Primary hypertension, anti-hypertensive medications and the risk of severe COVID-19 in UK Biobank

ABSTRACT

Introduction: Hypertension appears to be one of the commonest comorbidities in COVID-19 patients, although whether hypertensive individuals have a higher risk of severe COVID-19 compared with non-hypertensives is unclear. It is also unclear whether the absolute level of systolic blood pressure, or the type of antihypertensive medication is related to this risk. Method(s) Analyses were conducted using data from the UK Biobank and linked health records. Logistic regression models were fitted to assess the impact of hypertension, systolic blood pressure and medications on the risk of severe COVID-19. Result(s) 17,094 individuals tested positive for severe acute respiratory syndrome-coronavirus, 22% (n = 3,774) developed severe COVID-19 and 40% (n = 6,899) were hypertensive. Hypertension was associated with 25% higher odds of severe COVID-19 (OR 1.25;95% CI 1.15, 1.36), compared with normotension after adjusting for confounding variables. In those taking anti-hypertensive medications, elevated systolic blood pressure showed a dose-response relationship with severe COVID-19 (150-159mmHg versus 120-129 mmHg (OR 1.51;95% CI 1.15, 1.97), >180+mmHg versus 120-129mmHg (OR 2.10;95% CI 1.21, 3.67)). Systolic blood pressure <120 mmHg was associated with greater odds of severe COVID-19 (OR 1.37;95% CI 1.08, 1.74). Angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers were not associated with altered risk of severe COVID-19. Conclusion(s) Hypertension is an important risk factor for COVID-19. A better understanding of the underlying mechanisms is warranted in case of more severe strains or other viruses in the future.