Does Hypertension Alone Increase Mortality in Young Hypertensive Patients Having COVID-19? Single Center Retrospective Study of 100 Patients

Abstract

Purpose: Whether hypertension is an independent risk factor for the severity of COVID-19 symptoms and COVID-19 mortality is still unclear. In this study, it was aimed to investigate the effect of hypertension independently in the course of COVID-19 by comparing clinical characteristics and laboratory measurements in COVID-19 patients with and without preexisting hypertension.

Materials and Methods: Fifty COVID-19 patients under the age of 45 with preexisting hypertension without accompanying chronic diseases were compared with 50 normotensive COVID-19 patients. All patients received the same treatment protocol. The frequency of symptoms, blood levels of inflammatory markers, length of hospital stay, intensive care unit (ICU) requirement, and mortality rates were compared between the groups.

Results: Peak leukocyte count (8.1±2.7 x 103/mm3 vs. 6.9±1.9x103/mm3, p=0.012), peak C-reactive protein (52.7±9.7mg/L vs. 18.9±3.7 mg/L, p=0.024), and peak erythrocyte sedimentation rate (ESR) (55.5±5.7 mm/h, vs. 33.4±5.1 mm/h, p<0.01) were significantly higher in hypertensive patients compared to normotensive ones (all values respectively). Hospital stay duration was significantly longer in hypertensive patients than the normortensive ones. (hypertensive group 11±2.4 days; normotensive group 9.1±2.2 days, p=0.001).

Conclusions: COVID-19 patients having hypertension have higher levels of inflammatory markers, higher levels of troponin, and longer hospital stay compared to COVID-19 subjects without hypertension. It appears that hypertensive patients tend to have a more severe COVID-19 infection than normotensive patients.

Keywords

• COVİD19,
• SARSCoV-2,
• mortality,
• hypertension.

COVID-19 lu Genç Hipertansif Hastalarda, Hipertansiyon Tek Başına Mortaliteyi Artırır Mı? 100 Hasta ile Tek Merkez Retrospektif Çalışma

Abstract

Amaç: Hipertansiyonun, tek başına COVID-19 bulgularının şiddeti ve COVID-19 kaynaklı mortalite için bağımsız bir risk faktörü olup olmadığı hala açık değildir. Bu çalışmada, önceden hipertansiyonu olan ve olmayan COVID-19 hastalarını klinik özellikler ve laboratuvar ölçümleri açısından karşılaştırarak hipertansiyonun tek başına COVID-19 seyrine etkisini araştırmak amaçlandı.

Araçlar ve Yöntem: Önceden hipertansiyonu olan ancak başka hiçbir kronik hastalığı olmayan 45 yaşından küçük 50 COVID-19 hastası, 50 normotansif COVID-19 hastasıyla karşılaştırıldı. Tüm hastalar aynı tedavi protokolünü aldı. Gruplar arasında semptomların sıklığı, inflamatuvar belirteçlerin kan düzeyleri, hastanede kalış süresi, yoğun bakım ünitesi(YBÜ) gereksinimi ve ölüm oranları karşılaştırıldı.

Bulgular: Hipertansif grupta normotansif grupla karşılaştırıldığında tepe lökosit sayısı (8,1±2,7x103/mm3 vs. 6,9±1,9x103/mm3, p=0.012), tepe C-reaktif protein (52.7±9.7mg/L vs. 18.9±3.7mg/L, p=0.024), ve tepe eritrosit sedimentasyon hızı (55.5±5.7 mm/h, vs. 33.4±5.1 mm/h, p<0.01) anlamlı derecede yüksekti ( tüm değerler sırasıyla). Hastanede yatiş süresi hipertansif grupta normotansif gruba göre önemli oranda uzundu (hipertansif grupta11±2.4 gün; normotansif grupta 9.1±2.2 gün, p=0.001).

Sonuç: Hipertansiyonu olan COVID-19 hastaları, hipertansiyonu olmayan COVID-19 hastalarına kıyasla daha yüksek seviyelerde inflamatuar belirteçlere, daha yüksek troponin seviyelerine ve daha uzun hastanede kalış sürelerine sahiptir. Görüldüğüne göre hipertansif hastalar normotansif olanlara göre COVID-19 enfeksiyonunu daha şiddetli geçirme eğilimindedir.

Keywords

• COVİD-19,
• SARS-CoV-2,
• mortalite,
• hipertansiyon.

References

1. 1. Joshi S, Parkar J, Ansari A, et al. Role of favipiravir in the treatment of COVID-19. Int J Infect Dis. 2021;102:501-508.
2. 2. Harapan H, Itoh N, Yufika A et al. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020;13(5):667-673.
3. 3. Li X, Xu S, Yu M et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146 (1):110-118.
4. 4. Zhou F, Yu T, Du R et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062.
5. 5. Kumar A, Arora A, Sharma P et al. Is diabetes mellitus associated with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab Syndr. 2020;14(4):535-545.
6. 6. Weston S, Frieman MB. COVID-19: Knowns, Unknowns, and Questions. mSphere. 2020;5(2):e00203-20.
7. 7. Shahid Z, Kalayanamitra R, Mcclafferty B et al. COVID-19 and Older Adults: What We Know. J Am Geriatr Soc. 2020;68(5):926-929.
8. 8. Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet. 2020;395(10229):1014-1015.

9. 9. Zhang L, Yan X, Fan Q et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J Thromb Haemost. 2020;18(6):1324-1329.
10. 10. Apicella M, Campopiano MC, Mantuano M et al. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. Lancet Diabetes Endo. 2020;8(9):782-792.
11. 11. Gao C, Cai Y, Zhang K et al. Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study. Eur Heart J. 2020;41(22):2058-2066.
12. 12. Kulkarni S, Jenner BL, Wilkinson I. COVID-19 and hypertension. J Renin Angiotensin Aldosterone Syst. 2020;21(2):1-5.
13. 13. Yahia F, Zakhama L, Ben Abdelaziz A. COVID-19 and Cardiovascular diseases. Scoping review study. Tunis Med. 2020;98(4):283-294.
14. 14. Hulot JS. COVID-19 in patients with cardiovascular diseases. Arch Cardiovasc Dis. 2020;113(4):225-226.
15. 15. Kang Y, Chen T, Mui D et al. Cardiovascular manifestations and treatment considerations in covid-19. Heart. 2020;106(15):1132-1141.
16. 16. Akhmerov A, Marbán E. COVID-19 and the Heart. Circ Res. 2020;126(10):1443-1455.
17. 17. Guo J, Huang Z, Lin L, Lv J. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease: A Viewpoint on the Potential Influence of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Onset and Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Am Heart Assoc. 2020;9(7):e016219.
18. 18. Huang C, Wang Y, Li X et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
19. 19. Wu C, Chen X, Cai Y et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.
20. 20. Kreutz R, Algharably EaE, Azizi M et al. Hypertension, the renin-angiotensin system, and the risk of lower respiratory tract infections and lung injury: implications for COVID-19. Cardiovasc Res. 2020;116(10):1688-1699.
21. 21. Lippi G, Wong J, Henry BM. Hypertension in patients with coronavirus disease 2019 (COVID-19): a pooled analysis. Pol Arch Intern Med. 2020;130(4):304-309.
22. 22. Zaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: A systematic review. Diabetes Metab Syndr.2020;14(5):1133-1142.