Prognostic significance of day‐by‐day in‐hospital blood pressure variability in COVID‐19 patients with hypertension

Abstract

Hypertension is the most common comorbidity in patients with coronavirus disease 2019 (COVID‐19) and increases in‐hospital mortality. Day‐by‐day blood pressure (BP) variability (BPV) is associated with clinical outcomes in hypertensive patients. However, little information is available on the association of BPV with the outcomes of COVID‐19 patients with hypertension. This study aimed to demonstrate whether day‐by‐day in‐hospital BPV had prognostic significance in these patients. The authors included 702 COVID‐19 patients with hypertension from Huoshenshan Hospital (Wuhan, China), who underwent valid in‐hospital BP measurements on at least seven consecutive days. Day‐by‐day BPV was assessed by standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM). Overall, patients with severe COVID‐19 and non‐survivors had higher BPV than moderate cases and survivors, respectively. Additionally, higher BPV was correlated with greater age and higher levels of C‐reactive protein, procalcitonin, high‐sensitive cardiac troponin I, and B‐type natriuretic peptide. In multivariable Cox regression, SD of systolic BP (SBP) was predictive of mortality [hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.05–1.30] as well as acute respiratory distress syndrome (ARDS) (HR 1.09, 95% CI 1.01–1.16). Similar trends were observed for CV and VIM of SBP, but not indices of diastolic BP variability. The authors demonstrated that day‐by‐day in‐hospital SBP variability can independently predict mortality and ARDS in COVID‐19 patients with hypertension. And high BPV might be correlated with severe inflammation and myocardial injury. Further studies are needed to clarify whether early reduction of BPV will improve the prognosis of these patients.

Day‐to‐day blood pressure variability in COVID‐19: A biomarker of disrupted central autonomic network

“…In this issue of the Journal , the paper by He and coworkers 1 provides several new insights into the significant relationships of day‐to‐day systolic blood pressure (SBP) variability, that is, standard derivation (SD), coefficient of variation (CV), and variability independent of mean (VIM)—with acute respiratory distress syndrome (ARDS) and mortality in 702 COVID‐19 patients with hypertension. In addition, increased blood pressure (BP) variability was associated with severe inflammation and myocardial injury 1 …”

“…In addition, increased blood pressure (BP) variability was associated with severe inflammation and myocardial injury. 1 …”

“…In COVID‐19, systemic inflammation, 2 endothelial dysfunction, 3 breakdown of blood‐brain‐barrier (BBB), 4 and endocardial endothelial barrier, respectively, and alterations in cardiac response 5 have been considered to play pivotal roles in the pathophysiology of BP dysregulation leading to increased BP variability that could precede ARDS and critically ill in COVID‐19 patients with hypertension. 1 …”

“… 10 Increased peripheral arterial chemosensitivity and reflex SNS overactivation due to Ic dysregulation might be associated with increased day‐to‐day BP variability in COVID‐19 patients with hypertension reported by He and coworkers. 1 …”

“…In addition to strict BP control, it might be important to minimize day‐to‐day BP variability in order to reduce the mortality in COVID‐19 patients. The data presented in the study by He and coworkers 1 thus make an important contribution, provided that they are considered within the context of the precise pathophysiology underlying the relationship between COVID‐19 infection and day‐to‐day BP variability.…”