Care of Hypertensive people during Covid-19 pandemic

 What is the need?

As we all know till now, the presence of co-morbidities like Hypertension and Diabetes is a strong predictor of the disease related morbidity and mortality in COVID-19 infected people. In our country there is high prevalence of hypertension & COVID-19 cases are still increasing, hence its very important to know about the care & management of hypertensive people.

How COVID-19 is affecting hypertension management?

Angiotensin Converting Enzyme 2 (ACE 2) is present in the Heart, Lungs and Kidneys & it has a protective role on the Cardio-vascular system as it converts Angiotensin II to Angiotensin (1-7). Now it is known that SARS CoV-2 spike protein binds to ACE 2 & reduces the Cardio-protective effect of this enzyme. Now concern is being raised about treating patients with ACEIs (eg. Lisinopril, captopril etc.) which increases the level of ACE 2 thereby facilitating the penetration of SARS CoV-2 (as its spikes binds to ACE 2)  into the Cardiac cell.

Guidelines for management of hypertension:

Pharmacological:

• The target Blood Pressure should be less than 140/90 mm Hg & frequent monitoring of Blood pressure should be done 
• If a person is COVID-19 positive & is already taking anti-hypertensive other than ACEIs or ARBs, they may continue the same 
• If a person is COVID-19 positive & has newly diagnosed hypertension, the choice of drug varies upon the clinical scenario.
• Calcium Channel Blockers are the preferred drug of choice in this situation.
• Both Beta blockers and ACEIs can cause respiratory symptoms (like Bronchospasm and cough), hence not preferred as the first line drugs for initiating treatment of hypertension.
• Hypertensive patients who are already on CCB and not getting controlled, ARBs instead of ACEI may be added as the Second line of drug.
• ACEI is avoided in this situation due to its facilitation of penetration of the COVID-19 virus into the cardiac cell.

Non-pharmacological:

• Low salt diet (reducing salt intake to less than 5 g of salt per day)
• Avoidance of Alcohol and smoking
• High consumption of vegetables and fruits
• Low fat diet (Dietary Advice to Stop Hypertension-DASH) 
• Any warning symptom like palpitation, swelling of legs, chest pain, headache, giddiness, etc. should be addressed.
• Self medication should be strictly prohibited as drugs especially NSAIDs and Steroids increase BP or may contain Sodium which may further increase the BP.
• Reducing weight and maintaining it.
• Regular physical exercise - at least 30 min of moderate-intensity exercise (walking, jogging) on 5 -7 days a week.
• Do yoga & meditation for relaxation. 
• Hypertensive people should stay at home & should not go outside unnecessarily.
• They should wear mask, maintain social distancing & practice hand hygiene to prevent infection.
• Call your physician whenever needed to consult & follow the instructions given.

References:

1. Guidelines for management of hypertension during COVID-19 pandemic, NHM-Tamil nadu
2. https://www.nhp.gov.in/disease/cardio-vascular/hypertension-high-blood-pressure
3. Ernesto L Schiffrin, John M Flack, Sadayoshi Ito, Paul Muntner, R Clinton Webb, Hypertension and COVID-19, American Journal of Hypertension, Volume 33, Issue 5, May 2020, Pages 373–374, https://doi.org/10.1093/ajh/hpaa057
4. https://onlinelibrary.wiley.com/doi/10.1111/jch.13917
5. https://journals.sagepub.com/doi/full/10.1177/1470320320927851
6. https://www.nature.com/articles/s41371-020-0356-y
7. https://ish-world.com/news/a/A-statement-from-the-International-Society-of-Hypertension-on-COVID-19/
8. https://www.whleague.org/index.php/2014-07-09-22-47-11/covid-19-hypertension-guidance
9. https://bloodpressuremeasurementblog.wordpress.com/2015/06/19/how-to-take-blood-pressure-in-easiest-possible-manner/ photo credit
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12. https://www.yogajournal.com/practice/yjs-40-frequently-answered-questions-yoga photo credit
13. https://www.owensborohealth.org/news-events/news-media/2020/covid-19-signage/ photo credit