Hypertension patients four times more likely to be bedridden

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• Have seven times higher chance of dying from COVID-19

Nigerian researchers have found that hypertension posed an increased risk of severe morbidity (approximately four-fold) and death (approximately seven-fold) from COVID-19 in the presence of multiple comorbidities.

The study titled, ‘Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study’, was published, last week, in the Global Health Research and Policy journal.

The researchers, led by Prof. Akin Osibogun, who is a consultant public health physician, former Chief Medical Director, Lagos University Teaching Hospital (LUTH) Idi-Araba, and Chairman, Lagos State Primary Health Care Board, concluded: “The role of other comorbidities worsening the severity and outcomes of COVID-19 has been highlighted in this study. This recognition of the potential morbidity and mortality risks of hypertension especially with other co-morbidities in COVID-19 could help direct efforts to- wards prevention and prognostication.

“This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritising them for future antiviral interventions. Until more information is available to guide the treatment and management of COVID-19 patients with hypertension, it is important to control blood pressure according to current clinical practice guidelines.”

The researchers were from: Lagos State Ministry of Health/Lagos Incident Management Command System; College of Medicine University of Lagos, Idi-Araba; Lagos State Primary Health Care Board; Mainland Hospital, Yaba, Lagos; Lagos State University College of Medicine; Lagos State Biobank; World Health Organisation, Nigeria Office, Abuja; Nigeria Centre for Disease Control, Abuja; Lagos University Teaching Hospital; Lagos State University Teaching Hospital; and Nigerian Heart Foundation, Lagos.

Indeed, the current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients. Until now, the morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.

In this retrospective cohort study, all confirmed COVID-19 adult patients (greater than and equal to 18 years of age) in Lagos between February 27 to July 62,020 were included.

Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centres in Lagos. Outcomes included dying, being discharged after recovery or being evacuated/transferred.

According to the researchers, a total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8 per cent followed by diabetes (7.2 per cent) and asthma (2.0 per cent). Overall mortality was 4.2 per cent, while mortality among hypertensives was 13.7 per cent. Severe symptoms and mortality were significantly higher among hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to 50 per cent from 91 per cent for those with hypertension alone and from 98 per cent for all other patients. After adjustment for confounders (age and sex), severe COVID-19 and death were higher for hypertensive.

“Hypertension posed an increased risk of severe morbidity (approximately four-fold) and death (approximately seven-fold) from COVID-19 in the presence of multiple comorbidities,” they noted.

Osibogun told The Guardian: “High blood pressure is common among people over 60 years of age, the prevalence being nearly as high as two-thirds of this population. Long-term ill health and aging lead to a weakened immune system increasing the susceptibility of people with chronic illnesses to coronavirus infection. Along with the increased risk of infection and worsened outcomes among hypertensives, there is a growing concern that some medications used in the treatment may influence mortality in patients with COVID-19. These medications such as angiotensin- converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) cause a rise in blood levels of ACE2. The theory is that the COVID-19 virus infects human cells by forming a bond with ACE2, a requirement for viral entry into host cells, thus increasing individual susceptibility to infection and propagation of the virus. Several other studies have, however, found no association between the use of these drugs and the severity of COVID-19.

“The epidemiological and clinical characteristics of patients with COVID-19 in terms of the detailed clinical course of illness, risk factors for mortality its spread and even its treatment are still being studied and documented.

“Understanding the potential effect of hypertension on the risk of mortality from COVID-19 could help clinicians to identify and characterise patients’ prognoses at an early stage so as to provide timely intervention. This study, hence, was aimed at assessing the hypothesis that hypertension worsens the morbidity and mortality outcomes of confirmed COVID-19 patients.”