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Impact of Antihypertensive Treatments in COVID-19
Quick Takes
- Compared with patients without hypertension, hypertensive patients have a two-fold relative increase in the risk of COVID-19 mortality.
- Patients with a history of hypertension but without antihypertensive treatment were associated with a significantly higher risk of mortality compared with those receiving antihypertensive treatments.
- Based on all available data, it seems prudent to continue RAAS inhibitors in patients with COVID-19 infection with hypertension.
Study Questions:
What is the impact of the treatment of hypertension on the mortality of patients diagnosed with coronavirus disease 2019 (COVID-19)?
Methods:
The investigators conducted 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. The primary endpoint was all-cause mortality during hospitalization. Other endpoints included the time elapsed between onset of symptoms and discharge, the rates of use of invasive mechanical ventilation, and the severity of COVID-19. The variances in outcomes between exposure cohorts were assessed by the multivariable Cox proportional hazards model.
Results:
Among 2,877 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 results 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).
Conclusions:
The authors concluded that they did not detect any harm of RAAS inhibitors in patients infected with COVID-19.
Perspective:
This study reports that compared with patients without hypertension, hypertensive patients have a two-fold relative increase in the risk of COVID-19 mortality. Furthermore, while the severity of COVID-19, and percentages of ventilation were not statistically different between the patients treated with RAAS inhibitors and non-RAAS inhibitors, RAAS inhibitors tended to be associated with a lower risk of mortality. Of note, patients with a history of hypertension but without antihypertensive treatment or discontinuation were associated with a significantly higher risk of mortality compared with those on antihypertensive treatment. Given the observational nature of the study, the results need to be validated; however, based on all available data, it seems prudent to continue RAAS inhibitors in patients with COVID-19 infection with hypertension.
Clinical Topics: COVID-19 Hub, Heart Failure and Cardiomyopathies, Prevention, Hypertension
Keywords: Antihypertensive Agents, Coronavirus, COVID-19, Hypertension, Patient Discharge, Primary Prevention, Renin-Angiotensin System, Respiration, Artificial, Risk, severe acute respiratory syndrome coronavirus 2, Vascular Diseases
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