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Characteristics and outcomes of patients with COVID-19 with and without prevalent hypertension: a multinational
Carlen Reyes1, Andrea Pistillo1, Sergio Fernández-Bertolín1
1Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Insights
Patients with hypertension experiencing COVID-19 (coronavirus disease 2019) faced higher risks of hospitalization and death. This study highlights the increased vulnerability of hypertensive individuals to severe outcomes from the virus.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Hypertension is a prevalent comorbidity globally.
- The impact of hypertension on COVID-19 outcomes requires further characterization.
- Understanding risk factors is crucial for managing public health crises.
Purpose of the Study:
- To characterize patients with and without hypertension diagnosed with COVID-19.
- To assess adverse outcomes, including hospitalisation and mortality, in both cohorts.
- To compare outcomes between hypertensive and non-hypertensive COVID-19 patients.
Main Methods:
- Retrospective cohort study utilizing 15 healthcare databases across the USA, Europe, and South Korea.
- Standardized data using the Observational Medical Outcomes Partnership common data model.
- Defined two cohorts: diagnosed COVID-19 and hospitalised COVID-19, stratified by hypertension status.
- Follow-up period of 30 days post-diagnosis or hospitalisation.
Main Results:
- Over 2.8 million diagnosed and 563,000 hospitalised COVID-19 patients were analysed.
- Hypertension was more prevalent in hospitalised patients and associated with older age and female sex.
- Patients with hypertension showed significantly higher rates of hospitalisation, mortality, acute respiratory distress syndrome, and arrhythmia compared to those without hypertension.
Conclusions:
- Hypertension is a significant risk factor for severe COVID-19 outcomes.
- Individuals with hypertension are more susceptible to adverse events and mortality following COVID-19 infection.
- Findings underscore the importance of managing hypertension for mitigating COVID-19 severity.
Objective:
To characterise patients with and without prevalent hypertension and COVID-19 and to assess adverse outcomes in both inpatients and outpatients.
Design And Setting:
This is a retrospective cohort study using 15 healthcare databases (primary and secondary electronic healthcare records, insurance and national claims data) from the USA, Europe and South Korea, standardised to the Observational Medical Outcomes Partnership common data model. Data were gathered from 1 March to 31 October 2020.
Participants:
Two non-mutually exclusive cohorts were defined: (1) individuals diagnosed with COVID-19 (diagnosed cohort) and (2) individuals hospitalised with COVID-19 (hospitalised cohort), and stratified by hypertension status. Follow-up was from COVID-19 diagnosis/hospitalisation to death, end of the study period or 30 days.
Outcomes:
Demographics, comorbidities and 30-day outcomes (hospitalisation and death for the 'diagnosed' cohort and adverse events and death for the 'hospitalised' cohort) were reported.
Results:
We identified 2 851 035 diagnosed and 563 708 hospitalised patients with COVID-19. Hypertension was more prevalent in the latter (ranging across databases from 17.4% (95% CI 17.2 to 17.6) to 61.4% (95% CI 61.0 to 61.8) and from 25.6% (95% CI 24.6 to 26.6) to 85.9% (95% CI 85.2 to 86.6)). Patients in both cohorts with hypertension were predominantly >50 years old and female. Patients with hypertension were frequently diagnosed with obesity, heart disease, dyslipidaemia and diabetes. Compared with patients without hypertension, patients with hypertension in the COVID-19 diagnosed cohort had more hospitalisations (ranging from 1.3% (95% CI 0.4 to 2.2) to 41.1% (95% CI 39.5 to 42.7) vs from 1.4% (95% CI 0.9 to 1.9) to 15.9% (95% CI 14.9 to 16.9)) and increased mortality (ranging from 0.3% (95% CI 0.1 to 0.5) to 18.5% (95% CI 15.7 to 21.3) vs from 0.2% (95% CI 0.2 to 0.2) to 11.8% (95% CI 10.8 to 12.8)). Patients in the COVID-19 hospitalised cohort with hypertension were more likely to have acute respiratory distress syndrome (ranging from 0.1% (95% CI 0.0 to 0.2) to 65.6% (95% CI 62.5 to 68.7) vs from 0.1% (95% CI 0.0 to 0.2) to 54.7% (95% CI 50.5 to 58.9)), arrhythmia (ranging from 0.5% (95% CI 0.3 to 0.7) to 45.8% (95% CI 42.6 to 49.0) vs from 0.4% (95% CI 0.3 to 0.5) to 36.8% (95% CI 32.7 to 40.9)) and increased mortality (ranging from 1.8% (95% CI 0.4 to 3.2) to 25.1% (95% CI 23.0 to 27.2) vs from 0.7% (95% CI 0.5 to 0.9) to 10.9% (95% CI 10.4 to 11.4)) than patients without hypertension.
Conclusions:
COVID-19 patients with hypertension were more likely to suffer severe outcomes, hospitalisations and deaths compared with those without hypertension.
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