Impact of preexisting hypertension and antihypertensive medication on prognosis of COVID-19 patients

Document Type : original articles

Authors

1 Clinical Research Development Center, Shahid Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Department of Internal Medicine, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Objectives: Coronavirus disease-2019(COVID-19) patients with comorbidities experience severe disease. Hypertension (HTN) is one of the most common comorbidities seen in these patients. The published reports are conflicting regarding the role of HTN and antihypertensive medication on the in-hospital prognosis of COVID-19 patients. This study investigated the effect of HTN on the prognosis of hospitalized COVID-19 individuals and sought to identify the risk factors for worse clinical outcomes in this population.
 
Methods: This descriptive-analytical observational study was conducted on COVID-19 patients hospitalized in two teaching hospitals (Shahid Rahnemoon and Shahid Sadoughi) in Yazd, Iran from February 20, 2022, to April 20, 2022. All hospitalized patients with positive polymerase chain reaction (PCR) tests for COVID-19 were included in the study. The demographic, laboratory, imaging, pharmaceutical and clinical data were extracted and analyzed by SPSS v-26.
 
Results: Out of 615 participants, 243 had HTN. Hypertensive patients had significantly more need for Intensive Care Unit (ICU) admission (P=0.001) and endotracheal intubation (P<0.001) and experienced higher mortality (P<0.001). The length of hospital and ICU stay and duration of endotracheal intubation were not significantly different. No antihypertensive medication was found to impact the patient's prognosis significantly. In hypertensive individuals, the multivariate regression analysis revealed the vaccination status (OR=0.27; CI 95%: 0.10-0.69), a score of Computed tomography (CT) scan involvement (OR=7.49; CI 95%: 3.50-16.01), and neutrophil-to-lymphocyte ratio (NLR) (OR=1.05; CI 95%: 1.00-1.11) as the predictors of need to ICU admission.
 
Conclusions: Hypertensive COVID-19 patients experience higher mortality and require more ICU admission and endotracheal intubation. None of the antihypertensive drugs had a significant effect on prognosis. The vaccination status, NLR, and the degree of lung involvement in chest imaging predicted the need for ICU admission in this subgroup of patients.

Keywords

References

1.Krammer F. The role of vaccines in the COVID-19 pandemic: what have we learned? Semin Immunopathol. 2024; 45(4-6):451-468.
2.Iaccarino G, Grassi G, Borghi C, et al. Age and multimorbidity predict death among COVID-19 patients: results of the SARS-RAS study of the Italian Society of Hypertens ion. Hypertension. 2020;76(2):366-372.
3.Arutyunov GP, Tarlovskaya EI, Arutyunov AG, et al. International register “Dynamics analysis of comorbidities in SARS-CoV-2survivors” (AKTIV SARS-CoV-2): analysis of 1,000 patients. Russ J Cardiol. 2020; 25(11):4165.
4.Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020323(18):1775-1776.
5.Al-Qudimat AR, Ameen A, Sabir DM, et al. The Association of Hypertension with Increased Mortality Rate During the COVID-19 Pandemic: An Update with Meta-analysis. J Epidemiol Glob Health.2023;13(3):495-503.
6.Tadic M, Cuspidi C, Grassi G, et al. COVID‐19 and arterial hypertension: hypothesis or evidence? J Clin Hypertens (Greenwich). 2020;22(7):1120-1126.
7.Henry BM, Vikse J, Benoit S, et al. Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: a novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clin Chim Acta. 2020;507:167-173.
8.Gallo G, Calvez V, Savoia C. Hypertension and COVID-19: current evidence and perspectives. High Blood Press Cardiovasc Prev. 2022;29(2):115-123.
9.Vahedian-Azimi A, Mohammadi SM, Beni FH, et al. Improved COVID-19 ICU admission and mortality outcomes following treatment with statins: a systematic review and meta-analysis. Arch Med Sci.2021;17(3):579-595.
10.Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722.
11.Gholinataj Jelodar M, Mirzaei S, Saghafi F, et al. Impact of vaccination status on clinical outcomes of hospitalized COVID-19 patients. BMC Infect Dis.2024;24(1):254.
12.Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-1581.
13.Lippi G, Wong J, Henry BM. Hypertension and its severity or mortality in Coronavirus Disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med. 2020;130(4):304-309.
14.McFarlane E, Linschoten M, Asselbergs FW, et al. The impact of pre-existing hypertension and its treatment on outcomes in patients admitted to hospital with COVID-19. Hypertens Res. 2022;45(5):834-845.
15.Matsumoto C, Shibata S, Kishi T, et al. Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19.Hypertens Res. 2023;46(3):601-619.
16.D'Elia L, Giaquinto A, Zarrella AF, et al. Hypertension and mortality in SARS-COV-2 infection: A meta-analysis of observational studies after 2 years of pandemic. Eur J Intern Med. 2023;108:28-36.
17.Sakurai K, Chubachi S, Asakura T, et al. Prognostic significance of hypertension history and blood pressure on admission in Japanese patients with coronavirus disease 2019: integrative analysis from the Japan COVID-19 Task Force. Hypertens Res. 2024;47(3):639-648.
18.Xiong T-Y, Huang F-Y, Liu Q, et al. Hypertension is a risk factor for adverse outcomes in patients with coronavirus disease 2019: a cohort study. Ann Med. 2020;52(7):361-366.
19.Iaccarino G, Grassi G, Borghi C, et al. Gender differences in predictors of intensive care units admission among COVID-19 patients: The results of the SARS-RAS study of the Italian Society of Hypertension. PLoS One. 2020;15(10):e0237297.
20.Qian Z, Li Z, Peng J, et al. Association between hypertension and prognosis of patients with COVID-19: A systematic review and meta-analysis. Clin Exp Hypertens. 2022;44(5):451-458.
21.Lian J, Jin X, Hao S, et al. Analysis of epidemiological and clinical features in older patients with coronavirus disease 2019 (COVID-19) outside Wuhan. Clin Infect Dis. 2020;71(15):740-747.
22.Singh P, Bhaskar Y, Verma P, et al. Impact of comorbidity on patients with COVID-19 in India: A nationwide analysis. Front Public Health.2023;10:1027312.
23.Gao Yd, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID‐19 patients: a review. Allergy. 2021;76(2):428-455.
24.Lee K-A, Flores RR, Jang IH, et al. Immune senescence, immunosenescence and aging. Front Aging. 2022;3:900028.
25.Venkata C, Sampathkumar P, Afessa B. Hospitalized patients with 2009 H1N1 influenza infection: the Mayo Clinic experience. Mayo Clin Proc. 2010;85(9):798-805.
26.Maurizi G, Della Guardia L, Maurizi A, et al. Adipocytes properties and crosstalk with immune system in obesity‐related inflammation. J Cell Physiol.2018;233(1):88-97.
27.Arulanandam B, Beladi H, Chakrabarti A. Obesity and COVID-19 mortality are correlated. Sci Rep.2023;13(1):5895.
28.Tong L, Khani M, Lu Q, et al. Association between body-mass index, patient characteristics, and obesity-related comorbidities among COVID-19 patients: A prospective cohort study. Obes Res Clin Pract.2023;17(1):47-57.
29.Xiong TY, Huang FY, Liu Q, et al. Hypertension is a risk factor for adverse outcomes in patients with coronavirus disease 2019: a cohort study. Ann Med. 2020;52(7):361-366.
30.Liu J, Huang L, Wei W, et al. Effects of Antihypertensive Agents on the Clinical Outcome of Hospitalized COVID-19 Patients Concomitant with Hypertension: A Systematic Review and Meta-Analysis. Heart Lung. 2024;63:78-85.
31.Chouchana L, Beeker N, Garcelon N, et al. Association of Antihypertensive Agents with the Risk of In-Hospital Death in Patients with Covid-19. Cardiovasc Drugs Ther. 2022;36(3):483-488.
32.Lee MMY, Kondo T, Campbell RT, et al. Effects of renin-angiotensin system blockers on outcomes from COVID-19: a systematic review and meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. 2024;10(1):68-80.
33.Braude P, Carter B, Short R, et al. The influence of ACE inhibitors and ARBs on hospital length of stay and survival in people with COVID-19. Int J Cardiol Heart Vasc. 2020;31:100660.
34.Liu Q, Fu W, Zhu CJ, et al. Effect of continuing the use of renin-angiotensin system inhibitors on mortality in patients hospitalized for coronavirus disease 2019: a systematic review, meta-analysis, and meta-regression analysis. BMC Infect Dis. 2023;23(1):53.
35.Busse LW, Chow JH, McCurdy MT, et al. COVID-19 and the RAAS-a potential role for angiotensin II? Crit Care. 2020;24(1):136.
36.Muthukrishnan J, Vardhan V, Mangalesh S, et al. Vaccination status and COVID-19 related mortality: A hospital based cross sectional study. Med J Armed Forces India. 2021;77:S278-S282.
37.Buonacera A, Stancanelli B, Colaci M, et al. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases.Int J Mol Sci. 2022;23(7):3636.
38.Henry BM, de Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med.2020;58 (7):1021-1028.
39.Asperges E, Albi G, Zuccaro V, et al. Dynamic NLR and PLR in Predicting COVID-19 Severity: A Retrospective Cohort Study. Infect Dis Ther.2023;12(6):1625-1640.
40.Sarkar S, Khanna P, Singh AK. The Impact of Neutrophil-Lymphocyte Count Ratio in COVID-19: A Systematic Review and Meta-Analysis. J Intensive Care Med.2022;37 (7):857-69.
Cardiovascular Biomedicine
Volume 4, Issue 1
August 2024
Pages 45-53

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History

  • Receive Date: 27 June 2024
  • Revise Date: 06 August 2024
  • Accept Date: 07 August 2024

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