Does COVID-19 Cause Non-Dıpper Hypertension?

A population-based study of incident prescribing for hypercholesterolaemia and hypertension in Scotland: is the healthcare system recovering from the impact of COVID-19?

BACKGROUND

COVID-19 pandemic caused significant disruptions in healthcare services, with previous studies estimated that the early months of the pandemic led to a substantial decline in new prescriptions for hypercholesterolemia and hypertension. The long-term recovery of healthcare systems in addressing these gaps remains uncertain. We aimed to assess the recovery of the healthcare system in Scotland regarding the initiation of treatments for hypercholesterolemia and hypertension post-COVID-19 pandemic.

METHOD

This retrospective cohort study analysed prescription data from January 2020 to December 2022 in Scotland, as well as In-hours encounters with general practitioners. Incident prescribing patterns for drugs used in the treatment of hypercholesterolemia and hypertension were compared against pre-pandemic averages from 2018 to 2019. Data were stratified by health regions and socioeconomic status.

RESULTS

New treatment initiations for drugs used in the treatment of hypercholesterolemia and hypertension significantly increased from mid-2021 onwards, surpassing pre-pandemic levels. By December 2022, there were approximately 40,000 and 60,000 additional new treatments for drugs used to treat hypercholesterolemia and hypertension, respectively, compared to the expected numbers based on 2018-2019 averages. The stratified analysis showed a relatively higher increase in less deprived quintiles. GP encounter activities mirrored trends in new antihypertensive and lipid-lowering initiations, with a significant reduction starting in March 2020 due to the first COVID-19 lockdown. Encounter rates gradually recovered from May 2020, reaching near pre-pandemic levels by March 2021. Notably, the encounter rate slopes during the reference period (2018-2019) and post-recovery phase (May 2021-December 2022) showed no significant difference [-0.7 (95% CI: -4.0, 2.5) vs. 0.9 (95% CI: -3.1, 4.9)].

CONCLUSIONS

The observed increase in new treatments for drugs to treat hypercholesterolemia and hypertension suggests recovery of the healthcare system in Scotland following the COVID-19 pandemic. These higher prescribing rates post-pandemic hypothesise potential long-term sequelae associated with COVID-19. The findings demonstrate the potential for improved pharmacotherapy strategies that address both the backlog of untreated cases and new-onset conditions linked to COVID-19. This underscores the need for ongoing surveillance and flexible healthcare responses to manage emerging health challenges effectively. Additionally, our findings suggest novel research areas that could offer a more comprehensive understanding of the COVID-19 pandemic's influence on the prescribing patterns of these widely used medications.

Microvascular Capillary and Precapillary Cardiovascular Disturbances Strongly Interact to Severely Affect Tissue Perfusion and Mitochondrial Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Evolving from the Post COVID-19 Syndrome

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a frequent, debilitating and still enigmatic disease. There is a broad overlap in the symptomatology of ME/CFS and the Post-COVID-19 Syndrome (PCS). A fraction of the PCS patients develop the full clinical picture of ME/CFS. New observations in microvessels and blood from patients suffering from PCS have appeared and include microclots and malformed pathological blood cells. Capillary blood flow is impaired not only by pathological blood components but also by prothrombotic changes in the vascular wall, endothelial dysfunction, and the expression of adhesion molecules in the capillaries. These disturbances can finally cause a low capillary flow and even capillary stasis. A low cardiac stroke volume due to hypovolemia and the inability of the capacitance vessels to adequately constrict to deliver the necessary cardiac preload generate an unfavorable low precapillary perfusion pressure. Furthermore, a predominance of vasoconstrictor over vasodilator influences exists, in which sympathetic hyperactivity and endothelial dysfunction play a strong role, causing the constriction of resistance vessels and of precapillary sphincters, which leads to a fall in capillary pressure behind the sphincters. The interaction of these two precapillary cardiovascular mechanisms causing a low capillary perfusion pressure is hemodynamically highly unfavorable in the presence of a primary capillary stasis, which is already caused by the pathological blood components and their interaction with the capillary wall, to severely impair organ perfusion. The detrimental coincidence of microcirculatory and precapillary cardiovascular disturbances may constitute the key disturbance of the Post-COVID-19 syndrome and finally lead to ME/CFS in predisposed patients because the interaction causes a particular kind of perfusion disturbance-capillary ischemia/reperfusion-which has a high potential of causing mitochondrial dysfunction by inducing sodium- and calcium-overload in skeletal muscles. The latter, in turn, worsens the vascular situation through the generation of reactive oxygen species to close a vicious cycle from which the patient can hardly escape.