Observational Study

. 2021 Mar 3;77(3):856-867.

doi: 10.1161/HYPERTENSIONAHA.120.16563. Epub 2020 Dec 30.

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Enrique Rodilla^{1

2}, Maria Dolores López-Carmona³, Xavi Cortes^{1

2}, Lidia Cobos-Palacios³, Sergio Canales^{1

2}, Maria Carmen Sáez^{1

2}, Samara Campos Escudero⁴, Manuel Rubio-Rivas⁵, Jesus Díez Manglano⁶, Santiago J Freire Castro⁷, Nuria Vázquez Piqueras⁸, Elisabeth Mateo Sanchis⁹, Paula Maria Pesqueira Fontan¹⁰, Jeffrey Oskar Magallanes Gamboa¹¹, Andrés González García^{12

13}, Victor Madrid Romero¹⁴, Lara Tamargo Chamorro¹⁵, Julio González Moraleja¹⁶, Javier Villanueva Martínez¹⁷, Amara González Noya¹⁸, Ana Suárez-Lombraña¹⁹, Anyuli Gracia Gutiérrez^{12

13}, Manuel Lorenzo López Reboiro²⁰, José Manuel Ramos Rincón²¹, Ricardo Gómez Huelgas³; SEMI-COVID-19 Network

Affiliations

¹ From the Internal Medicine Department, Hypertension and Vascular Risk Unit, Sagunto University Hospital, Sagunto (Valencia), Spain (E.R., X.C., S.C., M.C.S.).
² Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., X.C., S.C., M.C.S.).
³ Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain (M.D.L.-C., L.C.-P., R.G.H.).
⁴ Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain (S.C.E.).
⁵ Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain (M.R.-R.).
⁶ Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain (J.D.M.).
⁷ Internal Medicine Department, A Coruña University Hospital, Spain (S.J.F.C.).
⁸ Internal Medicine Department, Consorci Sanitari Integral, Moisès Broggi Hospital Sant Joan Despí (Barcelona), Spain (N.V.P.).
⁹ Internal Medicine Department, Dr. Peset University Hospital, Valencia, Spain (E.M.S.).
¹⁰ Internal Medicine Department, Santiago Clinical Hospital, Santiago de Compostela (A Coruña), Spain (P.M.P.F.).
¹¹ Internal Medicine Department, Nuestra Señora del Prado Hospital, Talavera de la Reina (Toledo), Spain (J.O.M.G.).
¹² Internal Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain (A.G.G.).
¹³ Internal Medicine Department, Defensa General Hospital, Zaragoza, Spain (A.G.G.).
¹⁴ Internal Medicine Department, Zamora Hospital Complex, Spain (V.M.R.).
¹⁵ Internal Medicine Department, Cabueñes Hospital, Gijón (Asturias), Spain (L.T.C.).
¹⁶ Internal Medicine Department, Virgen de la Salud Hospital, Toledo, Spain (J.G.M.).
¹⁷ Internal Medicine Department, Infanta Cristina University Hospital, Parla (Madrid), Spain (J.V.M.).
¹⁸ Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain (A.G.N.).
¹⁹ Internal Medicine Department, Platón Hospital, Barcelona, Spain (A.S.-L.).
²⁰ Internal Medicine Department, Monforte de Lemos Hospital, Spain (M.L.L.R.).
²¹ Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain (J.M.R.R.).

PMID: 33377393
PMCID: PMC7884247
DOI: 10.1161/HYPERTENSIONAHA.120.16563

Observational Study

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Enrique Rodilla et al. Hypertension. 2021.

. 2021 Mar 3;77(3):856-867.

doi: 10.1161/HYPERTENSIONAHA.120.16563. Epub 2020 Dec 30.

Authors

Affiliations

¹ From the Internal Medicine Department, Hypertension and Vascular Risk Unit, Sagunto University Hospital, Sagunto (Valencia), Spain (E.R., X.C., S.C., M.C.S.).
² Department of Medicine, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain (E.R., X.C., S.C., M.C.S.).
³ Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Spain (M.D.L.-C., L.C.-P., R.G.H.).
⁴ Internal Medicine Department, 12 de Octubre University Hospital, Madrid, Spain (S.C.E.).
⁵ Internal Medicine Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat (Barcelona), Spain (M.R.-R.).
⁶ Internal Medicine Department, Royo Villanova Hospital, Zaragoza, Spain (J.D.M.).
⁷ Internal Medicine Department, A Coruña University Hospital, Spain (S.J.F.C.).
⁸ Internal Medicine Department, Consorci Sanitari Integral, Moisès Broggi Hospital Sant Joan Despí (Barcelona), Spain (N.V.P.).
⁹ Internal Medicine Department, Dr. Peset University Hospital, Valencia, Spain (E.M.S.).
¹⁰ Internal Medicine Department, Santiago Clinical Hospital, Santiago de Compostela (A Coruña), Spain (P.M.P.F.).
¹¹ Internal Medicine Department, Nuestra Señora del Prado Hospital, Talavera de la Reina (Toledo), Spain (J.O.M.G.).
¹² Internal Medicine Department, Ramón y Cajal University Hospital, Madrid, Spain (A.G.G.).
¹³ Internal Medicine Department, Defensa General Hospital, Zaragoza, Spain (A.G.G.).
¹⁴ Internal Medicine Department, Zamora Hospital Complex, Spain (V.M.R.).
¹⁵ Internal Medicine Department, Cabueñes Hospital, Gijón (Asturias), Spain (L.T.C.).
¹⁶ Internal Medicine Department, Virgen de la Salud Hospital, Toledo, Spain (J.G.M.).
¹⁷ Internal Medicine Department, Infanta Cristina University Hospital, Parla (Madrid), Spain (J.V.M.).
¹⁸ Internal Medicine Department, Ourense University Hospital Complex, Ourense, Spain (A.G.N.).
¹⁹ Internal Medicine Department, Platón Hospital, Barcelona, Spain (A.S.-L.).
²⁰ Internal Medicine Department, Monforte de Lemos Hospital, Spain (M.L.L.R.).
²¹ Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain (J.M.R.R.).

PMID: 33377393
PMCID: PMC7884247
DOI: 10.1161/HYPERTENSIONAHA.120.16563

Abstract

Older age and cardiovascular comorbidities are well-known risk factors for all-cause mortality in patients with coronavirus disease 2019 (COVID-19). Hypertension and age are the 2 principal determinants of arterial stiffness (AS). This study aimed to estimate AS in patients with COVID-19 requiring hospitalization and analyze its association with all-cause in-hospital mortality. This observational, retrospective, multicenter cohort study analyzed 12 170 patients admitted to 150 Spanish centers included in the SEMI-COVID-19 Network. We compared AS, defined as pulse pressure ≥60 mm Hg, and clinical characteristics between survivors and nonsurvivors. Mean age was 67.5 (±16.1) years and 42.5% were women. Overall, 2606 (21.4%) subjects died. Admission systolic blood pressure (BP) <120 and ≥140 mm Hg was a predictor of higher all-cause mortality (23.5% and 22.8%, respectively, P<0.001), compared with systolic BP between 120 and 140 mm Hg (18.6%). The 4379 patients with AS (36.0%) were older and had higher systolic and lower diastolic BP. Multivariate analysis showed that AS and systolic BP <120 mm Hg significantly and independently predicted all-cause in-hospital mortality (adjusted odds ratio [ORadj]: 1.27, P=0.0001; ORadj: 1.48, P=0.0001, respectively) after adjusting for sex (males, ORadj: 1.6, P=0.0001), age tertiles (second and third tertiles, ORadj: 2.0 and 4.7, P=0.0001), Charlson Comorbidity Index (second and third tertiles, ORadj: 4.8 and 8.6, P=0.0001), heart failure, and previous and in-hospital antihypertensive treatment. Our data show that AS and admission systolic BP <120 mm Hg had independent prognostic value for all-cause mortality in patients with COVID-19 requiring hospitalization.

Keywords: COVID-19; arterial stiffness; blood pressure; heart failure; hypertension; pulse pressure.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

**Figure 1.**
**Patient inclusion flow chart.** COVID-19 indicates coronavirus disease 2019.

**Figure 2.**
**Kaplan-Meier curves in patients with/without arterial stiffness (AS).** Log rank P<0.001. PP indicates pulse pressure.

**Figure 3.**
**All-cause in-hospital mortality according to systolic blood pressure (SBP) at hospital admission and presence (pulse pressure [PP] ≥60 mm Hg) or absence (PP <60 mm Hg) of arterial stiffness.** *P<0.0001.

See this image and copyright information in PMC

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Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Affiliations

Impact of Arterial Stiffness on All-Cause Mortality in Patients Hospitalized With COVID-19 in Spain

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials