Key result
Among patients with COVID-19, pre-existing primary aldosteronism was associated with a higher risk of critical care and all-cause mortality compared to essential hypertension (aHR 1.14, p=0.001).
Why the study?
Primary aldosteronism increases the risk of adverse cardiovascular and kidney events, but the impact of COVID-19 on patients with primary aldosteronism was not well understood.
Does primary aldosteronism increase the risk of critical care, mortality, MACE, and MAKE in patients with COVID-19 compared to essential hypertension?
Cohort (n=9,628)
Yes
Does primary aldosteronism increase the risk of critical care, mortality, MACE, and MAKE in patients with COVID-19 compared to essential hypertension?
Hazard Ratio: 1.14
p-value: p=0.001
Primary aldosteronism is associated with a significantly higher risk of critical outcomes, MACE, and MAKE following COVID-19 infection compared to essential hypertension.
May warrant enhanced monitoring in COVID-19 patients with primary aldosteronism; leaves open causal role and need for prospective validation.
BACKGROUND: Primary Aldosteronism (PA) is a common subtype of hypertension that increases the risk of adverse cardiovascular and kidney events. The impact of COVID-19 on patients with PA is not well understood. This study aimed to investigate the impact of COVID-19 on patients with PA and compare their outcomes with hypertensive patients with essential hypertension. METHODS: A cohort study was conducted using data from the Trinetx platform, including 9,817,307 participants enrolled between January 1, 2020, and July 31, 2022. The study group consisted of participants who tested positive for PCR SARS-CoV-2. The primary outcome was critical care and all-cause mortality, while the secondary outcomes were major adverse cardiac events (MACE) or major adverse kidney events (MAKE). The study included 4814 patients with PA and 4814 hypertensive controls. RESULTS: Patients with PA had a higher risk of critical outcomes than the hypertensive control group (adjusted hazard ratio [aHR] 1.14, p = 0.001). Moreover, they had higher risks of MACE (aHR 1.32, p < 0.001) and MAKE (aHR 1.36, p < 0.001) for up to 180 days after COVID-19. The analysis of the aHR as a horizon plot after discharge showed that patients with pre-existing PA and COVID-19 had the highest risk of critical outcomes at 7 months (aHR = 1.21), MACE (aHR = 1.35) at 9 months, and MAKE (aHR = 1.47) at 10 months compared to those with EH. CONCLUSIONS: This study provides a comprehensive analysis of the cardiovascular impact of the COVID-19 pandemic on individuals with PA. The findings underscore the increased risk of mortality, critical care, MACE, and MAKE among patients with PA and COVID-19. The study highlights the need for continued optimization of strategies for follow-up care for patients with PA after SARS-CoV-2 infections.
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Wu et al. (2023) conducted a cohort in COVID-19 and Primary Aldosteronism (n=9,628). Primary aldosteronism vs. Essential hypertension was evaluated on Critical care and all-cause mortality (aHR 1.14, p=0.001). Among patients with COVID-19, pre-existing primary aldosteronism was associated with a higher risk of critical care and all-cause mortality compared to essential hypertension (aHR 1.14, p=0.001).
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