Antihypertensive treatment may reduce mortality risk in COVID-19
Patients with hypertension had elevated mortality risk associated with COVID-19, but those who were treated for hypertension had a reduced mortality risk compared with those who did not receive treatment, according to a new study.
“It is important that patients with high blood pressure realize that they are at increased risk of dying from COVID-19,” Fei Li, MD, PhD, professor in the department of cardiology at Xijing Hospital in Xi’an, China, said in a press release. “They should take good care of themselves during this pandemic, and they need more attention if they are infected with the coronavirus.”
Patients in Wuhan, China
Chao Gao, of Xijing Hospital, and colleagues analyzed data from 2,877 patients with COVID-19 who were admitted to Huoshenshan Hospital in Wuhan, China, between Feb. 5 and March 15. Patients with hypertension (n = 2,027; median age, 55 years; 51% men) were compared with those without hypertension (n = 850; median age, 64 years; 52% men).
Data were obtained from electronic medical records including demographic characteristics and clinical data such as comorbidities, symptoms, outcomes and laboratory findings. The primary endpoint for this study was all-cause mortality during hospitalization. Follow-up was conducted for a median of 21 days.
Patients with hypertension had an increased risk for mortality compared with those without hypertension even after adjusting for confounders (4% vs. 1.1%; adjusted HR = 2.12; 95% CI, 1.17-3.82). With regard to treatment, patients with hypertension who were not taking antihypertensive medications (n = 140) had a significantly higher risk for mortality vs. those who were taking the medications (n = 730; 7.9% vs. 3.2%; aHR = 2.17; 95% CI, 1.03-4.57).
Patients taking renin-angiotensin-aldosterone system inhibitors (n = 183) had similar mortality rates as those who were taking beta-blockers (n = 527; 2.2% vs. 3.6%; aHR = 0.85; 95% CI, 0.28-2.58). In contrast, a study-level meta-analysis of four studies found that patients taking renin-angiotensin-aldosterone system inhibitors had a lower risk for mortality compared with those not taking the medications (RR = 0.65; 95% CI, 0.45-0.94).
“These data showed that untreated hypertensive patients are at the highest risk,” Gao and colleagues wrote. “There are remaining questions: Which kind of medication should be given to those patients (calcium channel blockers or renin-angiotensin-aldosterone system inhibitors); could such medications mitigate the risk of these patients, and will the use of renin-angiotensin-aldosterone system inhibitors affect the risk of infection when equally exposed to the virus?”
In a related editorial, Luis M. Ruilope, MD, head of cardiorenal investigation at the Cardiorenal Translational Laboratory and Hypertension Unit at the Institute of Research at Hospital Universitario 12 de Octubre in Madrid, and colleagues wrote: “The study by Gao et al contains data obtained in an adequately controlled retrospective analysis proving the absence of the need to withdraw renin-angiotensin-aldosterone system blockers and opening the door for a specific indication to improve the prognosis of COVID-19 patients by different mechanisms and independently of the presence of elevated blood pressure.”
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