COVID-19 Blood Pressure Endothelium Interaction Study (OBELIX)
Condition: COVID; Hypertension
MeSH terms: Hypertension
Study type: Observational

Summary: 
      The current COVID-19 pandemic (caused by the SARS-CoV-2 virus) represents the biggest medical
      challenge in decades. Whilst COVID-19 mainly affects the lungs it also affects multiple organ
      systems, including the cardiovascular system. There are documented associations between
      severity of disease and risk of death and To provide all the information required by review
      bodies and research information systems, we ask a number of specific questions. This section
      invites you to give an overview using language comprehensible to lay reviewers and members of
      the public. Please read the guidance notes for advice on this section.

      5 DRAFT Full Set of Project Data IRAS Version 5.13 advancing age, male sex and associated
      comorbid disease (hypertension, ischaemic heart disease, diabetes, obesity, COPD and cancer).
      The most common complications include cardiac dysrhythmia, cardiac injury, myocarditis, heart
      failure, pulmonary embolism and disseminated intravascular coagulation.

      It is thought that the mechanism of action of the virus involves binding to a host
      transmembrane enzyme (angiotensin- converting enzyme 2 (ACE2)) to enter some lung, heart and
      immune cells and cause further damage. While ACE2 is essential for viral invasion, it is
      unclear if the use of the common antihypertensive drugs ACE inhibitors or angiotensin
      receptor blockers (ARBs) alter prognosis.

      This study aims to look closely at the health of the vascular system of patients after being
      treated in hospital for COVID-19 (confirmed by PCR test) and compare them to patients who had
      a hospital admission for suspected COVID-19 (negative PCR test) . Information from this study
      is essential so that clinicians treating patients with high blood pressure understand the
      impact of the condition and these hypertension medicines in the context of the current
      COVID-19 pandemic. This will allow doctors to effectively treat and offer advice to patients
      currently prescribed these medications or who are newly diagnosed with hypertension.
    

Detailed description: 
      COVID-19 is pandemic and, though it primarily affects the lungs, there is evidence of
      cardiovascular system involvement. Mechanistically, SARS-CoV-2, following proteolytic
      cleavage of its S protein by a serine protease, binds to the transmembrane
      angiotensin-converting enzyme 2 (ACE2) -a homologue of ACE-to enter type 2 pneumocytes,
      macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial
      dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque
      instability, and myocardial infarction. While ACE2 is essential for viral invasion, it is
      unclear if the use of the common antihypertensive drugs ACE inhibitors or angiotensin
      receptor blockers alter prognosis.
    

Intervention name(s): ABPM; ECG; FMD; PWV; Rarefaction
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test
Intervention description(s): 24 hour ambulatory blood pressure monitoring; Electrocardiogram; Flow mediated dilatation; Pulse wave velocity; nailbed capillaroscopy
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients admitted through QEUH immediate assessment unit and acute receiving units with
        suspected or confirmed COVID-19 during 01/04/20 - 31/12/20 and who are alive at discharge.
        Clinically suspected COVID-19 should have at least two of the following presenting features
        (fever, new onset cough, fatigue, myalgia, breathlessness, GI symptoms, anosmia/dysgeusia,
        contact with known COVID-19 positive patient).
      
Biospecimen description: 
      blood and urine samples for vascular phenotpying marker, immuno phenotyping markers and
      future biomarker studies