Impact of Hypertension on Progression and Prognosis in Patients with COVID-19: A Retrospective Cohort Study in 1,031 Hospitalized Cases in Wuhan, China

Author(s): Tianlu Zhang, Xingwei He, Yuxin Du, Yan Tong, Xueli Wang, Weizhong Zhang, Hesong Zeng, Yin Shen

Background: A large proportion of COVID-19 patients with chronic comorbidities have been reported to be in severe conditions with unpromising clinical outcomes. However, whether and how these demographic characteristics and underlying diseases, especially hypertension, influence the progression and prognosis of COVID-19 has not been clarified.

Methods: We included COVID-19 patients who had been admitted to Tongji Hospital (Wuhan, China) from January 27, 2020, to March 8, 2020. Raw data were extracted from electronic medical records and statistically analysed by investigators.

Results: Among 1,031 COVID-19 inpatients in this study, 866 were discharged, and 165 were deceased in the hospital. 73% of 165 deceased patients had chronic comorbidities. Patients with underlying diseases showed a CFR (case-fatality rate) 2.8 times that of patients without. Senility and males were observed to be main risk factors for increased CFR, with OR (odds ratio) being 2.94 (95% CI: 2.00 to 4.33; P<0.001) and 2.47 (95% CI: 1.65 to 3.70; P<0.001), respectively. The OR of cases with composite endpoints for patients with simple hypertension was 1.53 (95% CI: 1.07 to 2.17; P=0.019). Senile patients with hypertension were proven to be at high risk early in the disease. The OR of CFR for hypertensive patients taking calcium channel blockers (CCB) was 0.67 (95% CI: 0.37 to 1.20; P=0.176). Among 271 severe cases without IKF, the OR of CFR was 0.42 (95% CI: 0.18 to 0.99; P=0.046) for patients taking CCB after adjustment.

Conclusions: Hypertension is a risk factor affecting the severity of COVID-19 and plays a critical role in worsening clinical outcomes. Therefore, hypertension management in patients with COVID-19 should be regarded as a major challenge in diagnostic and therapeutic strategies.