Patients with hypertension are at a higher risk of contracting the SARS-CoV-2 viral infection that causes COVID-19.
The World Health Organization (WHO) has identified hypertension as one of the most significant risk factors for morbidity and mortality worldwide; and diagnoses of hypertension are on the rise. More than 30% of the current global population suffer from this serious medical condition.
Hypertension significantly increases the risk for cardiovascular diseases (CVD), which are the cause of approximately 17 million deaths globally each year. These numbers highlight the urgency of optimised cardiovascular risk stratification. The significance of hypertension has increased even more since the COVID-19 pandemic; it has been shown that more than 50% of COVID-19 patients who died have suffered from hypertension.
Arteriograph: the solution for determining arterial age
In the field of hypertension management, a novel technological innovation called Arteriograph (manufactured by TensioMed) is penetrating the healthcare market with the first oscillometric method for measuring arterial function parameters. This modern method equips physicians with a unique tool for the detection of arterial stiffness, which is directly associated with the increased risk for a cardiovascular event. The measurement of arterial stiffness has been recommended by the European Society of Hypertension (ESH) since 2007.
The Arteriograph is a patented and clinically validated medical device that measures the aortic pulse wave velocity (PWVao), the central systolic blood pressure (SBPao), and the augmentation of the second (reflected) systolic wave (AIXao). These functional vascular parameters form the basis for improved cardiovascular risk stratification. Quality of life and life expectancy can be improved and costs can be reduced at the same time, by preventing the transition of the vascular damage to deadly and costly diseases, such as stroke and myocardial infarction.
Next to researchers, the target demographics of Arteriograph primarily consist of cardiologists, hypertension specialists, and doctors specialising in internal medicine, but other medical specialists are becoming more and more interested in adopting this technology.
The effect of COVID-19 on hypertensive patients
The most common comorbidity observed in patients affected by COVID-19 is hypertension and scientific evidence appears to indicate that SARS-CoV-2 infection is basically an endothelial disease.1 The expression of ACE2 receptors, which act as a vector for SARS-CoV-2 infection, is increased in hypertension and cardiovascular diseases, heightening the patient’s risk of becoming infected by the SARS-CoV-2 virus due to the higher number of the entry points for the penetration of the virus into the human body. ACE2 levels are also increased in asymptomatic atherosclerosis and in chronic kidney diseases.
In fact, the aortic augmentation index (AIXao), measured with Arteriograph, is tightly connected to the actual peripheral vasodilatory or vasoconstrictive status maintained by the small arteries and arterioles. There is a significant correlation between the augmentation index and the vasodilatory effect caused by increased ACE2 activities.2 This relationship can be a predictive risk factor for identifying subjects with a heightened risk of contracting COVID-19. During SARS-CoV-2 infection, endothelial dysfunction develops, and the developed vasoconstrictive effects can be pointed out as increased augmentation index.
As a conclusion, by measuring the vasodilative and vasoconstrictive arterial status with Arteriograph, we can find subjects with increased risk for COVID-19 infection; furthermore, we can also monitor the endothelial damage this causes.
Monitoring vascular function will provide us with important insight into the assessment of the vascular effects of the different antiviral therapies. Measuring arterial function with Arteriograph plays a fundamental role in hypertension management and the more efficient and precise cardiovascular risk assessment in daily clinical routine.
Interview with Professor Dr Martin Middeke
Specialist for internal medicine with 30 years of experience in hypertension research and head of the Hypertension Centre Munich (Excellence Centre of the European Society of Hypertension)
Which patient groups do you primarily focus on for the Arteriograph measurement?
For more than 10 years I have been measuring all my patients with Arteriograph to determine their individual form of hypertension. This is particularly important for characterising juvenile isolated hypertension in younger individuals as well as demasking arterial vascular stiffness or arteriosclerosis in elderly people with normal brachial blood pressure, but elevated aortic blood pressure. This is referred to as masked aortic hypertension, because conventional measurement alone does not detect this phenomenon – only the pulse wave analysis leads to demasking. For these two groups, the measurement with Arteriograph is indispensable for correct diagnosis and for the right therapy decision.
Regardless of the blood pressure situation, the biological age of the vessels can be determined in all patients by measuring the pulse wave velocity, which is in accordance with the guiding principle of the English physician Thomas Sydenham: ‘A man is as old as his arteries’.
Have you been able to integrate pulse wave analysis into your everyday practice?
Yes, indeed! In our hypertension centre, every patient is measured with the Arteriograph. The measurement is easy to perform, operator independent and comparable to a conventional blood pressure measurement. The device connects wirelessly to the computer and transmits the recorded pressure waves to the screen in real time. This technology is unique, because one can distinguish the direct and the reflecting wave and immediately see if there is an augmentation of the systolic blood pressure. Consequently, the measurement is very transparent and comprehensible and not a ‘black box’. The measurement of the aortic blood pressure is recommended by international guidelines, including those issued by the European Society of Cardiology and Hypertension. In Germany, the billing of services is possible for private patients and self-payers; consequently the investment can be returned quickly.
How does measurement with Arteriograph influence and benefit the patient?
The depiction of the pulse wave on the computer screen can be optimally used to demonstrate to patients the importance of a normal pulse wave or an abnormal wave. The elimination of the augmentation with a good blood pressure stabilisation within only a few weeks is always impressive for the patients and increases the motivation for each therapeutic measure. The patients see visually that due to increased vascular elasticity the aortic blood pressure is significantly lowered.
What do you envision for the future of hypertension management?
The aortic blood pressure should be taken into account to a greater extent. Many doctors are already working with this method but it is desirable that more physicians gain experience with pulse wave analysis and apply it in practice. The method has reached practical suitability. I would definitely recommend making use of the on-site instruction and training by the manufacturers in order to use the new technology optimally*.
1 Bai, Y., Yao, L., Wei, T., Tian, F., Jin, D. Y., Chen, L., & Wang, M. (2020). Presumed asymptomatic carrier transmission of COVID-19. Jama, 323(14), 1406-1407.
2 Anguiano, L., Riera, M., Pascual, J., Valdivielso, J. M., Barrios, C., Betriu, A., & Soler, M. J. (2016). Circulating angiotensin converting enzyme 2 activity as a biomarker of silent atherosclerosis in patients with chronic kidney disease. Atherosclerosis, 253, 135-143.