New Delhi: Patients with high blood pressure or hypertension are at a “two-fold increased risk” of dying from Covid-19 compared to those who don’t, a study published in the peer-reviewed European Heart Journal has concluded.
The study was conducted by researchers in China and Ireland, who analysed data from 2,877 Covid-19 patients admitted at Huo Shen Shan hospital in Wuhan, China, between 5 February and 15 March. Wuhan is the town where Covid-19 was first reported towards the end of 2019. It was published in the European Heart Journal, the flagship publication of the European Society of Cardiology, on 4 June.
The hospital in question was opened on 5 February exclusively to treat coronavirus patients. Of the patients, 29.5 per cent (850) had a medical history of high blood pressure (hypertension).
The researchers, led by Professors Fei Li and Ling Tao from China’s Xijing Hospital, found that 34 of the 850 hypertensive Covid-19 patients (4 per cent) died, compared to 22 out of 2,027 patients without hypertension (1.1 per cent) — a “two-fold increased risk” after adjustment for other factors that could affect the results, such as age, sex and other medical conditions, the study says.
The aim of the study was to infer if the treatment of hypertension influences the mortality of patients diagnosed with Covid-19.
“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,” Professor Li, one of the researchers, said in a statement to European Society of Cardiology (ESC).
Professor Ling Tao, another researcher involved in the study, said in the statement, “Soon after we started to treat Covid-19 patients in early February in Wuhan, we noticed that nearly half of the patients who died had high blood pressure, which was a much higher percentage compared to those with only mild Covid-19 symptoms.”
The European Heart Journal is published on behalf of the ESC by Oxford Journals, a division of Oxford University Press.
Although very detailed, the results, the study said, should be considered as “exploratory and interpreted cautiously”.
“As this was a study that looked at data from observations in the hospital, the researchers say it is too early to make clinical recommendations based on these results, and that results from randomised controlled clinical trials are needed to look, in particular, at the role played by RAAS inhibitors,” the statement on ESC said.
“These data should be interpreted cautiously. However, they support recommendations for the European Society of Cardiology that patients should not discontinue or change their normal, antihypertensive treatment,” Professor Tao said in the statement.
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Indian doctors agree
The findings of the study have found resonance with Indian doctors, who claim they reflect the realities of treating Covid-19 patients.
Speaking to ThePrint, Dr Anoop Misra, chairman of the Delhi-based Fortis Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, said the fact was known for the past two months.
Seventy-five per cent of those who died due to Covid-19, he added, had some combination of hypertension, diabetes and heart disease.
“This is absolutely true. We have come across many such cases, but most of them also were obese and had diabetes. Those who are dying due to Covid, 75 per cent will have some combination of hypertension, diabetes, heart disease,” Misra said.
When asked what makes high BP patients more vulnerable, Misra said, “Hypertension corrodes arteries”.
“Covid-19 also attacks the arteries. In addition, as indicated previously, they have many more accompanying diseases,” he added.
Dr Devesh Patel, chief medical officer for Vadodara, said more than 50 per cent of patients who died of Covid-19 in the Gujarat district had high blood pressure.
“These are standalone cases, wherein Covid patients (only) had high blood pressure. In cases where hypertension was clubbed with diabetes, obesity, the mortality rate was over 70 per cent,” he added.
“Hypertension affects blood circulation in the body, which also affects the circulation inside lungs, making it easier for the virus to penetrate,” he said. “This is the reason that cases with high BP are more vulnerable.”
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Patients not taking BP medicines at greater risk
The Wuhan study also suggests that patients with high BP who were not taking medication to control the condition were at an even greater risk of dying from Covid-19.
“Among the patients with hypertension who were not taking medication for the condition, 11 out 140 (7.9 per cent) died from coronavirus compared to 23 out of 710 (3.2 per cent) of those who were taking medication — a 2.17-fold increased risk after adjusting for confounding factors,” the study says.
“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,” Professor Li told the ECS.
The study also sought to investigate the death rates in hypertensive patients being treated with drugs targeting the renin-angiotensin-aldosterone system (RAAS), which is essential to regulating 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 study said.
According to the study, the researchers found a lower risk of death among the 183 patients treated with RAAS inhibitors than in 527 patients treated with other drugs.
The researchers also said in the study that BP patients should not discontinue their medicines, unless advised specifically by their physician.
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