- We have come up with some prognostic factors to predict the severity of COVID-19 among hypertensive patients. 
- Medical profiles of 598 COVID-19 cases were analyzed. Patients were divided into two comparative groups according to their positive or negative history of hypertension. Then, epidemiologic, clinical, laboratory and radiological features and also clinical outcomes were compared.
- 176 (29.4%) patients had underlying hypertension. Diabetes was significantly higher in hypertensive group 
- In COVID-19 patients with hypertension, severe/critical types were significantly higher.
- Body mass index > 25, age over 60, increased hospitalization period, type 2 diabetes and chronic kidney disease were related with progression of COVID-19.
- Hypertensive patients with Age > 60-year-old, BMI > 25 Kg/m2, CVD, diabetes and chronic kidney disease are associated with poor outcomes in those with COVID-19 infection.

Should all patients with hypertension be worried about developing severe coronavirus disease 2019 (COVID-19)?

Sleep hygiene habits can be influenced by other family members and are often mimicked. Depending on the functionality of the family dynamic, poor habits promoted within the household can increase risk for hypertension, especially in youth.

Family Dynamics in Sleep Health and Hypertension

If left unmanaged, hypertension can lead to severe health complications. These include critical cardiovascular events such as a heart attack, stroke, or heart failure. Additionally, it can cause damage to other organs, potentially resulting in kidney failure and blindness.

Consequences of Unchecked Hypertension

A wide range of stressors are linked to the development of hypertension. These include chronic life stressors such as persistent job strain, marital conflict, natural disasters, and exposure to high levels of traffic noise at home. Perceived discrimination has also been identified as a significant factor, particularly among African Americans. Furthermore, acute stress induced in laboratory settings—through tasks like timed mental arithmetic, the cold pressor test (immersing a hand in ice water), mirror tracing, and public speaking—has been demonstrated to cause temporary elevations in blood pressure.

Stress-Related Risk Factors for Hypertension

Read the following scenario and evaluate the individual's situation. Based on the information provided, what is the most significant potential health condition that may be going undetected, and why is it particularly dangerous in this case?

Assessing Unseen Health Risks

Based on the information provided in the scenario below, what is the most significant, often asymptomatic, cardiovascular disorder this individual is likely facing, and why is their self-reported feeling of being 'fine' a critical part of the danger associated with this condition?

Cardiovascular Risk Assessment

Hypertension, commonly known as high blood pressure, is a significant cardiovascular disorder and a major risk factor for heart disease. This condition increases the physical strain on the heart by forcing it to pump blood more forcefully. A dangerous aspect of hypertension is that it often presents with no symptoms, leading to its description as the 'silent killer,' as individuals may be unaware they have the condition.

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University of Chicago

Emory University

New York University

University of Michigan - Ann Arbor

- According to the WHO, "Cardiovascular disease is the name for the group of disorders of heart and blood vessels."  
- As per WHO, cardiovascular disease includes hypertension, coronary heart disease, cerebrovascular disease,  peripheral vascular disease, heart failure, rheumatic heart disease, congenital heart disease, and cardiomyopathies. 
- Cardiovascular disease is a risk factor for severe COVID-19, and COVID-19 causes cardiovascular complications. 

Cardiovascular disease 

Many of the complications of binge eating disorder result after an extended duration of the condition, often as a result of body weight and body fat gained through binge-eating:

- Obesity
- Metabolic syndrome
- Type 2 diabetes
- Hypertension
- Nonalcoholic fatty liver disease
- Elevated cholesterol
- Elevated triglycerides
- Nutrient deficiencies

Chronic Binge Eating Disorder Complications

A wide array of factors contribute to the development of heart disease. These can be broadly categorized into social determinants (e.g., age, socioeconomic status), behavioral choices (e.g., diet, physical activity), and other medical conditions (e.g., obesity, diabetes).

Risk Factors for Heart Disease

Singh, S., Shankar, R., & Singh, G. P. (2017). Prevalence and Associated Risk Factors of Hypertension: A Cross-Sectional Study in Urban Varanasi. International journal of hypertension, 2017, 5491838. https://doi.org/10.1155/2017/5491838

Prevalence and Associated Risk Factors of Hypertension: A Cross-Sectional Study in Urban Varanasi

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

- Summary: This systematic review and meta-analysis is aimed at defining the clinical, electrocardiographic, and pathologic spectrum of cardiovascular disease (CVD), frequency of elevated cardiac and inflammatory biomarkers, and their frequency and relationship with severity of the disease and mortality in COVID-19 patients and to develop a triage risk stratification tool (TRST) that can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy. Triage Risk Stratification Tool can serve as a guide for the timely recognition of the high-risk patients and mechanism-targeted therapy.
- Method
- Result


Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool

- The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices.
- The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. 
- Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020.  Location in a low-income and lower-middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth.
- COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged.


International Impact of COVID-19 on the Diagnosis of Heart Disease

- Hospitalizations for acute cardiovascular conditions have declined, raising concern that patients may be avoiding hospitals because of fear of contracting severe acute respiratory syndrome- coronavirus-2 (SARS-CoV-2).
- This investigation aimed to evaluate whether population-level deaths due to cardiovascular causes increased during the COVID-19 pandemic.
- The authors conducted an observational cohort study using data from the National Center for Health Statistics to evaluate the rate of deaths due to cardiovascular causes after the onset of the pandemic in the United States, from March 18, 2020, to June 2, 2020, relative to the period immediately preceding the pandemic (January 1, 2020 to March 17, 2020). Changes in deaths were compared with the same periods in the previous year.
- New York City experienced a large relative increase in deaths caused by ischemic heart disease (2.39, 95% confidence interval: 1.39 to 4.09) and hypertensive diseases (2.64, 95% confidence interval: 1.52 to 4.56) during the pandemic. 
- There was an increase in deaths caused by ischemic heart disease and hypertensive diseases in some regions of the United States during the initial phase of the COVID-19 pandemic. 

Cardiovascular Deaths During the COVID-19 Pandemic in the United States

Coronary Artery Disease (CAD) is the second most common form of cardiovascular disease in the United States, according to the American Heart Association. Apart from COVID-19, cardiovascular disease is the leading cause of death in the US, according to the Peterson-KFF Health System Tracker.

Coronary Artery Disease

Hypertension

Cardiovascular disease is a risk factor for severe COVID-19, and COVID-19 causes cardiovascular complications. 

Cardiovascular Disease and COVID-19

Cardiovascular Disease Infographic | World Heart Federation

This condition is when the body can’t use the insulin produced in the pancreas. As a result, there is an abundance amount of sugar in the bloodstream. This type of diabetes is managed by eating healthy and exercising or taking medication and insulin.

Type 2 Diabetes

Negative affectivity refers to an individual's tendency to feel distressing emotional statuses such as anger, fear, guilt, nervousness, and etc. 

Negative Affectivity 

Extensive research has identified the anger and hostility dimension of the Type A behavior pattern as a primary predictor for the development of heart disease. This link is strongly supported by meta-analyses, such as a major 2009 review of 35 studies, which concluded that anger and hostility are significant long-term risk factors for negative cardiovascular outcomes. This risk applies to both healthy individuals and those with pre-existing heart conditions.

Anger and Hostility as Risk Factors for Heart Disease

Social and economic factors, often referred to as social determinants, play a significant role in the risk of developing heart disease. These include demographic characteristics like aging, as well as socioeconomic indicators such as income, level of education, and employment status.

Social Determinants of Heart Disease

Certain lifestyle choices and behaviors are major contributors to the risk of heart disease. Key behavioral risk factors include maintaining an unhealthy diet, using tobacco, leading a physically inactive lifestyle, and consuming excessive amounts of alcohol.

Behavioral Risk Factors for Heart Disease

In addition to social and behavioral factors, pre-existing health conditions like obesity and diabetes are recognized as significant independent risk factors for the development of heart disease.

Obesity and Diabetes as Risk Factors for Heart Disease

In recent decades, there has been a growing understanding of the significant role that stress and other psychological elements play in the health of the cardiovascular system. Research has established a clear connection between exposure to various types of stressors and the development of cardiovascular issues.

Psychological Factors in Cardiovascular Health

Identified by cardiologists Friedman and Rosenman, the Type A behavior pattern describes individuals who are prone to heart disease. These individuals are characterized as intensively driven workaholics, constantly rushed and preoccupied with deadlines. The core of this pattern is an aggressive and chronic struggle to achieve progressively more in less time. A key finding from their initial research highlighted this risk, showing that heart disease was over seven times more common among Type A individuals compared to their more relaxed, Type B counterparts.

Type A Behavior Pattern

Negative affectivity is the tendency to experience distressing emotional states, including anger, contempt, disgust, guilt, fear, and nervousness. This disposition has been identified as a significant risk factor for cardiovascular disorders, with research linking it to the development of both hypertension and heart disease.

Negative Affectivity as a Risk Factor for Cardiovascular Disease

A substantial body of evidence, particularly since the early 1990s, has established a clear link between depression and an elevated risk for developing heart disease and experiencing cardiac-related death.

Depression as a Risk Factor for Heart Disease

Analyze the provided case study. Identify three different *types* of risk factors for heart disease that Alex exhibits. For each type you identify, provide a specific, corresponding example from the text.

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