Association Between Hypertension and Diabetes Control and COVID‐19 Severity: National Patient‐Centered Clinical Research Network, United States, March 2020 to February 2022

Abstract

Background Hypertension and diabetes are associated with increased COVID‐19 severity. The association between level of control of these conditions and COVID‐19 severity is less well understood. Methods and Results This retrospective cohort study identified adults with COVID‐19, March 2020 to February 2022, in 43 US health systems in the National Patient‐Centered Clinical Research Network. Hypertension control was categorized as blood pressure (BP) <130/80, 130 to 139/80 to 89, 140 to 159/90 to 99, or ≥160/100 mm Hg, and diabetes control as glycated hemoglobin <7%, 7% to <9%, ≥9%. Adjusted, pooled logistic regression assessed associations between hypertension and diabetes control and severe COVID‐19 outcomes. Among 1 494 837 adults with COVID‐19, 43% had hypertension and 12% had diabetes. Among patients with hypertension, the highest baseline BP was associated with greater odds of hospitalization (adjusted odds ratio [aOR], 1.30 [95% CI, 1.23–1.37] for BP ≥160/100 versus BP <130/80), critical care (aOR, 1.30 [95% CI, 1.21–1.40]), and mechanical ventilation (aOR, 1.32 [95% CI, 1.17–1.50]) but not mortality (aOR, 1.08 [95% CI, 0.98–1.12]). Among patients with diabetes, the highest glycated hemoglobin was associated with greater odds of hospitalization (aOR, 1.61 [95% CI, 1.47–1.76] for glycated hemoglobin ≥9% versus <7%), critical care (aOR, 1.42 [95% CI, 1.31–1.54]), mechanical ventilation (aOR, 1.12 [95% CI, 1.02–1.23]), and mortality (aOR, 1.18 [95% CI, 1.09–1.27]). Black and Hispanic adults were more likely than White adults to experience severe COVID‐19 outcomes, independent of comorbidity score and control of hypertension or diabetes. Conclusions Among 1.5 million patients with COVID‐19, higher BP and glycated hemoglobin were associated with more severe COVID‐19 outcomes. Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID‐19.

Public Health Surveillance in Electronic Health Records: Lessons From PCORnet

“…This COVID-19 surveillance program has generated important information on the prevalence of post-acute sequelae of SARS-CoV-2 infection ( 28 ), disparities in uptake of COVID-19 therapeutics ( 18 , 29 ), cardiac complications after COVID-19 mRNA vaccines and SARS-CoV-2 infection ( 30 ), and association of uncontrolled diabetes and hypertension and severe COVID-19 ( 19 ). Information also was captured on trends in chronic and infectious disease incidence and preventive care services before and during the pandemic and the incidence of and therapeutics for mpox to support CDC’s response.…”

“…The PCORnet team leading this surveillance effort also changed the modular statistical programs to allow for characterization of cohorts using results of qualitative viral testing information, available mortality information (ie, typically deaths reported to the health care system or in-hospital deaths) and records of vaccinations given in the health care system or populated in EHRs from state registry linkages, when available. The statistical programs also were updated to allow for distributed advanced analytics, including the use of multiple regression models that execute behind institutions’ firewalls and return only summary model output; these results can be combined across sites using meta-analytic techniques ( 19 ). Since October 2020, PCORnet has participated in a cooperative agreement funded by the Centers for Disease Control and Prevention (CDC) to provide COVID-19 information from up to 43 PCORnet institutions on a biweekly basis.…”

Sex differences in patients with COVID-19 after bariatric surgery: a multicenter cross-sectional study

“…Therefore, relevant variables were identified based on professional knowledge ( 15 , 16 ), and their associations with the self-reported duration of severe symptoms of COVID-19 were examined as the main outcome. Employing a historical confounding approach, a multivariate regression model incorporated age (years) ( 17 ), BMI group ( 18 ), education level ( 19 ), marital status ( 20 ), smoking status ( 21 ), alcohol consumption ( 22 ), bariatric surgery type (SG, RYGB, and others) ( 23 ), hypertension ( 24 ), and diabetes ( 25 ). Due to the skewed distribution of BMI data, we grouped the values into intervals with uniform spacing of 5, namely (<20, 20–25, 25–30, 30–35, 35–40, 45–50, 50–55, and 55–60 kg/m 2 ).…”

Evaluation of blood pressure variation in recovered COVID-19 patients at one-year follow-up: a retrospective cohort study

“…Among these, hypertension stands out as one of the most prevalent comorbidities, present in roughly 25% of COVID-19 patients [ 3 ]. Prior studies have explored its relationship with adverse COVID-19 outcomes including hospitalization, critical care, mechanical ventilation, and mortality [ 4 – 6 ].…”