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

• Published in: The journal of clinical hypertension (Greenwich, Conn.) Vol. 24; no. 3; pp. 234 - 236
• Main Authors: Nagai, Michiaki, Förster, Carola Yvette
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.03.2022; John Wiley and Sons Inc; Wiley
• Subjects: Autonomic Nervous System - physiopathology; Biomarkers; Blood pressure; Blood Pressure - physiology; Catecholamines; Coronaviruses; COVID-19; Cytokine storm; Endothelium; Heart Rate - physiology; Humans; Hypertension; Hypertension - diagnosis; Hypertension - physiopathology; Infections; Inflammation; Mortality; Nervous system; Pathophysiology; Respiratory distress syndrome; Stroke
• ISSN: 1524-6175; 1751-7176; 1751-7176
• DOI: 10.1111/jch.14438

In a recent systematic review, a predominant abnormality of the Ic was reported in patients with COVID-19. 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 the spontaneously hypertensive rat, an increased SNS activity was shown to be attributed to the alterations of neurovascular unit in the Ic leading to changes in the neurogenic BP elevation. 11 On the other hand, Ic was reported to store immune-related information using activity-dependent cell labeling in mice. 12 Clinical studies revealed that the damage involved the Ic has associations with increased BP variability, myocardial injury, a higher plasma level of catecholamine, ARDS, and a poor prognosis. 13–15 In the Jichi Medical School ABPM Study Wave 2 Core, the left Ic atrophy had a significant correlation with the level of brain natriuretic peptide, the right Ic atrophy had a significant correlation with the level of noradrenaline. 14,16 In addition, the left posterior Ic damage in acute ischemic stroke was associated with increased BP variability. 17 Patients with the left Ic-involved stroke had a significant decrease in baroreflex sensitivity. 18 Ic-involved stroke was also associated with increased cardiac troponin T. 19,20 Thus, in COVID-19, imbalance in autonomic nervous system and dysregulation in immune system might be caused simultaneously by disruption of CAN including Ic due to BBB breakdown. At the molecular level, hydrocortisone induces an increase of occludin in protein and mRNA levels by activation of the glucocorticoid receptor. 29 Thus, the earlier use of glucocorticoids in COVID-19 might be associated with BBB protection, and could reduce day-to-day SBP variability via CAN preservation. [...]at the pulmonary epithelial cell level, administration of glucocorticoids might help prevent the pulmonary epithelial mesenchymal conversion, 30 as it is characteristic for COVID-19 lungs. The underlying molecular mechanisms are currently under investigation in our laboratory. [...]there have been few reports assessing the relationship between day-to-day BP variability and mortality in COVID-19.