COVID-19 Outcomes Stratified by Control Status of Hypertension and Diabetes: Preliminary Findings From PCORnet, U.S.
Sandra L. Jackson, PhD,
Jason P. Block, MD, MPH,
Deborah B. Rolka, MS,
Meda E. Pavkov, MD, PhD,
Jennifer R. Chevinsky, MD,
Akaki Lekiachvili, MD, MBA,
Thomas W. Carton, PhD, MS,
Deepika Thacker, MD,
Joshua L. Denson, MD,
Anuradha Paranjape, MD, MPH,
Michael D. Kappelman, MD, MPH,
Tegan K. Boehmer, PhD, MPH,
Evelyn Twentyman, MD
Affiliations
Sandra L. Jackson, PhD
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia; Address correspondence to: Sandra L. Jackson, PhD, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Building 107, Mail Stop 107-1, Chamblee GA 30341.
Jason P. Block, MD, MPH
Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, Massachusetts
Deborah B. Rolka, MS
Division for Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
Meda E. Pavkov, MD, PhD
Division for Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
Jennifer R. Chevinsky, MD
Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
Akaki Lekiachvili, MD, MBA
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
Thomas W. Carton, PhD, MS
Louisiana Public Health Institute, New Orleans, Louisiana
Deepika Thacker, MD
Nemours Cardiac Center, Nemours Children's Health, Jacksonville, Florida
Joshua L. Denson, MD
Section of Pulmonary, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana
Anuradha Paranjape, MD, MPH
Temple University, Philadelphia, Pennsylvania
Michael D. Kappelman, MD, MPH
Department of Pediatrics, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Tegan K. Boehmer, PhD, MPH
Center for Surveillance, Epidemiology, and Laboratory Services (CSELS), Centers for Disease Control and Prevention, Atlanta, Georgia
Evelyn Twentyman, MD
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention, Atlanta, Georgia
Introduction: Hypertension and diabetes are associated with increased COVID-19 severity, yet less is known about COVID-19 outcomes across levels of disease control for these conditions. Methods: All adults aged ≥20 years with COVID-19 between March 1, 2020 and March 15, 2021 in 42 healthcare systems in National Patient-Centered Clinical Research Network were identified. Results: Among 656,049 adults with COVID-19, 41% had hypertension, and 13% had diabetes. Of patients with classifiable hypertension, 35% had blood pressure <130/80 mmHg, 40% had blood pressure of 130‒139/80‒89 mmHg, 21% had blood pressure of 140‒159/90‒99 mmHg, and 6% had blood pressure ≥160/100 mmHg. Severe COVID-19 outcomes were more prevalent among those with blood pressure of ≥160/100 than among those with blood pressure of 130–139/80–89, including hospitalization (23.7% [95% CI=23.0, 24.4] vs 11.7% [95% CI=11.5, 11.9]), receipt of critical care (5.5% [95% CI=5.0, 5.8] vs 2.4% [95% CI=2.3, 2.5]), receipt of mechanical ventilation (3.0% [95% CI=2.7, 3.3] vs 1.2% [95% CI=1.1, 1.3]), and 60-day mortality (4.6% [95% CI=4.2, 4.9] vs 1.8% [95% CI=1.7, 1.9]). Of patients with classifiable diabetes, 44% had HbA1c <7%, 35% had HbA1c 7% to <9%, and 21% had HbA1c ≥9%. Hospitalization prevalence was 31.3% (95% CI=30.7, 31.9) among those with HbA1c <7% vs 40.2% (95% CI=39.4, 41.1) among those with HbA1c ≥9%; other outcomes did not differ substantially by HbA1c. Conclusions: These findings highlight the importance of appropriate management of hypertension and diabetes, including during public health emergencies such as the COVID-19 pandemic.
