Exaggerated blood pressure elevation in response to orthostatic challenge, a post-acute sequelae of SARS-CoV-2...2023, González-Hermosillo G et al

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

Journal of Autonomic Neuroscience, 2023 Apr 21;247:103094. doi: 10.1016/j.autneu.2023.103094

Authors: J Antonio González-Hermosillo G, Esteban Jorge Galarza, Onasis Vicente Fermín, José Manuel Núñez González, Lucia Mariel Félix Álvarez Tostado, Marco Antonio Estrada Lozano, Claudia Ruíz Rabasa , María del Rocio Martínez Alvarado.

Abstract
Objective: 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.

Research design and methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Long-COVID-19; Neurogenic hypertension; Orthostatic hypertension; Pos acute sequelae of SARS-CoV2.

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Other works by J Antonio González-Hermosillo include one from 2007 Value of Symptoms to Predict Tilt Testing Outcome in Patients with Clinical Suspicion of Vasovagal Syncope and 2009 Psychopathology and personality in patients with vasovagal syncope. PAYWALLED.

Also these, posted on the forum: Early Cerebral Hypoperfusion .. with OI Without Tachycardia During .. Tilt Test is Independent of Vasovagal Response, 2021, González-Hermosillo et al (thread) and Post-Acute COVID-19 Symptoms, a Potential Link with [ME/CFS]: A 6-Month Survey in a Mexican Cohort, 2021, González-Hermosillo et al (thread) and Complete remission with histamine blocker in a patient with intractable hyperadrenergic postural orthostatic tachycardia syndrome secondary to long coronavirus disease syndrome, 2024, Gonzalez-Alvarez et al (thread).