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Meta-Analysis
. 2021 Mar 10;31(3):745-755.
doi: 10.1016/j.numecd.2020.12.009. Epub 2020 Dec 11.

Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis

Yanbin Du  1 , Nan Zhou  2 , Wenting Zha  3 , Yuan Lv  4
Affiliations
Meta-Analysis

Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis

Yanbin Du et al. Nutr Metab Cardiovasc Dis. .

Abstract

Aims: As reported, hypertension may play an important role in adverse outcomes of coronavirus disease-2019 (COVID-19), but it still had many confounding factors. The aim of this study was to explore whether hypertension is an independent risk factor for critical COVID-19 and mortality.

Data synthesis: The Medline, PubMed, Embase, and Web of Science databases were systematically searched until November 2020. Combined odds ratios (ORs) with their 95% confidence interval (CIs) were calculated by using random-effect models, and the effect of covariates was analyzed using the subgroup analysis and meta-regression analysis. A total of 24 observational studies with 99,918 COVID-19 patients were included in the meta-analysis. The proportions of hypertension in critical COVID-19 were 37% (95% CI: 0.27 -0.47) when compared with 18% (95% CI: 0.14 -0.23) of noncritical COVID-19 patients, in those who died were 46% (95%CI: 0.37 -0.55) when compared with 22% (95% CI: 0.16 -0.28) of survivors. Pooled results based on the adjusted OR showed that patients with hypertension had a 1.82-fold higher risk for critical COVID-19 (aOR: 1.82; 95% CI: 1.19 - 2.77; P = 0.005) and a 2.17-fold higher risk for COVID-19 mortality (aOR: 2.17; 95% CI: 1.67 - 2.82; P < 0.001). Subgroup analysis results showed that male patients had a higher risk of developing to the critical condition than female patients (OR: 3.04; 95%CI: 2.06 - 4.49; P < 0.001) and age >60 years was associated with a significantly increased risk of COVID-19 mortality (OR: 3.12; 95% CI: 1.93 - 5.05; P < 0.001). Meta-regression analysis results also showed that age (Coef. = 2.3×10-2, P = 0.048) had a significant influence on the association between hypertension and COVID-19 mortality.

Conclusions: Evidence from this meta-analysis suggested that hypertension was independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.

Keywords: COVID-19; Critical illness; Hypertension; Meta-analysis; Mortality.

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Conflict of interest statement

Declaration of competing interest The authors declare that there are no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of study procedure.
Figure 2
Figure 2
Effects of hypertension on critical COVID-19 patients.
Figure 3
Figure 3
Effects of hypertension on COVID-19 mortality.
Figure 4
Figure 4
Random-effects meta-regression analysis of the effect of age and sex on association between hypertension and critical COVID-19 (a,b) and mortality (c,d).
Figure 5
Figure 5
Funnel plots of detecting publication bias in the studies reporting the effects of hypertension on critical COVID-19 and mortality.
See this image and copyright information in PMC

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