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Sheppard, James P; Nicholson, Brian D; Lee, Joseph; McGagh, Dylan; Sherlock, Julian; Koshiaris, Constantinos; Oke, Jason; Jones, Nicholas R; Hinton, William; Armitage, Laura; Van Hecke, Oliver; Lay-Flurrie, Sarah; Bankhead, Clare R; Liyanage, Harshana; Williams, John; Ferreira, Filipa; Feher, Michael D; Ashworth, Andrew J; Joy, Mark P; de Lusignan, Simon; Hobbs, F D Richard
Hypertension (Dallas, Tex. 1979), 03/2021, Volume: 77, Issue: 3Journal Article
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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