The highest spike in blood pressure occurs early in the morning, around 4 to 5 am and before 7 am, in a 24-hour circadian period. Therefore, heart attacks and strokes happen early in the morning
Hypertension or high blood pressure, the silent killer disease needs to be managed in an effective manner to avoid complications related to COVID-19. Apart from the regular risks associated with patients with hypertension, patients with COVID-19 were found to have a high rate of co-morbidities. Hypertension affects vital organs such as the kidneys, heart and brain even though the person has no symptoms. Heart or kidney failure, as well as a debilitating paralytic stroke, can be the first sign of hypertension. According to WHO, India accounts for over a fifth of these deaths. Undetected and untreated hypertension has been ranked as the highest risk factor for heart disease and related deaths.
Though a majority of COVID-19 patients experience mild symptoms such as fever, sore throat, cough and are able to recover fully, it has been noticed that some patients who have hypertension, Diabetes and heart diseases are at the risk of developing more severe symptoms and the resultant complications. The ICMR has thus advised extra care for these patients.
It has also been speculated that hypertensive patients may not respond to anti-covid treatment protocols in comparison to non-hypertensive patients. Therefore, hypertensive patients can become very critical with respect to COVID-19 prognosis. A majority of the hypertensive patients are given medications known as “ACE-Inhibitors”. Since these drugs work via the ACE receptors, and the coronavirus binds itself to the ACE receptors located on lung cells (pneumocytes), it was being assumed that patients taking ACE inhibitors to regulate blood pressure might do worse than others. However, to the relief of the medical fraternity in majority of the trials, this hypothesis has been disproved. It is therefore advised that patients who have successfully regulated their blood pressure with these medications should continue to do so and those who have COVID-19 should monitor their blood pressure closely and try to regulate it as much as possible. They must also be in regular touch with their consulting doctors and must immediately contact them in case of any major fluctuations in the blood pressure so as to manage Covid-19 more effectively.
It has been observed that in the early stages of hypertension, patients do not experience any pain or sickness and hence it goes undetected only to surface during a routine check-up. Factors that increase the risk of high blood pressure and heart diseases include unhealthy weight, obesity, an unhealthy diet, lack of physical activity, smoking, and poorly controlled cholesterol levels, among others. A doctor will look for signs such as high blood pressure, rapid heartbeat, lack of appetite, shortness of breath, ankle swelling and chest tightness while diagnosing hypertensive heart disease.
This year, the World Hypertension Day theme was “Measure Your Blood Pressure Accurately, Control It, Live Longer,” with a focus on combating low awareness rates worldwide, especially in low to middle income areas, as well as accurate blood pressure measurement methods.
We must understand that the highest spike in blood pressure occurs early in the morning, around 4 to 5 am and before 7 am, in a 24-hour circadian period. Therefore, heart attacks and strokes happen early in the morning. The early morning surge in blood pressure is caused by a high level of catecholamines in the body. As a result, the drugs must be picked up in a way that guarantees 24-hour blood pressure regulation or delivered at a time that addresses the morning blood pressure spike. For example, if a person has a morning surge-on a 24-hour blood pressure monitor, he should be given some of the medicine in the evening, about tea time in order to avoid heart attacks, paralysis and strokes.
The writer is Dr Subhash Chandra Chairman & HOD, Cardiology at BLK-Max Super Speciality Hospital