Hypertensive patients at greater risk of severe COVID-19

The coronavirus disease 2019 (COVID-19) is more likely to turn into a severe disease in patients with hypertension, according to a recent Chiba study.

“Overall, our comparative analysis of COVID-19 patients with and without hypertension showed that hypertensive patients had greater disease severity and adverse progression than nonhypertensive patients,” researchers said. “However, this result may be related to the higher age in this group than in nonhypertension group.”

Of the 310 enrolled COVID-19 patients (median age, 62 years; 43.9 percent female), half (n=155) were identified to have severe disease, as defined by the National Health Committee of the People’s Republic of China. Common presenting symptoms were cough, dyspnoea, and expectoration. There were 58 in-hospital deaths, yielding a rate of 18.7 percent. [Hypertens Res 2020;43:824-831]

Hypertension was the most common comorbidity, detected in 36.5 percent of the sample. These patients were older (median, 67 vs 57 years) and had higher rates of diabetes (28.3 percent vs 8.1 percent). In addition, hypertensive patients more frequently had cerebrovascular diseases than their nonhypertensive counterparts (12.4 percent vs 3.6 percent).

Severe COVID-19 was also more common in the hypertensive subgroup (63.7 percent vs 42.1 percent), as were the use of noninvasive mechanical ventilation (16.8 percent vs 7.6 percent) and admission to the intensive care unit (23.9 percent vs 12.2 percent). Mortality rate was also higher for hypertensive patients (24.8 percent vs 15.2 percent).

Laboratory indices revealed differences between hypertensive and nonhypertensive COVID-19 patients. Those with hypertension had significantly elevated neutrophil counts, neutrophil-lymphocyte ratio, fibrinogen, alanine aminotransferase, and creatinine, while the activated partial prothrombin time was reduced.

This indicated that “COVID-19 patients with hypertension tended to show more severe inflammation and organ damage than COVID-19 patients without hypertension, which may lead to a poor prognosis,” the researchers explained.

After excluding patients with complications other than hypertension, multivariate logistic regression analysis showed a nominal, nonsignificant, and positive interaction between hypertension and COVID-19 severity (odds ratio [OR], 1.562, 95 percent confidence interval [CI], 0.929–2.625; p=0.092) and mortality (OR, 1.262, 95 percent CI, 0.683–2.332; p=0.458).

“Our multivariate analysis showed that after adjusting for age and sex, hypertension did not show a significant correlation with increased COVID-19 disease severity or mortality,” researchers said, noting that this may be due to the small sample size and a limited number of end events in the present analysis.

The specific biological pathways and mechanisms linking hypertension to worse COVID-19 outcomes is still unknown, although one plausible explanation is an imbalance in cytokines, they added. “At present, there is a lack of research on hypertensive COVID-19 patients, especially those adjusted for age and sex, and our study can be regarded as a reference.”