Hypertension increases risk for COVID-19 hospitalization
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Hypertension was associated with increased risk for COVID-19 requiring hospitalization during the omicron surge, even in patients with full vaccination and a booster, researchers reported in Hypertension.
“It is not just older adults with major comorbid conditions who are vulnerable [to omicron and hospitalization],” Joseph Ebinger, MD, director of clinical analytics at Smidt Heart Institute at Cedars-Sinai, told Healio. “Our data show that this can happen to an adult of any age and especially if a person has only hypertension and otherwise no major chronic disease. This was a surprising finding. Even when we looked only at people without any major chronic disease, the presence of hypertension was still a major driver of developing more severe COVID-19 illness from omicron — and even after having received three doses of a messenger RNA vaccine.”
In a retrospective cohort study, Ebinger and colleagues evaluated 912 participants who received at least three messenger RNA vaccine doses and got COVID-19 in the omicron surge to determine what characteristics were related to an infection that required hospitalization.
Characteristics previously associated with severe COVID-19, such as diabetes, chronic kidney disease (CKD), prior MI, HF and prior chronic obstructive pulmonary disease or asthma, were used as variables. Hypertension and obesity were also measured variables.
Demographic, clinical and outcomes data were all found through electronic health records.
Of the 912 adults studied, 15.9% were hospitalized, and a multivariable analysis showed that older age, more time between last vaccine and infection, hypertension, CKD and MI or HF were significantly associated with a hospitalization risk.
In the cohort, hypertension was the strongest predictor of hospitalization from COVID-19 (OR = 2.29; 95% CI, 1.24-4.32). Other predictors included MI or HF, CKD and age.
Further, a sensitivity analysis that excluded those with a history of hypertension-related conditions, including CKD, MI or HF, demonstrated that the magnitude of hypertension-related risk for COVID-19 hospitalization remained high (OR = 2.64; 95% CI, 1.32-5.37). This result was comparable when another analysis that removed ACE inhibitor/angiotensin receptor blocker use was performed.
“The biological mechanism underpinning the association between hypertension and severe COVID-19 remains underexplored,” Ebinger told Healio. “Future work should focus on understanding the factors linking hypertension to severe COVID-19, as this may elucidate both information on how SARS-CoV-2 affects the body and potential targets for intervention.
“We need to raise understanding around the fact that receiving three doses of vaccine may not prevent severe COVID-19 illness in everyone — even when the circulating viral variant is presumed to be causing only mild disease in most people,” Ebinger said. “Moreover, the people who are most at risk are not whom we might think they are. They are not the sickest of the sick. They include people who might not have major conditions such as heart disease or kidney disease, but they do have hypertension.”
For more information:
Joseph Ebinger, MD, can be reached at cda-research@cshs.org.
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