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Objective. To study the changes in the vascular wall, vascular age and metabolic parameters in polymorbid COVID-19 conva-lescents. Material and methods. The study included 62 patients with hypertension who reached the target blood pressure (BP) with dual an-tihypertensive therapy after severe and extremely severe COVID-19. The following examinations were performed: laboratory tests of metabolic parameters, assessment of changes in the vessel elasticity indices (pulse-wave velocity (PWV), augmentation index (AI), central systolic BP (cSBP), 24-hour BP monitoring, and non-invasive markers of liver fibrosis. Results. According to office BP measurements, after the coronavirus infection, an increase in systolic BP (SBP) by 29.6% and di-astolic BP (DBP) by 23.6%, as well as heart rate (HR) by 11.8% (p<0.05) was reported during regular antihypertensive therapy. In addition, 24-hour BP monitoring data indicated an increase in the average daily SBP, DBP, and heart rate. After the coronavirus infection, an increase in PWV by 35.4% (p<0.05), AI by 24.4% (p<0.05), cSBP by 22.1% were reported. Carbohydrate and lipid metabolism parameters deteriorated. A pronounced adverse effect of coronavirus infection on liver function was observed. The vascular age (according to the modified SCORE scale) increased by 6 years (p<0.05). Conclusion. Our study showed that patients after severe and extremely severe COVID-19 have a high risk of liver fibrosis, hypertension and lipid metabolism control worsening and accelerating vascular aging.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Objective. To study the changes in the vascular wall, vascular age and metabolic parameters in polymorbid COVID-19 conva-lescents. Material and methods. The study included 62 patients with hypertension who reached the target blood pressure (BP) with dual an-tihypertensive therapy after severe and extremely severe COVID-19. The following examinations were performed: laboratory tests of metabolic parameters, assessment of changes in the vessel elasticity indices (pulse-wave velocity (PWV), augmentation index (AI), central systolic BP (cSBP), 24-hour BP monitoring, and non-invasive markers of liver fibrosis. Results. According to office BP measurements, after the coronavirus infection, an increase in systolic BP (SBP) by 29.6% and di-astolic BP (DBP) by 23.6%, as well as heart rate (HR) by 11.8% (p<0.05) was reported during regular antihypertensive therapy. In addition, 24-hour BP monitoring data indicated an increase in the average daily SBP, DBP, and heart rate. After the coronavirus infection, an increase in PWV by 35.4% (p<0.05), AI by 24.4% (p<0.05), cSBP by 22.1% were reported. Carbohydrate and lipid metabolism parameters deteriorated. A pronounced adverse effect of coronavirus infection on liver function was observed. The vascular age (according to the modified SCORE scale) increased by 6 years (p<0.05). Conclusion. Our study showed that patients after severe and extremely severe COVID-19 have a high risk of liver fibrosis, hypertension and lipid metabolism control worsening and accelerating vascular aging.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Objective. To study the changes in the vascular wall, vascular age and metabolic parameters in polymorbid COVID-19 conva-lescents. Material and methods. The study included 62 patients with hypertension who reached the target blood pressure (BP) with dual an-tihypertensive therapy after severe and extremely severe COVID-19. The following examinations were performed: laboratory tests of metabolic parameters, assessment of changes in the vessel elasticity indices (pulse-wave velocity (PWV), augmentation index (AI), central systolic BP (cSBP), 24-hour BP monitoring, and non-invasive markers of liver fibrosis. Results. According to office BP measurements, after the coronavirus infection, an increase in systolic BP (SBP) by 29.6% and di-astolic BP (DBP) by 23.6%, as well as heart rate (HR) by 11.8% (p<0.05) was reported during regular antihypertensive therapy. In addition, 24-hour BP monitoring data indicated an increase in the average daily SBP, DBP, and heart rate. After the coronavirus infection, an increase in PWV by 35.4% (p<0.05), AI by 24.4% (p<0.05), cSBP by 22.1% were reported. Carbohydrate and lipid metabolism parameters deteriorated. A pronounced adverse effect of coronavirus infection on liver function was observed. The vascular age (according to the modified SCORE scale) increased by 6 years (p<0.05). Conclusion. Our study showed that patients after severe and extremely severe COVID-19 have a high risk of liver fibrosis, hypertension and lipid metabolism control worsening and accelerating vascular aging.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Aim: This study aimed at investigating the impact of COVID-19 lockdown on metabolic profile in bipolar disorder and schizophrenia patients at the time of COVID-19. Material(s) and Method(s): This study was completed with 190 individuals diagnosed with schizophrenia (116) and bipolar disorder (74). Waist circumference and blood pressure measurements were taken on the same date as triglyceride, glucose and HDL data in the electronic recording system of the participants. Initial assessment data are measurements within 3 months prior to the publication of the first case in Turkey. The second evaluation data, on the other hand, is the data obtained within 3 months after the date of removal or relaxation of the restrictions, which is defined as the normalization period. Result(s): A significant increase was observed in the incidence of metabolic syndrome in the participants after the COVID-19 lockdown. In addition, a significant increase in glucose, triglyceride and diastolic blood pressure values, and a significant decrease in HDL values were detected. There was no significant change in systolic blood pressure and waist circumference values. Discussion(s): It has been shown that the COVID-19 lockdown increases the incidence of metabolic syndrome in patients with schizophrenia and bipolar disorder and causes irregularities in metabolic syndrome parameters.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Background: Hypertension is the most important modifiable cause of cardiovascular (CV) disease and all-cause mortality worldwide. Numerous epidemiological studies and pharmacological intervention trials have demonstrated that lower and lowering blood pressures (BP) are associated with fewer CV events and lower mortality. Despite the positive correlations between BP levels and later CV events are continuous since BP levels as low as 90/60 mmHg in almost all large-scale epidemiological studies, the diagnostic criteria of hypertension and BP thresholds and targets of antihypertensive therapy have largely remained at the level of 140/90 mmHg in the past 30 years (since the release of the Fifth Report of the Joint National Committee [JNC 5] on high BP in 1993). The publication of both the SPRINT and the STEP trials (comprising >8,500 Caucasian/African and Chinese participants, respectively) provides enough evidence to shake this 140/90 mmHg dogma. In both trials, lowering systolic BP (SBP) to <130 mmHg, compared to the traditional SBP target of <140 (130-139) mmHg, was consistently associated with a 25-30% relative risk reduction in CV events. Another dogma regarding hypertension management is "office (or clinic) BP measurements" Although standardized office BP measurement has been widely recommended, the practice of office BP measurements is hard to be or has never been ideal in real-world practice. Further, the debate regarding the numerical equivalence between automated office BP (AOBP) measurements adopted in the SPRINT trial and office BP measurements has never been settled. The variations of office BP readings and the differences between office BP and home BP readings bewilder not only patients, but also healthcare professionals. On the other hand, out-of-office BP monitoring receives growing attention in contemporary hypertension guidelines. Home BP monitoring (HBPM) and ambulatory BP monitoring (ABPM) are two recognized approaches to obtaining out-of-office BP. HBPM is easy-to-use, more likely to be free of environmental and/or emotional stress (such as white-coat effect), feasible to document long-term BP variations, of good reproducibility and reliability, and more correlated with hypertension-mediated organ damage (HMOD) and CV events. Methods/Results: The Taiwan Hypertension Society (THS) and the Taiwan Society of Cardiology (TSOC) jointly issued the Consensus Statement on HBPM in 2020. The "722" protocol to standardize HBPM has been advocated by both Societies and widely accepted by healthcare professionals. In the 2022 Taiwan Hypertension Guidelines, we break the dogma of "office BP-based management strategy" and further expand the role of HBPM to the whole hypertension management process, from diagnosis to long-term follow-up. The Task Force considers that, to improve the quality of long-term management of all chronic diseases including hypertension, patients themselves should take an active role and HBPM is the right tool to achieve this goal, regardless of many other advantages of HBPM. This approach is of particularly importance in the post-COVID era and can bridge the management with artificial intelligence technologies. Conclusion(s): To facilitate implementation of the guidelines, a series of flowcharts to encompass assessment, adjustment, and HBPM-guided hypertension management are provided.
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COVID-19 had an unprecedented effect on acute stroke services, both directly and indirectly. Intracerebral haemorrhage (ICH) appears to be increasing as a percentage of stroke patients post COVID-19 and is reported to have risen in Grampian from 13.6% of total strokes in 2019, to 17.7% in 2021. In this descriptive analysis we use the NHS Grampian Stroke audit data to explore the factors which could have contributed to this rise. The number of ICH patients on anticoagulation increased from 16.7% in 2019 to 18.4% in 2021. Of these, the proportion on a direct oral anticoagulant (DOAC) has increased from 66.7% in 2018 to 78.3% in 2021. Of the patients that were on anticoagulation, the proportion with a diagnosis of hypertension was similar between 2019 (52.9%) and 2021 (52.0%) but rose to 60% in 2022. In 2019, all ICH patients diagnosed with hypertension were on an antihypertensive. Whereas, in 2021 23.1% of ICH patients had a diagnosis of hypertension but were not on any antihypertensive treatment. The rise in the number of intracerebral haemorrhages post COVID-19 will likely be multifactorial. In this descriptive analysis there appears to be an increase in the number of ICH patients on anticoagulation, and also an increase in patients with untreated hypertension. Potential confounders include excess alcohol use or stress both of which increase the risk of ICH and are known to have risen during COVID-19.
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Arterial hypertension (AH), especially insufficiently and inadequately treated, is a disease with serious morbidity-mortality consequences. AH was the most common comorbidity in patients with COVID-19 infection. During the first wave of the COVID-19 pandemic, Slovakia has low number of COVID 19 patients. However, worldwide was reported 2-fold higher mortality in COVID 19 positive patients with untreated AH compared to patients with treated AH. Many patients have discontinued antihypertensive treatment due to changes in access to healthcare as well as the dissemination of unverified information. The aim of our study was to evaluate the AH treatment in patients during the first wave of the COVID-19 pandemic, to analyze the consequences of changes in AH treatment. It is a retrospective analysis of antihypertensive treatment of patients followed in the tertiary center. A total of 112 consecutive patients with AH who had a scheduled follow-up during the months of March-April 2020 were included. A telephone check-up was performed 6 months after the scheduled follow-up. These were patients with a mean age of 64 ± 18.1 years, 73 patients (65.2%) were male, and the mean number of antihypertensives per patient was 3.6 ± 2.2 drugs. Out of a total of 112 patients, 9 (8%) patients completely discontinued AH treatment, 15 (13.4%) patients discontinued ACEI / ARB without substitution, 5 (4.5%) patients discontinued ACEI / ARB with subsequent AH adjustment treatment. In the observed period March-April 2020, patients with newly diagnosed AH were absent. In our followed patient population (1.8%) were tested as COVID positive, 0 patients were hospitalized for COVID 19 infection. 4 (16,7%) patients overcame stroke, 1 (4.2%) patient overcame TIA, 1 (4.2%) was hospitalized for ACS, 2 (8.3%) for AF with rapid ventricular response, 2 (8.3%) for pulmonary edema, 2 (8.3%) patients died. In the group of patients who had adjusted treatment or did not discontinue AH treatment (a total of 88 patients) 1 (1.1%) patient overcame stroke, 1 (1.1%) was hospitalized for ACS, 1 (1.1%) for newly diagnosed AF, 1 (1.1%) patient died. Unjustified complete or partial discontinuation of antihypertensive treatment during the first wave of the COVID-19 pandemic has led to an increase in complications of arterial hypertension. Achieving BP targets should also be crucial during the COVID 19 pandemic.
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Objective: To study the association of calcium channel blockers (CCBs), the renin-angiotensin-aldosterone system (RAAS) inhibitors or their combination as antihypertensive medications and the clinical outcome of COVID-19 infection. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of COVID-19 patients in two isolation centers. Medical history, demographic data, symptoms, complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID-19 hospitalized patients between Feb 2020 and July 2021. Hypertension and antihypertensive treatments were confirmed by medical history and clinical records. Continuous variables were presented as means ± standard deviation (SD) while categorical variables were presented as percent proportions. Logistic regression was used to assess the impact of antihypertensive drugs (RAAS inhibitors, CCBs, combination of RAAS inhibitors and CCBs and those not receiving medication) on the prognosis of COVID-19 patients and to explore the risk factors associated with mortality. Result: Out of 406 hospitalized COVID-19 patients, 242 (59.6%) had a history of hypertension. Hypertensive patients under the age of 65 years and receiving RAAS inhibitors or the combination of both RAAS inhibitors and CCBs were at higher risk of mortality than those on CCBs only (odds ratio [OR]: 4.45, 95% confidence interval [CI]: 1.56-12.56, P = 0.005 and OR:3.57, CI: 1.03-12.36, P = 0.045 respectively). Antihypertensive medications did not seem to influence mortality rates among hypertensive patients above 65 years. Routine laboratory investigations were not significantly different between the subgroups receiving different antihypertensive medications regardless of age. Cough was the only symptom associated with mortality among patients under 65 years (OR:2.34, CI:1.24-4.41, P = 0.009). Type II respiratory failure was significantly associated with death among hypertensives under 65 years (OR:5.43, CI:1.08-28.07, P = 0.044) whereas acute kidney injury and septic shocks are the common complications related to death among hypertensives above 65 years (OR:3.59, CI:1.54-8.36, P = 0.003 and OR:7.87, CI: 1.68-36.78, P = 0.009 respectively). Conclusion: Administration of CCBs may improve the outcome of COVID-19 hypertensive patients under 65 years of age. Antihypertensive treatment does not seem to influence the prognosis of COVID-19 patients above 65 years. Such results may affect management strategy of COVID-19 hypertensive patients. Type-II respiratory failure among patients under 65 years of age, acute kidney injury and septic shock among those above 65 years are the most serious complications that can lead to death regardless of blood pressure.
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In patients who have undergone coronavirus infection, decompensation of the course of chronic cardiovascular diseases, including arterial hypertension, is often observed, which is due to a num-ber of their common pathogenetic mechanisms. To evaluate the comparative effectiveness of controlling arterial hypertension and improving the quality of life who underwent a new coronavirus infection. Totally 62 patients with arterial hypertension who had previously undergone coronavirus infection were examined. The criterion for inclusion in the study was a decrease in blood pressure control on the background of previously effective two-component therapy. Depending on the heart rate at rest, the patients were divided into two groups. In both groups, triple antihypertensive therapy was used as a second step. In the first group-a combination of perindopril 5 mg, indapamide 2.5 mg, amlo-dipine 5 mg. The second group included patients with a heart rate of more than 80 beats per minute, perindopril 5 mg, bisoprolol 5 mg, amlodipine 5 mg. The antihypertensive efficacy of the studied drug combinations was analyzed according to the data of 24-hour blood pressure monitoring. During the treatment of arterial hypertension, the dynamics of quality-of-life indicators was analyzed. A study of 24-hour monitoring and blood pressure variability in both groups of patients with coro-navirus infection demonstrated the lack of effective blood pressure control. The use of the analyzed variants of three-component therapy made it possible to achieve the target level of blood pressure in 89.6% and 93.9% of cases, respectively. In both study groups, the achievement of office blood pressure control was accompanied by a statistically significant decrease in all its daily parameters. On the background of antihypertensive therapy in both groups of the study, there was a significant and reliable (p<0.05) increase in all parameters for assessing the quality of life, which reflects the effectiveness of the treatment of arterial hypertension in patients who have had a coronavirus infection in increasing satisfaction with their lives and improving social functioning. Therapy with the use of perindopril, bisoprolol, amlodipine was accompanied by the achievement of significantly (p<0.05) higher rates of mental and physical health components. Copyright © 2022, Yerevan State Medical University. All rights reserved.
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Glucagon-like peptide 1 (GLP-1) is a gut-derived hormone released after a meal, which alleviates hyperglycemia, increases beta-cell survival, reduces body weight, and reduces inflammation. These thrilling effects motivated clinical studies to discover the potential use of GLP-1 receptor agonists (GLP-1 RAs) in the management of T2D. GLP-1 RAs are potential anti-diabetic agents that can reduce blood pressure, glucose levels, HbA1c and, weight loss without hypoglycemia risk. This manuscript reviews the importance of GLP-1 RAs and their role in the management of T2D with or without COVID-19 infection. Hence, this manuscript can help physicians and researchers to choose the most appropriate drugs for the individualized treatment of subjects. Copyright © 2022 Mirzaei et al.
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In patients who have undergone coronavirus infection, decompensation of the course of chronic cardiovascular diseases, including arterial hypertension, is often observed, which is due to a num-ber of their common pathogenetic mechanisms.To evaluate the comparative effectiveness of controlling arterial hypertension and improving the quality of life who underwent a new coronavirus infection.Totally 62 patients with arterial hypertension who had previously undergone coronavirus infection were examined. The criterion for inclusion in the study was a decrease in blood pressure control on the background of previously effective two-component therapy. Depending on the heart rate at rest, the patients were divided into two groups. In both groups, triple antihypertensive therapy was used as a second step. In the first group -a combination of perindopril 5 mg, indapamide 2.5 mg, amlo- dipine 5 mg. The second group included patients with a heart rate of more than 80 beats per minute, perindopril 5 mg, bisoprolol 5 mg, amlodipine 5 mg. The antihypertensive efficacy of the studied drug combinations was analyzed according to the data of 24-hour blood pressure monitoring. During the treatment of arterial hypertension, the dynamics of quality-of-life indicators was analyzed.A study of 24-hour monitoring and blood pressure variability in both groups of patients with coro-navirus infection demonstrated the lack of effective blood pressure control. The use of the analyzed variants of three-component therapy made it possible to achieve the target level of blood pressure in 89.6% and 93.9% of cases, respectively. In both study groups, the achievement of office blood pres- sure control was accompanied by a statistically significant decrease in all its daily parameters.On the background of antihypertensive therapy in both groups of the study, there was a signifi- cant and reliable (p<0.05) increase in all parameters for assessing the quality of life, which reflects the effectiveness of the treatment of arterial hypertension in patients who have had a coronavirus infection in increasing satisfaction with their lives and improving social functioning.Therapy with the use of perindopril, bisoprolol, amlodipine was accompanied by the achieve-ment of significantly (p<0.05) higher rates of mental and physical health components.
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Objective. To determine the presence or absence of the effect of therapy with renin-angiotensin-aldosterone system (RAAS) blockers in patients with COVID-19. Design and methods. We examined 57 patients who were treated in a medical unit at the FGAU CEC "Patriot" in the period from October to November 2020, with the diagnosis of "New coronavirus infection" and differed in the prescribed antihypertensive therapy. In group 1, drugs that affect the RAAS were used to treat hypertension before COVID-19 onset and during the treatment of COVID-19. In group 2, other drugs were used as the main antihypertensive agents before and during treatment for COVID-19. The severity of pneumonia in patients according to the results of computed tomography was 1-2. The patients were monitored for anthropometric indicators, body temperature, and laboratory data. Results. Groups 1 and 2 are comparable, differing only by height, but not by body mass index. The duration of treatment in group 2 was 1-2 days shorter than in group 1, but the result is not statistically significant due to the small sample. Thus, the hypothesis that differences between previous and ongoing antihypertensive therapy throughout the COVID-19 treatment period may affect the course and effectiveness of treatment has not been confirmed. Conclusions. Concomitant antihypertensive therapy with RAAS blockers does not alter the course of COVID-19 infection in patients. The duration of COVID-19 in patients receiving RAAS system blockers may be one day longer than for patients receiving other antihypertensive therapy. Copyright © 2021 All-Russian Public Organization Antihypertensive League. All rights reserved.
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Objective. Evaluation of the possibility of a fixed combination of azilsartan medoxomil + chlorthalidone in additional angioprotection in patients with arterial hypertension (HTN) and high pulse wave velocity (PWV) after confirmed severe or extremely severe COVID-19 (bilateral polysegmental viral pneumonia)treated by genetically engineered biological drugs, who had not previously received combined antihypertensive therapy. Design and methods. An open observational study lasting 12 weeks included 30 patients, 28-31 days after discharge from the hospital after a severe and extremely severe COVID-19, who received or had not previously received antihypertensive therapy. Patients underwent 24-hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), measurement of PWV, laboratory tests before and after prescription of a fixed combination of azilsartan medoxomil + chlorthalidone. Results. At baseline, patients showed an increase in office blood pressure to 153,06/92,2 mmHg. After treatment with a fixed combination of azilsartan medoxomil + chlorthalidone, a decrease in systolic BP by 18,47 % and diastolic BP by 16,24 % was observed. According to ambulatory BP monitoring, the decrease in systolic BP was 19,65 % and diastolic BP - 24,68 %, PWV decreased by 34,4 %, augmentation index - by 9,42 %, central systolic BP - by 15,48 % (p < 0,05). At baseline, vascular age (VA) was increased to 44,96 years compared to the passport age of 35,03 years. After treatment, there was a significant decrease in VA to 38,74 years (p < 0,01). In addition, the levels of C-reactive protein, fibrinogen, D-dimer, glucose, blood urea nitrogen and uric acid significantly decreased. Conclusions. The fixed combination of azilsartan medoxomil + chlorthalidone provides better control of BP. It also helps to improve vascular elasticity (augmentation index, PWV, central systolic BP, decrease in VA) and to reduce post-infectious inflammation in HTN patients after a severe coronavirus infection. Copyright © 2021 All-Russian Public Organization Antihypertensive League. All rights reserved.
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Background and Aims: The case fatality rate of acute spontaneous intracerebral hemorrhage (ICH) is high 54% at 1 year, and only 12% to 39% of survivors achieve long term functional independence. The INTEnsive care bundle with blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT3) was an international, multicentre, cluster-randomized clinical trial to assess a multifaceted goal-directed care bundle of physiological management in patients with acute ICH. We aimed to study the challenges encountered in recruitment during the pandemics in India. Method(s): Between August 2020 and October 2022, all adult patients presenting with spontaneous ICH within 6 hours from symptom onset were enrolled under the standard of usual care management until they are informed of crossing over to intervention and to be contacted at 6 months follow-up. Result(s): Six out of ten screened centres participated. The pandemic posed many challenges to the recruitment of patients in the trial: The ethics committee meetings were interrupted, preventing us enrolling more sites. Fewer patients presented to hospital due to fear of covid, economic crisis, transportation barriers, delayed presentation beyond 6 hours due to poor triaging, delay in RTPCR testing, slow referrals, unwillingness to followup in outpatient clinic. Solutions: frequent virtual meetings with ethics committees were held by site PIs, RTPCR switched to rapid testing, ER physicians trained to rapidly identify ICH cases and trial strategy was modified at each centre to boost recruitment. Conclusion(s): Alternative approaches for rapid triaging and modified strategies to recruitment are needed to overcome challenges of implementing a stroke trial during a pandemic.
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Background: Hypofibrinolysis, is the underlying reason behind hypercoagulability in severe COVID-19. Hypertension, cardiovascular diseases and diabetes are the prime comorbidities. Blood clotting, maintained by regulatory balance between procoagulants and anticoagulants, lead to equilibrium between coagulation and fibrinolysis. Fibrin clots made of meshwork of polymerized fibrin threads, generated by proteolysis of fibrinogen by thrombin, play a cardinal role in thrombosis. RBC, WBC and platelets get embroiled in the meshwork of fibrin thread to form clot . Clots made up thin, highly branched fibrin fibers with smaller pores are less susceptible to fibrinolysis, on the contrary clots with thick fibers, less branched with larger pores are prone to lysis. Factor VIIIa crosslinks to fibrin, also crosslinks alpha2-antiplasmin, TAFI, and PAI-2 to fibrin, to increase resistance to fibrinolysis and enhancing thrombosis risk. Aim(s): How COVID-19 comorbidities escalate hypofibrinolysis? Methods: Methods are from published literatures. Result(s): Fibrinogen levels are found to be enhanced in diabetes, with fibrin clots denser and resistant to fibrinolysis. Glycation of fibrinogen attributes to increased fibrin polymerization and crosslinkings, ensuing in abnormal clots. Altered fibrin structures, resistant to fibrinolysis are also observed in patients with coronary artery diseases and peripheral arterial diseases. Hypertension has also contributed to altered fibrin structures, with antihypertensive treatment increasing the clot susceptibility to lysis. Interestingly, platelet derived polyphosphate has been known to induce higher mass-length ratio of fibrin threads making it fibrinolysis resistant. More so, thromboembolic COVID-19 patients reported of elevated factor VIII, in comparison to patients without thromboembolisms. Severe COVID-19 patients also reported of elevated anticoagulant proteins as SERPINS, PAI-1, alpha2-antiplasmin and TAFI, reflective of impaired fibrinolysis. Supportively, expression of PAI-1 and TAFI are known to be enhanced in comorbidities. Conclusion(s): Altered fibrin structures coupled with enhanced anticoagulant production, can lead to hypofibrinolysis, which predisposes to thromboembolisms in some severe COVID-19 patients with comorbidities.
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Introduction: Despite being an AHA Class 1 recommendation to achieve a blood pressure (BP) < 130/80 for secondary stroke prevention, only an estimated 20% of the general population can achieve this benchmark. Furthermore, it has been suggested that stroke patients may be at higher risk for an inability to achieve this goal. We aimed to examine real world clinic data to evaluate BP control among stroke patients. Method(s): We conducted a population-based retrospective study using electronic health records collected during routine care at our institution for all adult patients 18 years or older with a diagnosis for stroke between January 2019 to November 2021. BP measurements were taken in an outpatient setting between 90 and 180 days from the index stroke. Descriptive statistics using R (R Core Team, 2022, r-project.org) were reported as the mean and standard deviation for continuous variables and frequencies and proportions for categorical variables. Result(s): Our review identified a total of 1,583 patients with a new diagnosis of acute ischemic stroke (AIS: 1,252;79.1%) or intracerebral hemorrhage (ICH: 331;20.9%). AIS patients were 45.7% female with a mean age of 68 years old, compared to 47.7% female and 59 years old for ICH patients. AIS patients had a higher proportion of secondary medical issues, including 34.7% with diabetes, 33.0% congestive heart failure, 19.2% cardiac disease, and 33.9% renal disease (compared to 22.2%, 16.1%, 8.8%, 19.2% respectively for ICH patients). In follow-up, only 11.7% of AIS patients were at goal (defined as a BP < 130/80) at 3 months, 17.3% at 6 months, 11.6% at 9 months, and 8.9% at 12 month follow-up. Conversely, ICH patients were slightly better controlled with 21.6%, 32.8%, 15.8%, and 12.2% controlled at 3, 6, 9, and 12 month follow-up respectively. Patients with stroke after March 2020 (post-COVID19 pandemic) had lower rates of blood pressure control compared to those diagnosed one year prior to the pandemic. Conclusion(s): Patients with AIS have lower rates of BP control compared to the general population, which was further amplified by the COVID19 pandemic. These results may suggest that stroke patients face unique barriers in BP management and highlight the need to perform targeted treatment for this especially vulnerable group.
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Introduction: The EXIT (ex-utero intrapartum treatment) procedure allows management of an abnormal fetal airway during operative delivery while they remain on utero-placental circulation. The vast majority of published cases were conducted under deep volatile anaesthesia [1] in order to provide uterine relaxation and a degree of fetal anaesthesia.10 cases have been reported under combined spinalepidural anaesthesia or intrathecal catheter, with supplemental GTN (glyceryl trinitrate) and remifentanil infusions. Recent research has improved the ability to predict the likelihood and complexity of surgical intervention. Regional anaesthesia cases all had a hysterotomy time of under 21 minutes. Here we present the first case report of an EXIT procedure conducted with simple spinal anaesthesia. Case Report: A 35-year-old woman with a BMI of 37 kg/m2, asthma and a recent COVID-19 pneumonia, had a history of post-dural puncture headache after a difficult epidural for labour, spinal anaesthetics requiring ultrasound and a lumbar puncture requiring x-ray guidance. Her fetal MRI had shown a 5.6 cm cystic neck mass, with a deviated but patent airway. The ENT team predicted surgical interventionwas unlikely or would be very short, but intubation likely. We advised a general anaesthetic as our centre did not yet have experience with EXIT under regional anaesthesia, but the patient adamantly wanted spinal anaesthesia until the baby was born, to be aware of their outcome on delivery. She preferred to avoid an epidural. An arterial line aided the challenging blood pressure management with intrathecal hyperbaric bupivacaine 13.5 mg and diamorphine 300 μg, remifentanil and GTN infusions. The uterus remained relaxed on 2.3 μg/kg/minute of GTN. Uterine tonewas later re-established with intravenous Syntocinon 10 U and intramuscular ergometrine 500 μg, with only 500 mL maternal blood loss. Despite remifentanil target controlled infusion (Minto model) at 3.5 ng/mL for 15 minutes before hysterotomy, the baby cried spontaneously. Hysterotomy timewas two minutes. Discussion: Our team were satisfied with this technique, allowing us to offer more choice to mothers with an expected short EXIT procedure. The utero-placental transfer of remifentanil has previously been found to be variable, but cases have described no fetal response to intubation from maternal remifentanil titrated to light sedation [2]. It is common for additional drugs to be given directly to the fetus even with volatile anaesthetic.
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Objective: The study aims to determine whether ACEI/ARB use associated with an increased probability of viral infection and investigate whether there are differences in disease severity and mortality between ACEI/ARB users and non-ACEI/ARB users. Material and methods: In this retrospective study, 330 patients with severe acute respiratory syndrome coronavirus 2 disease were divided into two groups: patients using ACEI/ARB Blocker and patients not using it. Baseline features and prognoses were compared for the two groups. Results: The rate of intensive care hospitalization in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB on the day of hospitalization in the intensive care unit. The degree of clinical classification in the group using ACEI/ARB was significantly (p<0.05) higher than the group not using ACE/ARB. The mortality rate in the group using ACE/ARB was significantly (p<0.05) higher than the group not using ACEI/ARB. Conclusion: Although it has been determined that the use of antihypertensive ACEI/ARB in COVID 19 patients is associated with mortality and survival, it has been concluded that the continuation of ACEI/ARB use would be more appropriate for the continuation of antihypertensive treatment.
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Background: The first reports on coronaviruse disease 2019 (COVID-19) revealed an exaggerated mortality rate in hypertensive patients. In this regard, concerns about angiotensin-converting enzyme (ACE) inhibitors’ and angiotensin-receptor blockers’ (ARBs) have been aroused. Our aim in this study was to evaluate the potential bad outcome effect of hypertension and anti-hypertensive therapy on COVID-19. Methods: 183 patients with polymerase-chain-reaction (PCR)-proven COVID-19, who were admitted to our hospital and consulted to cardiology department between 15th of March and 15th of April 2020 were included. Data were recruited from hospital records. Results: Thirty-two out of 183 patients with COVID-19 died in hospital. Hypertension incidence was not statistically different between patients who survived and died (76 [50.3%] vs 19 [59.4%, p = 0.352]). Although the usage rate of ACEI were similar among groups, ARB usage rate was significantly higher in patients who died than survived (11 [34.4%] vs 23 [15.2%], p = 0.011). Binary regression analysis showed an association between ARBs and mortality (OR: 0.032, 95% CI 1.045–2.623, p = 0.032). Conclusion: Our study confirmed previous concerns regarding a potential harmful effects of ARBs on COVID-19 related mortality.
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Aim. To study the dynamics of the lipid profile of hypertensive patients with dyslipidemia who underwent COVID-19. Material and methods. Hypertensive patients with dyslipidemia who underwent COVID-19 [n=126;58 men and 68 women;median age 60 (56.0;65.5) years] examined. Patients were included into two groups: group 1 (n=64) received a single pill combination of lisinopril + amlodipine + rosuvastatin;2 groups (n=62) continued the previous drug treatment. Clinical, demographic, office blood pressure (BP), total cholesterol (TC), low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol, triglycerides, C-reactive protein (CRP) levels were assessed in all patients in 3 visits within 24 weeks. Results. The groups did not differ in prior antihypertensive therapy (except for more frequent use of angiotensin II receptor blockers in group 2, p<0.05), lipid profile and blood pressure parameters at study entry. A decrease in systolic (by 9.5%) and diastolic blood pressure (by 12.1%) after 24 weeks was found in group 1 compared with 4.29% and 5.56%, respectively, in group 2 (p<0.05). A decrease in the level of total cholesterol by 14.5% and LDL-c by 31.4% after 24 weeks was found in group 1 compared with 11.2% and 9.7%, respectively, in group 2 (p<0.05). The level of CRP during the observation period decreased by 53.7% in group 1 versus 43.4% in patients of group 2 (p<0.05). Conclusion. The single pill combination of lisinopril/amlodipine/rosuvastatin in hypertensive patients with dyslipidemia who underwent COVID-19 led to an improvement in lipid profile and blood pressure control.