Blood pressure control and adverse outcomes of COVID-19 infection in patients with concomitant hypertension in Wuhan, China

Abstract

Hypertension is a common comorbidity in hospitalized patients with COVID-19 infection. This study aimed to estimate the risks of adverse events associated with in-hospital blood pressure (BP) control and the effects of angiotensin II receptor blocker (ARB) prescription in COVID-19 patients with concomitant hypertension. In this retrospective cohort study, the anonymized medical records of COVID-19 patients were retrieved from an acute field hospital in Wuhan, China. Clinical data, drug prescriptions, and laboratory investigations were collected for individual patients with diagnosed hypertension on admission. Cox proportional hazards models were used to estimate the risks of adverse outcomes associated with BP control during the hospital stay. Of 803 hypertensive patients, 67 (8.3%) were admitted to the ICU, 30 (3.7%) had respiratory failure, 26 (3.2%) had heart failure, and 35 (4.8%) died. After adjustment for confounders, the significant predictors of heart failure were average systolic blood pressure (SBP) (hazard ratio (HR) per 10 mmHg 1.89, 95% confidence interval (CI): 1.15, 3.13) and pulse pressure (HR per 10 mmHg 2.71, 95% CI: 1.39, 5.29). The standard deviations of SBP and diastolic BP were independently associated with mortality and ICU admission. The risk estimates of poor BP control were comparable between patients receiving ARBs and those not receiving ARBs, with the only exception of a high risk of heart failure in the non-ARB group. Poor BP control was independently associated with higher risks of adverse outcomes of COVID-19. ARB drugs did not increase the risks of adverse events in hypertensive patients.

Association between laboratory parameters and CT severity in patients infected with Covid-19: A retrospective, observational study

“…These previous works highlight the presence of hypertension and the increase in the mortality risk, rather than high BP measured at the ED admittance. In another study, the patients with poor prognosis was reported to have higher systolic and diastolic pressure on admission [ 20 ]. Similar to this study, our results indicated that the systolic BP recorded at the ED admittance was found to be higher in the CT-positive group than in the negative one.…”

Risk factors for severe and critically ill COVID‐19 patients: A review

“…The Center for Disease Control and Prevention (CDC) states that individuals with hypertension might be at increased risk for severe illness from COVID‐19 62 . In a retrospective study including 803 COVID‐19 patients with coexisting hypertension, high average systolic blood pressure and high systolic/diastolic blood pressure variability during hospitalization were independently associated with in‐hospital mortality, ICU admission, and heart failure, suggesting that lower and stable blood pressure is predictive of a better prognosis for these patients 63 . The imbalance between the two major renin‐angiotensin‐aldosterone system pathways, that is, downregulated angiotensin‐converting enzyme (ACE) 2/angiotensin‐(1‐7) and upregulated ACE/Angiotensin II, 64 may contribute to the increased risk of severity of COVID‐19 patients with comorbidities and advanced age, as depicted in Figure 1.…”

Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension

“…Most recently, a study based on data from hospitals in China suggested that it is higher blood pressure, not specific medication use, which is an important independent risk factor for complications, such as heart failure, in patients with COVID-19 with hypertension. 13 Establishing whether this is also the case for hypertensive patients living in the community is important because the focus on routine chronic disease management has reduced during the pandemic. 14 Based on previous studies, 3 – 5 , 13 , 15 – 17 we hypothesized that uncontrolled blood pressure would be associated with worse COVID-19 outcomes for hypertensive patients with suspected COVID-19.…”

“… 13 Establishing whether this is also the case for hypertensive patients living in the community is important because the focus on routine chronic disease management has reduced during the pandemic. 14 Based on previous studies, 3 – 5 , 13 , 15 – 17 we hypothesized that uncontrolled blood pressure would be associated with worse COVID-19 outcomes for hypertensive patients with suspected COVID-19. We used the electronic health records from primary care to test this hypothesis and examined the association between blood pressure control and SARS-CoV-2 infection, COVID-19–related hospitalization, and death.…”