Association of Hypertension with All-Cause Mortality among Hospitalized Patients with COVID-19

Rodilla, Enrique; Saura, Alberto; Jiménez, Iratxe; Mendizábal, Andrea; Pineda-Cantero, Araceli; Lorenzo-Hernández, Elizabeth; Fidalgo-Montero, Maria del Pilar; López-Cuervo, Joaquín Fernandez; Gil-Sánchez, Ricardo; Rabadán-Pejenaute, Elisa; Abella-Vázquez, Lucy; Giner-Galvañ, Vicente; Solís-Marquínez, Marta Nataya; Boixeda, Ramon; de la Peña-Fernández, Andrés; Carrasco-Sánchez, Francisco Javier; González-Moraleja, Julio; Torres-Peña, José David; Guisado-Espartero, María Esther; Escobar-Sevilla, Joaquín; Guzmán-García, Marcos; Martín-Escalante, María Dolores; Martínez-González, Ángel Luis; Casas-Rojo, José Manuel; Gómez-Huelgas, Ricardo

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.