Association of hypertension with mortality in patients hospitalised with COVID-19
Clara K Chow,
David Brieger,
William van Gaal,
Leonard Kritharides,
James Weaver,
Benjamin Harris,
Sidney T Lo,
Antony Walton,
Isuru Ranasinghe,
Anthony Delaney,
Brendan McQuillan,
William Wilson,
Ravinay Bhindi,
Andrew I MacIsaac,
Girish Dwivedi,
Bernard Hudson,
Usaid K Allahwala,
Astin Lee,
Kunwardeep S Bhatia,
Hari P Sritharan,
Jonathan Ciofani,
Justin Chia,
Karina Chui,
Daniel Nour,
Sheran Vasanthakumar,
Dhanvee Khandadai,
Pavithra Jayadeva,
Rohan Bhagwandeen,
Christopher Choong,
Graham Hillis,
George Javorski,
Nigel Jepson,
Logan Kanagaratnam,
George Kotsiou,
Andy S C Yong,
John Zhu
Affiliations
Clara K Chow
2 Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
David Brieger
Cardiology, Concord Hospital, Concord, New South Wales, Australia
William van Gaal
16 Department of Cardiology, Northern Health, Melbourne, Victoria, Australia
Leonard Kritharides
Cardiology, Concord Hospital, Concord, New South Wales, Australia
James Weaver
Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
Benjamin Harris
Lyell Immunopharma, South San Francisco, CA, USA
Sidney T Lo
Cardiology, University of New South Wales, Liverpool Hospital, Liverpool, New South Wales, Australia
Antony Walton
Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
Isuru Ranasinghe
4 Cardiology, The University of Queensland, Saint Lucia, Queensland, Australia
Anthony Delaney
The George Institute for Global Health, Sydney, New South Wales, Australia
Brendan McQuillan
School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
William Wilson
Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Ravinay Bhindi
Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Andrew I MacIsaac
Cardiology Department, St Vincent`s Health Australia, Sydney, New South Wales, Australia
Girish Dwivedi
Department of Advanced Clinical and Translational Cardiovascular Imaging, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
Bernard Hudson
2University of Sydney, Sydney, NSW, Australia
Usaid K Allahwala
Cardiology Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Astin Lee
Cardiology, Wollongong Hospital, Wollongong, New South Wales, Australia
Kunwardeep S Bhatia
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Hari P Sritharan
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Jonathan Ciofani
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Justin Chia
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Karina Chui
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Daniel Nour
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Sheran Vasanthakumar
Cardiology, Northern Hospital Epping, Epping, Victoria, Australia
Dhanvee Khandadai
Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
Pavithra Jayadeva
Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Rohan Bhagwandeen
Cardiology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
Christopher Choong
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Graham Hillis
Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
George Javorski
Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
Nigel Jepson
Cardiology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
Logan Kanagaratnam
Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
George Kotsiou
Infectious Diseases and Microbiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
Andy S C Yong
Cardiology, Concord Hospital, Sydney, New South Wales, Australia
John Zhu
Cardiology, Lismore Base Hospital, Lismore, New South Wales, Australia
Objective To assess whether hypertension is an independent risk factor for mortality among patients hospitalised with COVID-19, and to evaluate the impact of ACE inhibitor and angiotensin receptor blocker (ARB) use on mortality in patients with a background of hypertension.Method This observational cohort study included all index hospitalisations with laboratory-proven COVID-19 aged ≥18 years across 21 Australian hospitals. Patients with suspected, but not laboratory-proven COVID-19, were excluded. Registry data were analysed for in-hospital mortality in patients with comorbidities including hypertension, and baseline treatment with ACE inhibitors or ARBs.Results 546 consecutive patients (62.9±19.8 years old, 51.8% male) hospitalised with COVID-19 were enrolled. In the multivariable model, significant predictors of mortality were age (adjusted OR (aOR) 1.09, 95% CI 1.07 to 1.12, p<0.001), heart failure or cardiomyopathy (aOR 2.71, 95% CI 1.13 to 6.53, p=0.026), chronic kidney disease (aOR 2.33, 95% CI 1.02 to 5.32, p=0.044) and chronic obstructive pulmonary disease (aOR 2.27, 95% CI 1.06 to 4.85, p=0.035). Hypertension was the most prevalent comorbidity (49.5%) but was not independently associated with increased mortality (aOR 0.92, 95% CI 0.48 to 1.77, p=0.81). Among patients with hypertension, ACE inhibitor (aOR 1.37, 95% CI 0.61 to 3.08, p=0.61) and ARB (aOR 0.64, 95% CI 0.27 to 1.49, p=0.30) use was not associated with mortality.Conclusions In patients hospitalised with COVID-19, pre-existing hypertension was the most prevalent comorbidity but was not independently associated with mortality. Similarly, the baseline use of ACE inhibitors or ARBs had no independent association with in-hospital mortality.
