Objectives

A systematic analysis of concomitant arterial hypertension in COVID-19 patients and the impact of angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB’s) have not been studied in a large multicenter cohort yet.We conducted a subanalysis from the international HOPE-Registry (https://hopeprojectmd.com, NCT04334291) comparing COVID-19 in presence and absence of arterial hypertension.

Methods

Out of 5837 COVID-19 patients 2850 (48.8%) patients had the diagnosis arterial hypertension. 1978/2813 (70.3%) patients were already treated with ACEI or ARB’s. The clinical outcome of the present subanalysis included all-cause mortality over 40 days of follow-up.

Results

Patients with arterial hypertension suffered significantly more from different complications including respiratory insufficiency (60.8% versus 39.5%), heart failure (9.9% versus 3.1%), acute kidney injury (25.3% versus 7.3%), pneumonia (90.6% versus 86%), sepsis (14.7% versus 7.5%) and bleeding events (3.6% versus 1.6%). The mortality rate was 29.6% in patients with concomitant arterial hypertension and 11.3% without arterial hypertension (p<0.001). Invasive and non-invasive respiratory supports were significantly more required in presence of arterial hypertension as compared without it.

In the multivariate cox regression analysis, whereas age≥65, benzodiazepine, antidepressant at admission, elevated LDH or creatinine, respiratory insufficiency and sepsis might be a positive independent predictors of mortality, antiviral drugs, interferon treatment, ACEI or ARB’s at discharge or oral anticoagulation at discharge might be an independent negative predictor of the mortality.

Conclusions

The mortality rate and in-hospital complications might be increased in COVID-19 patients with a concomitant history of arterial hypertension. The history of ACEI or ARB’s treatments does not seem to impact the outcome of these patients.