Exaggerated blood pressure elevation in response to orthostatic challenge, a post-acute sequelae of SARS-CoV-2 infection (PASC) after hospitalization

• Published in: Autonomic neuroscience Vol. 247; p. 103094
• Main Authors: González-Hermosillo G, J. Antonio, Galarza, Esteban Jorge, Fermín, Onasis Vicente, González, José Manuel Núñez, Tostado, Lucia Mariel Félix Álvarez, Lozano, Marco Antonio Estrada, Rabasa, Claudia Ruíz, Martínez Alvarado, María del Rocio
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.07.2023
• Subjects: Autonomic Nervous System Diseases; Blood Pressure; COVID-19 - complications; Disease Progression; Hospitalization; Humans; Hypertension; Long-COVID-19; Neurogenic hypertension; Orthostatic hypertension; Pos acute sequelae of SARS-CoV2; Post-Acute COVID-19 Syndrome; SARS-CoV-2; Pos acute sequelae of SARS-CoV2; Orthostatic hypertension; Neurogenic hypertension; Long-COVID-19
• ISSN: 1566-0702; 1872-7484; 1872-7484
• DOI: 10.1016/j.autneu.2023.103094

Post-acute sequelae of SARS-COV-2 (PASC) are emerging as a major health challenge. Orthostatic intolerance secondary to autonomic failure has been found in PASC patients. This study investigated the effect of COVID-19 after recovery on blood pressure (BP) during the orthostatic challenge. Thirty-one out of 45 patients hospitalized due to COVID-19-related pneumonia that developed PASC and did not have hypertension at discharge were studied. They underwent a head-up tilt test (HUTT) at 10.8 ± 1.9 months from discharge. All met the PASC clinical criteria, and an alternative diagnosis did not explain the symptoms. This population was compared with 32 historical asymptomatic healthy controls. Exaggerated orthostatic blood pressure response (EOPR)/orthostatic hypertension (OHT) was detected in 8 out of 23 (34.7 %) patients, representing a significantly increased prevalence (7.67-fold increase p = 0.009) compared to 2 out of 32 (6.4 %) asymptomatic healthy controls matched by age, who underwent HUTT and were not infected with SARS-CoV-2. This prospective evaluation in patients with PASC revealed abnormal blood pressure rise during the orthostatic challenge, suggesting of autonomic dysfunction in a third of the studied subjects. Our findings support the hypothesis that EOPR/OHT may be a phenotype of neurogenic hypertension. Hypertension in PASC patients may adversely affect the cardiovascular burden in the world. •Head-up tilt may unmask an exaggerated blood pressure response after COVID-19.•Renin-angiotensin imbalance enhancing sympathetic tone may be the mechanism.•Preclinical hypertension could be a sequelae of COVID-19.