Journal
HYPERTENSION
Volume 77, Issue 3, Pages 846-855Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/HYPERTENSIONAHA.120.16472
Keywords
blood pressure; COVID-19; electronic health records; mortality; pandemic
Categories
Funding
- Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) hub
- University of Oxford Medical Sciences Division Urgent coronavirus disease (COVID) Fund
- Primary Care Research Trust
- Public Health England
- National Institute for Health Research (NIHR) Oxford
- Thames Valley Applied Research Collaboration
- Wellcome Trust/Royal Society [211182/Z/18/Z]
- NIHR Oxford Biomedical Research Centre
- Wellcome Trust [203921/Z/16/Z]
- NIHR School for Primary Care Research
- NIHR Collaboration for Leadership in Health Research and Care (CLARHC) Oxford
- NIHR Oxford Biomedical Research Centre (Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust)
- NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative (Oxford Meditech and In-Vitro Diagnostics Co-operative)
- NIHR Thames Valley Applied Research Collaborative
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This study found that patients with controlled blood pressure among those with hypertension had worse outcomes when infected with COVID-19, possibly due to more advanced atherosclerosis and target organ damage.
Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent BP reading within 24 months of the index date (January 1, 2020). BP was defined as controlled (<130/80 mm Hg), raised (130/80-139/89 mm Hg), stage 1 uncontrolled (140/90-159/99 mm Hg), or stage 2 uncontrolled (>= 160/100 mm Hg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19-related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45 418 patients (mean age, 67 years; 44.7% male) included, 11 950 (26.3%) had controlled BP. These patients were older, had more comorbidities, and had been diagnosed with hypertension for longer. A total of 4277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (odds ratio, 0.76 [95% CI, 0.62-0.92]) compared with patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalization. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.
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