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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Outcome of COVID-19 infection in patients on antihypertensives: A cross-sectional study
Sakthivadivel Varatharajan, Gopal K Bohra, Pradeep K Bhatia, Satyendra Khichar, Mahadev Meena, Naveenraj Palanisamy, Archana Gaur, Mahendra K Garg
Sakthivadivel Varatharajan, Department of General Medicine, All India Institute of Medical Sciences - Bibinagar, Hyderabad 508126, Telangana, India
Gopal K Bohra, Satyendra Khichar, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
Pradeep K Bhatia, Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
Mahadev Meena, Department of General Medicine, All India Institute of Medical Sciences, Bhopal 462020, Madhya Pradesh, India
Naveenraj Palanisamy, Department of General Medicine, ESIC Medical College & Hospital, Chennai 600021, Tamilnadu, India
Archana Gaur, Department of Physiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad 508126, Telangana, India
Mahendra K Garg, Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, Jodhpur 342005, Rajasthan, India
Co-first authors: Sakthivadivel Varatharajan and Gopal K Bohra.
Author contributions: Varatharajan S and Bohra GK conceived, designed, and coordinated the study, participated in the acquisition and interpretation of the data, and drafted the manuscript; Both of them played crucial role in all aspects of the study; Khichar S, Meena M, and Palanisamy N participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Gaur A, Bhatia PK, and Garg MK participated in the analysis and interpretation of the data and revised the article critically for important intellectual content; All authors have read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by All India Institute of Medical Sciences- Jodhpur Institutional Review Board (AIIMS/IEC/2020-21/2003).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
vsakthivadivel28@gmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items—and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Sakthivadivel Varatharajan, MD, Additional Professor, Department of General Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad 508126, Telangana, India.
vsakthivadivel28@gmail.com
Received: May 17, 2024
Revised: August 7, 2024
Accepted: August 13, 2024
Published online: September 9, 2024
Processing time: 104 Days and 19.2 Hours
BACKGROUND
Patients with coronavirus disease 2019 (COVID-19) infection frequently have hypertension as a co-morbidity, which is linked to adverse outcomes. Antihypertensives may affect the outcome of COVID-19 infection.
AIM
To assess the effects of antihypertensive agents on the outcomes of COVID-19 infection.
METHODS
A total of 260 patients were included, and their demographic data and clinical profile were documented. The patients were categorized into nonhypertensive, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB), calcium channel blocker (CCB), a combination of ACEI/ARB and CCB, and beta-blocker groups. Biochemical, hematological, and inflammatory markers were measured. The severity of infection, intensive care unit (ICU) intervention, and outcome were recorded.
RESULTS
The mean age of patients was approximately 60-years-old in all groups, except the nonhypertensive group. Men were predominant in all groups. Fever was the most common presenting symptom. Acute respiratory distress syndrome was the most common complication, and was mostly found in the CCB group. Critical cases, ICU intervention, and mortality were also higher in the CCB group. Multivariable logistic regression analysis revealed that age, duration of antihypertensive therapy, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, and interleukin 6 were significantly associated with mortality. The duration of antihypertensive therapy exhibited a sensitivity of 70.8% and specificity of 55.7%, with a cut-off value of 4.5 years and an area under the curve of 0.670 (0.574-0.767; 95% confidence interval) for COVID-19 outcome.
CONCLUSION
The type of antihypertensive medication has no impact on the clinical sequence or mortality of patients with COVID-19 infection. However, the duration of antihypertensive therapy is associated with poor outcomes.
Core Tip: Hypertension is a common co-morbidity among patients with coronavirus disease 2019 (COVID-19) infection. Antihypertensives have various effects on the outcome of COVID-19. In this single-center study, we evaluated the effects of antihypertensives, especially angiotensin-converting enzyme inhibitors, beta-blockers, and calcium channel blockers, on the outcome of COVID-19 infection. Duration of antihypertensive therapy rather than the type of antihypertensive medication was significantly associated with poor outcomes.
