January 1, 2021International Journal of HypertensionOpen Access

Hypertension May Reduce the Infection Risk but Increase the Severity of COVID‐19: Based on the Current Data in China

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Why the study?

Increasing evidence showed an unusual relationship between hypertension and COVID-19 that may not be simple, prompting an evaluation of the association of hypertension with COVID-19 onset and development.

Does hypertension affect the infection risk and severity of COVID-19, and does ACEI/ARB therapy improve mortality in hypertensive COVID-19 patients?

Structured PICO

Does hypertension affect the infection risk and severity of COVID-19, and does ACEI/ARB therapy improve mortality in hypertensive COVID-19 patients?

Population

14,138 COVID-19 patients from 42 studies in China (with reference to an additional study of 72,314 confirmed cases)

Intervention

Hypertension (as an exposure/risk factor) and ACEI/ARB therapy

Comparator

General population (for infection risk), non-severe/survivors (for severity), and non-ACEI/ARB users (for treatment outcomes)

Outcome

Prevalence of hypertension in COVID-19 patients, disease severity, and mortalityhard clinical

Hypertension may be associated with a lower risk of COVID-19 infection but higher disease severity and mortality, while ACEI/ARB therapy appears to reduce mortality in hypertensive COVID-19 patients.

Implication

Supports ACEI/ARB continuation in hypertensive COVID-19 patients; extends meta-analytic associations with severity and mortality.

Abstract

Increasing evidence has shown an unusual relationship between hypertension and COVID-19, which may not be as simple as previously thought. The purpose of our study was to determine the association of hypertension with the onset and development of COVID-19. A meta-analysis was performed to summarize the prevalence of hypertension in COVID-19 patients, as well as the usage of ACEIs/ARBs. Metaregression analyses were used to evaluate the association of hypertension with disease severity and mortality. PubMed and Google Scholar were searched for relevant studies. A total of 42 studies including 14138 patients were enrolled in the study. The proportion of hypertension in COVID-19 patients in China was 17.7% according to the enrolled studies, while it was 6.0% in a study containing 72314 confirmed cases, which are both much lower than in the general population. All of the data from the 11 provinces in China showed the same tendency. The proportions of hypertension were higher in severe/ICU patients and nonsurvivors than in nonsevere/ICU patients and survivors. The metaregression analyses suggested that both disease severity and risk of death were associated with the incidence of hypertension. A total of 27.6% of COVID-19 patients with hypertension received ACEI/ARB therapy. The proportion of deaths in COVID-19 patients with hypertension treated with ACEIs/ARBs was significantly lower than that in nonuse patients treated with ACEIs/ARBs. In conclusion, hypertension may reduce the infection risk of COVID-19 but increase the risk of developing worse clinical outcomes. The use of ACEIs/ARBs may benefit COVID-19 patients with hypertension.