Hypertension and mortality in SARS-COV-2 infection: A meta-analysis of observational studies after 2 years of pandemic

D’Elia, Lanfranco; Giaquinto, Alfonso; Zarrella, Aquilino Flavio; Rendina, Domenico; Idelson, Paola Iaccarino; Strazzullo, Pasquale; Galletti, Ferruccio

doi:10.1016/j.ejim.2022.11.018

Cited by 11 publications

(8 citation statements)

References 65 publications

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“…Our results on the pooled adjusted risk ratios for diabetes and hypertension in relation to COVID-19 mortality are consistent with the summary RR estimates adjusted for multiple confounders reported in recently published meta-analyses with inclusion of studies published as of 2022 2 50 51 56. Therefore, our findings provide further evidence and support on the independent effects and highlighted importance of possible confounding effects for the association of diabetes and hypertension with COVID-19 mortality.…”

Section: Discussionsupporting

confidence: 91%

Associations of diabetes, hypertension and obesity with COVID-19 mortality: a systematic review and meta-analysis

Li,

Islam,

Gutierrez

et al. 2023

BMJ Glob Health

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IntroductionDespite a growing body of scholarly research on the risks of severe COVID-19 associated with diabetes, hypertension and obesity, there is a need for estimating pooled risk estimates with adjustment for confounding effects. We conducted a systematic review and meta-analysis to estimate the pooled adjusted risk ratios of diabetes, hypertension and obesity on COVID-19 mortality.MethodsWe searched 16 literature databases for original studies published between 1 December 2019 and 31 December 2020. We used the adapted Newcastle-Ottawa Scale to assess the risk of bias. Pooled risk ratios were estimated based on the adjusted effect sizes. We applied random-effects meta-analysis to account for the uncertainty in residual heterogeneity. We used contour-funnel plots and Egger’s test to assess possible publication bias.ResultsWe reviewed 34 830 records identified in literature search, of which 145 original studies were included in the meta-analysis. Pooled adjusted risk ratios were 1.43 (95% CI 1.32 to 1.54), 1.19 (95% CI 1.09 to 1.30) and 1.39 (95% CI 1.27 to 1.52) for diabetes, hypertension and obesity (body mass index ≥30 kg/m2) on COVID-19 mortality, respectively. The pooled adjusted risk ratios appeared to be stronger in studies conducted before April 2020, Western Pacific Region, low- and middle-income countries, and countries with low Global Health Security Index scores, when compared with their counterparts.ConclusionsDiabetes, hypertension and obesity were associated with an increased risk of COVID-19 mortality independent of other known risk factors, particularly in low-resource settings. Addressing these chronic diseases could be important for global pandemic preparedness and mortality prevention.PROSPERO registration numberCRD42021204371.

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Section: Discussionsupporting

confidence: 91%

Associations of diabetes, hypertension and obesity with COVID-19 mortality: a systematic review and meta-analysis

Li,

Islam,

Gutierrez

et al. 2023

BMJ Glob Health

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“…We are particularly interested in the discussion pertaining to the association between hypertension and severe COVID-19, where the authors concluded that there is currently mixed evidence on the risk of severe COVID-19 in patients with hypertension, upon reviewing the published findings about the association. We agree with the authors in which the association between hypertension and severe COVID-19 may not be straightforward, and this is indeed exemplified in a recently published systematic review and meta-analysis [ 2 ]. In the systematic review and meta-analysis [ 2 ], pre-existing hypertension was significantly associated with mortality due to COVID-19, both in unadjusted (hazard ratio = 2.58; 95% confidence interval 1.66 to 4.02) and adjusted models (hazard ratio = 1.55; 95% confidence interval 1.22 to 1.97), but with significant heterogeneity in both models (I 2 = 97 and 89%).…”

supporting

confidence: 90%

“…We agree with the authors in which the association between hypertension and severe COVID-19 may not be straightforward, and this is indeed exemplified in a recently published systematic review and meta-analysis [ 2 ]. In the systematic review and meta-analysis [ 2 ], pre-existing hypertension was significantly associated with mortality due to COVID-19, both in unadjusted (hazard ratio = 2.58; 95% confidence interval 1.66 to 4.02) and adjusted models (hazard ratio = 1.55; 95% confidence interval 1.22 to 1.97), but with significant heterogeneity in both models (I 2 = 97 and 89%). In addition, the association disappeared when the results adjusted for crucial and strong predictors of mortality in patients with COVID-19 (e.g., body weight).…”

supporting

confidence: 90%

Hypertension and severe COVID-19

2023

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“…As they emphasized [ 1 ], the recent meta-analysis showed that the association of hypertension with COVID-19 mortality in crude analysis disappeared after adjustment with strong predictors of mortality [ 3 ], supporting the non-straightforward relationship between these two disorders. The importance of appropriate assessment and adjustment of crucial risk factors has also been highlighted by the findings of the CAPACITY-COVID registry [ 4 ].…”

mentioning

confidence: 99%