Pharmacotherapeutic considerations for the management of cardiovascular diseases among hospitalized COVID-19 patients

ABSTRACT

Introduction

Cardiovascular diseases (CVDs) are among the most frequently identified comorbidities in hospitalized patients with COVID-19. Patients with CV comorbidities are typically prescribed with long-term medications. We reviewed the management of co-medications prescribed for CVDs among hospitalized COVID-19 patients.

Areas covered

There is no specific contraindication or caution related to COVID-19 on the use of antihypertensives unless patients develop severe hypotension from septic shock where all antihypertensives should be discontinued or severe hyperkalemia in which continuation of renin-angiotensin system inhibitors is not desired. The continuation of antiplatelet or statin is not desired when severe thrombocytopenia or severe transminitis develop, respectively. Patients with atrial fibrillation receiving oral anticoagulants, particularly those who are critically ill, should be considered for substitution to parenteral anticoagulants.

Expert opinion

An individualized approach to medication management among hospitalized COVID-19 patients with concurrent CVDs would seem prudent with attention paid to changes in clinical conditions and medications intended for COVID-19. The decision to modify prescribed long-term CV medications should be entailed by close follow-up to check if a revision on the decision is needed, with resumption of any long-term CV medication before discharge if it is discontinued during hospitalization for COVID-19, to ensure continuity of care.

KEYWORDS:

• Cardiovascular
• covid-19
• drug-drug interaction
• renin-angiotensin system
• statin

Article highlights

• Patients with novel coronavirus disease 2019 frequently present with one or more underlying medical conditions, with hypertension and cardiovascular diseases being one of the most commonly reported comorbidities.

• Emerging studies among patients with novel coronavirus disease 2019 have reported no harm from the use of renin-angiotensin system inhibitors for hypertension or other established indications.

• Calcium channel blockers, especially the dihydropyridines, might be protective towards the development of severe illness and mortality from novel coronavirus disease 2019, though pending more evidence.

• Despite the uncertain risk of increased susceptibility and severe illness from COVID-19, patients receiving statin therapy had significantly reduced risk of mortality during hospitalization for COVID-19.

• Oral anticoagulants prescribed in patients with atrial fibrillation may have significant drug-drug interactions with pharmacological agents intended for the treatment of novel coronavirus disease 2019.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.