Hypertension, Vascular Dysfunction And Downregulation Of The Renin Angiotensin System Sequelae Of COVID-19

Hypertension, vascular dysfunction and downregulation of the renin angiotensin system as sequelae of COVID-19 The long-term CV consequences of COVID are unknown however the potential for ongoing cardiac and vascular inflammation with RAAS alteration may increase the risk of developing hypertension and CV disease. Non-hypertensive patients hospitalised in April-May 2020 with either confirmed COVID19 (cases) or non-COVID (controls) diagnosis were recruited ≥12 weeks post-discharge. All underwent detailed BP and vascular/immune and RAAS phenotyping. The primary outcome was ABPM 24-hr SBP. Paired t-tests and multivariable regression models used to assess differences. Thirty cases and eighteen controls completed the study. Cases were older (51±7 vs 45±9 years) with lower discharge SBP (121±10 vs 128±15 mmHg; p0.01). ABPM at study visit was higher in the cases compared to controls (24-hour SBP (OR[95%CI]: 8.6[0.9-16.3]; p0.03), day-time SBP (8.6[1.5-17.3]; p0.02), day-time DBP (4.6[0.1-9.1]; p<0.05). Paired analysis of office BP showed a 11 mmHg difference between cases and controls (11.5[3.12];19.8; p=0.008; figure) Cases had lowerRenin and Ang-1-10 levels (-0.4[-0.9-0.1]; p0.08; -0.7[-1.2- -0.1]; p0.02 respectively) and higher TNF-alpha (0.5[0.1-0.9]; p0.01). Confirmed COVID requiring hospitalisation is associated with elevated SBP, reduced renin and Ang-1-10 and elevated TNF-alpha at ≥12 weeks post-discharge.