High blood pressure in a COVID-19 crisis
The highly pathogenic severe acute respiratory syndrome 2 (SARS-CoV-2), which causes coronavirus disease, is currently causing mayhem across the global health landscape.
There are more than 25 million documented cases and more than 800,000 deaths globally. COVID-19 epicentres have highlighted that mortality and morbidity rates were highest in patients with hypertension, commonly known as high blood pressure. Research has also shown that hypertensive patients are twice as likely to die from COVID-19 than those without the condition. This is of great concern to Jamaica, as one in every three Jamaicans is hypertensive. Hypertension is diagnosed by blood pressure reading above 140/90mmHg taken on two separate days. The top number refers to the systolic pressure and represents the highest blood pressure level due to heart contractions as it pumps blood to the arteries. The bottom number, on the other hand, indicates the diastolic pressure which is the lowest blood pressure level following relaxation of the heart.
SARS-CoV-2 hijacks human cells by binding to angiotensin converting enzyme II (ACE 2) receptor, a key regulator of blood pressure. These receptors are expressed in the nose, lungs, heart, intestines, and kidneys. They offer significant cardiovascular benefits by lowering blood pressure, diminishing inflammation, and reducing lung damage. SARS-CoV-2 consumes these receptors causing higher incidences of inflammation, lung damage and exacerbates elevated blood pressure. Hypertension is associated with chronic inflammation which may weaken the immune system, making persons more susceptible to COVID-19. Severe immune inflammatory response and cytokine storm linked to COVID-19 may therefore be aggravated in patients with uncontrolled hypertension and may account for the increased risk of death.
The importance of taking precautionary steps to mitigate the risk of COVID-19 cannot be overemphasised. Thousands of Jamaicans have undiagnosed hypertension, as the condition may not be accompanied by warning signs and symptoms. Undiagnosed hypertension may increase the risk of COVID-19-related death, therefore, it is essential for individuals to get their blood pressure checked to know their status. Hypertensive patients should buy digital home blood pressure monitors to do regular self-monitoring. Blood pressure levels can also be checked at regular intervals at some pharmacies and workplaces across Jamaica. This would facilitate medical intervention when required rather than a time- dependent approach which may not be very effective. The most important steps for managing hypertension are taking medication and making lifestyle modifications.
The protocols established by the Government of Jamaica to reduce the spread of the virus, such as social distancing, good hand hygiene and the wearing of masks in public spaces, are absolutely paramount to individuals with high blood pressure. Ways to control and prevent the development of hypertension include compliance with blood pressure medications, limiting salt intake, participating in regular physical activity, limiting alcoholic beverage consumption, and quitting smoking.
Non-compliance with high blood pressure medication is a growing concern in Jamaica, which may see a rise in critically ill COVID-19 patients. Therefore, there is a great need to engage family members and friends, especially the elderly and those who need assistance, to adhere to their medication regimens.
According to the World Health Organization, it is important to limit salt intake to less than five grams per day as excessive salt consumption causes significant elevation of blood pressure and cardiac complications. Salt should not be completely restricted from the diet but should be consumed in moderation as levels that are too low can be counterproductive and may lead to cardiovascular damage as well.
Physical activity is also important in managing or reducing the risk of hypertension. It is encouraged to engage in physical activity such as brisk walking, swimming, jogging, and cycling for at least 30 minutes per day for five days a week. This lowers blood pressure and improves cardiovascular strength. Even though physical activity is useful, it is recommended that a doctor be consulted before starting any exercise programme.
Increased consumption of alcoholic beverages can increase blood pressure and compromise the immune system. The Centers for Disease Control and Prevention advises that men should have no more than two drinks per day while women should have no more than one drink per day. Lowering alcoholic consumption offers the benefit of improved immune system function which is essential in the COVID-19 era, as there is no vaccine or established medication against the disease.
Smoking leads to acute elevation in blood pressure and heart rate and may cause adverse respiratory events which worsens COVID-19 episodes. Cessation of smoking improves heart and lung health, which is very critical, particularly in a COVID-19 pandemic.
As we traverse these scary and unprecedented times, it is crucial to limit the spread of the virus and know how a medical condition can impact your health if affected by COVID-19. Individuals with hypertension should manage the condition by complying with blood pressure treatment, reducing salt and alcohol intake, exercising regularly and quitting smoking. This may reduce the risk of severe illness and death in hypertensive COVID-19 patients.
Melisa Anderson is a clinical chemistry lecturer at the College of Health Sciences, University of Technology, Jamaica.