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Пульс - медицинский центр
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A separate problem is the treatment of hypertension in patients with COVID-19. The presence of a history of hypertension in patients with COVID-19 was associated with a more severe course of infection, in contrast to patients who did not have hypertension. According to modern concepts, during the COVID-19 pandemic, patients with hypertension should carefully monitor their blood pressure levels and take constantly prescribed medications. This also applies to the use of so-called blockers of the renin-angiotensin system for the treatment of patients with hypertension: angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. A number of recent studies show that these groups of drugs not only do not increase the risk of infection with the virus, but also significantly improve the course of coronavirus disease.
The most common diseases associated with hypertension include: obesity, primarily abdominal obesity (AO), type 2 diabetes mellitus (DM), coronary heart disease (CHD), arrhythmias and conduction disorders, chronic kidney disease (CKD), cerebrovascular diseases , joint diseases, chronic obstructive pulmonary disease, sleep apnea syndrome, thyroid disease and other endocrine diseases. In this regard, the 2018 European Society of Hypertension and European Society of Cardiology guidelines emphasized the need for careful stratification of cardiovascular and overall risk of complications in order to select the most optimal antihypertensive therapy.
Treatment with corticosteroids (especially prednisolone ≥20 mg/day or equivalent) is associated with an increased risk of infection. However, it is unclear whether corticosteroid therapy is associated with an increased risk of developing COVID-19 or its complications. Data on budesonide, a topical corticosteroid with low systemic bioavailability, show that these drugs are associated with significantly fewer side effects compared to systemic corticosteroids and their side effects are close to placebo. If possible, corticosteroids should be avoided and a rapid dose reduction considered, and a switch to budesonide is recommended. This must be taken into account, taking into account the risk of exacerbation of CKD. If a patient with COPD is in contact with a person with COVID-19 or develops COVID-19, it is recommended to gradually reduce the dose of corticosteroids, the use of budesonide is preferred, but taking into account the severity of COPD and the risk of exacerbation.
Skin lesions in coronavirus infection caused by the SARS-CoV-2 virus are divided into seven categories. The first category includes skin angiitis caused directly by COVID-19 infection, against which the walls of small vessels of the dermis are damaged by immune complexes circulating in the blood. Angiitis is localized on the skin of the upper and lower extremities. They look like frostbite, painful, itchy. Such manifestations usually occur in young patients with a mild course of the disease, appear in the late stages and last about 12 days. The second category includes papular-vesicular rashes, which are characterized by acute clinical manifestations in the form of chickenpox, more similar to prickly heat, occurring against a background of high fever and increased sweating.
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