The Association of Hypertension With the Severity of and Mortality From the COVID-19 in the Early Stage of the Epidemic in Wuhan, China: A Multicenter Retrospective Cohort Study

Sumaira Mubarik; Xiaoxue Liu; Ehab S Eshak; Keyang Liu; Qing Liu; Fang Wang; Fang Shi; Haoyu Wen; Jianjun Bai; Chuanhua Yu; Jinhong Cao

doi:10.3389/fmed.2021.623608

The Association of Hypertension With the Severity of and Mortality From the COVID-19 in the Early Stage of the Epidemic in Wuhan, China: A Multicenter Retrospective Cohort Study

Front Med (Lausanne). 2021 May 12:8:623608. doi: 10.3389/fmed.2021.623608. eCollection 2021.

Authors

Sumaira Mubarik¹, Xiaoxue Liu¹, Ehab S Eshak^{2

3}, Keyang Liu^{2

4}, Qing Liu¹, Fang Wang¹, Fang Shi¹, Haoyu Wen¹, Jianjun Bai¹, Chuanhua Yu^{1

5}, Jinhong Cao¹

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China.
² Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan.
³ Public Health and Community Medicine, Faculty of Medicine, Minia University, Minia, Egypt.
⁴ Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
⁵ Global Health Institute, Wuhan University, Wuhan, China.

Abstract

Background: Hypertension may affect the prognosis of COVID-19 illness. We analyzed the epidemiological and clinical characteristics associated with the disease severity and mortality in hypertensive vs. non-hypertensive deceased COVID-19 patients. Methods: We included all the deceased patients with laboratory-confirmed COVID-19 admitted to >200 health facilities in Wuhan between December 1 and February 24, 2020. The median survival time in COVID-19 patients with and without hypertension, the association of hypertension with the disease severity, and the risk factors associated with the COVID-19 mortality stratified by the hypertension status were assessed using the Kaplan-Meier survival analysis, logistic regression, and Cox proportional regression, respectively before and after the propensity score-matching (PS) for age and sex. Results: The prevalence of hypertension in the studied 1,833 COVID-19 patients was 40.5%. Patients with hypertension were more likely to have severe COVID-19 illness than patients without hypertension; the PS-matched multivariable-adjusted odds ratio (95% CI) was 2.44 (1.77-3.08). Moreover, the median survival time in the hypertension group was 3-5 days shorter than the non-hypertension group. There was a 2-fold increased risk of COVID-19 mortality in the hypertension group compared with the non-hypertension group; the PS-matched multivariable-adjusted hazard ratio (HR) = 2.04 (1.61-2.72), and the significant increased risk of COVID-19 mortality in the moderate vs. mild COVID-19 illness was confined to patients with hypertension. Additionally, the history and the number of underlying chronic diseases, occupation, and residential location showed stronger associations with the COVID-19 mortality among patients with hypertension than patients without hypertension. Conclusion: Hypertension was associated with the severity and mortality of COVID-19 illness.

Keywords: COVID-19; critical; hypertension; mortality; risk factors; severe.