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Clin Respir J . Predictors of fatal outcomes of hospitalized COVID-19 patients with pre-existing hypertension in China

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  • Clin Respir J . Predictors of fatal outcomes of hospitalized COVID-19 patients with pre-existing hypertension in China


    Clin Respir J


    . 2021 May 3.
    doi: 10.1111/crj.13382. Online ahead of print.
    Predictors of fatal outcomes of hospitalized COVID-19 patients with pre-existing hypertension in China


    Tao Wang 1 2 , Ruidi Tang 1 2 , Honglian Ruan 3 , Ruchong Chen 1 , Zili Zhang 1 2 , Ling Sang 1 , Xi Su 4 , Shuting Yi 4 , Zhengyi Ni 5 , Yu Hu 6 , Lei Liu 7 8 , Hong Shan 9 , Chunliang Lei 10 , Yixiang Peng 11 , Chunli Liu 1 , Jing Li 1 , Cheng Hong 1 , Nuofu Zhang 1 , Nanshan Zhong 1 , Shiyue Li 1 , China Medical Treatment Expert Group for COVID-19



    Affiliations

    Abstract

    Background: Coronavirus disease 2019 (COVID-19) is an emerging, rapidly evolving pandemic, hypertension is one of the most common co-existing chronic conditions and a risk factor for mortality. Nearly one third of the adult population are hypertensive worldwide, it is urgent to identify the factors that determine the clinical course and outcomes of COVID-19 patients with hypertension.
    Methods and results: 148 COVID-19 patients with pre-existing hypertension with clarified outcomes (discharge or deceased) from a national cohort in China were included in this study, of whom 103 were discharged and 45 died in hospital. Multivariate regression showed higher odds of in-hospital death associated with high-sensitivity cardiac troponin (hs-cTn) > 28 pg/mL (hazard ratio [HR]: 3.27, 95% confidence interval [CI]: 1.55-6.91) and interleukin-6 (IL-6) > 7 pg/mL (HR: 3.63, 95% CI:1.54-8.55) at admission. Patients with uncontrolled blood pressure (BP) (n = 52) which were defined as systolic BP ? 140 mmHg or diastolic BP ? 90 mmHg for more than once (? 2 times) during hospitalization, were more likely to have ICU admission (P=0.037), invasive mechanical ventilation (P=0.028), and renal injury (P=0.005). A stricter BP control with the threshold of 130/80 mmHg was associated with lower mortality. Treatment with renin-angiotensin-aldosterone system (RAAS) suppressors, including angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB) and spironolactone, was associated with lower rate of ICU admission compared to other types of anti-hypertensive medications (8 (22.9%) Vs. 25 (43.1%), P=0.048).
    Conclusion: Among COVID-19 patients with pre-existing hypertension, elevated hs-cTn and IL-6 could help clinicians to identify patients with fatal outcomes at an early stage, blood pressure control is associated with better clinical outcomes, and RAAS suppressors do not increase mortality and may decrease the need of ICU admission.

    Keywords: Blood pressure control; COVID-19; Cardiac injury; Hypertension; Renin-angiotensin-aldosterone system suppressors.

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