Wuhan, China—With much discussion, and even debate, on which chronic conditions predispose patients to a more severe case of COVID-19, a Chinese study sought to quantify the effects of hypertension. Their results underscored the importance of compliance with medications that lower blood pressure.

Research published in the European Heart Journal notes that patients with elevated blood pressure have a two-fold increased risk of dying from the coronavirus COVID-19 compared with patients without the condition. It further determined that hypertension patients who were not on medications to control their condition had even higher mortality risks.

That is based on findings from researchers in China and Ireland who analyzed data from 2,866 patients with COVID-19 who were admitted to Huo Shen Shan hospital in Wuhan, China, between February 5, 2020, and March 15, 2020. Of the patients admitted to the new COVID-19 ward, 29.5% had a medical history of high blood pressure.

Researchers report that 34 out of 850 hypertensive patients (4%) with novel coronavirus died compared with 22 out of 2,027 patients without hypertension, 1.1%—a 2.12-fold increased risk after adjustment for factors that could affect the results, such as age, sex and other medical conditions.

Furthermore, they point out that among the hypertension patients who were not taking medication, 11 out 140 (7.9%) died from coronavirus compared with 23 out of 710 (3.2%) of those who were taking medication—2.17-fold increased risk after adjusting for confounding factors.

In a meta-analysis, the researchers then pooled the data from the Huo Shen Wan patients with data from nearly 2,300 patients in three other studies to investigate the death rates in patients being treated with drugs to control hypertension by targeting the renin-angiotensin-aldosterone system (RAAS), including angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). 

Results indicate a lower risk of death among the 183 patients treated with RAAS inhibitors than in 527 patients treated with other drugs. Researchers caution, however, that because of the small numbers involved, the favorable findings could be due to chance.

“Soon after we started to treat COVID-19 patients in early February in Wuhan, we noticed that nearly half of the patients who died had high blood pressure, which was a much higher percentage compared to those with only mild COVID-19 symptoms,” recounted cosenior author Ling Tao, PhD, of Xijing. “At the same time, some researchers were raising concerns that RAAS inhibitors might be facilitating the entry of the coronavirus into cells and making people more susceptible to the disease.

“We were quite surprised that these results did not support our initial hypothesis; in fact, the results were in the opposite direction, with a trend in favor of ACE inhibitors and ARBs. We think this is exactly why practice based on clinical evidence is more vital than ever.”

He adds that the data, while they should be interpreted cautiously, support recommendations of the European Society of Cardiology that patients should not discontinue or change their normal, antihypertensive treatment.

“While hypertension and the discontinuation of antihypertensive treatment are suspected to be related to increased risk of mortality, in this retrospective observational analysis, we did not detect any harm of RAAS inhibitors in patients infected with COVID-19. However, the results should be considered as exploratory and interpreted cautiously,” the researchers conclude.

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