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Meta-Analysis
. 2022 Dec 1;40(12):2323-2336.
doi: 10.1097/HJH.0000000000003266. Epub 2022 Aug 8.

The effects of hypertension on the prognosis of coronavirus disease 2019: a systematic review and meta-analysis on the interactions with age and antihypertensive treatment

Alimamy Umaru Kabia  1 , Ping Li  1 , Zhichao Jin  2 , Xiaojie Tan  1 , Yilong Liu  3 , Yuqi Feng  3 , Keyao Yu  3 , Ming Hu  1 , Dongming Jiang  4 , Guangwen Cao  1
Affiliations
Meta-Analysis

The effects of hypertension on the prognosis of coronavirus disease 2019: a systematic review and meta-analysis on the interactions with age and antihypertensive treatment

Alimamy Umaru Kabia et al. J Hypertens. .

Abstract

Background: Hypertension and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) have been reported to be associated with the prognosis of COVID-19, but the findings remain controversial. Here, we conducted a systematic review to summarize the current evidence.

Methods: We retrieved all the studies by MEDLINE via PubMed, CENTRAL, and Embase using the MeSH terms until 30 April 2021. A fixed or random effect model was applied to calculate pooled adjusted odds ratio (AOR) with 95% confidence interval (CI). Interactive analysis was performed to identify the interaction effect of hypertension and age on in-hospital mortality.

Results: In total, 86 articles with 18 775 387 COVID-19 patients from 18 countries were included in this study. The pooled analysis showed that the COVID-19 patients with hypertension had increased risks of in-hospital mortality and other adverse outcomes, compared with those without hypertension, with an AOR (95% CI) of 1.36 (1.28-1.45) and 1.32 (1.24-1.41), respectively. The results were mostly repeated in countries with more than three independent studies. Furthermore, the effect of hypertension on in-hospital mortality is more evident in younger and older COVID-19 patients than in 60-69-year-old patients. ACEI/ARBs did not significantly affect the mortality and adverse outcomes of COVID-19 patients, compared with those receiving other antihypertensive treatments.

Conclusion: Hypertension is significantly associated with an increased risk of in-hospital mortality and adverse outcomes in COVID-19. The effect of hypertension on in-hospital mortality among consecutive age groups followed a U-shaped curve. ACEI/ARB treatments do not increase in-hospital mortality and other poor outcomes of COVID-19 patients with hypertension.

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Conflict of interest statement

There are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of study selection.
FIGURE 2
FIGURE 2
Forest plot for the effect of hypertension on in-hospital mortality of coronavirus disease 2019 patients. AOR, adjusted odds ratio; COVID-19, coronavirus disease 2019.
FIGURE 3
FIGURE 3
Forest plot of subgroup analysis by country for the effect of hypertension on in-hospital mortality of coronavirus disease 2019 patients. AOR, adjusted odds ratio; COVID-19, coronavirus disease 2019.
FIGURE 4
FIGURE 4
Interactive effect of hypertension and age on in-hospital mortality of coronavirus disease 2019 patients. Dark points represent AORs and line bars represent 95% CIs. 95% CI was discarded in the oldest age group (≥74 years), as only two studies were included. AOR, adjusted odds ratio; CI, confidence interval; COVID-19, coronavirus disease 2019.
FIGURE 5
FIGURE 5
Forest plot for the effect of hypertension on ICU admission, mechanical intubation requirement, and severe disease in coronavirus disease 2019 patients. AOR, adjusted odds ratio; COVID-19, coronavirus disease 2019.
FIGURE 6
FIGURE 6
Forest plot for the effect of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker treatment on in-hospital mortality of coronavirus disease 2019 patients with hypertension. ACEI, angiotensin-converting enzyme inhibitor; AOR, adjusted odds ratio; ARB, angiotensin receptor blocker; COVID-19, coronavirus disease 2019.
FIGURE 7
FIGURE 7
Forest plot for the effect of coronavirus disease 2019 treatment on ICU admission, mechanical intubation requirement, and severe disease in coronavirus disease 2019 patients with hypertension. ACEI, angiotensin-converting enzyme inhibitor; AOR, adjusted odds ratio; ARB, angiotensin receptor blocker; COVID-19, coronavirus disease 2019.
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