The impact of pre-existing hypertension and its treatment on outcomes in patients admitted to hospital with COVID-19

Abstract

The impact of pre-existing hypertension on outcomes in patients with the novel corona virus (SARS-CoV-2) remains controversial. To address this, we examined the impact of pre-existing hypertension and its treatment on in-hospital mortality in patients admitted to hospital with Covid-19. Using the CAPACITY-COVID patient registry we examined the impact of pre-existing hypertension and guideline-recommended treatments for hypertension on in-hospital mortality in unadjusted and multi-variate-adjusted analyses using logistic regression. Data from 9197 hospitalised patients with Covid-19 (median age 69 [IQR 57-78] years, 60.6% male, n = 5573) was analysed. Of these, 48.3% (n = 4443) had documented pre-existing hypertension. Patients with pre-existing hypertension were older (73 vs. 62 years, p < 0.001) and had twice the occurrence of any cardiac disease (49.3 vs. 21.8%; p < 0.001) when compared to patients without hypertension. The most documented class of anti-hypertensive drugs were angiotensin receptor blockers (ARB) or angiotensin converting enzyme inhibitors (ACEi) (n = 2499, 27.2%). In-hospital mortality occurred in (n = 2020, 22.0%), with more deaths occurring in those with pre-existing hypertension (26.0 vs. 18.2%, p < 0.001). Pre-existing hypertension was associated with in-hospital mortality in unadjusted analyses (OR 1.57, 95% CI 1.42,1.74), no significant association was found following multivariable adjustment for age and other hypertension-related covariates (OR 0.97, 95% CI 0.87,1.10). Use of ACEi or ARB tended to have a protective effect for in-hospital mortality in fully adjusted models (OR 0.88, 95% CI 0.78,0.99). After appropriate adjustment for confounding, pre-existing hypertension, or treatment for hypertension, does not independently confer an increased risk of in-hospital mortality patients hospitalized with Covid-19.

Keywords: COVID-19; Hypertension; Public health; SARS-Cov-2.

Fig. 1

Distribution of pre-existing hypertension by age group as a proportion of total sample N = 9197. 0 blue: indicates no documented pre-existing hypertension; 1 red: indicates documented pre-existing hypertension

Fig. 2

Association of anti-hypertensive medications and in-hospital mortality. Data displayed is odds ratio for (1) crude unadjusted or adjusted odds ratio [95% CI] N = 9197. Grey circle indicates p value > 0.05 and red circle indicates p value < 0.05. ACEi angiotensin converting enzyme inhibitor, ARB angiotensin receptor blocker, BB beta-blocker, CCB calcium channel blocker, D diuretic. ACEi or ARB is a pooled variable N = 2499 and was examined separately to ACEi N = 1512 and ARB N = 1007. Solid vertical line on x-axis 1 indicates reference—not receiving a type of anti-hypertensive medication