NEW ONSET HYPERTENSION IN POST COVID-19 RECOVERED PATIENTS: A CASE SERIES FROM A TERTIARY CARE HOSPITAL IN EASTERN INDIA

Abstract

Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on healthcare demographics worldwide. Post Covid Syndrome is a new clinical entity that has emerged as a concern in recent times. It is dened as the presence of some persistent symptoms like fatigue, cognitive impairment and sleep disturbances in patients even after four weeks of recovery from Covid-19. Recent medical literature has hinted on Post-Covid vascular complications and our study has supplemented it by reporting new-onset hypertension in a series of eight patients within four weeks of recovery from laboratory proven Covid-19. None of the patients had pre-existing hypertension, cardiac disease, renal abnormalities or any history of long term steroid intake. These patients presented to the fever clinic with initial symptoms of fever, sore throat, mild cough and fatigue. `They were managed conservatively at home but one of the patients required hospital admission due to hypoxia.All the patients recovered within ten days of presentation and weekly follow-up visits were scheduled for six weeks at Post-Covid Recovery clinic. At the clinic, some of them complained of persistent headaches, occasional palpitations or prolonged fatigue. Examination incidentally revealed consistently elevated blood pressure in all the eight patients, even those who did not have any post covid symptoms. They were advised on antihypertensive drug therapy and lifestyle modications after six week of routine follow-up and home monitoring. It is proposed that the close binding of the virus with Angiotensin Converting Enzyme-2 (ACE2) can lead to decrease in the serum enzyme levels, which in turn inhibit the protective pathway of the Renin-Angiotensin-Aldosterone (RAAS) axis. It might lead to imprudent rise in Angiotensin-2 and thereby blood pressure. Hypertension and its concomitant effect on target organ damage is a well known risk factor for increased mortality and morbidity among hospitalized Covid-19 patients. The development of hypertension and other cardiovascular manifestations in the post covid-19 recovery phase warrants further research to understand the molecular mechanisms, early identication and timely intervention to reduce incidence of adverse cardiovascular events in such patient cohorts.