Clinical Course and Outcomes of COVID-19 Patients with Hypertension

Background: Coronavirus disease 2019 (COVID-19) is now still an emerging, evolving pandemic, causing more than 64 million people infected. Hypertension, a common cardiovascular condition, has been reported as a risk factor for higher mortality. In order to a better management, it is necessary to know the clinical course and identify the factors associated with clinical outcomes in COVID-19 patients with hypertension.Methods and results: A total of 148 COVID-19 cases who had pre-existing hypertension with clarified outcomes (discharge or deceased) were included in this study. Medical history, clinical manifestation, epidemiological, and laboratory data were analyzed. 45 (30.4%) patients had died during hospitalization, multivariate COX regression analysis revealed some predicted factors at admission for in-hospital death including elevated level of hs-cTn (HR: 3.98, 95% CI:1.95-8.16) and IL-6 (HR: 3.31, 95% CI: 1.42-7.72). Patients with uncontrolled blood pressure (BP) (n = 52) which were defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg for more than once (≥ 2 times) during hospitalization, were more likely to have ICU admission (P=0.037), invasive mechanical ventilation(P=0.028), and renal injury(P=0.005). With a stricter criterion which was defined as systolic BP ≥ 130 mmHg or diastolic BP ≥ 80 mmHg for more than once (≥ 2 times) during hospitalization, 105 (70.9%) patients with uncontrolled BP had higher mortality rate (P=0.046). In our study, there were 35 (23.6%) patients taking renin-angiotensin-aldosterone system (RAAS) suppressor including angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB) and spironolactone. Patients with these RAAS suppressors treatment were less likely to be admitted to ICU (P = 0.048). And treatment with RAAS suppressors didn't have an obvious influence in mortality.Conclusion: Among COVID-19 patients with hypertension, elevated hs-cTn and IL-6 at admission were associated with higher mortality, suggesting that they could possibly be used as predictors for fatal outcomes. Blood pressure control with a stricter criterion of less than 130/80mmHg during hospitalization is associated with better prognosis. And treatment with RAAS suppressors didn't not contribute to a higher mortality.