Hypertension as a sequela in patients of SARS-CoV-2 infection

Abstract

Background: COVID-19 is a respiratory infectious disease caused by SARS-CoV-2, and cardiovascular damage is commonly observed in affected patients. We sought to investigate the effect of SARS-CoV-2 infection on cardiac injury and hypertension during the current coronavirus pandemic.

Study design and methods: The clinical data of 366 hospitalized COVID-19-confirmed patients were analyzed. The clinical signs and laboratory findings were extracted from electronic medical records. Two independent, experienced clinicians reviewed and analyzed the data.

Results: Cardiac injury was found in 11.19% (30/268) of enrolled patients. 93.33% (28/30) of cardiac injury cases were in the severe group. The laboratory findings indicated that white blood cells, neutrophils, procalcitonin, C-reactive protein, lactate, and lactic dehydrogenase were positively associated with cardiac injury marker. Compared with healthy controls, the 190 patients without prior hypertension have higher AngⅡ level, of which 16 (8.42%) patients had a rise in blood pressure to the diagnostic criteria of hypertension during hospitalization, with a significantly increased level of the cTnI, procalcitonin, angiotensin-II (AngⅡ) than those normal blood pressure ones. Multivariate analysis indicated that elevated age, cTnI, the history of hypertension, and diabetes were independent predictors for illness severity. The predictive model, based on the four parameters and gender, has a good ability to identify the clinical severity of COVID-19 in hospitalized patients (area under the curve: 0.932, sensitivity: 98.67%, specificity: 75.68%).

Conclusion: Hypertension, sometimes accompanied by elevated cTnI, may occur in COVID-19 patients and become a sequela. Enhancing Ang II signaling, driven by SARS-CoV-2 infection, might play an important role in the renin-angiotensin system, and consequently lead to the development of hypertension in COVID-19.

Fig 1. The flow diagram of patient screening.

Chronic heart disease includes ischemic heart disease, arrhythmia, valvular disease, and heart failure.

Fig 2

A. The systolic blood pressure and cTnI change of patients with elevated blood pressure. B. The systolic blood pressure, cTnI, white blood cells, and chest computed tomography changes of one patient with elevated blood pressure. Late follow-up: The 4^th week after discharge from the hospital.

Fig 3

A. ROC curves of the age, cTnI, gender, and the presence of hypertension and diabetes for the identification of the severity of COVID-19. B. The calibration plot for the comparison of the predicted and actual probability. The X-axis and Y-axis represent the model-predicted and actual probability of MAE, respectively. The red line: perfect prediction. The black line: predictive performance of the model after bootstrapping (B = 1000 repetitions).