Impact of Hypertension on Progression and Prognosis in Patients with COVID-19 A Retrospective Cohort Study in 1031 Hospitalized Cases in Wuhan, China

  1. Hesong Zeng
  2. Tianlu Zhang
  3. Xingwei He
  4. Yuxin Du
  5. Yan Tong
  6. Xueli Wang
  7. Weizhong Zhang
  8. Yin Shen

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Abstract

Objectives

The main aim of our study is to observe clinical characteristics and effects of antihypertensive drugs in different hospitalized populations, and to further provide evidence to explore causes and specific clinical markers of the aggravation of COVID-19 in patients with underlying hypertension.

Design

This was a retrospective cohort study focusing on the clinical data of COVID-19 inpatients admitted at the early stage of pandemic.

Setting

A single center study conducted in Tongji Hospital, Tongji Medical College of Huazhong university of Science and Technology (Wuhan, China).

Participants

All 1031 inpatients diagnosed with COVID-19 according to Prevention and control Scheme for Novel Coronavirus Pneumonia published by National Health Commission of the People’s Republic of China and WHO interim guidance in Tongji hospital (Wuhan, China), from January 27, 2020, to March 8, 2020 with the cutoff date being March 30, 2020, were included in this study.

Main outcome measures

Demographic data, medical history, clinical symptoms and signs, laboratory findings, chest computed tomography (CT), treatment, and clinical outcomes were extracted from electronic medical records.

Results

1031 COVID-19 inpatients were included in this study, of whom 866 were discharged and 165 were deceased in hospital. 73% of 165 deceased patients had chronic comorbidities. Patients with underlying diseases showed CFR 2.8 times as that of patients without. Senility and males were observed to be main risk factors for increased in-hospital case-fatality rate, with the odds ratio in multivariable regression being 2.94 (95%CI: 2.00 to 4.33; P <0.001) and 2.47 (95%CI: 1.65 to 3.70; P <0.001), respectively. The odds ratio of cases with composite endpoints for patients with simple hypertension was 1.53 (95%CI: 1.07 to 2.17; P=0.019). Senile patients with hypertension were proved to be at high risk early in the disease, which might be associated with the level of CRP, LDH, and eGFR. The odds ratio of case-fatality rate for patients with hypertension taking CCB group was 0.67 (95%CI: 0.37 to 1.20; P = 0.176). Among 271 severe cases without IKF, the odds ratio of case-fatality rate was 0.42 (95CI%: 0.18 to 0.99; P = 0.046) for patients in the CCB group after adjustment of age, sex, and underlying diseases.

Conclusions

Hypertension is not just a chronic underlying comorbidity, but also a risk factor affecting the severity of COVID-19 and does play a critical role in worsening patients’ clinical outcomes. Therefore, hypertension management in patients with COVID-19 should be regarded as a major challenge in the diagnostic and therapeutic strategies.

Trial registration

N.A.

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  1. Version published to 10.1101/2020.06.14.20125997v2 on medRxiv
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    SciScore for 10.1101/2020.06.14.20125997: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The Institutional Review Board of Tongji Hospital, Wuhan, China, approved this retrospective study and written informed consent was waived (No. TJ-C20200140).
    Consent: The Institutional Review Board of Tongji Hospital, Wuhan, China, approved this retrospective study and written informed consent was waived (No. TJ-C20200140).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableAcute cardiac injury (ACI) was diagnosed if serum levels of TNI were more than 0.342 μg/L for males and more than 0.156 μg/L for females.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All the analyses were performed using SPSS (version 21.0) and GraphPad Prism (version 8.4.0) software.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    [19] Our retrospective cohort study has some limitations. Firstly, only admission examination for the indicator of eGFR was captured in the collected data, and the overall level of IKF might therefore be underestimated. Secondly, the information of patients prior to admission was not put into the medical history, so it could not be determined whether the patients continued to take or changed the medication during hospitalization. Thirdly, there was no national unified standard for the normal reference values of some laboratory indicators, thus we followed the standards set by the hospital. Finally, the data entry of underlying diseases was based on the inquiries of patients enrolled in the hospital and might be underestimated due to the influence of awareness rate.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.14.20125997v1 on medRxiv