SHM Converge Scientific Abstract ePoster Gallery-Resistant Hypertension and Malabsoprtion With Chronic Diarrhea After Covid-19 Infection

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This case report describes a 45-year-old woman with recurrent COVID-19 who developed resistant hypertension and chronic diarrhea afterward. She presented with headache, dyspnea, palpitations, flushing, and daily diarrhea, with home blood pressures around 180/100 and an emergency department blood pressure of 215/144 plus pulmonary edema, requiring IV antihypertensive treatment.<br /><br />Despite adherence to a multi-drug oral regimen including carvedilol, losartan, furosemide, clonidine, and nifedipine, her blood pressure remained poorly controlled. A broad secondary hypertension work-up was negative, including evaluation for renal artery stenosis, hyperaldosteronism, Cushing’s disease, thyroid disease, pheochromocytoma, renal parenchymal disease, and major rheumatologic causes.<br /><br />Because of persistent diarrhea and variable response to oral medications, clinicians suspected malabsorption. Gastrointestinal evaluation showed no structural or histologic abnormalities on endoscopy or colonoscopy, and celiac testing and fecal elastase were negative. Stool studies demonstrated a high fecal osmolar gap, supporting malabsorption. Her blood pressure improved when clonidine was changed from oral to transdermal formulation, and later when liquid formulations of antihypertensives were used, suggesting impaired absorption of pills.<br /><br />The authors propose that COVID-19 may contribute to both hypertension and gastrointestinal dysfunction through ACE-2 mediated injury to vascular endothelial cells and intestinal brush border cells. They suggest that post-COVID intestinal damage may cause malabsorption, reducing the effectiveness of oral medications and complicating blood pressure control.<br /><br />Overall, the case highlights the need for a broad, systems-based approach in patients with difficult-to-treat post-COVID complications, and raises concern that post-COVID malabsorption may play an important role in apparent resistant hypertension.

Asset Subtitle

Katherine M. Cooper

Meta Tag

Author List Bhavin Patel, Katherine M. Cooper, Rose Martin

Category Clinical Vignettes

Concept Hypertension

Concept Malabsorption

Concept Fecal Osmolar Gap

Concept Secondary Hypertension Work-up

Concept Prior COVID-19 Infection

Distinguished Finalist

Presenter Organization University of Massachusetts Medical School

Presenting Author Katherine M. Cooper

Track Adult

Keywords

COVID-19

resistant hypertension

malabsorption

chronic diarrhea

secondary hypertension workup

ACE-2

oral medication absorption

transdermal clonidine

pulmonary edema

post-COVID complications

Hypertension

Malabsorption

Fecal Osmolar Gap

Secondary Hypertension Work-up

Prior COVID-19 Infection