Hypertension Is Associated With Increased Mortality and Severity of Disease in COVID-19 Pneumonia: A Systematic Review, Meta-Analysis and Meta-Regression

J Renin Angiotensin Aldosterone Syst. Apr-Jun 2020;21(2):1470320320926899. doi: 10.1177/1470320320926899.

Abstract

Objective: To investigate the association between hypertension and outcome in patients with Coronavirus Disease 2019 (COVID-19) pneumonia.

Methods: We performed a systematic literature search from several databases on studies that assess hypertension and outcome in COVID-19. Composite of poor outcome, comprising of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care unit (ICU) care and disease progression were the outcomes of interest.

Results: A total of 6560 patients were pooled from 30 studies. Hypertension was associated with increased composite poor outcome (risk ratio (RR) 2.11 (95% confidence interval (CI) 1.85, 2.40), p < 0.001; I2, 44%) and its sub-group, including mortality (RR 2.21 (1.74, 2.81), p < 0.001; I2, 66%), severe COVID-19 (RR 2.04 (1.69, 2.47), p < 0.001; I2 31%), ARDS (RR 1.64 (1.11, 2.43), p = 0.01; I2,0%, p = 0.35), ICU care (RR 2.11 (1.34, 3.33), p = 0.001; I2 18%, p = 0.30), and disease progression (RR 3.01 (1.51, 5.99), p = 0.002; I2 0%, p = 0.55). Meta-regression analysis showed that gender (p = 0.013) was a covariate that affects the association. The association was stronger in studies with a percentage of males < 55% compared to ⩾ 55% (RR 2.32 v. RR 1.79).

Conclusion: Hypertension was associated with increased composite poor outcome, including mortality, severe COVID-19, ARDS, need for ICU care and disease progression in patients with COVID-19.

Keywords: COVID-19; Hypertension; coronavirus; mortality; severity.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Betacoronavirus*
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / mortality
  • Coronavirus Infections* / physiopathology
  • Disease Progression
  • Female
  • Humans
  • Hypertension / complications*
  • Intensive Care Units
  • Male
  • Pandemics*
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / mortality
  • Pneumonia, Viral* / physiopathology
  • Respiratory Distress Syndrome, Adult / complications
  • Respiratory Distress Syndrome, Adult / mortality
  • Respiratory Distress Syndrome, Adult / physiopathology
  • Severity of Illness Index
  • Sex Factors

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2