COVID-19 and the impact of arterial hypertension-An analysis of the international HOPE COVID-19 Registry (Italy-Spain-Germany).

Abstract

BACKGROUND:

A systematic analysis of concomitant arterial hypertension in COVID-19 patients and the impact of angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) have not been studied in a large multicentre cohort yet. We conducted a subanalysis from the international HOPE Registry (https://hopeprojectmd.com, NCT04334291) comparing COVID-19 in presence and absence of arterial hypertension.

MATERIALS AND METHODS:

Out of 5837 COVID-19 patients, 2850 (48.8%) patients had the diagnosis arterial hypertension. 1978/2813 (70.3%) patients were already treated with ACEI or ARBs. The clinical outcome of the present subanalysis included all-cause mortality over 40 days of follow-up.

RESULTS:

Patients with arterial hypertension suffered significantly more from different complications including respiratory insufficiency (60.8% vs 39.5%), heart failure (9.9% vs 3.1%), acute kidney injury (25.3% vs 7.3%), pneumonia (90.6% vs 86%), sepsis (14.7% vs 7.5%), and bleeding events (3.6% vs 1.6%). The mortality rate was 29.6% in patients with concomitant arterial hypertension and 11.3% without arterial hypertension (P < .001). Invasive and non-invasive respiratory supports were significantly more required in presence of arterial hypertension as compared without it. In the multivariate cox regression analysis, while age≥65, benzodiazepine, antidepressant at admission, elevated LDH or creatinine, respiratory insufficiency and sepsis might be a positive independent predictors of mortality, antiviral drugs, interferon treatment, ACEI or ARBs at discharge or oral anticoagulation at discharge might be an independent negative predictor of the mortality.

CONCLUSIONS:

The mortality rate and in-hospital complications might be increased in COVID-19 patients with a concomitant history of arterial hypertension. The history of ACEI or ARBs treatments does not seem to impact the outcome of these patients.

• Authors: Ibrahim El-Battrawy, Ivan J Nuñez-Gil, Mohammad Abumayyaleh, Vicente Estrada, Víctor Manuel Becerra-Muñoz, Aitor Uribarri, Inmaculada Fernández-Rozas, Gisela Feltes, Ramón Arroyo-Espliguero, Daniela Trabattoni, Javier López-País, Martino Pepe, Rodolfo Romero, Alex F Castro-Mejía, Enrico Cerrato, Thamar Capel Astrua, Fabrizio D'Ascenzo, Oscar Fabregat-Andres, Jaime Signes-Costa, Francisco Marín, Danilo Buonsenso, Alfredo Bardají, María Jesús Tellez, Antonio Fernández-Ortiz, Carlos Macaya, Ibrahim Akin
• Journal: European journal of clinical investigation (Eur J Clin Invest) Vol. 51 Issue 11 Pg. e13582 (Nov 2021) ISSN: 1365-2362 [Electronic] England
• PMID: 34409593 (Publication Type: Journal Article)
• Copyright: © 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Antiviral Agents
• Creatinine
• L-Lactate Dehydrogenase

Topics

• Acute Kidney Injury (epidemiology)
• Age Factors
• Aged
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Antiviral Agents (therapeutic use)
• COVID-19 (epidemiology, metabolism, therapy)
• Creatinine (metabolism)
• Female
• Germany (epidemiology)
• Heart Failure (epidemiology)
• Hospital Mortality
• Humans
• Hypertension (drug therapy, epidemiology)
• Italy (epidemiology)
• L-Lactate Dehydrogenase (metabolism)
• Male
• Middle Aged
• Multivariate Analysis
• Noninvasive Ventilation
• Pneumonia (epidemiology)
• Proportional Hazards Models
• Registries
• Respiration, Artificial
• Respiratory Insufficiency (epidemiology)
• SARS-CoV-2
• Sepsis (epidemiology)
• Severity of Illness Index
• Spain (epidemiology)