Avaliação da variabilidade da frequência cardíaca e da pressão arterial em pacientes com teste positivo para COVID-19 em Unidade de Saúde da Família de João Pessoa - Paraíba

Abstract

The COVID-19 pandemic has significantly impacted public health, including cardiovascular autonomic dysfunctions. This study evaluated the effects of COVID-19 on autonomic regulation in patients approximately 113 days post-infection using heart rate variability (HRV) parameters and the Valsalva maneuver response. Fifty-eight participants were analyzed, comprising 29 previously infected individuals and 29 healthy controls recruited from the Verde Vida Family Health Unit in João Pessoa, Paraíba. Post-COVID-19 patients exhibited autonomic imbalance characterized by reduced vagal modulation, as evidenced by decreased RMSSD (control group: 41.63 ± 4.92; COVID-19 group: 29.98 ± 4.32; p = 0.048) and SD1 (control group: 29.47 ± 3.48; COVID-19 group: 21.22 ± 3.06; p = 0.048), positively correlated with the parasympathetic nervous system (PNS) index (control group: -0.64 (-1.40 – 0.49); COVID-19 group: -1.14 (-1.57 – (-0.64)); p = 0.029). Baroreflex sensitivity was also reduced, demonstrated by the lack of pressure reduction after the Valsalva maneuver in post-COVID-19 patients (mean arterial pressure, MAP, at rest: 94.98 ± 3.11 mmHg; post-MV: 93.31 ± 2.76 mmHg; p = 0.159), unlike the control group (MAP at rest: 93.32 ± 2.46 mmHg; post-MV: 88.47 ± 2.39 mmHg; p = 0.005). Infection severity correlated positively with age (r = 0.717; p < 0.001), resting systolic blood pressure (SBP; r = 0.458; p = 0.013), and stress index (r = 0.411; p = 0.027), suggesting sympathetic hyperactivity and greater cardiovascular burden in more severely affected individuals. This study underscores the association between COVID-19 and autonomic regulation alterations, irrespective of initial infection severity. Despite limitations such as small sample size and lack of pre-infection data, the findings enhance the understanding of the disease's long-term effects. HRV emerges as a non-invasive tool applicable to autonomic nervous system (ANS) monitoring, with potential to guide management strategies across all levels of post-COVID-19 healthcare.