According to findings given in a poster session during the virtual Hypertension 2020 Scientific Sessions, COVID-19 may influence hypertension individuals in various ways, including being a trigger for significant dips in blood pressure that put them at risk for acute kidney injury (AKI).
A second study presented at the symposium reveals that, while the use of ACE inhibitors and ARBs is related to increased mortality in COVID-19, the requirement for the drugs may be a marker for patients with a more significant underlying burden of chronic health disorders and CV risk.
Virtual Hypertension 2020 Scientific Sessions
Paolo Manunta, MD, Ph.D. (San Raffaele University, Milan, Italy), and colleagues looked at 392 consecutive COVID-19 patients admitted to their hospital in March and April 2020. More than half of the patients, aged 67 on average, had hypertension.
In the study, mean blood pressure at presentation was inversely associated with the risk of AKI. After controlling for age and respiratory distress, patients with a history of hypertension who turned hypotensive had a roughly fivefold more significant risk of AKI (P = 0.044). AKI was also elevated ninefold in people with severe hypotension (P = 0.021) and fourfold in people with mild hypotension (P = 0.009).
Those with hypotension were also more likely to die during hospitalization. Having mild hypotension on arrival at the emergency department was associated with a doubling of in-hospital mortality, regardless of age, concurrent disorders, or COVID-19 severity.
“Early discontinuation of antihypertensive medication if blood pressure is less than 120/70 may reduce AKI development and mortality in COVID-19,” Manunta and colleagues write.
Researchers stated that given the multisystem disease processes associated with symptomatic COVID-19 infection, it is not surprising that previously hypertensive patients can suddenly become hypotensive and develop AKI.
“Under these conditions, antihypertensive medications, including ACE inhibitors and ARBs, must be discontinued to prevent worsening of the acute kidney injury,” they wrote in their studies.
The Use of ACE/ARBs and Mortality
Early in the COVID-19 pandemic, there was conjecture that using renin-angiotensin-aldosterone system (RAAS) inhibitors may worsen the prognosis in people infected. The American College of Cardiology, American Heart Association, and Heart Failure Society of America published a statement in March recommending patients not to discontinue ACE inhibitors or ARBs unless instructed to do so by their doctor. At the time, the societies also stated that more data was required to solve the problem.
Since then, a study in Wuhan, China, found that not taking antihypertensive medication increased the risk of mortality among hypertensive COVID-19 patients. Most recently, the BRACE-CORONA randomized controlled trial found no increased risk of death or prolonged length of stay in hospitalized COVID-19 patients who continued on their previously prescribed ACE inhibitors or ARBs versus those who stopped.
A second poster presentation at Hypertension 2020 looked at this growing topic differently. In this study, Baher Al-Abbasi, MD (University of Miami/JFK Medical Center, Atlantis, FL), and colleagues found that 172 COVID-19 patients taking ACE inhibitors or ARBs had higher in-hospital mortality (33 % vs. 13 %; P = 0.003), as well as a higher likelihood of ICU admission (28 % vs. 13 % ; P = 0.038). However, there were no statistically noticeable changes in in-hospital mortality rates by RAAS inhibitor use in a multivariable analysis that took age, obesity, hypertension, diabetes, and chronic renal disease into account (P = 0.8372).
Additional research is needed to evaluate whether there is an actual cause-and-effect link between ACE inhibitors or ARBs and mortality in COVID-19.
“In the interim, it is prudent to weigh the advantages and hazards of ACE-I or ARB medication in patients at risk of CV disease before making any modifications to their treatment in the absence of hypotension,” she noted.
A comprehensive, global analysis, a third study, also given as a presentation at the symposium, confirms that hypertension is the most common comorbidity among COVID-19 patients. The pooled analysis of almost 11,000 patients from eight nations discovered a 42 % prevalence of hypertension, followed by a 23 % rate of diabetes.
Non-hypertensive CV disease, chronic renal disease, stroke, and COPD were less common comorbidities.
You can also consult a specialist to know more factual details about the connection between blood pressure and COVID. You can book an appointment with the Best Cardiologist in Lahore through Marham anytime, anywhere you want to without any difficulty.
Frequently Asked Questions (FAQs)
1- Who is at a higher risk of having severe illness due to COVID-19?
People over the age of 65 and those with underlying medical conditions such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to acquire serious illnesses.
2- Under what circumstances does COVID-19 survive the longest?
Coronaviruses die quickly when exposed to UV radiation in the sun. SARS-CoV-2, like other encapsulated viruses, thrives best at room temperature or below and with low relative humidity (50 %).
3- How is the COVID-19 disease spread?
COVID-19 spreads through the air when people breathe in droplets and minute airborne particles containing the virus. The risk of inhaling these is high when individuals are close together, although they can be inhaled over greater distances, especially indoors.
4- Is COVID-19 more likely to cause severe disease in smokers?
Tobacco use is an established risk factor for numerous respiratory infections and worsens respiratory disease severity. A review of studies discovered that smokers are more likely than non-smokers to suffer severe disease from COVID-19.
5- What effect does COVID-19 have on the cardiovascular system?
The virus can induce immediate myocardial injury as well as long-term cardiovascular disease.
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