People with high BP at increased risk of dying from Covid-19

By June Shannon Coronavirus News   |   9th Jun 2020

Study also suggests an even greater risk of dying from COVID-19 if high blood pressure is not treated

People with high blood pressure may be twice as likely to die from COVID-19 if they contract the virus, compared to people without hypertension, a new study by cardiology experts at NUI Galway and a research team from China has suggested.

The study, which is based on Chinese data and published in the European Heart Journal (EHJ), also revealed that patients with high blood pressure, who were not taking medication to control it, were at an even greater risk of dying from COVID-19.

The expert team at NUI Galway collaborated with a team in China and analysed data from 2,866 patients with COVID-19 who were admitted to Huo Shen Shan hospital in Wuhan, China, between 05th February and 15th March 2020.

Of these patients, 29.5% (850) had a medical history of high blood pressure (hypertension). They found that 34 out of 850 patients with high blood pressure (4%) with coronavirus died compared to 22 out of 2,027 patients without hypertension (1.1%) – a 2.12-fold increased risk. This result was adjusted to allow for other factors that could affect the results such as the patients’ age, sex and other medical conditions.

Among the patients with high blood pressure who were not taking medication for the condition, 11 of 140 (7.9%) died from coronavirus compared to 23 of 710 (3.2%) of those who were taking medication – 2.17-fold increased risk.

" We suggest that patients should not discontinue or change their usual antihypertensive treatment unless instructed by a physician.”

Professor Fei Li , Xijing Hospital, China

In a smaller study researchers also analysed the death rates in patients who were taking certain drugs to control their high blood pressure.

These drugs include, angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Other, non-RAAS inhibiting drugs used for treating high blood pressure include beta-blockers, calcium channel blockers (CCBs) or diuretics.

The researchers found a lower risk of death among the 183 patients treated with RAAS inhibitors than in 527 patients treated with other drugs. However, they stated that the results should be treated with caution as the number of patients in this analysis was small and so the differences found could be due to chance.

One of the reserachers Professor Fei Li from Xijing Hospital in China said, “It is important that patients with high blood pressure realise that they are at increased risk of dying from COVID-19. They should take good care of themselves during this pandemic and they need more attention if they are infected with the coronavirus.

“In addition, there were 140 patients admitted to hospital with COVID-19 who had discontinued their anti-hypertensive treatment due to various reasons. We found that this was associated with a greater risk of dying from the coronavirus.

“In contrast to our initial hypothesis, we found that RAAS inhibitors, such as ACE inhibitors or angiotensin receptor blockers, were not linked to an increased risk of dying from COVID-19 and, in fact, may be protective. Therefore, we suggest that patients should not discontinue or change their usual antihypertensive treatment unless instructed by a physician.”

“This study is further confirmation that people with high blood pressure are at increased risk from COVID 19,"

Dr Angie Brown, Medical Director, The Irish Heart Foundation

Commenting Dr Angie Brown, Medical Director of the Irish Heart Foundation said, “This study is further confirmation that people with high blood pressure are at increased risk from COVID 19.

“High blood pressure also increases the risk of many other problems such as stroke, dementia, kidney failure and heart failure but the good news is that good treatment of high blood pressures reduces the risk from COVID 19 and all the other consequences of hypertension. Furthermore the study provides some reassurance that treatment with Angiotensin Converting Enzyme Inhibitors (ACE) and Angiotensin receptor blockers (ARBs) is not harmful and may in fact be beneficial. It also reiterates the importance of taking all your blood pressure medication regularly.”

The expert cardiology team at NUI Galway will now carry out further studies on high blood pressure and COVID-19 and a grant for a randomised clinical trial has been submitted by Professors J. William McEvoy and Patrick Serruys, co-authors of the EHJ paper.

Professor Patrick W Serruys said, “There are three remaining questions, and we hope our clinical trial in Ireland will answer the first two: what kind of medication should be given to COVID-19 patients with hypertension – RAAS inhibitors or non-RAAS inhibitors – and could these medications mitigate the risk of dying in these patients? The last question is whether or not RAAS inhibitors influence the risk of infection for COVID-19.”

“As for the last question, a recent population-based study in the New England Journal of Medicine has suggested that antihypertensive medications, such as ACE inhibitors and ARBs are not associated with an increased risk of testing positive for COVID-19.”

As this is a retrospective and observational study, it cannot show a causal relationship between RAAS inhibitors and the risk of dying from COVID-19.

Other limitations include the inability to include all relevant confounding factors; some data, such as electrocardiograms (ECGs) were not recorded in detail; and the impact of antihypertensive medications can only be assessed in the short-term, with prospective studies needed to see longer-term effects.

For more information on high blood pressure please see here.

We are here for you

The Irish Heart Foundation’s nurse support line is available five days a week. Anyone living with heart disease and stroke who has concerns or questions about the coronavirus can contact the nurse support line on 01 668 5001 or support@irishheart.ie.

The Irish Heart Foundation’s new heart support group is on Facebook. Anyone who lives with heart failure or another heart condition or has a family member living with a heart condition can join here: www.facebook.com/groups/heartsupportnetwork/

The Irish Heart Foundation runs 21 stroke support groups and 5 heart failure groups around the country. All these groups have moved to telephone and online support. For more information, see https://irishheart.ie/get-support/.

The Irish Heart Foundation in conjunction with the HSE National Stroke Programme, has launched a new telephone support service for stroke patients who have recently been discharged from hospital. For more information, see here. 

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If found this article helpful and would like to donate to the Irish Heart Foundation please see here.

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