Impact of preexisting hypertension and antihypertensive medication on prognosis of COVID-19 patients

Mohsen  Gholinataj Jelodar; Samaneh  Mirzaei; Majid  Hajimaghsoudi

doi:10.18502/cbj.v4i1.16227

Mohsen Gholinataj Jelodar Clinical Research Development Center, Shahid Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Samaneh Mirzaei Department of Health in Emergencies and Disasters, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Majid Hajimaghsoudi Clinical Research Development Center, Shahid Rahnemoon Hospital, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

DOI: https://doi.org/10.18502/cbj.v4i1.16227

Keywords: SARS-CoV-2, Coronavirus, Hypertension, Antihypertensive Agents, Prognosis

Abstract

Objectives: Coronavirus disease-2019(COVID-19) patients with comorbidities experience severe disease. Hypertension (HTN) is one of the most common comorbidities seen in these patients. The published reports are conflicting regarding the role of HTN and antihypertensive medication on the in-hospital prognosis of COVID-19 patients. This study investigated the effect of HTN on the prognosis of hospitalized COVID-19 individuals and sought to identify the risk factors for worse clinical outcomes in this population.

Methods: This descriptive-analytical observational study was conducted on COVID-19 patients hospitalized in two teaching hospitals (Shahid Rahnemoon and Shahid Sadoughi) in Yazd, Iran from February 20, 2022, to April 20, 2022. All hospitalized patients with positive polymerase chain reaction (PCR) tests for COVID-19 were included in the study. The demographic, laboratory, imaging, pharmaceutical and clinical data were extracted and analyzed by SPSS v-26.

Results: Out of 615 participants, 243 had HTN. Hypertensive patients had significantly more need for Intensive Care Unit (ICU) admission (P=0.001) and endotracheal intubation (P<0.001) and experienced higher mortality (P<0.001). The length of hospital and ICU stay and duration of endotracheal intubation were not significantly different. No antihypertensive medication was found to impact the patient's prognosis significantly. In hypertensive individuals, the multivariate regression analysis revealed the vaccination status (OR=0.27; CI 95%: 0.10-0.69), a score of Computed tomography (CT) scan involvement (OR=7.49; CI 95%: 3.50-16.01), and neutrophil-to-lymphocyte ratio (NLR) (OR=1.05; CI 95%: 1.00-1.11) as the predictors of need to ICU admission.

Conclusions: Hypertensive COVID-19 patients experience higher mortality and require more ICU admission and endotracheal intubation. None of the antihypertensive drugs had a significant effect on prognosis. The vaccination status, NLR, and the degree of lung involvement in chest imaging predicted the need for ICU admission in this subgroup of patients.