Hypertension and COVID-19: Relation with Complications, Comorbidities and Mortality
DOI:
https://doi.org/10.24950/rspmi.1204Keywords:
Comorbidity, COVID-19, Hospital Mortality, Hypertension, SARS-CoV-2Abstract
Introduction: SARS-CoV-2 infection is characterized by hyperproduction of pro-inflammatory cytokines that impact
the cardiovascular system. In addition, several cardiovascular risk factors, like arterial hypertension, were identified as risk factors for greater disease severity and mortality in these patients. The objective of this study is to evaluate the prevalence of hypertension in patients with COVID-19 and its association with complications, comorbidities and mortality.
Methods: Retrospective study of the patients with COVID-19 admitted to Internal Medicine ward between March 2020
and February 2021. Data was collected from the digital clinical file. Logistic regression was applied to clarify the effect of independent variables on mortality.
Results: The sample included 1291 patients with COVID-19, a median age of 73 years (IQR: 22) and male gender predominance (n = 701, 54.3%). There were 65.5% (n = 845) of patients with hypertension, 54.9% (n = 709) dyslipidemia and about a third had diabetes mellitus and obesity (31 and 38%, respectively). Comparatively to the non-hypertensive patients, hypertensive group presented with higher prevalence of other cardiovascular risk factors (diabetes mellitus, obesity and dyslipidemia (p <0.001)) and lower functionality and more comorbidities (as calculated by AVDezIS and Charlson modified scores, p<0.001). There was also higher proportion of severe COVID-19 disease (p = 0.003), greater number of patients admitted to intensive care units (p <0.001) and higher in-hospital mortality (p <0.001). Hypertension was not a mortality predictive factor in these patients.
Conclusion: In this study, patients with hypertension presented with higher severity of COVID-19 disease, higher prevalence of other cardiovascular risk factors, complications during hospitalization and in-hospital mortality, however, its presence was not a mortality predictive factor.
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References
Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020;324:782-93. doi: 10.1001/jama.2020.12839.
World Health Organization. WHO Coronavirus (COVID-19) dashboard. [Acedido a 22-04-2022.] Disponível em: https://covid19.who.int.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J. et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62. doi: 10.1016/S0140-6736(20)30566-3.
Ribeiro AC, Uehara SC. Systemic arterial hypertension as a risk factor for the severe form of covid-19: scoping review. Rev Saude Publica. 2022;56:20. doi: 10.11606/s1518-8787.2022056004311
Du Y, Lv Y, Zha W, Zhou N, Hong X. Association of body mass index (BMI) with critical COVID-19 and in-hospital mortality: A dose-response meta-analysis. Metabolism. 2021 ;117:154373. doi: 10.1016/j.metabol.2020.154373.
Liu Y, Pan Y, Yin Y, Chen W, Li X. Association of dyslipidemia with the severity and mortality of coronavirus disease 2019 (COVID-19): a meta-analysis. Virol J. 2021;18:157. doi: 10.1186/s12985-021-01604-1.
Yang Y, Cai Z, Zhang J. Hyperglycemia at admission is a strong predictor of mortality and severe/critical complications in COVID-19 patients: a meta-analysis. Biosci Rep. 2021;41:BSR20203584. doi: 10.1042/BSR20203584.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021-104. doi: 10.1093/eurheartj/ehy339.
Rodrigues AP, Gaio V, Kislaya I, Graff-Iversen S, Cordeiro E, Silva AC,et al; INSEF Research group. Prevalência de hipertensão arterial em Portugal – resultados do Primeiro Inquérito Nacional com Exame Físico (INSEF 2015). Boletim Epidemiológico Observações. 2017;6:11-4.
Polonia J, Martins L, Pinto F, Nazare J. Prevalence, awareness, treatment and control of hypertension and salt intake in Portugal: changes over a decade. The PHYSA study. J Hypertens. 2014;32:1211-21. doi: 10.1097/HJH.0000000000000162.
Martins Y, Simões R, Miranda M, Tavares LP. Avaliação Funcional no Idoso e Resultados Clínicos. Med Interna. 22016;23:22-8.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-83. doi: 10.1016/0021-9681(87)90171-8.
Direção Geral de Saúde. Norma 004/2020 : Abordagem das Pessoas com Suspeita ou Confirmação de COVID-19. Lisboa: DGS; 2020.
Gallo G, Calvez V, Savoia C. Hypertension and COVID-19: Current Evidence and Perspectives. High Blood Press Cardiovasc Prev. 2022;29:115-23. doi: 10.1007/s40292-022-00506-9.
Xia F, Zhang M, Cui B, An W, Chen M, Yang P, et al. COVID-19 patients with hypertension are at potential risk of worsened organ injury. Sci Rep. 2021;11:3779. doi: 10.1038/s41598-021-83295-w.
Du Y, Zhou N, Zha W, Lv Y. Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutr Metab Cardiovasc Dis. 2021;31:745-55. doi: 10.1016/j.numecd.2020.12.009.
Du Y, Zhou N, Zha W, Lv Y. Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis. Nutr Metab Cardiovasc Dis. 2021;31:745-55. doi: 10.1016/j.numecd.2020.12.009.
Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134:441-50. doi: 10.1161/CIRCULATIONAHA.115.018912.
Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M; SARS-RAS Investigators. Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension. Hypertension. 2020;76:366-72. doi: 10.1161/HYPERTENSIONAHA.120.15324.
Docherty AB, Harrison EM, Green CA, Hardwick HE, Pius R, Norman L, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985. doi: 10.1136/bmj.m1985.
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