7 IMPACT OF DAY-TO-DAY BLOOD PRESSURE VARIABILITY TO IN-HOSPITAL MORTALITY IN PATIENTS WITH COVID-19 AND EFFICACY OF ANTIHYPERTENSIVE AGENTS

Abstract

Background: Blood pressure variability (BPV) plays an important role in hypertensive patients, and frequently associated with organ damage, but the impact of BPV to outcome in COVID-19 patients remain unclear. Objectives: To investigate the relationship between BPV and in-hospital mortality, hypertensive status, severity of COVID-19, and antihypertensives in patients with COVID-19. Methods: This was a cohort prospective study that enrolled 351 patients hospitalized with COVID-19. Subjects were classified according to the presence of hypertension, the severity of COVID-19, and BPV status. Mean Arterial Pressure (MAP) was measured at 6 a.m. and 6 p.m. during hospitalization, and BPV was calculated as the coefficient of variation of MAP (MAPCV). MAPCV values above the median were defined as high BPV. We compared the hypertensive status, COVID-19 severity, in-hospital mortality and antihypertensive agents between the BPV groups. Results: The mean age was 53.85±18.84 years-old. Subjects with high BPV were significantly associated with hypertension status (PR=1.38; 95%CI=1.13-1.70; p=0.003) or severe COVID-19 (PR=1.39; 95%CI=1.09-1.76; p=0.005). High BPV also significantly increased risk of mortality (HR=2.30; 95%CI=1.73-3,86; p=<0.001). Patients with severe COVID-19, hypertension, and high BPV had the highest risk of in-hospital mortality (HR=3.51; 95%CI=2.32-4,97; p<0.001) compared to other groups. In COVID-19 patients with hypertension, CCB had significantly decreased BPV (PR=0.50; 95%CI=0.27-0.93; p=0.004) and mortality (HR=0.17; 95%CI=0.05-0.56; p=0.004). Conclusions: High BPV was associated with hypertensive status and severe COVID-19, and these factors together increased in-hospital mortality. CCB are antihypertensive agents that were potentially effective in suppressing BPV and mortality in COVID-19 patients.