Predictors of the development of cognitive impairment in hypertensive patients with long-term post-COVID syndrome

Objective. To determine the predictors of the development of cognitive impairment in patients with hypertension (HTN) with long-term post-COVID syndrome. Design and methods. A single-stage screening clinical study was conducted. Over a period of 3 years, 205 patients (23,4 %) with long-term post-COVID syndrome according to the NICE criteria were recruited among eligible 878 patients with HTN. The patients were divided taking into account the presence of cognitive impairment using the SEMOGRAPH information system: the first group included 80 patients (39,0 %) with cognitive impairment, the second group included 125 patients (61,0 %) without cognitive impairment. Results. The predictors of the development of cognitive impairment in patients with long-term post-COVID syndrome and their cut-off points were chosen using ROC curve: for body mass index values, a cut-off point of 28,36 kg/m² was set, > 26,0 mm/h — for erythrocyte sedimentation rate, < 126,0 g/l — for hemoglobin level, > 3,9 mg/l — for C-reactive protein serum concentration, > 101,9 pg/ml — for serum N-terminal fragment of brain natriuretic propeptide, > 171,1 μg/l — for ferritin, > 0,016 pg/ml — for serum tumor necrosis factor alpha, > 28,8 pg/ml — for serum caspase-6. In HTN patients with long-term post-COVID syndrome after hospitalization due to COVID-19-related pneumonia, the relative risk of cognitive impairment is increased by 2,8 times (95 % confidence interval (95 % CI) 1,63–4,92); the risk of concentration problems — by 8,1 times (95 % CI 4,84–13,99); “brain fog” symptom — by 2,5 times (95 % CI 1,75–3,50), abnormal blood pressure (BP) circadian profile “Non-dipper / Night-peaker systolic BP” — by 1,9 times (95 % CI 1,37–2,68); “Over-dipper systolic BP” — by 18,8 times (95 % CI 2,67–390,89); masked nocturnal hypertension — by 5,1 times (95 % CI 1,61–18,13). Conclusion. More severe forms of COVID-19, long-term post-COVID syndrome manifested by symptoms such as “brain fog”, impaired concentration, as well as abnormal patterns of circadian BP rhythm, obesity, ferrokinetic disorders, the development of myocardial stress, the presence of low-intensity non-specific inflammation, and signs of apoptosis were predictors of the development of cognitive impairment in COVID-19 survivors with HTN.

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