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. 2022 Sep;1(1):100012.
doi: 10.1016/j.focus.2022.100012. Epub 2022 Jul 10.

COVID-19 Outcomes Stratified by Control Status of Hypertension and Diabetes: Preliminary Findings From PCORnet, U.S

Sandra L Jackson  1 , Jason P Block  2 , Deborah B Rolka  3 , Meda E Pavkov  3 , Jennifer R Chevinsky  4 , Akaki Lekiachvili  5 , Thomas W Carton  6 , Deepika Thacker  7 , Joshua L Denson  8 , Anuradha Paranjape  9 , Michael D Kappelman  10 , Tegan K Boehmer  11 , Evelyn Twentyman  5
Affiliations

COVID-19 Outcomes Stratified by Control Status of Hypertension and Diabetes: Preliminary Findings From PCORnet, U.S

Sandra L Jackson et al. AJPM Focus. 2022 Sep.

Abstract

Introduction: Hypertension and diabetes are associated with increased COVID-19 severity, yet less is known about COVID-19 outcomes across levels of disease control for these conditions.

Methods: All adults aged ≥20 years with COVID-19 between March 1, 2020 and March 15, 2021 in 42 healthcare systems in National Patient-Centered Clinical Research Network were identified.

Results: Among 656,049 adults with COVID-19, 41% had hypertension, and 13% had diabetes. Of patients with classifiable hypertension, 35% had blood pressure <130/80 mmHg, 40% had blood pressure of 130‒139/80‒89 mmHg, 21% had blood pressure of 140‒159/90‒99 mmHg, and 6% had blood pressure ≥160/100 mmHg. Severe COVID-19 outcomes were more prevalent among those with blood pressure of ≥160/100 than among those with blood pressure of 130-139/80-89, including hospitalization (23.7% [95% CI=23.0, 24.4] vs 11.7% [95% CI=11.5, 11.9]), receipt of critical care (5.5% [95% CI=5.0, 5.8] vs 2.4% [95% CI=2.3, 2.5]), receipt of mechanical ventilation (3.0% [95% CI=2.7, 3.3] vs 1.2% [95% CI=1.1, 1.3]), and 60-day mortality (4.6% [95% CI=4.2, 4.9] vs 1.8% [95% CI=1.7, 1.9]). Of patients with classifiable diabetes, 44% had HbA1c <7%, 35% had HbA1c 7% to <9%, and 21% had HbA1c ≥9%. Hospitalization prevalence was 31.3% (95% CI=30.7, 31.9) among those with HbA1c <7% vs 40.2% (95% CI=39.4, 41.1) among those with HbA1c ≥9%; other outcomes did not differ substantially by HbA1c.

Conclusions: These findings highlight the importance of appropriate management of hypertension and diabetes, including during public health emergencies such as the COVID-19 pandemic.

Keywords: COVID-19; Hypertension; blood pressure; diabetes mellitus; glycated hemoglobin.

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Figures

Image, graphical abstract
Graphical abstract
Figure 1
Figure 1
COVID-19 outcomes by (A) hypertension control status and (B) diabetes control status. This figure shows variation in inpatient hospitalization, mechanical ventilation, critical care use, and 60D mortality by strata of chronic disease control. For no hypertension, n=389,101, and for no diabetes, n=571,323. For the entire cohort, N=656,049, and outcome prevalences were 14% inpatient hospitalization, 2% mechanical ventilation, 2% critical care, and 3% 60D mortality. 60D, 60-day.
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