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1.
Acta Anaesthesiol Scand ; 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2107884

ABSTRACT

INTRODUCTION: Critically ill Covid-19 patients are likely to develop the sequence of acute pulmonary hypertension (aPH), right ventricular strain, and eventually right ventricular failure due to currently known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. Furthermore, an in-hospital trans-thoracic echocardiography (TTE) diagnosis of aPH is associated with a substantially increased risk of early mortality. The aim of this retrospective observational follow-up study was to explore the mortality during the 1-24-month period following the TTE diagnosis of aPH in the intensive care unit (ICU). METHODS: A previously reported cohort of 67 ICU-treated Covid-19 patients underwent an electronic medical chart-based follow-up 24 months after the ICU TTE. Apart from the influence of aPH versus non-aPH on mortality, several TTE parameters were analyzed by the Kaplan-Meier survival plot technique (K-M). The influence of biomarkers for heart failure (NTproBNP) and myocardial injury (Troponin-T), taken at the time of the ICU TTE investigation, was analyzed using receiver-operator characteristics curve (ROC) analysis. RESULTS: The overall mortality at the 24-month follow-up was 61.5% and 12.8% in group aPH and group non-aPH, respectively. An increased relative mortality risk continued to be present in aPH patients (14.3%) compared to non-aPH patients (5.6%) during the 1-24-month period. The easily determined parameter of a tricuspid valve regurgitation, allowing a measurement of a systolic pulmonary artery pressure (regardless of magnitude), was associated with a similar K-M outcome as the generally accepted diagnostic criteria for aPH (systolic pulmonary artery pressure >35 mmHg). The biomarker values of NTproBNP and Troponin-T at the time of the TTE did not result in any clinically useful ROC analysis data. CONCLUSION: The mortality risk was increased up to 24 months after the initial examination in ICU-treated Covid-19 patients with a TTE diagnosis of aPH, compared to non-aPH patients. Certain individual TTE parameters were able to discriminate 24-month risk of morality.

2.
Aging (Albany NY) ; 14(21): 8585-8594, 2022 11 02.
Article in English | MEDLINE | ID: covidwho-2100593

ABSTRACT

This study aims to determine the differences in myocardial enzymes in COVID-19 patients with and without hypertension. A total of 130 patients with COVID-19 in Yunmeng County People's Hospital were analyzed. The clinical manifestations and laboratory indicators were collected and analyzed. We found that COVID-19 patients with hypertension had higher mortality rate, greater age, and higher rates of basic disease such as diabetes than patients without hypertension. The γ-glutamyl transpeptidase (GGT), blood urea nitrogen (BUN), albumin/globulin (A/G), Ca, Mg, lactate dehydrogenase (LDH), and α-hydroxybutyric-dehydrogenase (α-HBD) levels in COVID-19 patients with hypertension were higher than in COVID-19 patients without hypertension. We found that the predictive effect of the creatine kinase isoenzyme (CK-MB), LDH-L, and α-HBD levels in the COVID-19 patients without hypertension were higher than in COVID-19 patients with hypertension. We used the ROC curve model to predict whether patients would have hypertension, and we found that CK-MB, LDH-L and HBD parameters could distinguish the COVID-19 patients with hypertension and non-hypertension, and could predict the mortality of COVID-19 patients.


Subject(s)
COVID-19 , Hypertension , Humans , Retrospective Studies , Myocardium , L-Lactate Dehydrogenase
3.
Cureus ; 14(9): e29654, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2100372

ABSTRACT

Current research suggests COVID-19 in pregnancy is associated with poor maternal and fetal outcomes, although the exact mechanisms remain unclear, and the approach to the management of affected patients presents a distinct challenge to clinicians. We present a case of gestational hypertension, eclampsia, and postpartum depression in a 39-year-old gravida 4, para 0030 (G4P0) pregnant patient following multiple prenatal severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) infections. After a case of coronavirus disease-19 (COVID-19) during her first trimester, the patient received a two-dose mRNA vaccine against SARS-CoV-2. Despite vaccination, she again contracted COVID-19 during her third trimester of pregnancy. She subsequently developed gestational hypertension at 38 weeks necessitating a cesarean section at 38+4 weeks. The patient delivered a healthy neonate, however, her postpartum course was complicated by eclampsia and postpartum depression. This case bolsters current literature and emphasizes the necessity of continued research into the effects of COVID-19 in pregnant and postpartum women.

4.
Turk J Ophthalmol ; 52(5): 342-347, 2022 10 28.
Article in English | MEDLINE | ID: covidwho-2100077

ABSTRACT

Bilateral acute depigmentation of the iris (BADI) and bilateral acute iris transillumination (BAIT) are relatively new clinical entities characterized by acute pigment dispersion from the iris stroma or iris pigment epithelium, respectively. While BADI presents with diffuse or geographic areas of iris stromal depigmentation without transillumination, BAIT cases typically develop diffuse iris transillumination and mydriatic atonic pupils. Prolonged pigment dispersion and ocular hypertension are more common in BAIT. Although the exact etiopathogenesis is still unknown, moxifloxacin toxicity appears to be a probable/likely cause. The underlying cause of BADI or BAIT in patients who were not exposed to fluoroquinolone antibiotics remains unexplained. Systemic viral infections, including coronavirus disease 2019, may be the triggering event in several cases.


Subject(s)
COVID-19 , Iris Diseases , Humans , Iris Diseases/chemically induced , Iris Diseases/diagnosis , Transillumination , Iris/pathology , Fluoroquinolones
5.
Indian J Community Med ; 47(3): 400-404, 2022.
Article in English | MEDLINE | ID: covidwho-2100015

ABSTRACT

Context: Adult population visiting COVID vaccination center is a potential teachable moment for screening and preventive advice on non-communicable diseases. Objectives: The objective of this study was to assess the proportion of vaccinees volunteering for screening and to know the proportion of newly detected hypertensives and diabetics among the screened vaccinees at COVID-19 vaccination center. Setting and Design: This descriptive, cross-sectional, operational research study was carried out at the COVID vaccination center at a medical college in central Gujarat from July to September 2021. Methods: After receiving the vaccine, the vaccinee was offered screening through a community-based assessment checklist for risk factors of non-communicable diseases, blood pressure, and blood sugar measurement. Those volunteering for this screening received a slip mentioning their risk score, blood pressure and blood sugar reading, and relevant health information and disease prevention advice. The study variables were acceptability (proportion of vaccinees volunteering for screening) and yield (newly detected hypertensives and diabetics among those screened). Results: Among vaccinees, 27.7% volunteered for risk scoring and blood pressure measurement, whereas 8.3% volunteered for blood sugar measurement. Around 15.5% of vaccinees had high-risk scores as per the community-based assessment checklist. The yield of freshly detected high blood pressure and high blood sugar was 19.3% and 10.5%, respectively. The yield was similar even among vaccinees under 30 years of age. Conclusions: Vaccinees demonstrated interest in undergoing screening for non-communicable diseases. Yield indicates that such screening is worth the effort.

6.
Br J Gen Pract ; 2022 Aug 30.
Article in English | MEDLINE | ID: covidwho-2099922

ABSTRACT

BACKGROUND: Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does not dip, or rises (reverse dipping), have poorer cardiovascular outcomes. AIM: To investigate the importance of measuring night-time BP when assessing individuals for hypertension. DESIGN AND SETTING: Retrospective cohort study of two patient populations - namely, hospital patients admitted to four UK acute hospitals located in Oxfordshire, and participants of the BP in different ethnic groups (BP-Eth) study, who were recruited from 28 UK general practices in the West Midlands. METHOD: Using BP data collected for the two cohorts, three systolic BP phenotypes (dipper, non-dipper, and reverse dipper) were studied. RESULTS: Among the hospital cohort, 48.9% ( n = 10 610/21 716) patients were 'reverse dippers', with an average day-night systolic BP difference of +8.0 mmHg. Among the community (BP-Eth) cohort, 10.8% ( n = 63/585) of patients were reverse dippers, with an average day-night systolic BP difference of +8.5 mmHg. Non-dipper and reverse-dipper phenotypes both had lower daytime systolic BP and higher night-time systolic BP than the dipper phenotype. Average daytime systolic BP was lowest in the reverse-dipping phenotype (this was 6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thereby placing them at risk of undiagnosed, or masked, hypertension. CONCLUSION: Not measuring night-time BP puts reverse-dippers (those with a BP rise at night-time) at risk of failure to identify hypertension. As a result of this study, it is recommended that GPs should offer ABPM to all patients aged ≥60 years as a minimum when assessing for hypertension.

7.
Egypt Heart J ; 72(1): 41, 2020 Jul 13.
Article in English | MEDLINE | ID: covidwho-2098495

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has drastically affected global health. Despite several studies, there is yet a dearth of data regarding the mechanisms of cardiac injury, clinical presentation, risk factors, and treatment of COVID-19-associated cardiovascular disease. This systematic review and meta-analysis is aimed at defining the clinical, electrocardiographic, and pathologic spectrum of cardiovascular disease (CVD), frequency of elevated cardiac and inflammatory biomarkers, and their frequency and relationship with severity of the disease and mortality in COVID-19 patients and to develop a triage risk stratification tool (TRST) that can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy. We conducted an online search in databases of PubMed and Embase to identify relevant studies. Data selection was in concordance with PRISMA guidelines. Results were presented as pooled frequencies, odds ratio, standardized mean difference (SMD), and forest and funnel plots. RESULTS: We gathered a total of 54 studies and included 35 of them in our meta-analysis. Acute cardiac injury occurred in more than 25% of cases, mortality was 20 times higher, and admission to intensive care unit increased by 13.5 times. Hypertension was the most common pre-existing comorbidity with a frequency of 29.2%, followed by diabetes mellitus (13.5%). The deceased group of patients had higher cardiac and inflammatory biomarkers, with statistically significant SMD, compared with survivors. Pediatric patients were predominantly mildly affected. However, less frequently, the presentation was very similar to Kawasaki disease or Kawasaki shock syndrome. This latter presentation hass been called as multisystem inflammatory syndrome in children (MIS-C). CONCLUSIONS: There is a wide spectrum of cardiac involvement in COVID-19 patients, and hence a Triage Risk Stratification Tool can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy.

8.
Cardiovasc Hematol Disord Drug Targets ; 22(2): 104-117, 2022.
Article in English | MEDLINE | ID: covidwho-2098958

ABSTRACT

BACKGROUND: Hypertension and heart failure are known risk factors for coronavirus disease 2019 (COVID-19) severity and mortality outcomes. Beta-blocker is one of the drugs of choice to treat these conditions. The purpose of this study is to explore the relationship between preadmission beta-blocker use and COVID-19 outcomes. METHODS: PubMed and Europe PMC were used as the database for our search strategy by using combined keywords related to our aims until December 10th, 2020. All articles related to COVID- 19 and beta-blocker were retrieved. Review Manager 5.4 and Comprehensive Meta-Analysis 3 software were used to perform statistical analysis. RESULTS: A total of 43 studies consisting of 11,388,556 patients were included in our analysis. Our meta-analysis showed that the use of beta-blocker was associated with increased risk of COVID-19 [OR 1.32 (95% CI 1.02 - 1.70), p = 0.03, I2 = 99%, random-effect modelling], clinical progression [OR 1.37 (95% CI 1.01 - 1.88), p = 0.04, I2 = 89%, random-effect modelling], and mortality from COVID-19 [OR 1.64 (95% CI 1.22 - 2.19), p = 0.0009, I2 = 94%, random-effect modelling]. Metaregression showed that the association with mortality outcome were influenced by age (p = 0.018) and hypertension (p = 0.005). CONCLUSION: The risk and benefits of using beta-blocker as a drug of choice to treat hypertensive patients should be considered and reviewed individually, case by case, knowing their association with higher incidence and severity of COVID-19 infections. Other first-line antihypertensive drugs may be considered as an alternative therapy if the risk of administering beta blockers outweighs the benefits of COVID-19 infection. REGISTRATION DETAILS: PROSPERO (CRD42021260455).


Subject(s)
COVID-19 , Hypertension , Humans , COVID-19/drug therapy , Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Adrenergic beta-Antagonists/therapeutic use
9.
Hypertension ; 79(12): 2733-2742, 2022 12.
Article in English | MEDLINE | ID: covidwho-2098093

ABSTRACT

BACKGROUND: The COVID-19 pandemic may have negatively affected medical care for and self-management of chronic hypertension. We sought to examine the impact of the pandemic on blood pressure (BP) among individuals with hypertension. METHODS: Using an interrupted time series analysis, we compared the level and trend (slope) of BP outcomes before the public health emergency declaration (prepandemic period: August 2018 through January 2020) versus after the stay-at-home orders (pandemic period: April 2020 through November 2020) among adults with hypertension followed at 3 large health systems (n=137 593). Outcomes include systolic and diastolic BP recorded in electronic health records and the proportion of individuals with BP <140/90 mm Hg. RESULTS: The number of BP measurements substantially dropped early in the pandemic and then gradually increased. During the pandemic period, systolic and diastolic BP increased by 1.79 mm Hg (95% CI, 1.57-2.01; P<0.001) and 1.30 mm Hg (95% CI, 1.18-1.42; P<0.001), respectively, compared with the prepandemic period. Similarly, the proportion of patients with controlled BP decreased by 3.43 percentage points (95% CI, -3.97 to -2.90; P<0.001). A trend showing increasing control in the prepandemic period (+3.19 percentage points per year [95% CI, +2.96 to +3.42]; P<0.001) flattened during the pandemic period (+0.27 percentage points per year [95% CI, -0.81 to -1.37]; P=0.62). CONCLUSIONS: The first 8 months of the pandemic were associated with worsening BP outcomes among individuals with hypertension. Opportunities to ensure ongoing access to health care with telemedicine and home BP monitoring may mitigate adverse impacts on BP control for future disasters/emergencies.


Subject(s)
COVID-19 , Hypertension , Telemedicine , Adult , Humans , Blood Pressure/physiology , Pandemics , COVID-19/epidemiology , Time Factors , Hypertension/epidemiology , Blood Pressure Monitoring, Ambulatory
10.
Am J Hypertens ; 35(11): 948-954, 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2097304

ABSTRACT

BACKGROUND: Although hypertension is a risk factor for severe Coronavirus Disease 2019 (COVID-19) illness, little is known about the effects of COVID-19 on blood pressure (BP). Central BP measures taken over a 24-hour period using ambulatory blood pressure monitoring (ABPM) adds prognostic value in assessing cardiovascular disease (CVD) risk compared with brachial BP measures from a single time point. We assessed CVD risk between adults with and without a history of COVID-19 via appraisal of 24-hour brachial and central hemodynamic load from ABPM. METHODS: Cross-sectional analysis was performed on 32 adults who tested positive for COVID-19 (29 ± 13 years, 22 females) and 43 controls (28 ± 12 years, 26 females). Measures of 24-hour hemodynamic load included brachial and central systolic and diastolic BP, pulse pressure, augmentation index (AIx), pulse wave velocity (PWV), nocturnal BP dipping, the ambulatory arterial stiffness index (AASI), and the blood pressure variability ratio (BPVR). RESULTS: Participants who tested positive for COVID-19 experienced 6 ± 4 COVID-19 symptoms, were studied 122 ± 123 days after testing positive, and had mild-to-moderate COVID-19 illness. The results from independent samples t-tests showed no significant differences in 24-hour, daytime, or nighttime measures of central or peripheral hemodynamic load across those with and without a history of COVID-19 (P > 0.05 for all). CONCLUSIONS: No differences in 24-hour brachial or central ABPM measures were detected between adults recovering from mild-to-moderate COVID-19 and controls without a history of COVID-19. Adults recovering from mild-to-moderate COVID-19 do not have increased 24-hour central hemodynamic load.


Subject(s)
COVID-19 , Hypertension , Vascular Stiffness , Adult , Female , Humans , Blood Pressure Monitoring, Ambulatory/methods , Pulse Wave Analysis/methods , Cross-Sectional Studies , Blood Pressure , Vascular Stiffness/physiology , Hemodynamics
11.
World Neurosurg ; 2022 Nov 02.
Article in English | MEDLINE | ID: covidwho-2096139

ABSTRACT

BACKGROUND: Increasing evidence supports the effectiveness of venous sinus stenting (VSS) with favorable outcomes, safety, and expenses compared to shunting for idiopathic intracranial hypertension. Yet, no evidence is available regarding optimal postoperative recovery, which has growing importance with the burdens on healthcare imposed by the COVID pandemic. We examined adverse events and costs after VSS and propose an optimal recovery pathway to maximize patient safety while reducing stress on healthcare resources. METHODS: Retrospective review of elective VSS operations performed from May 2008 to August 2021 at a single institution. Primary data included hospital length of stay (LOS), intensive care unit (ICU) LOS, adverse events, need for ICU interventions, and hospital costs. RESULTS: 53 patients (98.1% female) met inclusion criteria. Of these, 51 patients (96.2%) discharged on post-operative day-1 (POD-1) and 2 patients discharged on POD-2. Both POD-2 patients remained because of groin hematomas from femoral artery access. There were no major complications nor care that required an ICU. There were 8 patients (15.1%) lateralized to other ICUs or remained in a post-anesthesia care unit due to the neurosciences ICU (NSICU) being above capacity. Total estimated cost for initial recovery day in a NSICU room was $2,361 versus $882 for a neurosurgery/neurology ward room. In our cohort, ward convalescence would save an estimated $79,866 for bed placement alone and increase ICU bed availability. CONCLUSION: Our findings reaffirm the safety of VSS. These patients should recover on a neurosurgery/neurology ward, which would save healthcare costs and increase ICU bed availability.

12.
eClinicalMedicine ; 55:101712, 2023.
Article in English | ScienceDirect | ID: covidwho-2095275

ABSTRACT

Summary Background Long-term hypertension control prevents heart attacks and other cardiovascular diseases, yet implementation is insufficient worldwide. The redesign of hypertension management by information and communication technology (ICT) improved hypertension control, e.g., by transmission of blood pressure (BP) measurements to a central webspace. However, an easy-to-use secure patient app connected with a practice management centre is lacking. This study evaluates the effectiveness of the newly developed PIA (PC-supported case management of hypertensive patients to implement guideline-based hypertension therapy using a physician-defined and -supervised, patient-specific therapeutic algorithm) intervention with PIA-ICT and eLearning for general practices. Methods The effectiveness of the PIA intervention was evaluated in a cluster-randomised study. Practices were randomly allocated (1:1) to the intervention or the control group (usual care). Group allocation was unmasked for participants and researchers. The primary outcome was the BP control rate (BP < 140/90 mmHg) after 6–12 months. Secondary outcomes included BP changes and satisfaction with PIA-ICT. The trial is registered in the German Clinical Trials Register (DRKS00012680). Findings Starting from December 1, 2019, 64 general practices were recruited over 1 year during the COVID-19 pandemic. Overall, 848 patients were enrolled between April 15, 2020 and March 31, 2021. The study was completed Sept 30, 2021. At baseline, 636 patients (intervention: 331;control: 305) of 50 general practices met the inclusion criteria. The final dataset for analyses comprised 47 practices and 525 patients (intervention 265;control 260). In the adjusted hierarchical model, the PIA intervention increased the BP control rate significantly by 23.1% points (95% CI: 5.4–40.8%): intervention 59.8% (95% CI: 47.4–71.0%) compared to 36.7% (95% CI: 24.9–50.3%) in the control group. Systolic BP decreased by 21.1 mmHg in the intervention and 15.5 mmHg in the control group. Interpretation The PIA redesign of care processes improved BP in an outcome-relevant way. Prospectively, it may constitute an important model for hypertension care in Germany. Funding This study is funded by the German Innovation Fund (Grant number: 01NVF17002).

13.
Medical Science ; 26(125), 2022.
Article in English | Web of Science | ID: covidwho-2091792

ABSTRACT

Background: Corona virus disease 2019 pandemic had a major impact on the general wellbeing of people. Hypertension patients are more liable to psychological stress. This study aims to assess the prevalence of psychological stress in hypertensive patients affected by Covid-19 in Madinah. Methods: Hypertension patients in Al Madinah were invited to participate in an online questionnaire in the period from December 2020 to May 2021. It included the personal data, questions assessing hypertension and psychological health status using the General Health Questionnaire. Results: Total number of participants in our study was 588. 30.8% of participants were mildly distressed and 6.8% were severely distressed. Females are being more at risk of severe distress. Regarding taking prescribed medications there was a significant relationship between groups. Conclusion: The prevalence was found to be 0.376. Hypertensive patients in Al Madinah are at more risk of psychological stress especially females, students, unemployed, and those who are not adherent to their medications. More psychological care should be provided to them in pandemics. Objectives: To evaluate the prevalence of psychological stress after Covid-19 in hypertensive patients in Madinah.

14.
Ter Arkh ; 94(9): 1052-1056, 2022 Oct 24.
Article in Russian | MEDLINE | ID: covidwho-2091507

ABSTRACT

On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.


Subject(s)
COVID-19 , Hypertension, Pulmonary , Pulmonary Embolism , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Chronic Disease , COVID-19/complications , Pulmonary Embolism/diagnosis , Pulmonary Embolism/complications , Echocardiography
15.
Acta Clin Croat ; 61(Suppl 1): 23-27, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-2091289

ABSTRACT

The aim of this study was to determine the frequency of newly verified or worsened existing hypertension in patients who had coronavirus 2019 (COVID-19). To be categorized as a COVID-19 patient, a positive reverse-transcription polymerase chain reaction test at a single point in time was required. The patients' age, history, laboratory values and antihypertensive therapy of patients were recorded. In one year, 32 of 199 patients studied had either newly verified (15) or worsened existing (17) arterial hypertension. Among those patients, the median time from a verified infection to the onset of symptoms was 3 months. When the patients were divided into groups, 4 were in the acute, 11 in the sub-acute, 8 in the chronic and 9 in the "long COVID" group. Compared to the rest of the study population, patients presenting with arterial hypertension had significantly higher systolic (median 141 mmHg vs 130 mmHg, p<0.001) and diastolic (median 93 mmHg vs 80 mmHg, p<0.001) blood pressure and were significantly younger (median 51 vs 59 years, p 0.032). Arterial hypertension following COVID-19, either newly verified or worsened existing, is a relatively common occurrence (16% of our patient pool), indicating that more effort should be directed at evaluating the blood pressure values of patients following COVID-19.


Subject(s)
COVID-19 , Coronavirus , Hypertension , Humans , Retrospective Studies , COVID-19/complications , COVID-19/epidemiology , Tertiary Care Centers , Hypertension/epidemiology , Blood Pressure/physiology
16.
Viruses ; 14(11)2022 Oct 30.
Article in English | MEDLINE | ID: covidwho-2090371

ABSTRACT

BACKGROUND: COVID-19 severity is determined by cardiometabolic risk factors, which can be further aggravated by chronic immunosuppression in kidney transplant recipients (KTRs). We aimed to verify the main risk factors related to hypertension (HTN) that contribute to COVID-19 progression and mortality in that population. METHODS: Retrospective analysis of 300 KTRs from March 2020 to August 2020 in a single center. We compared the main outcomes between HTN (n = 225) and non-HTN (n = 75), including admission to the intensive care unit (ICU), development of acute kidney injury (AKI), need for invasive mechanical ventilation or oxygen, and mortality. RESULTS: Of the patients in the study, 57.3% were male, 61.3% were white, the mean age was 52.5 years, and 75% had HTN. Pre-existing HTN was independently associated with higher rates of mortality (32.9%, OR = 1.96, p = 0.036), transfer to the ICU (50.7%, OR = 1.94, p = 0.017), and AKI with hemodialysis (HD) requirement (40.4%, OR = 2.15, p = 0.011). In the hypertensive group, age, diabetes mellitus, heart disease, smoking, glycemic control before admission, C-reactive protein, lactate dehydrogenase, lymphocytes, and D-dimer were significantly associated with COVID-19 progression and mortality. Both lower basal and previous estimated glomerular filtration rates posed KTRs with HTN at greater risk for HD requirement. CONCLUSIONS: Therefore, the early identification of factors that predict COVID-19 progression and mortality in KTRs affected by COVID-19 contributes to therapeutic decisions, patient flow management, and allocation of resources.


Subject(s)
Acute Kidney Injury , COVID-19 , Hypertension , Kidney Transplantation , Humans , Male , Middle Aged , Female , Kidney Transplantation/adverse effects , Retrospective Studies , Transplant Recipients , Hypertension/epidemiology , Hypertension/etiology , Risk Factors , Cohort Studies
17.
Front Endocrinol (Lausanne) ; 13: 1025699, 2022.
Article in English | MEDLINE | ID: covidwho-2089832

ABSTRACT

Objective: Coronavirus disease-2019 (COVID-19) increases risk of hospitalization and death in diabetes and diabetes-related conditions. We examined the temporal trends in COVID-19-related hospitalization and mortality in the total Danish population by diabetes and diabetes-related conditions in the two first waves of COVID-19 in Denmark. Materials and methods: We identified all persons with diabetes in the whole Danish population using national registries. COVID-19-related risks of hospitalization and death were assessed using Cox regression analysis in wave 1 (1 March-31 August 2020) and wave 2 (1 September 2020-28 February 2021) of the pandemic for persons with (n=321,933) and without diabetes (n=5,479,755). Analyses were stratified according to status of hypertension, obesity, cardiovascular and microvascular disease. Results: The cumulative incidence of COVID-19 hospitalization increased from wave 1 to wave 2 in both persons without (from 4 to 10 in 10,000) and with diabetes (from 16 to 54 per 10,000). The relative risk of hospitalization, however, increased more in patients with diabetes compared to persons without (age-, sex- and co-morbidity-adjusted HR [aHR] 1.40 (95% CI 1.27, 1.55) versus 1.76 (1.65, 1.87), p<0.001 for interaction with wave). The mortality rate, according to the whole population, increased similarly in persons without and with diabetes from wave 1 to wave 2 (from 0.63 to 1.5 versus from 4.3 to 10 in 10,000; aHR 1.65; 1.34, 2.03 and 1.64; 1.43, 1.88). However, when mortality was restricted to the hospitalized population, the crude mortality fell from 26.8% to 19.6% in persons with diabetes, while only a minor decrease was seen in persons without diabetes (from 16.7% to 15.5%). Conclusion: The risk of COVID-19-related hospitalization increased more in persons with than without diabetes from wave 1 to wave 2 of the COVID-19 pandemic in the Danish population. However, mortality according to the whole population did not change, due to reduced mortality among hospitalized persons with diabetes.


Subject(s)
COVID-19 , Diabetes Mellitus , Humans , COVID-19/complications , COVID-19/epidemiology , Pandemics , Cohort Studies , SARS-CoV-2 , Diabetes Mellitus/epidemiology , Denmark/epidemiology
18.
J Pharm Pract ; : 8971900221136629, 2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2089079

ABSTRACT

INTRODUCTION: Studies have shown positive clinical outcomes in chronic conditions, such as hypertension, through pharmacist-delivered medication therapy management and medication adherence services. Given the need for social distancing during the COVID-19 pandemic, increased utilization of telepharmacy strategies has been employed for managing blood pressure control. METHODS: A retrospective single-center cohort study that compared in-person pharmacist visits and telepharmacy visits in primary care patients with hypertension via electronic chart review from January 2018 to July 2022. Subjects were included who were at least 18 years of age with hypertension. Comparator groups were patients who underwent an in-person pharmacy (pre-COVID-19) visit vs a telepharmacy visit (post-COVID-19). The primary outcome was the number of patients with controlled blood pressure based on a blood pressure goal of less than or equal to 130/80 following telepharmacy visit vs in-person visit. Medication adherence, pharmacist intervention, incidence of antihypertensive side-effects, and blood pressure maintenance based on a goal of ≤140/90 were also evaluated. RESULTS: A total of 77 patients were included. There was no difference in the primary outcome following in person pharmacy visits compared to telepharmacy visits (P = .690). There was also no difference found for the secondary endpoints of blood pressure goal less than or equal to 140/90 mmHg (P = .481), medication adherence (P = 1.00), or antihypertensive adverse events (P = .344). CONCLUSION: Telepharmacy visits had a nonsignificant change in blood pressure control when compared to in-person visits. Results suggest that the utilization of either in-person or telepharmacy strategies benefit the management of hypertension.

19.
Hypertens Res ; 2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2087193

ABSTRACT

Blood pressure variability (BPV) is essential in hypertensive patients and is frequently associated with organ damage. As of today, hypertension is still the most common comorbidity in COVID-19, but the impact of BPV and the therapeutic target of BPV on outcomes in COVID-19 patients with hypertension remain unclear. Therefore, this study investigated the relationship between BPV and severity of COVID-19, in-hospital mortality, hypertensive status, and efficacy of antihypertensives in suppressing hypertensive covid-19 patient BPV. This cohort retrospective study enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the severity of COVID-19, the presence of hypertension, and their BPV status. During hospitalization, mean arterial pressure (MAP) was measured at 6 a.m. and 6 p.m., and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. In addition, we compared the hypertensive status, COVID-19 severity, in-hospital mortality, and antihypertensive agents between the BPV groups. The mean age was 53.85 ± 18.84 years old. Hypertension was significantly associated with high BPV with prevalence ratio (PR) = 1.38 (95% CI = 1.13-1.70; p = 0.003) or severe COVID-19 (PR = 1.39; 95% CI = 1.09-1.76; p = 0.005). In laboratory findings, high BPV group had lower Albumin, higher WBC, serum Cr, CRP, and creatinine to albumin ratio. High BPV status also significantly increased risk of mortality (HR = 2.30; 95% CI = 1.73-3.86; p < 0.001). Patients with a combination of severe COVID-19 status, hypertension, and high BPV status had the highest risk of in-hospital mortality (HR = 3.51; 95% CI = 2.32-4.97; p < 0.001) compared to other combination status groups. In COVID-19 patients with hypertension, combination therapy with calcium channel blockers (CCB) as well as CCB monotherapy significantly develop low BPV (PR = 2.002; 95 CI% = 1.33-3.07; p = 0.004) and low mortality (HR = 0.17; 95% CI = 0.05-0.56; p = 0.004). Hypertensive status and severe COVID-19 were significantly associated with high BPV, and these factors increased in-hospital mortality. CCBs might be antihypertensive agents that potentially effectively suppressing BPV and mortality in COVID-19 patients.

20.
Hipertens Riesgo Vasc ; 2022 Oct 20.
Article in Spanish | MEDLINE | ID: covidwho-2086271

ABSTRACT

INTRODUCTION AND OBJECTIVES: Cardiovascular prevention measures place the emphasis on controlling cardiovascular risk factors (CVRF). However, the most recent studies provide disappointing data, the impact of which remains to be determined. The objective of this study was to analyse the impact that the different CVRFs, and their degree of control, have on the prognosis of patients after acute coronary syndrome. PATIENTS AND METHODS: Epidemiological, pharmacological, and CVRF control data were collected from 1,689 consecutive patients admitted from 2018 to 2020 for acute coronary syndrome to a tertiary hospital. Finally, the rate of major adverse cardiovascular events was calculated. RESULTS: The patients admitted for acute coronary syndrome were predominantly men, with body mass index>25Kg/m2, smokers (or former smokers) and with poor CVRF control (50% for hypertension and diabetes and 35% for dyslipidaemia), especially those patients with a personal history of ischaemic heart disease. An underutilisation of useful drugs for CVRF control was found. A directly proportional relationship was observed between the number of CVRFs (or their poor control) and the incidence of major adverse cardiovascular events at 2 years, hypertension being the factor with the greatest cardiovascular impact. The SARS-CoV-2 lockdown worsened the degree of CVRF control and cardiovascular prognosis. CONCLUSION: There is still room for improvement in the control of CVRF, which would translate into a prognostic benefit for patients with ischaemic heart disease. The implementation of cardiovascular prevention campaigns seems essential.

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