Pharmacotherapy for hypertensive urgency and emergency in COVID-19 patients

Angeli, Fabio; Verdecchia, Paolo; Reboldi, Gianpaolo

INTRODUCTION: Hypertension is a common chronic disorder in patients hospitalised for coronavirus disease 2019 (COVID-19). Furthermore, an exaggerated cardiovascular response with persistently raised blood pressure during hospitalization seems independently associated with in-hospital all-cause mortality, intensive care unit admission and heart failure. However, the real burden of elevated blood pressure during the acute phase of COVID-19 remains undefined. AREAS COVERED: The authors review the available evidence on the pharmacotherapy for the treatment of acute elevations in BP (including hypertensive urgency and emergency) in COVID-19 patients. EXPERT OPINION: Acute elevations in blood pressure and unstable in-hospital blood pressure may be associated with organ damage and worse outcome in patients with COVID-19. In this setting, hypertensive emergencies require immediate reduction in BP through intravenous treatment according to specific features and goals. Conversely, hypertensive urgencies usually require solely oral treatment. Diuretics, beta-blockers, renin-angiotensin-aldosterone system inhibitors, and calcium channel blockers may be of benefit in treating COVID-19 patients with elevated blood pressure values.