COVID‐19 and the impact of arterial hypertension—An analysis of the international HOPE COVID‐19 Registry (Italy‐Spain‐Germany)

El‐Battrawy, Ibrahim; Nuñez‐Gil, Ivan J.; Abumayyaleh, Mohammad; Estrada, Vicente; Manuel Becerra‐Muñoz, Víctor; Uribarri, Aitor; Fernández‐Rozas, Inmaculada; Feltes, Gisela; Arroyo‐Espliguero, Ramón; Trabattoni, Daniela; López‐País, Javier; Pepe, Martino; Romero, Rodolfo; Castro‐Mejía, Alex F.; Cerrato, Enrico; Capel Astrua, Thamar; D'Ascenzo, Fabrizio; Fabregat‐Andres, Oscar; Signes‐Costa, Jaime; Marín, Francisco; Buonsenso, Danilo; Bardají, Alfredo; Jesús Tellez, María; Fernández‐Ortiz, Antonio; Macaya, Carlos; Akin, Ibrahim

BACKGROUND: A systematic analysis of concomitant arterial hypertension in COVID‐19 patients and the impact of angiotensin‐converting‐enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARBs) have not been studied in a large multicentre cohort yet. We conducted a subanalysis from the international HOPE Registry (https://hopeprojectmd.com, NCT04334291) comparing COVID‐19 in presence and absence of arterial hypertension. MATERIALS AND METHODS: Out of 5837 COVID‐19 patients, 2850 (48.8%) patients had the diagnosis arterial hypertension. 1978/2813 (70.3%) patients were already treated with ACEI or ARBs. The clinical outcome of the present subanalysis included all‐cause mortality over 40 days of follow‐up. RESULTS: Patients with arterial hypertension suffered significantly more from different complications including respiratory insufficiency (60.8% vs 39.5%), heart failure (9.9% vs 3.1%), acute kidney injury (25.3% vs 7.3%), pneumonia (90.6% vs 86%), sepsis (14.7% vs 7.5%), and bleeding events (3.6% vs 1.6%). The mortality rate was 29.6% in patients with concomitant arterial hypertension and 11.3% without arterial hypertension (P < .001). Invasive and non‐invasive respiratory supports were significantly more required in presence of arterial hypertension as compared without it. In the multivariate cox regression analysis, while age≥65, benzodiazepine, antidepressant at admission, elevated LDH or creatinine, respiratory insufficiency and sepsis might be a positive independent predictors of mortality, antiviral drugs, interferon treatment, ACEI or ARBs at discharge or oral anticoagulation at discharge might be an independent negative predictor of the mortality. CONCLUSIONS: The mortality rate and in‐hospital complications might be increased in COVID‐19 patients with a concomitant history of arterial hypertension. The history of ACEI or ARBs treatments does not seem to impact the outcome of these patients.