Disaster hypertension and cardiovascular events in disaster and COVID-19 pandemic

Abstract

The incidence of large disasters has been increasing worldwide. This has led to a growing interest in disaster medicine. In this review, we report current evidence related to disasters and coronavirus disease-2019 (COVID-19) pandemic, such as cardiovascular diseases during disasters, management of disaster hypertension, and cardiovascular diseases associated with COVID-19. This review summarizes the time course and mechanisms of disaster-related diseases. It also discusses the use of information and communication technology (ICT) as a cardiovascular risk management strategy to prevent cardiovascular events. During the 2011 Great East Japan Earthquake, we used the "Disaster Cardiovascular Prevention" system that was employed for blood pressure (BP) monitoring and risk management using ICT. We introduced an ICT-based BP monitoring device at evacuation centers and shared patients' BP values in the database to support BP management by remote monitoring, which led to improved BP control. Effective use of telemedicine using ICT is important for risk management of cardiovascular diseases during disasters and pandemics in the future.

Keywords: COVID-19; cardiovascular disease; disaster; hypertension.

FIGURE 1

Time course of the onset of disaster‐related disease. DVT, deep‐vein thrombosis; PTSD, post‐traumatic stress disorder. Source: Kario and colleagues ¹

FIGURE 2

Potential mechanisms of the disaster‐related cardiovascular risk factors. A disaster induces acute stress and changes in the living environment, which leads to hyperactivity of the sympathetic nervous system. Furthermore, excess salt intake and disruption of the circadian rhythm (eg, sleep disturbances) induce BP elevation or disaster hypertension. In addition to sympathetic hyperactivity, changes in the living environment and lifestyles, such as long stasis and dehydration, cause a tendency for thrombosis. Sympathetic hyperactivity, elevation of BP, and thrombotic tendencies are considered the causes of cardiovascular events. BP, blood pressure; CVD, cardiovascular disease

FIGURE 3

Flow chart of disaster hypertension management. BP, blood pressure

FIGURE 4

Disaster cardiovascular prevention risk score (AFHCHDC7) and prevention score (SEDWITMP8). *Total number of risk factors as an individual's risk score (0–7 points). ^#Total number of prevention factors as an individual's prevention score (0–8 points). The target prevention score was ≥6 particularly in high‐risk patients. DCAP, disaster cardiovascular prevention; SBP, systolic blood pressure. Source: Kario and colleagues ¹

FIGURE 5

Disaster cardiovascular prevention network. The DCAP network system uses a blood pressure (BP) monitoring device equipped with a card reader and information and communication technology to measure BP and sends the measured BP values to a cloud data center. This BP monitoring device can be used for home BP monitoring. The DCAP network system can be useful for the prevention of cardiovascular events in high‐risk patients living in evacuation centers or their houses during a disaster. DCAP, disaster cardiovascular prevention. Source: JCS, JSH, and JCC Joint Working Group, ² Kario and colleagues ²²