Poor BP control worsens COVID-19 in hypertensive patients

19 Nov 2020

Hypertensive patients with the novel coronavirus disease (COVID-19) who have poor blood pressure (BP) control are at greater risk of worse outcomes, a recent China study has found. In contrast, the use of angiotensin II receptor blockers (ARB) does not seem to worsen disease outcomes.

The researchers retrospectively assessed the anonymized records of 803 hypertensive COVID-19 patients. Disease outcomes included mortality, admission into the intensive care unit (ICU), and respiratory and heart failure, which were assessed with regard to BP control.

At baseline, 609 patients had available BP information. Nearly half had normal measurements, with mean systolic (SBP) and diastolic BP (DBP) values of 137.0±19.7 and 84.2±12.8 mm Hg, respectively. Overall, 82.4 percent (n=662 of 803) were deemed to have good BP control.

Cox proportional hazards analysis revealed that average SBP was a significant and independent predictor of heart failure (hazard ratio [HR] per 10 mm Hg, 1.89, 95 percent confidence interval [CI], 1.15–3.13). The same was true for pulse pressure (PP; HR per 10 mm Hg, 2.71, 95 percent CI, 1.39–5.29).

In addition, greater SBP variability emerged as a significant risk factor for both mortality (HR per 1 mm Hg, 1.23, 95 percent CI, 1.11–1.36) and ICU admission (HR per 1 mm Hg, 1.12, 95 percent CI, 1.05–1.20). DBP variability had the same effect (mortality: HR per 1 mm Hg, 1.33, 95 percent CI, 1.12–1.75; ICU admission: HR per 1 mm Hg, 1.20, 95 percent CI, 1.08–1.33). There were no BP factors associated with respiratory failure.

In terms of medication, patients on ARB saw a significantly lower risk of ICU admission (HR, 0.21, 95 percent CI, 0.06–0.73).

“ARB drugs did not cause higher risks of adverse outcomes in hypertensive patients, and even a benefit in regard to heart failure was observed. This supports the continuation of ARB drugs in COVID-19 patients,” the researchers said.

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