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CASE PRESENTATION

A 76-year-old male with a medical history of diabetes and hypertension was brought to the emergency department (ED) by ambulance, with complaint of generalized weakness and mechanical fall. Patient was found on the ground on emergency medical services (EMS) arrival and was hypoxic to 89% on room air, which improved with 2 L of oxygen. As per patient, he had a positive COVID-19 test 1 week prior.

His initial symptoms were dry cough, worsening anorexia, worsening of generalized weakness, and lightheadedness for 1 week. Home medications included losartan and amlodipine. In the ED, his blood pressure (BP) was noted to be 185/95 mmHg, heart rate of 85 beats/min, afebrile, and oxygen saturation of 98% on 2 L nasal cannula. His physical examination showed bibasilar crackles on chest exam. Electrocardiogram (ECG) was unremarkable. Computed tomography (CT) of the head did not show any acute findings, and chest X-ray showed multifocal pneumonia. Laboratory tests showed an elevated inflammatory marker (see Table 8-1). He was started on ceftriaxone, azithromycin, and remdesivir. His BP was persistently elevated, and he was started on intravenous labetalol. He was transferred to the coronary care unit. Later he started to improve and was transitioned to oral antihypertensive medications. He completed antibiotics for 5 days and reported feeling better and was discharged home.

TABLE 8-1Inflammatory Markers

Epidemiology

As per definition based on the American College of Cardiology and American Heart Association guidelines released in 2017, approximately 45 million adults in the United States are diagnosed with hypertension. The global burden of hypertension, which currently exceeds 1.4 billion people, is expected to exceed 1.6 billion adults by year 2025 and as of today hypertension remains the leading cause of death across the globe, especially in high-income countries.

The latest definition of hypertension uses the following BP cutoffs:

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BP Category SBP (mmHg)   DBP (mmHg)
Normal <120 and <80
Elevated 120-129 and <80
Hypertension      
Stage 1 130-139 or 80-89
Stage 2 ≥140 or ≥90

DBP, diastolic blood pressure; SBP, systolic blood pressure.

Patients with hypertension have associated modifiable and nonmodifiable risk factors. Among the modifiable risk factors, the common factors are cigarette smoking, diabetes mellitus, hypercholesterolemia, obesity, physical inactivity, and unhealthy diet. Relatively fixed risk factors are chronic kidney disease, family history of hypertension, increased age, low-socioeconomic status, male gender, obstructive sleep apnea, and psychosocial stress.

Hypertension and COVID-19

Today, the world is seriously affected by a global pandemic caused by SARS-CoV-2, which has caused huge loss of life, a significant economic crisis, and significant healthcare access problems. Due to various lockdown implementations ...

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