Vol 25, No 3 (2021)
Review paper
Published online: 2021-09-30

open access

Page views 11411
Article views/downloads 795
Get Citation

Connect on Social Media

Connect on Social Media

Hypertension management in the COVID-19 era. Getaway from pandemic snares

Jacek Wolf1, Krzysztof Narkiewicz1
Arterial Hypertension 2021;25(3):93-99.


On the verge of the second decade of our millennium, controlled hypertension was estimated at the range of approximately 30% to 50% among those European middle-age and older patients who were already treated. Experts agree that non-adherence to pharmacotherapy and physician-related clinical inertia are the utmost challenge in hypertension management. Although treatment with blood pressure lowering drugs with single pill combination (SPC) offers effective solution to that  challenge, share of patients using SPC formulation is way under expectations.

Few months of COVID-19 pandemic and repetitive lock-downs negatively impacted health condition of the whole societies. Experts report that overall cardiovascular risk profile of majority of patients worsened essentially over the course of several months of pandemic. Aggravated cardiovascular risk factors which clustered with uncontrolled hypertension calls for immediate action. Robust advocacy for wide use of SPC formulation composed of long-acting blood pressure lowering agents appears to be effective and timely getaway from this snare.

Article available in PDF format

View PDF Download PDF file


  1. , et alNCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021; 398: 957–980.
  2. Banegas JR, López-García E, Dallongeville J, et al. Achievement of treatment goals for primary prevention of cardiovascular disease in clinical practice across Europe: the EURIKA study. Eur Heart J. 2011; 32(17): 2143–2152.
  3. Payeras AC. Evolución del control de la hipertensión arterial en Atención Primaria en España. Resultados del estudio Controlpres 2003. Hipertensión y Riesgo Vascular. 2005; 22(1): 5–14.
  4. Banegas JR, Graciani A, de la Cruz-Troca JJ, et al. Achievement of cardiometabolic goals in aware hypertensive patients in Spain: a nationwide population-based study. Hypertension. 2012; 60(4): 898–905.
  5. Williams B, Mancia G, Spiering W, et al. Authors/Task Force Members:, ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39(33): 3021–3104.
  6. Muntner P, Hardy ST, Fine LJ, et al. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018. JAMA. 2020; 324(12): 1190–1200.
  7. Flack JM. Better Implementation of What Is Known Will Reverse Falling Hypertension Control Rates: We Know How to Reverse Falling Hypertension Rates. Hypertension. 2021; 78(3): 588–590.
  8. Campana E, Cunha V, Glaveckaite S, et al. The use of single-pill combinations as first-line treatment for hypertension: translating guidelines into clinical practice. J Hypertens. 2020; 38(12): 2369–2377.
  9. Whelton PK, Carey RM, Aronow RM, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertens. 2018; 71(6): E13–E115.
  10. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020; 75(6): 1334–1357.
  11. Tykarski A, Filipiak K, Januszewicz A, et al. Zasady postępowania w nadciśnieniu tętniczym — 2019 rok. Nadciśnienie Tętnicze w Prakt. 2019; 5(1): 1–86.
  12. Visseren F, Mach F, Smulders Y, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021; 42(34): 3227–3337.
  13. De Backer T, Van Nieuwenhuyse B, De Bacquer D. Antihypertensive treatment in a general uncontrolled hypertensive population in Belgium and Luxembourg in primary care: Therapeutic inertia and treatment simplification. The SIMPLIFY study. PLoS One. 2021; 16(4): e0248471.
  14. Tziomalos K, Kirkineska L, Baltatzi M, et al. Prevalence of resistant hypertension in 1810 patients followed up in a specialized outpatient clinic and its association with the metabolic syndrome. Blood Press. 2013; 22(5): 307–311.
  15. Mancia G. Optimal control of blood pressure in patients with diabetes reduces the incidence of macro and microvascular events. J Hypertens Suppl. 2007; 25(1): S7–12.
  16. Lewinski AA, Patel UD, Diamantidis CJ, et al. Addressing Diabetes and Poorly Controlled Hypertension: Pragmatic mHealth Self-Management Intervention. J Med Internet Res. 2019; 21(4): e12541.
  17. Schoenthaler A, Leon M, Butler M, et al. Development and Evaluation of a Tailored Mobile Health Intervention to Improve Medication Adherence in Black Patients With Uncontrolled Hypertension and Type 2 Diabetes: Pilot Randomized Feasibility Trial. JMIR Mhealth Uhealth. 2020; 8(9): e17135.
  18. Flack JM, Duncan SE, Ohmit SE, et al. Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy. Vasc Health Risk Manag. 2007; 3(6): 1029–1037.
  19. Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci. 2014; 1311: 151–173.
  20. Hollander JE, Carr BG. Virtually Perfect? Telemedicine for Covid-19. N Engl J Med. 2020; 382(18): 1679–1681.
  21. Masroor S. Collateral damage of COVID-19 pandemic: Delayed medical care. J Card Surg. 2020; 35(6): 1345–1347.
  22. Metzler B, Siostrzonek P, Binder RK, et al. Decline of acute coronary syndrome admissions in Austria since the outbreak of COVID-19: the pandemic response causes cardiac collateral damage. Eur Heart J. 2020; 41(19): 1852–1853.
  23. Raport o zgonach w Polsce w 2020 roku. 2021;1–9. https://www.gov.pl/web/zdrowie/raport-o-zgonach-w-polsce-w-2020-r.
  24. Tadic M, Cuspidi C, Grassi G, et al. COVID-19 and arterial hypertension: Hypothesis or evidence? J Clin Hypertens (Greenwich). 2020; 22(7): 1120–1126.
  25. Kreutz R, Dobrowolski P, Prejbisz A, et al. European Society of Hypertension COVID-19 Task Force Review. Lifestyle, psychological, socioeconomic and environmental factors and their impact on hypertension during the coronavirus disease 2019 pandemic. J Hypertens. 2021; 39(6): 1077–1089.
  26. Berry JD, Dyer A, Cai X, et al. Lifetime risks of cardiovascular disease. N Engl J Med. 2012; 366(4): 321–329.
  27. Savoia C, Volpe M, Kreutz R. Hypertension, a Moving Target in COVID-19: Current Views and Perspectives. Circ Res. 2021; 128(7): 1062–1079.
  28. Bauer A, Schreinlechner M, Sappler N, et al. Discontinuation versus continuation of renin-angiotensin-system inhibitors in COVID-19 (ACEI-COVID): a prospective, parallel group, randomised, controlled, open-label trial. Lancet Respir Med. 2021; 9(8): 863–872.
  29. Trump S, Lukassen S, Anker MS, et al. Hypertension delays viral clearance and exacerbates airway hyperinflammation in patients with COVID-19. Nat Biotechnol. 2021; 39(6): 705–716.
  30. Guo X, Zhu Y, Hong Y. Decreased Mortality of COVID-19 With Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients With Hypertension: A Meta-Analysis. Hypertension. 2020; 76(2): e13–e14.
  31. Dahlöf B, Sever PS, Poulter NR, et al. ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005; 366(9489): 895–906.
  32. Laurent S, Mancia G, Poulter N. Perindopril 3.5 mg/amlodipine 2.5 mg versus renin-angiotensin system inhibitor monotherapy as first-line treatment in hypertension: a combined analysis. J Hypertens. 2018; 36(9): 1915–1920.
  33. Campana E, Cunha V, Glaveckaite S, et al. The use of single-pill combinations as first-line treatment for hypertension: translating guidelines into clinical practice. J Hypertens. 2020; 38(12): 2369–2377.
  34. Bangalore S, Fakheri R, Toklu B, et al. Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers in Patients Without Heart Failure? Insights From 254,301 Patients From Randomized Trials. Mayo Clin Proc. 2016; 91(1): 51–60.
  35. Savarese G, Costanzo P, Cleland JG, et al. A meta-analysis reporting effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients without heart failure. J Am Coll Cardiol. 2013; 61(2): 131–142.
  36. Cheng J, Zhang W, Zhang X, et al. Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with diabetes mellitus: a meta-analysis. JAMA Intern Med. 2014; 174(5): 773–785.
  37. Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet. 2007; 370(9590): 829–840.
  38. Glezer MG. FORSAGE Investigators. Antihypertensive Effectiveness of Perindopril Arginine and Indapamide Single-Pill Combination According to Body Mass Index: Findings from the FORSAGE Study. Cardiol Ther. 2020; 9(1): 139–152.
  39. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001; 358(9287): 1033–1041.
  40. Fox KM. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003; 362(9386): 782–788.
  41. Beckett NS, Peters R, Fletcher AE, et al. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008; 358(18): 1887–1898.
  42. Zhang W, Zhang S, Deng Y, et al. STEP Study Group. Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. N Engl J Med. 2021 [Epub ahead of print].