PROFILE OF HYPERTENSION THERAPY IN COVID-19 PATIENTS WITH HYPERTENSION AS COMORBID IN KOGABWILHAN II EMERGENCY HOSPITAL SURABAYA

Abstract

Covid-19 is a respiratory disease caused by a coronavirus called SARS-CoV-2. SARS-CoV-2  enters and infects human cells by binding with ACE2 receptors. Hypertension is one of the most  common comorbidities in Covid-19 patients. About 30% of SARS-CoV-2 patients have  Hypertension as comorbidity, these patients suffer a case fatality rate (CFR) of up to 14%. The  use of antihypertension agents especially angiotensin-converting enzyme inhibitors (ACEi) and  angiotensin receptor blockers (ARB) reduces ACE and increases ACE2 expression which  theoretically could mediate SARS-CoV-2 invasion and infection, causing viral spread and worsening lung injury. However, experimental studies demonstrated a protective effect of ACE2  on lung damage. ACE2 forms angiotensin 1-7 from angiotensin II thereby reducing the  inflammatory effect of angiotensin II and increasing the anti-inflammatory potential of  angiotensin 1-7 which helps reduce the degree of lung injury and prevent acute respiratory  distress syndrome (ARDS). Reynolds et al found that there is no association between the use of  ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, or thiazide diuretics and the  likelihood of positive or negative results on a Covid-19 test. This research aims to analyze the  profile of Hypertension therapy, patient characteristics, clinical symptoms, and length of hospital  stay in Covid-19 patients with Hypertension at KOGABWILHAN II Emergency Hospital in  Surabaya, in July-November 2020. This was observational study with cross-sectional  retrospective method. Data were collected from patient medical records using consecutive time limited sampling technique. The inclusion criteria were all patients diagnosed Covid-19 with  Hypertension as comorbid. The profile of Hypertension therapy, patient demographic data,  clinical characteristics, and length of hospital stay were analyzed descriptively and presented in  tables or graphs. The relationship/correlation between research variables was analyzed using the  Chi-Square and/or Spearman test, the differences between variables were analyzed using the  Mann-Whitney U test using SPSS version 25. This study included 222 patients. The most widely  used Hypertension therapy for single therapy is amlodipine (1x5 mg) po in 114 patients  (51.35%) and a combination therapy are amlodipine (1x10 mg) po + candesartan (1x8 mg) po in  18 patients (8.11%). The average rate of decrease in blood pressure for patients with amlodipine  (1x5 mg) po was 5,96 days and a combination of amlodipine (1x10 mg) po + candesartan (1x8  mg) po was 6.67 days. There were 156 patients (70.23%) without symptoms and 66 patients  (29.77%) with mild symptoms. The most frequent symptoms in this study were cough in 37  patients (56.06%), fever in 14 patients (21.21%). %) and headache in 14 patients (21.21%). A  total of 43 patients (19.37%) achieved the target blood pressure controlled with amlodipine (1x5  mg) po and 4 patients (1.80%) with a combination of amlodipine (1x10 mg) po + candesartan  (1x8 mg) po. A total of 157 patients (70.72%) did not achieve the target blood pressure in the  form of post therapy BPS levels ≥140 mmHg and/or BPD levels ≥90 mmHg.196 patients  (88.29%) were discharged from the hospital with negative RT-PCR test and 26 patients (11.71%)  with positive RT-PCR test. The majority of hospitalization in the range 1 - 5 days. The average  length of stay for total patients was 6.39 days, patients with amlodipine (1x5 mg) po was 6.0  days and the combination of amlodipine (1x10 mg) po + candesartan (1x8 mg) po was 6.67 days.  We conclude that hypertension therapy in this study had not achieved the expected therapeutic  goals.