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Day-by-day blood pressure variability in hospitalized patients with COVID-19
Fei-Ka Li1, De-Wei An2, Qian-Hui Guo2
1Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
High blood pressure variability (BPV) in hospitalized COVID-19 patients is linked to worse clinical outcomes. Greater BPV, measured by standard deviation, coefficient of variation, and variability independent of mean, predicted critical illness.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Hospitalized patients with COVID-19 face significant risks, including complications related to blood pressure regulation.
- Understanding factors influencing clinical outcomes in COVID-19 is crucial for improving patient management.
Purpose of the Study:
- To investigate the association between day-by-day blood pressure variability (BPV) and clinical outcomes in hospitalized COVID-19 patients.
- To compare BPV in critically ill patients versus those with severe disease who were discharged.
Main Methods:
- Retrospective analysis of 79 hospitalized COVID-19 patients.
- Assessment of BPV using standard deviation (SD), coefficient of variation (CV), and variability independent of mean (VIM).
- Comparison of BPV indices between critically ill and severe/discharged patient groups, with adjustment for confounding factors.
Main Results:
- Critically ill patients exhibited significantly greater systolic and diastolic BPV compared to severe/discharged patients, despite similar antihypertensive medication use and mean blood pressure levels.
- Increased systolic BPV (per 5-mmHg increment in SD, 5% in CV, 5 units in VIM) was associated with higher odds of critical illness (ORs 3.41, 4.09, 2.81, respectively).
- Similar trends were observed for diastolic BPV indices, indicating a consistent relationship between higher BPV and adverse outcomes.
Conclusions:
- Elevated blood pressure variability is a significant finding in hospitalized COVID-19 patients.
- Higher BPV is independently associated with worse clinical outcomes, including progression to critical illness.
- BPV may serve as a potential biomarker for risk stratification in COVID-19 patients.
Abstract:
In a retrospective analysis, the authors investigated day-by-day blood pressure variability (BPV) and its association with clinical outcomes (critical vs. severe and discharged) in hospitalized patients with COVID-19. The study participants were hospitalized in Tongji Hospital, Guanggu Branch, Wuhan, China, between February 1 and April 1, 2020. BPV was assessed as standard derivation (SD), coefficient of variation (CV), and variability independent of mean (VIM). The 79 participants included 60 (75.9%) severe patients discharged from the hospital after up to 47 days of hospitalization, and 19 (24.1%) critically ill patients transferred to other hospitals for further treatment (n = 13), admitted to ICU (n = 3) or died (n=3). Despite similar use of antihypertensive medication (47.4% vs. 41.7%) and mean levels of systolic/diastolic blood pressure (131.3/75.2 vs. 125.4/77.3 mmHg), critically ill patients, compared with severe and discharged patients, had a significantly (p ≤ .04) greater variability of systolic (SD 14.92 vs. 10.84 mmHg, CV 11.39% vs. 8.56%, and VIM 15.15 vs. 10.75 units) and diastolic blood pressure (SD 9.38 vs. 7.50 mmHg, CV 12.66% vs. 9.80%, and VIM 9.33 vs. 7.50 units). After adjustment for confounding factors, the odds ratios for critical versus severe and discharged patients for systolic BPV were 3.41 (95% confidence interval [CI] 1.20-9.66, p = .02), 4.09 (95% CI 1.14-14.67, p = .03), and 2.81 (95% CI 1.12-7.05, p = .03) for each 5-mmHg increment in SD, 5% increment in CV, and 5-unit increment in VIM, respectively. Similar trends were observed for diastolic BPV indices (p ≤ .08). In conclusion, in patients with COVID-19, BPV was greater and associated with worse clinical outcomes.
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