Hosseinzadeh R. Clinical Hypertension. 2021;27:3.
People with comorbidities have a higher risk of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and of developing serious illness. Hypertension is the most frequent comorbidity between COVID-19 patients which is accompanied by greater risk of infection and worse effects and prediction. The fact that hypertension is the most frequent comorbidity in COVID-19 patients is not a big surprise since the frequency and extremity of the infection is greater in elderly and hypertension is seen commonly in old individuals and as a result, hypertension can be anticipated in a lot of COVID-19 cases. But, it remains unclear either uncontrolled blood pressure is a risk factor for getting infected with COVID-19 and generating serious disease or not. Thus, Hosseinzadeh R, et al. conducted a study to assess epidemiologic, clinical and laboratory differences among COVID-19 patients with and without fundamental hypertension and came up with some predictive factors to forecast the extremity of the disorder and other possible effects between patients with pre-existing hypertension.
Medical profiles of 598 patients with COVID-19 pneumonia were assessed in the retrospective analytical study. The collection of data was achieved by checklists loaded with information derived from the medical profiles of patients. Patients’ information incorporating demographic data (age, gender, history of smoking, history of alcohol consumption, history of travel in past 2 weeks, history of contact with COVID-19 patents in past 2 weeks, history of hospital visit in past 2 weeks and history of having fundamental disorder), clinical and laboratory data (fever, gastrointestinal symptoms, biochemical tests, liver function tests, respiratory tests, blood work, radiological findings and computerized tomography [CT] scan) was gathered. Information about clinical outcomes (increase in hospitalization period, mortality and requirement of readmission) was also gathered. Later, patients were distributed into two comparative groups as per their positive or negative history of hypertension. Reverse transcription polymerase chain reaction (RT-PCR) and CT-scan results were used to detect and differentiate COVID-19 from other viruses such as influenza H1N1, H3N2 and H7N9, respiratory syncytial virus, parainfluenza virus, adenovirus, SARS-CoV and middle east respiratory syndrome coronavirus (MERS-CoV). Eventually, epidemiologic, clinical, laboratory and radiological characteristics and also clinical outcomes were compared among patients with and without hypertension.
176 patients were hypertensive (29.4%) and 422 patients were normotensive (70.6%). The mean age in the hypertensive group was 58.21 ± 22.5 and in the normotensive group, 56.21 ± 20.2. (p= 0.18). 115 (65.3%) of hypertensive patients and 289 (68.5%) of normotensive patients were male (p= 0.78). Hypertensive group showed increased rate of diabetes. 72 hypertensive patients (40.9%) and 76 normotensive patients (18%) were diabetic which was statistically substantial (p= 0.001). Hypertensive group [63 (35.7%)] showed substantially greater rate of cardiovascular disease as compared to normotensive group [44 (10.3%)] (p= 0.001). Hypertensive group exhibited substantially greater rate of renal disorders [25 (14.3%)] vs. [33 (7.8%)] respectively than normotensive group (p= 0.013). Hypertensive group showed substantially higher severe/ critical types as compared to normotensive one, [42 (23.8%) vs 41(9.7%)], (p= 0.012). Univariate evaluation exhibited that the hypertensive group [75 (44.3%)] showed substantially higher number of patients with high fever (> 38.5) as compared to normotensive one [125 (9.6%)], (p= 0.042). Comparable results were detected about dyspnea; [22 (12.5%) vs. 20 (4.5%)] (p= 0.023). Altogether, 23.8% of hypertensive patients progressed severe/ critical COVID-19. An innovative approach in logistic regression multivariate analysis, exhibited that body mass index (BMI) > 25 (ORAdj: 1.8, 95% CI:1.2 to 2.42; p-value: 0.027), age over 60 (ORAdj:1.26, 95% CI:1.08 to 1.42; p-value: 0.021), increased hospitalization period (ORAdj:2.1, 95% CI:1.24 to 2.97; p= 0.013), type 2 diabetes (ORAdj: 2.22, 95% CI:1.15 to 3.31; p= 0.001) and chronic kidney disease (ORAdj:1.83, 95% CI:1.19 to 2.21; p= 0.013) were the substantial independent risk factors of severe COVID-19 in patients with hypertension (Table 1).
Table 1: Multivariate logistic Regression of Factors Associated with Progression of disease in patients with and without hypertension
Thus, it was concluded that hypertensive patients are at elevated risk of developing more severe COVID-19 than normotensives, while some predictive factors such as age > 60-year-old, BMI > 25 Kg/m2, CVD, diabetes and chronic kidney disorders were correlated with poor outcomes in hypertensive patients with COVID-19 infection.