Does hypertension always lead to severe COVID-19?

By Angela Betsaida B. Laguipo, BSNJan 22 2021

Caused by the infectious agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the coronavirus disease 2019 (COVID-19) is often more severe in those with underlying medical conditions – such as diabetes, obesity, and hypertension.

Hypertension is the most common comorbidity among COVID-19 patients. In some cases, the condition leads to worse clinical outcomes, but there is a lack of evidence about prognostic factors among these patients.

Now, a team of researchers at the Baqiyatallah University of Medical Sciences in Iran have developed some prognostic factors to predict the severity of COVID-19 among hypertensive patients.

Study: Should all patients with hypertension be worried about developing severe coronavirus disease 2019 (COVID-19)? Image Credit: Micholas / Shutterstock

The research study, published in the journal Clinical Hypertension, hypertensive patients who are more than 60 years old, overweight, has cardiovascular disease, diabetes, and chronic kidney disease, are more likely to have poor outcomes when infected with SARS-CoV-2.

Hypertension and COVID-19

The coronavirus pandemic continues to spread worldwide, infecting over 96.82 million people. To date, the virus has claimed more than 2 million lives. Of these, a majority of deaths are tied to old age and underlying medical conditions.

While most people who contract SARS-CoV-2 develop mild symptoms, such as cough, fever, and fatigue, several patients may develop severe illness. Severe COVID-19 is characterized by symptoms such as difficulty of breathing, chest pain, and chest tightness.

The main causes of death in patients with COVID-19 are acute respiratory distress syndrome (ARDS), cardiac failure, and renal failure. The global mortality rate of COVID-19 is about 6 percent.

Health experts have acknowledged that people with comorbidities are at a heightened risk of getting infected with SARS-CoV-2 and developing severe illness. Hypertension is the most common comorbidity among these patients.

Many of the deaths related to COVID-19 have been seen in older adults, who are most likely to have hypertension. It remains unclear whether uncontrolled high blood pressure is a risk factor for infection and developing severe COVID-19.

The study

In the study, the researchers analyzed the medical profiles of 598 COVID-19 cases. The team divided the patients into two comparative groups, based on whether or not they had hypertension. Further, they compared epidemiologic, clinical, laboratory, and radiological features of both groups.

Of the medical profiles analyzed, 29.4 percent of the patients had hypertension, while 70.6 percent had normal blood pressure readings. The researchers saw more cases of diabetes, renal problems, and cardiovascular disease in the hypertensive group. This may explain why most patients who are hypertensive are at a higher risk of developing severe COVID-19.

Being overweight or having a body mass index (BMI) of more than 25, being more than 60 years old, longer hospitalization period, chronic kidney disease, and type 2 diabetes, were associated with progression of COVID-19 in stroke, respiratory disease, and cancer.

The team also noted that the reason why hypertensive patients are more likely to develop COVID-19 is unclear. One possible theory is that coronaviruses, including SARS-CoV-2, the Middle East respiratory syndrome coronavirus (MERS-CoV), and the severe acute respiratory syndrome coronavirus (SARS-CoV), bind to human cells through the angiotensin-converting enzyme 2 (ACE2) receptor, which is expressed by epithelial cells in the lungs, kidneys, intestines, and blood vessels.

In some hypertensive patients, the blood pressure is controlled by using angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs). Controlling hypertension with these drugs boosts ACE2 levels, which may facilitate COVID-19 infection.

Our novel study reveals predictive factors for developing severe COVID-19 that can be used by physicians to identify high risk hypertensive COVID-19 cases and determine appropriate treatment approach to achieve best possible clinical outcomes,” the researchers noted in the paper.

The researchers concluded that though people with hypertension are at a heightened risk of developing severe COVID-19, predictive factors can help determine patients with poor outcomes, including age, bodyweight, cardiovascular disease, chronic kidney disorder, and diabetes.