activities
 Carvedilol
• Carvedilol is a new beta-blocker antihypertensive agent with vasodilating properties
secondary to alpha 1-blocking activity. Peripheral vascular resistance is reduced, and cardiac
output and renal function are not altered with carvedilol.
Beta1-Adrenoceptor

PDB: 4AMJ
 Carvedilol (cont.)
• Carvedilol, a nonselective beta-blocker, suppresses the production of tumor necrosis factor
 COVID-19 and hypertension: risks and management. A scientific
statement on behalf of the British and Irish Hypertension Society

• The growing body of evidence

suggests that continuation of ACE
inhibitors and ARBs during the
current COVID-19 pandemic is safe.
• The stimulation of other properties of the immune
response by honey is also reported (Proliferation of
B- and T-lymphocytes and the phagocytes activity).
Honey induces the generation of antibodies.
Terima kasih atas perhatiannya,
Semoga bermanfaat J