tetano
Editor, Senior Moderator
Eur Heart J
. 2020 Jun 4;ehaa433.
doi: 10.1093/eurheartj/ehaa433. Online ahead of print.
Association of Hypertension and Antihypertensive Treatment With COVID-19 Mortality: A Retrospective Observational Study
Chao Gao[SUP] 1 2 [/SUP], Yue Cai[SUP] 1 3 [/SUP], Kan Zhang[SUP] 1 3 [/SUP], Lei Zhou[SUP] 3 4 [/SUP], Yao Zhang[SUP] 3 5 [/SUP], Xijing Zhang[SUP] 3 6 [/SUP], Qi Li[SUP] 3 7 [/SUP], Weiqin Li[SUP] 3 8 [/SUP], Shiming Yang[SUP] 3 9 [/SUP], Xiaoyan Zhao[SUP] 3 10 [/SUP], Yuying Zhao[SUP] 3 11 [/SUP], Hui Wang[SUP] 3 12 [/SUP], Yi Liu[SUP] 1 [/SUP], Zhiyong Yin[SUP] 1 [/SUP], Ruining Zhang[SUP] 1 [/SUP], Rutao Wang[SUP] 1 2 [/SUP], Ming Yang[SUP] 13 [/SUP], Chen Hui[SUP] 14 [/SUP], William Wijns[SUP] 2 [/SUP], J William McEvoy[SUP] 2 [/SUP], Osama Soliman[SUP] 2 [/SUP], Yoshinobu Onuma[SUP] 2 [/SUP], Patrick W Serruys[SUP] 2 15 [/SUP], Ling Tao[SUP] 1 [/SUP], Fei Li[SUP] 1 3 [/SUP]
Affiliations
Abstract
Aims: It remains unknown whether the treatment of hypertension influences the mortality of patients diagnosed with coronavirus disease 2019 (COVID-19).
Methods and results: This is a retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital. The hospital was dedicated solely to the treatment of COVID-19 in Wuhan, China. Hypertension and the treatments were stratified according to the medical history or medications administrated prior to the infection. Among 2877 hospitalized patients, 29.5% (850/2877) had a history of hypertension. After adjustment for confounders, patients with hypertension had a two-fold increase in the relative risk of mortality as compared with patients without hypertension [4.0% vs. 1.1%, adjusted hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.17-3.82, P = 0.013]. Patients with a history of hypertension but without antihypertensive treatment (n = 140) were associated with a significantly higher risk of mortality compared with those with antihypertensive treatments (n = 730) (7.9% vs. 3.2%, adjusted HR 2.17, 95% CI 1.03-4.57, P = 0.041). The mortality rates were similar between the renin-angiotensin-aldosterone system (RAAS) inhibitor (4/183) and non-RAAS inhibitor (19/527) cohorts (2.2% vs. 3.6%, adjusted HR 0.85, 95% CI 0.28-2.58, P = 0.774). However, in a study-level meta-analysis of four studies, the result showed that patients with RAAS inhibitor use tend to have a lower risk of mortality (relative risk 0.65, 95% CI 0.45-0.94, P = 0.20).
Conclusion: While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19. However, the results should be considered as exploratory and interpreted cautiously.
Keywords: Angiotensin receptor blockers (ARBs); Angiotensin-converting enzyme inhibitors (ACEIs); Antihypertensive regimen; COVID-19.
Published on behalf of the European Society of Cardiology. All rights reserved. ? The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
. 2020 Jun 4;ehaa433.
doi: 10.1093/eurheartj/ehaa433. Online ahead of print.
Association of Hypertension and Antihypertensive Treatment With COVID-19 Mortality: A Retrospective Observational Study
Chao Gao[SUP] 1 2 [/SUP], Yue Cai[SUP] 1 3 [/SUP], Kan Zhang[SUP] 1 3 [/SUP], Lei Zhou[SUP] 3 4 [/SUP], Yao Zhang[SUP] 3 5 [/SUP], Xijing Zhang[SUP] 3 6 [/SUP], Qi Li[SUP] 3 7 [/SUP], Weiqin Li[SUP] 3 8 [/SUP], Shiming Yang[SUP] 3 9 [/SUP], Xiaoyan Zhao[SUP] 3 10 [/SUP], Yuying Zhao[SUP] 3 11 [/SUP], Hui Wang[SUP] 3 12 [/SUP], Yi Liu[SUP] 1 [/SUP], Zhiyong Yin[SUP] 1 [/SUP], Ruining Zhang[SUP] 1 [/SUP], Rutao Wang[SUP] 1 2 [/SUP], Ming Yang[SUP] 13 [/SUP], Chen Hui[SUP] 14 [/SUP], William Wijns[SUP] 2 [/SUP], J William McEvoy[SUP] 2 [/SUP], Osama Soliman[SUP] 2 [/SUP], Yoshinobu Onuma[SUP] 2 [/SUP], Patrick W Serruys[SUP] 2 15 [/SUP], Ling Tao[SUP] 1 [/SUP], Fei Li[SUP] 1 3 [/SUP]
Affiliations
- PMID: 32498076
- DOI: 10.1093/eurheartj/ehaa433
Abstract
Aims: It remains unknown whether the treatment of hypertension influences the mortality of patients diagnosed with coronavirus disease 2019 (COVID-19).
Methods and results: This is a retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital. The hospital was dedicated solely to the treatment of COVID-19 in Wuhan, China. Hypertension and the treatments were stratified according to the medical history or medications administrated prior to the infection. Among 2877 hospitalized patients, 29.5% (850/2877) had a history of hypertension. After adjustment for confounders, patients with hypertension had a two-fold increase in the relative risk of mortality as compared with patients without hypertension [4.0% vs. 1.1%, adjusted hazard ratio (HR) 2.12, 95% confidence interval (CI) 1.17-3.82, P = 0.013]. Patients with a history of hypertension but without antihypertensive treatment (n = 140) were associated with a significantly higher risk of mortality compared with those with antihypertensive treatments (n = 730) (7.9% vs. 3.2%, adjusted HR 2.17, 95% CI 1.03-4.57, P = 0.041). The mortality rates were similar between the renin-angiotensin-aldosterone system (RAAS) inhibitor (4/183) and non-RAAS inhibitor (19/527) cohorts (2.2% vs. 3.6%, adjusted HR 0.85, 95% CI 0.28-2.58, P = 0.774). However, in a study-level meta-analysis of four studies, the result showed that patients with RAAS inhibitor use tend to have a lower risk of mortality (relative risk 0.65, 95% CI 0.45-0.94, P = 0.20).
Conclusion: While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19. However, the results should be considered as exploratory and interpreted cautiously.
Keywords: Angiotensin receptor blockers (ARBs); Angiotensin-converting enzyme inhibitors (ACEIs); Antihypertensive regimen; COVID-19.
Published on behalf of the European Society of Cardiology. All rights reserved. ? The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.