Risk of Covid-19 death may be twice as likely for those with high blood pressure

5 Jun 2020

Image: © Andrey Popov/Stock.adobe.com

Researchers are calling for further study after they found patients with high blood pressure have a two-fold increased risk of dying from Covid-19 compared to those who don’t.

A team of cardiologists at NUI Galway has contributed to a study published in the European Heart Journal that suggests those with high blood pressure may be at a greater risk from Covid-19.

Based on data from 2,866 patients with Covid-19 who were admitted to Huoshenshan hospital in Wuhan, China, the study found that there is a two-fold increased risk of dying from the disease if a patient has high blood pressure.

Those with high blood pressure who are not taking medication for the condition may be at even greater risk of dying from Covid-19. Of the patients analysed for the study, 29.5pc (850) had a medical history of hypertension (high blood pressure).

Call for Irish study

The researchers said that of the 850 patients in the study with hypertension, 34 died from Covid-19 (4pc), versus 22 who died out of the remaining 2,027 patients without hypertension (1.1pc).

Among the patients with hypertension who were not taking medication for the condition, 11 out of 140 (7.9pc) died from Covid-19, compared to 23 out of 710 (3.2pc) of those who were taking medication.

Limitations of the study cited by the researchers include the inability to include all relevant confounding factors such as electrocardiograms and that the impact of antihypertensive medication can only be assessed in the short term, requiring more prospective studies. However, their findings show a 2.17-fold increased risk after adjusting for factors that could affect results, such as the age, sex and other medical conditions of the patients.

As fewer cases of Covid-19 are now being diagnosed in China, NUI Galway professors William McEvoy and Patrick Serruys – co-authors of the most recent study – are seeking a grant for a randomised clinical trial in Ireland to further investigate their findings.

In a meta-analysis, the researchers pooled the data from the Huoshenwan patients with data from nearly 2,300 patients in three other studies. This was in order to investigate the death rates in patients being treated with drugs to control blood pressure levels by targeting the renin-angiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

Three remaining questions

It showed a lower risk of death among the 183 hypertension patients treated with RAAS inhibitors than in 527 patients treated with other drugs. As these patient numbers are quite low, the researchers said this finding should be treated with caution.

Furthermore, as it is a retrospective and observational study, it cannot show a causal relationship between RAAS inhibitors and the risk of dying from Covid-19.

“There are three remaining questions, and we hope our clinical trial in Ireland will answer the first two,” Serruys said.

“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.”

Research from the Royal College of Surgeons in Ireland published in April found that Irish patients with severe cases of Covid-19 were experiencing abnormal blood clotting which, in some cases, led to deaths. The researchers called for further studies to investigate whether blood-thinning treatments may have a role in selected high-risk patients to reduce clotting and help them recover from Covid-19.

Updated, 1.45pm, 5 June 2020: A previous version of the article said the study suggested patients with high blood pressure may have a 50pc increased risk of dying from Covid-19. This was updated to clarify that they have a two-fold increased risk of dying.

Colm Gorey was a senior journalist with Silicon Republic