Association Between Hypertension and Diabetes Control and COVID-19 Severity: National Patient-Centered Clinical Research Network, United States, March 2020 to February 2022

Abstract

Background Hypertension and diabetes are associated with increased COVID-19 severity. The association between level of control of these conditions and COVID-19 severity is less well understood. Methods and Results This retrospective cohort study identified adults with COVID-19, March 2020 to February 2022, in 43 US health systems in the National Patient-Centered Clinical Research Network. Hypertension control was categorized as blood pressure (BP) <130/80, 130 to 139/80 to 89, 140 to 159/90 to 99, or ≥160/100 mm Hg, and diabetes control as glycated hemoglobin <7%, 7% to <9%, ≥9%. Adjusted, pooled logistic regression assessed associations between hypertension and diabetes control and severe COVID-19 outcomes. Among 1 494 837 adults with COVID-19, 43% had hypertension and 12% had diabetes. Among patients with hypertension, the highest baseline BP was associated with greater odds of hospitalization (adjusted odds ratio [aOR], 1.30 [95% CI, 1.23-1.37] for BP ≥160/100 versus BP <130/80), critical care (aOR, 1.30 [95% CI, 1.21-1.40]), and mechanical ventilation (aOR, 1.32 [95% CI, 1.17-1.50]) but not mortality (aOR, 1.08 [95% CI, 0.98-1.12]). Among patients with diabetes, the highest glycated hemoglobin was associated with greater odds of hospitalization (aOR, 1.61 [95% CI, 1.47-1.76] for glycated hemoglobin ≥9% versus <7%), critical care (aOR, 1.42 [95% CI, 1.31-1.54]), mechanical ventilation (aOR, 1.12 [95% CI, 1.02-1.23]), and mortality (aOR, 1.18 [95% CI, 1.09-1.27]). Black and Hispanic adults were more likely than White adults to experience severe COVID-19 outcomes, independent of comorbidity score and control of hypertension or diabetes. Conclusions Among 1.5 million patients with COVID-19, higher BP and glycated hemoglobin were associated with more severe COVID-19 outcomes. Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID-19.

Keywords: COVID‐19; blood pressure; diabetes; glycated hemoglobin; hypertension.

Figure 1. Adjusted odds ratios for COVID‐19 outcomes by hypertension control status, PCORnet, March 2020 to February 2022.

This figure shows adjusted odds ratios for inpatient hospitalization, critical care use, mechanical ventilation, and 60‐day in‐hospital mortality by strata of blood pressure control, with blood pressure <130/80 mm Hg as the referent category. Models controlled for age in years, age squared, sex, race, ethnicity, obesity, Combined Comorbidity Index score, smoking status, COVID‐19 treatments (receipt of dexamethasone, receipt of remdesivir, receipt of monoclonal antibodies), and pandemic phase. This analysis was limited to patients with hypertension whose blood pressure control status could be categorized (n=518 293 overall; model sample sizes varied depending on participating PCORnet sites). The number of sites that had model convergence was 32, 24, 23, and 29 for each of the outcomes, respectively. aOR indicates adjusted odds ratio; PCORnet, National Patient‐Centered Clinical Research Network.

Figure 2. Adjusted odds ratios for COVID‐19 outcomes by diabetes control status, PCORnet, March 2020 to February 2022.

This figure shows adjusted odds ratios for inpatient hospitalization, mechanical ventilation, critical care use, and 60‐day in‐hospital mortality by strata of HbA1c control, with HbA1c <7% as the referent category. Models controlled for age in years, age squared, sex, race, ethnicity, obesity, Combined Comorbidity Index score, smoking status, COVID‐19 treatments (receipt of dexamethasone, receipt of remdesivir, receipt of monoclonal antibodies), and pandemic phase. This analysis was limited to patients with diabetes whose HbA1c control status could be categorized (n=123 557 overall; model sample sizes varied depending on participating PCORnet sites). The number of sites that had model convergence was 29, 22, 21, and 26 for each of the outcomes, respectively. aOR indicates adjusted odds ratio; HbA1c, glycated hemoglobin; PCORnet, the National Patient‐Centered Clinical Research Network.