European Health Data and Evidence Network
Published November 9, 2022 | Version v1
Journal article Open

Characteristics and outcomes of patients with COVID-19 with and without prevalent hypertension: a multinational cohort study

Creators

  • 1. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
  • 2. Janssen Research and Development Titusville, Titusville, New Jersey, USA
  • 3. School of Medical Sciences, The University of Manchester, Manchester, UK
  • 4. College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
  • 5. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Center, Oxford, UK
  • 6. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  • 7. Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
  • 8. Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
  • 9. National Institute for Health and Care Excellence (NICE), London, UK
  • 10. Center for Statistics in Medicine, NDORMS, University of Oxford, Botnar Research Center, Nuffield Orthopaedic Center, Oxford, UK
  • 11. Real-World Evidence, TFS, Barcelona, Spain
  • 12. IOMED, Barcelona, Spain
  • 13. Universitat Autonoma de Barcelona, Barcelona, Spain
  • 14. Director of Innovation and Digital Transformation, Hospital del Mar, Barcelona, Spain
  • 15. Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigació Mèdica (IMIM), Barcelona, Spain
  • 16. University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
  • 17. Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  • 18. Real-World Solutions, IQVIA, Cambridge, Massachusetts, USA
  • 19. Stanford University School of Medicine, Stanford, California, USA
  • 20. tanford University School of Medicine, Stanford, California, USA
  • 21. Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  • 22. VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
  • 23. School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 24. Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA
  • 25. Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
  • 26. Department of Biostatistics, Fielding School of Publich Health, University of California, Los Angeles, California, USA

Description

Objective To characterise patients with and without prevalent hypertension and COVID-19 and to assess adverse outcomes in both inpatients and outpatients.

Design and setting This is a retrospective cohort study using 15 healthcare databases (primary and secondary electronic healthcare records, insurance and national claims data) from the USA, Europe and South Korea, standardised to the Observational Medical Outcomes Partnership common data model. Data were gathered from 1 March to 31 October 2020.

Participants Two non-mutually exclusive cohorts were defined: (1) individuals diagnosed with COVID-19 (diagnosed cohort) and (2) individuals hospitalised with COVID-19 (hospitalised cohort), and stratified by hypertension status. Follow-up was from COVID-19 diagnosis/hospitalisation to death, end of the study period or 30 days.

Outcomes Demographics, comorbidities and 30-day outcomes (hospitalisation and death for the ‘diagnosed’ cohort and adverse events and death for the ‘hospitalised’ cohort) were reported.

Results We identified 2 851 035 diagnosed and 563 708 hospitalised patients with COVID-19. Hypertension was more prevalent in the latter (ranging across databases from 17.4% (95% CI 17.2 to 17.6) to 61.4% (95% CI 61.0 to 61.8) and from 25.6% (95% CI 24.6 to 26.6) to 85.9% (95% CI 85.2 to 86.6)). Patients in both cohorts with hypertension were predominantly >50 years old and female. Patients with hypertension were frequently diagnosed with obesity, heart disease, dyslipidaemia and diabetes. Compared with patients without hypertension, patients with hypertension in the COVID-19 diagnosed cohort had more hospitalisations (ranging from 1.3% (95% CI 0.4 to 2.2) to 41.1% (95% CI 39.5 to 42.7) vs from 1.4% (95% CI 0.9 to 1.9) to 15.9% (95% CI 14.9 to 16.9)) and increased mortality (ranging from 0.3% (95% CI 0.1 to 0.5) to 18.5% (95% CI 15.7 to 21.3) vs from 0.2% (95% CI 0.2 to 0.2) to 11.8% (95% CI 10.8 to 12.8)). Patients in the COVID-19 hospitalised cohort with hypertension were more likely to have acute respiratory distress syndrome (ranging from 0.1% (95% CI 0.0 to 0.2) to 65.6% (95% CI 62.5 to 68.7) vs from 0.1% (95% CI 0.0 to 0.2) to 54.7% (95% CI 50.5 to 58.9)), arrhythmia (ranging from 0.5% (95% CI 0.3 to 0.7) to 45.8% (95% CI 42.6 to 49.0) vs from 0.4% (95% CI 0.3 to 0.5) to 36.8% (95% CI 32.7 to 40.9)) and increased mortality (ranging from 1.8% (95% CI 0.4 to 3.2) to 25.1% (95% CI 23.0 to 27.2) vs from 0.7% (95% CI 0.5 to 0.9) to 10.9% (95% CI 10.4 to 11.4)) than patients without hypertension.

Conclusions COVID-19 patients with hypertension were more likely to suffer severe outcomes, hospitalisations and deaths compared with those without hypertension.

Files

2022_BMJ Open_Characteristics and outcomes of patients with COVID19 with and without prevalent hypertension.pdf

Files (3.2 MB)

Additional details

Funding

EHDEN – European Health Data and Evidence Network 806968
European Commission