Diabetes and hypertension affects COVID-19 patients more
Courtesy: Medscape

Impact Of Hypertension On COVID-19

August 11, 2020

COVID-19 affects different people in different ways, however, most of the infected people develop mild to moderate illness and they recover without hospitalization.

The most common symptoms of COVID-19 are:

  • Fever
  • Dry cough
  • Tiredness

Some of the less common symptoms are:

  • Aches and pains
  • Sore throat
  • Diarrhoea
  • Conjunctivitis
  • Headache
  • Loss of taste or smell
  • A rash on the skin, or discolouration of fingers or toes

Some of the serious symptoms of COVID-19:

  • Difficulty breathing or shortness of breath
  • Chest pain or pressure
  • Loss of speech or movement

The virus is transmitted among people as contaminated air droplets released when infected individuals cough or sneeze.

At present, no antiviral medication or vaccine to combat or prevent this illness is available.

Hence, public health measures to prevent contact between unaffected people with active disease or who might be carriers remains the primary strategy for containment.

The young, healthy, people affected by the virus usually experience a relatively mild illness, but older people- aged over 60- and individuals with co-morbid conditions are more vulnerable to serious outcomes, including death.

Throughout the world, governmental agencies and other authoritative organizations are providing instruction to people on how best to protect themselves.

People with hypertension:

About one-third of adults have hypertension- also known as high blood pressure and it is a serious condition that strongly increases the risk of major heart events, strokes and kidney disease.

Treating hypertension, usually with medications that reduce blood pressure, significantly lowers the risk of these dangerous outcomes.

Data from China and Italy- countries hit early by the virus- show a higher risk of COVID-19 infections and complications in people with high blood pressure.

In China, 25 per cent to 50 per cent of people who came to hospitals with coronavirus had high blood pressure or another health condition like cancer, diabetes, or lung disease.

In Italy, a report said that more than 99 per cent of people who had died from the virus had one of these conditions- and 76 per cent of them had high blood pressure.

Other research shows that people with high blood pressure are also slightly more likely to die from coronavirus.

Their risk is about twice as high as that of the overall population.

A weaker immune system is one reason people with high blood pressure and other health problems are at higher risk for coronavirus.

Long-term health conditions and ageing weaken your immune system so it's less able to fight off the virus. Nearly two-thirds of people over 60 have high blood pressure.

Another possibility is that the higher risk comes not from high blood pressure itself, but from certain drugs used to treat it- ACE inhibitors and angiotensin receptor blockers (ARBs).

The theory is based on the fact that ACE inhibitors and ARBs raise levels of an enzyme called ACE2 in your body. And to infect cells, the COVID-19 virus must attach itself to ACE2.

Some large studies found no ties between the use of these drugs and how severe COVID-19 is. Other research suggests that they may make COVID-19 less severe.

There’s also no proof that people have less severe illness after stopping them.

Stopping these medications may make heart and kidney disease worse. It can also raise your risk of death.

The American College of Cardiology and American Heart Association recommend that you keep taking your high blood pressure medicine as prescribed.

If you don’t, it could raise your risk for a heart attack or stroke, putting you in the hospital just as coronavirus cases are coming in.

How COVID-19 affects people with hypertension

While pneumonia is the most common complication of the virus, it can also damage the cardiovascular system.

High blood pressure damages arteries and reduces the flow of blood to your heart. That means your heart has to work harder to pump enough blood.

Over time, this extra work can weaken your heart to the point where it can't pump as much oxygen-rich blood to your body.

Coronavirus can also damage the heart directly, which can be especially risky if your heart is already weakened by the effects of high blood pressure.

The virus may cause inflammation of the heart muscle called myocarditis, which makes it harder for the heart to pump.

If you also have plaque buildup in your arteries, the virus may make those plaques more likely to break apart and cause a heart attack.

Past studies have shown that people with heart disease who get a respiratory illness like the flu or earlier types of coronavirus are at higher risk for a heart attack.

People with hypertension should observe the following rules for protecting themselves from the coronavirus.

General recommendations:

  • Frequently wash hands with soap (at least 20 seconds) or if hand washing is not possible to use an alcohol-based hand cleanser
  • Avoid touching your face (eyes/nose/mouth)
  • If you cough or sneeze do it into a tissue (and then discard it) or into the inside of your arm
  • Use household cleaning sprays or wipes to clean commonly touched objects, for instance, your mobile phone!
  • Avoid people with the illness who might be affected by the virus (fever/cough/shortness of breath)

If you have these symptoms yourself, remain as isolated as possible; if you can, inform your own doctor or source of healthcare in advance of going in-person to a medical facility

Maintain social distance (about two meters or six feet) even from people who appear to be healthy.

Avoid crowded places. This includes buses and trains, although sometimes it can be difficult to find alternatives when needing to get to work or to provide care for another person in need.

Focused recommendations for people with hypertension:

Continue taking your blood pressure medications as prescribed

If possible, measure your blood pressure at home. It might become somewhat lower or higher than usual, but if possible do not change your treatment without first talking to your doctor or clinic.

Remember: low blood pressure can result from poor hydration

Keep hydrated: Many people, particularly older adults, do not consume adequate fluids. Make up a schedule to ensure that throughout the day you drink fluids on a regular basis.

Physical activity: Because many of us will spend more time at home to minimize exposure to the virus, it is likely we will also reduce physical activity.

One solution: going for walks outside the home, provided the social distance is maintained, is a healthy and even morale-boosting activity during difficult times

People with hypertension at high risk:

Some people with hypertension are at a particularly high risk of the complications of hypertension as well as from the COVID-19. The following situations require special attention.

Older individuals (over 60) are at increased risk of poor outcomes from the COVID-19 flu as well as from their hypertension.

Be particularly vigilant in observing our recommendations. Do not hesitate to get medical help if you develop symptoms.

A previous heart condition, stroke or kidney disease: Be careful to take all your prescribed medications, follow all the recommendations already given and be prepared – if necessary – to actively seek medical help

Diabetes and high cholesterol (lipid disorders): People with hypertension quite often have diabetes and abnormal cholesterol.

It is very important to keep taking all prescribed medications and follow all our general recommendations, including proper hydration and physical activity, to counteract the increased risk of the COVID-19 flu and heart complication.

If you have diabetes please also read the special instructions provided through the World Health Organization for patients with diabetes.

Chronic obstructive lung disease, asthma, and a current or former smoker: People with these conditions are all predisposed to extra vulnerability to COVID-19 and to the complications of hypertension.

Be very sensitive to changes in how you feel, especially worsening of lung symptoms – shortness of breath/cough – and seek medical help rapidly.

(The author is WHO-NTEP consultant)

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