key: cord-0868254-8563oebr authors: Giménez‐Miranda, Luis; Beltrán‐Romero, Luis; León‐Jimenez, David; Stiefel, Pablo title: PostCOVID effect on endothelial function in hypertensive patients: A new research opportunity date: 2021-11-16 journal: J Clin Hypertens (Greenwich) DOI: 10.1111/jch.14376 sha: 763864caa02923c9841a4ff8b5749106c969e16c doc_id: 868254 cord_uid: 8563oebr SARS‐CoV‐2 is causing devastation both in human lives and economic resources. When the world seems to start overcoming the pandemics scourge, the threat of long‐term complications of COVID‐19 is rising. Reports show that some of these long‐term effects may contribute to the main cause of morbimortality worldwide: the vascular diseases. Given the evidence of damage in the endothelial cells due to SARS‐CoV‐2 and that endothelial dysfunction precedes the development of arteriosclerosis, the authors propose to measure endothelial function around 6–12 months after acute disease in hypertensive patients, especially if they have other cardiovascular risk factors or overt vascular disease. The methods the authors propose are cost‐effective and can be made available to any hypertension unit. These methods could be the “in vivo” assessment of endothelial function by flow mediated vasodilatation after ischemia by Laser‐Doppler flowmetry and the measurement of plasma free circulating DNA and microparticles of endothelial origin. One of the most recent and innovative techniques to assess the magnitude of response is Laser-Doppler flowmetry, which mainly allows the determination of the microcirculation status. This is a noninvasive technique, but its measurements are probably more independent of the observer since the results are automatically obtained by software. This software assesses many parameters both in general and adjusted analysis of the response. Although some parameters measure the speed of the response, such as the slope or the time to maximum hyperemia, others are related to the duration of this response, such as the time to reach the half value after the maximum hyperemia. A previous study of our group found that the area of hyperemia was the parameter with higher sensitivity and specificity for identification of patients with coronary artery disease, because the area depends on the speed as well as on the intensity and duration of the response. 4 Although initially related to neoplastic diseases cell-free DNA (c-fDNA) levels, has more recently been related to pathologies involving ischemia such as acute coronary syndrome, 5 ischemic heart failure, 6 stroke, 7 and mesenteric ischemia, 8 Circulating microparticles (MPs) are small vesicles that are released in response to several injuries. The level of circulating MPs in peripheral blood has been reported to be increased in cerebrovascular disease, hypertension, diabetes, smoking, coronary disease, and obstructive sleep apnea (OSA) syndrome. There exists a positive correlation between circulating levels of MPs and nocturnal hypoxemia severity. 15 We have also previously reported that changes in MPs after continuous positive airway pressure in OSA patients were greater in those with a more severe disease, defined according to the oxygen desaturation and apnea-hypopnea indexes, suggesting that in more severe patients the benefit is greater. 16 As these research studies will be on human beings, local ethics committee approval must be obtained and patients should be informed of the possible adverse effects of these techniques which will include those derived from venipuncture and keeping the cuff inflated on the arm for 4 min. Practically all hypertension units are located in hospitals that have or could have the three techniques mentioned above. The finding by Sinning and coworkers that is reproduced in Figure 1 (with the author's permission) shows how, from practically the first 6-12 months, both curves (those that present events and those that do not) begin to differ. Our proposal is very simple: all hypertensive patients who have suffered an episode of SARS-CoV-2 infection -and even more so if they have other associated vascular risk factors or already manifested vascular disease-should be evaluated from the point of view of their endothelial function at least once 6-12 months after the episode, by any of the three aforementioned methods. We encourage all interested researchers.to design a comparative study, age-sex-risk factor matched study of hypertensive patients with and without history of SARS-CoV-2. Both groups should be compared to decide whether there are significant differences, and in such case, establish cut-off points from which to establish measures aimed at improving the future vascular prognosis in infected patients who have worsened their vascular risk due to deterioration of endothelial function. There is not any conflict of interest. Endothelial dysfunction in COVID-19: a position paper of the ESC working group for atherosclerosis and vascular biology, and the ESC council of basic cardiovascular science Cardiovasc Res Persistent impairment of endothelial vasomotor function has a negative impact on outcome in patients with coronary artery disease Flow-mediated vasodilation as a diagnostic modality for vascular failure Which parameter is better to define endothelial dysfunction in a test of postocclusive hyperemia measured by laser-Doppler flowmetry? 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