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Большой проблемой является выбор наиболее оптимального лечения АГ, способного затормозить прогрессирование поражений сердца, сосудов, почек, головного мозга и глаз. Подавляющему большинству больных АГ, которые обращаются за медицинской помощью, требуется назначение комбинированной антигипертензивной терапии. При этом наиболее целесообразным на современном уровне считается применение фиксированных комбинаций таких лекарств. И пациенты, и врачи должны хорошо понять необходимость длительной терапии с периодическим контролем ключевых показателей и обязательным достижением так называемых целевых уровней АД, то есть стабильной нормализации АД. Только такой подход к лечению больных АГ может дать успешный результат. Но в настоящее время, как было указано выше, только очень небольшое количество больных АГ лечится эффективно. В этой связи в Украине не наблюдается снижение частоты осложнений данного заболевания.
The use of thiopurine (azathioprine and mercaptopurine) reduces the immune response to viruses, which is associated with an increased risk of opportunistic infections. There is limited evidence that they increase the risk of respiratory infections. The risks and benefits should be considered, but most patients can continue on a stable dose. In patients in stable remission, elderly patients and in the presence of concomitant pathology, it is recommended to stop taking thiopurine. During a pandemic, it is recommended to avoid starting thiopurine or increasing the dose, which will allow patients to avoid potential side effects. If the patient is in contact with a COVID-19 person, temporary withdrawal of thiopurine for 2 weeks should be considered. If a patient tests positive for SARS-CoV-2 and/or develops COVID-19, temporary discontinuation of thiopurine may be recommended until the patient clears the infection.
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.
Experts refer to the third category of skin manifestations as pink lichen and papulosquamous rashes, which are infectious-allergic skin lesions associated with COVID-19 infection. The clinical feature of pink lichen in this case is the absence of maternal plaque. The fourth category includes a measles rash. To the fifth - toxicodermia. This rash is associated with individual intolerance of patients of certain groups of drugs. The sixth category of skin manifestations of coronavirus infection, scientists include urticaria, which in some cases may be a harbinger of the onset of COVID-19.
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