People with raised blood pressure are at twice the risk of dying from Covid-19 compared to those without hypertension, according to an analysis published today.
A study published in today’s European Heart Journal also found that patients with high blood pressure who did not take medication to control the condition were at even greater risk of dying from the virus.
Researchers in China and Ireland analysed data from 2,866 patients with Covid-19 who were admitted to specially built Huo Shen Shan hospital in Wuhan, China, between 5 February and 15 March 2020 for coronavirus patients.
Out of the total number of patients, 850 (29.5%) had a history of hypertension. Of these, 34 (4%) with coronavirus died compared to 22 out of 2027 patients without hypertension (1.1%) – a 2.12-fold increased risk after adjustment for factors that could affect the results, such as age, sex and other medical conditions.
Professors Fei Li and Ling Tao from Xijing Hospital, who led the research, also found that of the hypertension patients who did not take medication for the condition, 11 out 140 (7.9%) died from coronavirus compared to 23 out of 710 (3.2%) of those who did – 2.17-fold increased risk after adjusting for confounding factors.
A meta-analysis pooled the data from the Huo Shen Wan patients with data from nearly 2,300 patients in three other studies to investigate the death rates in patients being treated with drugs to control blood pressure levels by targeting the renin-angiotensin-aldosterone system (RAAS).
They found a lower risk of death among the 183 patients treated with RAAS inhibitors than in 527 patients treated with other drugs. However, the researchers say this result should be treated with caution because of the small sample of patients analysed.
Prof Ling Tao said: “Soon after we started to treat Covid-19 patients in early February in Wuhan, we noticed that nearly half of the patients who died had high blood pressure, which was a much higher percentage compared to those with only mild Covid-19 symptoms.
“At the same time, some researchers were raising concerns that RAAS inhibitors might be facilitating the entry of the coronavirus into cells and making people more susceptible to the disease.
“We were quite surprised that these results did not support our initial hypothesis; in fact, the results were in the opposite direction, with a trend in favour of ACE inhibitors and ARBs. We think this is exactly why practice based on clinical evidence is more vital than ever.”
The researchers say the data should be interpreted cautiously, but add that they support recommendations for the European Society of Cardiology that patients should not discontinue or change their normal, antihypertensive treatment.
A randomised clinical trial is to run at the National University of Ireland Galway by Professors J. William McEvoy and Patrick Serruys, who are co-authors of the EHJ paper.
Prof Serruys said: “There are three remaining questions, and we hope our clinical trial in Ireland will answer the first two: what kind of medication should be given to Covid-19 patients with hypertension – RAAS inhibitors or non-RAAS inhibitors – and could these medications mitigate the risk of dying in these patients?”
Gao C, Cai Y, Zhang K et al. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. European Heart Journal 5 June 2020; doi:10.1093/eurheartj/ehaa433
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