Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression

• Published in: Journal of the renin-angiotensin-aldosterone system Vol. 21; no. 2; p. 1470320320926899
• Main Authors: Pranata, Raymond, Lim, Michael Anthonius, Huang, Ian, Raharjo, Sunu Budhi, Lukito, Antonia Anna
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-04-2020; Hindawi Limited
• Subjects: Betacoronavirus; Coronavirus Infections - complications; Coronavirus Infections - mortality; Coronavirus Infections - physiopathology; Coronaviruses; COVID-19; COVID-19 and the Renin-Angiotensin-Aldosterone System; Disease Progression; Female; Humans; Hypertension; Hypertension - complications; Intensive Care Units; Male; Meta-analysis; Mortality; Pandemics; Pneumonia; Pneumonia, Viral - complications; Pneumonia, Viral - mortality; Pneumonia, Viral - physiopathology; Respiratory Distress Syndrome - complications; Respiratory Distress Syndrome - mortality; Respiratory Distress Syndrome - physiopathology; SARS-CoV-2; Severity of Illness Index; Sex Factors; Systematic review; Hypertension; COVID-19; severity; mortality; coronavirus
• ISSN: 1470-3203; 1752-8976; 1752-8976
• DOI: 10.1177/1470320320926899

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.