IMPACT OF ARTERIAL HYPERTENSION AND ANTIHYPERTENSIVE PHARMACOTHERAPY ON IN-HOSPITAL MORTALITY IN COVID-19 PATIENTS: THE CRACOV-HHS STUDY

Abstract

Objective: Cardiovascular diseases including hypertension are common comorbidities in patients hospitalized due to COVID-19. We assessed the impact of hypertension on in-hospital mortality in patients hospitalized due to COVID-19. Design and method: We retrospectively analyzed the medical records of all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to confirmed SARS-CoV2 infection from March 2020 to May 2021. Results: Overall, data of 5191 patients (mean age 61.9 ± 16.7 years) were available for analysis. Patients with preexisting hypertension (58.3% of the study population) were older and had more comorbidities than patients without hypertension (p < 0.05). In-hospital mortality was significantly higher in patients with hypertension compared to those without hypertension also after adjustment for age (22.2% vs 12.9%; P = 0.02). Age above median (64 years, odds ratio [OR] 3.93; 95% confidence interval [CI] 3.23–4.83), male gender (OR 1.19; CI 1.01–1.40), a history of heart failure (OR 2.01; CI 1.58–2.56) or chronic kidney disease (OR 2.35; CI 1.86–2.96) and increased C-reactive protein levels (OR 1.09; CI 1.08–1.10), but not preexisting hypertension (OR 0.90; CI 0.74–1.09) were significantly associated with a higher risk of in-hospital death after multivariate logistic regression analysis. However, hypertension (OR 1.45; CI 1.06–1.97) was an independent predictor of in-hospital death in patients without established cardiovascular disease and antihypertensive treatment. Treatment with any first-line antihypertensive drug class in patients with hypertension at the time of hospitalization was associated with a lower risk of in-hospital death (beta-blockers OR 0.52; CI 0.41–0.65; angiotensin converting enzyme inhibitors OR 0.52; CI 0.38–0.68; angiotensin receptor blockers OR 0.24; CI 0.12–0.41; calcium channel blockers OR 0.61; CI 0.44–0.84; thiazide diuretics OR 0.40; CI 0.24–0.64). Conclusions: Besides the high prevalence, hypertension was not an independent risk factor of in-hospital death in the overall group of hospitalized COVID-19 patients. Treatment with all first-line antihypertensive medications was associated with significant reduction of in-hospital death in patients with hypertension.