SARS-Cov-2-Related Hypertensive Emergency

In hypertensive patients, COVID-19 exacerbates pre-existing hypertension through multiple interrelated mechanisms, including renin-angiotensin system (RAS) dysregulation, endothelial dysfunction, cytokine storm, autonomic nervous system imbalance, and acute kidney injury. A 67-year-old black male merchant was admitted to the emergency room on July 12, 2022, with a chief complaint of shortness of breath for two days. The patient exhibited edema and symmetric palpable pulses in his lower limbs. Electrocardiography revealed left axis deviation inversion, sinus tachycardia, and ST-segment elevation. Reverse transcription-polymerase chain reaction (RT-PCR) was conducted and was found to be positive for COVID-19. Hydralazine (5 mg) was administered intravenously immediately. He was then re-evaluated after 20 minutes and was detained in the emergency room. He experienced reflex tachycardia following two injections of hydralazine (5 mg each). He received ≈ 5,000 IU of low-molecular-weight heparin every 12 hours to prevent prothrombotic episodes. Acute hypertension and COVID-19-induced hypertensive emergencies with preexisting hypertension typically have worse prognoses.