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Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With

James P Sheppard¹, Brian D Nicholson¹, Joseph Lee¹

¹From the Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (J.P.S., B.D.N., J.L., D.M., J.S., C.K., J.O., N.R.J., W.H., L.A., O.V.H., S.L.-F., C.R.B., H.L., J.W., F.F., M.D.F., M.P.J., S.d.L., F.D.R.H.).

Hypertension (Dallas, Tex. : 1979)

|December 16, 2020

Insights

Hypertension control and COVID-19 outcomes were studied. Uncontrolled blood pressure (BP) stage 1 was linked to lower COVID-19 death odds, suggesting BP control may worsen outcomes.

Area of Science:

Cardiology
Infectious Diseases
Public Health

Background:

Hypertension is a known risk factor for severe coronavirus disease 2019 (COVID-19).
Understanding the impact of pre-infection blood pressure (BP) control on COVID-19 outcomes is crucial for patient management.
Previous research indicates a complex relationship between cardiovascular health and viral infection severity.

Purpose of the Study:

To investigate the association between pre-infection blood pressure control levels and COVID-19 outcomes in hypertensive patients.
To determine if varying degrees of blood pressure control influence COVID-19 diagnosis, hospitalization, or mortality.
To identify potential implications for public health strategies during the COVID-19 pandemic.

Main Methods:

Retrospective analysis of data from 460 general practices in England.
Inclusion of adult patients with hypertension tested or diagnosed with COVID-19.
Classification of blood pressure control into four categories: controlled, raised, stage 1 uncontrolled, and stage 2 uncontrolled.
Multivariable logistic regression to analyze the association between BP control and primary (28-day COVID-19 death) and secondary (COVID-19 diagnosis, hospitalization) outcomes.

Main Results:

Of 45,418 patients, 26.3% had controlled blood pressure.
Patients with stage 1 uncontrolled blood pressure (140/90-159/99 mm Hg) showed significantly lower odds of 28-day COVID-19 death (OR, 0.76; 95% CI, 0.62-0.92) compared to those with controlled BP.
No significant association was found between blood pressure control levels and COVID-19 diagnosis or hospitalization rates.

Conclusions:

Pre-infection blood pressure control may be associated with differential COVID-19 mortality risk.
Patients with less controlled blood pressure (stage 1 uncontrolled) exhibited lower odds of COVID-19 death.
These findings may relate to underlying atherosclerosis and target organ damage in patients with less controlled BP, suggesting a need for tailored public health guidance, such as enhanced social distancing for vulnerable hypertensive individuals.

Read full analysis

Abstract:

Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent BP reading within 24 months of the index date (January 1, 2020). BP was defined as controlled (<130/80 mm Hg), raised (130/80-139/89 mm Hg), stage 1 uncontrolled (140/90-159/99 mm Hg), or stage 2 uncontrolled (≥160/100 mm Hg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19-related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45 418 patients (mean age, 67 years; 44.7% male) included, 11 950 (26.3%) had controlled BP. These patients were older, had more comorbidities, and had been diagnosed with hypertension for longer. A total of 4277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (odds ratio, 0.76 [95% CI, 0.62-0.92]) compared with patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalization. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.

Keywords:

COVID-19 blood pressure electronic health records mortality pandemic

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