IMPACT OF POST-COVID MENTAL STRESS DISORDERS ON BLOOD PRESSURE RESPONSE TO EXERCISE

Abstract

Objective: Patients recovered from COVID-19 are at high risk of developing mental stress disorders over the long-term. Post-traumatical stress disorders (PTSD) are associated with increased BP and hypertension incidence. We tested the hypothesis that PTSD, occurring in patients after hospital discharge for severe COVID-19, is associated with an impaired BP response to exercise. Design and method: 108 patients previously hospitalized for severe COVID-19 were evaluated after 5 months from hospital discharge. A Revised Impact of Event Scale (IES-r) score>33 indicated probable COVID-related PTSDs All subjects underwent maximal cardio-pulmonary exercise test on a cycle ergometer with incremental ramp protocol. Submaximal BP was recorded after 4 minutes, at a workload threshold of 75W. Results: 95 subjects (mean age 58±10 years, 71% men) had complete data. Mean baseline BP was 128/82±12/11 mmHg. 51% were hypertensive. 32% had a IES-r score>33 (PTSD group). These patients were more frequently women (45% vs 20%, p = 0.01), whereas no differences in terms of age, BMI, hypertension history, other CV risk factors or diseases were found compared to non-PTSD group. Baseline BP did not differ between PTSD and non-PTSD groups (127/82±10/8 mmHg vs 129/82±15/9 mmHg, p = 0.43/0.88). By contrast, submaximal exercise SBP (eSBP) was increased in PTSD vs non-PTSD group (155±16 mmHg vs 146±14 mmHg, p<0.05). A strong sex-specific effect was found, being eSBP higher in PTSD vs non-PTSD women, but not in PTSD vs non-PTSD men (p for sex interaction = 0.01). Intrusion symptoms, such as unwanted and upsetting memories, nightmares and flashbacks, were more markedly associated with increased BP response to exercise. Conclusions: In people with mental stress disorders related to previous COVID-19 hospitalization, we showed increased submaximal BP during exercise. This finding showed a sex-specific association, being observed in women but not in men. Mental stress disorders could negatively impact on future CV risk in post-COVID-19 women through an exaggerated BP response to physical stressors.