Outcome of COVID-19 infection in patients on antihypertensives: A cross-sectional study

doi:10.5492/wjccm.v13.i3.96882

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Sep 9, 2024 (publication date) through Aug 30, 2024

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World Journal of Critical Care Medicine

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2220-3141

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Crit Care Med. Sep 9, 2024; 13(3): 96882
Published online Sep 9, 2024. doi: 10.5492/wjccm.v13.i3.96882

Table 1 Characteristic frequency among the study population

Parameter	Total population, n = 260	Nonhypertensive, n = 60	ACEI/ARB, n = 62	Calcium channel blockers, n = 64	ACEI/ARB + CCB, n = 60	Beta-blockers, n = 14	P value
Mean age in years (SD)	55.84 (15.8)	3 9.53 (14.7)¹	61.3 (11.9)	60.3 (12.6)	59.83 (13.7)	64 (9.6)	< 0.001
Male	192 (73.8)	35 (58.3)	53 (85.5)	44 (68.8)	48 (85.7)	12 (85.7)	0.005
Female	68 (26.2)	25 (41.7)	9 (14.5)	20 (31.2)	12 (14.3)	2 (14.3)
Duration of antihypertension in years (IQR)	-	-	2-7	2-6	2-8	2-11.25	0.080
Diabetes	105 (40.4)	3 (5)	41 (66.1)²	23 (35.9)	32 (53.3)	6 (42.9)	< 0.001
Hypothyroidism	10 (3.8)	1 (1.7)	4 (6.5)	3 (4.7)	1 (1.7)	1 (7.1)	0.523
Ischemic heart disease	29 (11.2)	1 (1.7)	6 (9.7)	7 (10.9)	11 (18.3)	4 (28.6)⁴	0.011
Smoking	7 (2.7)	3 (5)	1 (1.6)	-	3 (5)	-	0.301
Mean duration of stay in days (SD)	8.9 (4.5)	10.28 (5.4)	8.2 (4.2)	8.5 (3.4)	8.6 (4.7)	8.57 (4.7)	0.113
Symptoms
Fever	137 (52.7)	18 (30)	38 (61.3)	33 (51.6)	40 (66.7)³	8 (57.1)	0.001
Cough	126 (48.5)	20 (33.3)	33 (53.2)	29 (45.3)	35 (58.3)	9 (64.3)⁴	0.039
Respiratory distress	81 (31.2)	4 (6.7)	26 (41.9)	22 (34.4)	23 (38.3)	6 (42.9)⁴	< 0.001
Myalgia	7 (2.7)	4 (6.7)	-	1 (1.6)	2 (3.3)	-	0.190
Sore throat	9 (3.5)	8 (13.3)¹	1 (1.6)	-	-	-	< 0.001
Diarrhea	3 (1.2)	-	-	1 (1.6)	1 (1.7)	1 (7.1)	0.195

¹Significant difference between the nonhypertensive group and others.

²Significant difference between the ACEI/ARB group and others.

³Significant difference between the ACEI/ARB + CCB group and others.

⁴Significant difference between the beta-blocker group and others.

Data are n (%) unless indicatedotherwise. ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker; CCB: Calcium channel blocker; IQR: Interquartile range; SD: Standard deviation.

Table 2 Complication, severity, and outcome frequency among the study population

Parameter	Total population, n = 260	Nonhypertensive, n = 60	ACEI/ARB, n = 62	Calcium channel blockers, n = 64	ACEI/ARB + CCB, n = 60	Beta-blockers, n = 14	P value
Pneumonia	8 (3.1)	-	3 (4.8)	4 (6.2)	1 (1.7)	-	0.235
ARDS	30 (11.5)	-	9 (14.5)	11 (17.2)¹	8 (13.3)	2 (14.3)	0.031
MODS	4 (1.5)	-	1 (1.6)	2 (3.1)	1 (1.7)	-	0.694
AKI	13 (5)	1 (1.7)	1 (1.6)	6 (9.4)	3 (5)	2 (14.3)	0.091
Renal failure	12 (4.6)	-	1 (1.6)	5 (7.8)	5 (8.3)	1 (7.1)	0.101
MoHFW severity
Asymptomatic	44 (16.9)	16 (26.7)	6 (9.7)	12 (18.8)	8 (13.3)	2 (14.3)	0.003
Mild	104 (40)	33 (55)	23 (37.1)	23 (35.9)	17 (28.3)	8 (57.1)
Moderate	33 (12.7)	5 (8.3)	11 (17.7)	6 (9.4)	9 (15)	2 (14.3)
Severe	79 (30.4)	6 (10)	22 (35.5)	23 (35.9)	26 (43.3)²	2 (14.3)
WHO grade
Asymptomatic	44 (16.9)	16 (26.7)	6 (9.7)	12 (18.8)	8 (13.3)	2 (14.3)	0.006
Mild	104 (40)	33 (55)	23 (37.1)	23 (35.9)	17 (28.3)	8 (57.1)
Moderate	33 (12.7)	5 (8.3)	11 (17.7)	6 (9.4)	9 (15)	2 (14.3)
Severe	41 (15.8)	5 (8.3)	12 (19.4)	9 (14.1)	15 (25)	-
Critical	38 (14.6)	1 (1.7)	10 (16.1)	14 (21.9)¹	11 (18.3)	2 (14.3)
ICU intervention	46 (17.7)	1 (1.7)	13 (21)	18 (28.1)¹	12 (20)	2 (14.3)	0.003
Death	24 (9.2)	-	4 (6.5)	12 (18.8)¹	7 (11.7)	1 (7.1)	0.007

¹Significant difference between the CCB group and others.

²Significant difference between the ACEI/ARB + CCB group and others.

Data are n (%). ACEI: Angiotensin-converting enzyme inhibitor; AKI: Acute kidney injury; ARB: Angiotensin receptor blocker; ARDS: Acute respiratory distress syndrome; CCB: Calcium channel blocker; ICU: Intensive care unit; MODS: Multiple organ dysfunction syndrome; MoHFW: Ministry of Health and Family Welfare; WHO: World Health Organization.

Table 3 Laboratory parameters at admission

Parameter	Total population, n = 260	Nonhypertensive, n = 60	ACEI/ARB, n = 62	Calcium channel blockers, n = 64	ACEI/ARB + CCB, n = 60	Beta-blockers, n = 14	P value
Hemoglobin in gm/dL	12.95 (2.0)	13.47 (5.4)	12.94 (1.9)	12.45 (2.1)	12.9 (1.7)	13.36 (2.6)	0.077
Total leukocyte count as /cu mm	7683.8 (3991.9)	6993.83 (3576.08)	7755.32 (3712.07)	8126.41 (4186.3)	7739.33 (4604.2)	8062.86 (3205.9)	0.606
Neutrophil/lymphocyte ratio (IQR)	1-6	1-3	2-6.25	1.25-6	2-9.5	1-15.25⁵	< 0.001
Platelets as /cu mm	237765.38 (90546.23)	235183.33 (78058.10)	249467.74 (98418.26)	233046.88 (96977.24)	239116.67 (88116.08)	212785.71 (89160.33)	0.677
ESR in mm/h (IQR)	9-38	7-28.5	8-38.5	10.5-39.5	12.5-48.5⁴	10.5-40.2	0.007
Serumhs-CRP in mg/dL (IQR)	3-67	1.25-15	8.5-88.2	6-85.2	3-89.5⁴	13-85.7	< 0.001
Plasma glucose at admission in mg/dL	135.82 (65.1)	104.9 (48.5)	162 (63.9)²	126.28 (59.0)	148.9 (60.3)	139.43 (53.8)	< 0.001
Blood urea in mg/dL (IQR)	21-38	19-29¹	21-37.25	23.25-43	21-43.5	18.5-43.2	0.002
Serum creatinine in mg/dL	1.19 (0.78)	1.1 (0.54)	1.2 (1.05)	1.2 (0.64)	1.2 (0.4)	1.4 (1.6)	0.164
Serum interleukin 6 in pg/mL (IQR)	20-188.2	68.5-200	13.2-118.5²	17.2-219.2	16.7-159.5	10.7-155.7	0.004
Serum ferritin in ng/mL (IQR)	67.25-449.5	31.25-242.5	116-459	76.5-660.25³	46.5-541	46.5-520.5	0.017
D-Dimer in μg/mL (IQR)	0-2	0-1	0-3	0-2	0-2	0-1.2	0.43
Serum lactate dehydrogenase in IU/L (IQR)	179-321	180.2-256.7	170-330.2	186.7-318.5	175-359.7	187.2-347.7	0.751
Serum creatine kinase in IU/L (IQR)	45.25-107.7	49-109.5	45-98.2	39.75-118	48-108	49.75-109.7	0.964
Serum procalcitonin in ng/mL	0.16 (0.44)	0.12 (0.32)	0.26 (0.72)	0.13 (0.4)	0.13 (0.3)	0.21 (0.4)	0.695

¹Significant difference between the nonhypertensive group and others.

²Significant difference between the ACEI/ARB group and others.

³Significant difference between the CCB group and others.

⁴Significant difference between the ACEI/ARB + CCB group and others.

⁵Significant difference between the beta-blocker group and others.

Data are mean ± standard deviation unless indicated otherwise. ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker; CCB: Calcium channel blocker; ESR: Erythrocyte sedimentation rate; hs-CRP: High-sensitivity C-reactive protein; IQR: Interquartile range.

Table 4 Predictors of mortality in coronavirus disease 2019 patients by multivariable logistic regression

Risk factor	Adjusted odds ratio (95%CI)	P value
Age	1.21 (1.06-1.39)	0.005^a
Sex	-	0.742
Diabetes	-	0.057
Ischemic heart disease	-	0.686
Duration of antihypertensive therapy	0.69 (0.51-0.94)	0.008^a
ACEI/ARB	-	0.997
Calcium channel blockers	-	0.996
ACEI/ARB + calcium channel blockers	-	0.997
Beta-blockers	-	0.998
Hemoglobin	-	0.465
Neutrophil/lymphocyte ratio	-	0.071
ESR	0.92 (0.87-0.97)	0.005^a
hs-CRP	0.97 (0.95-0.99)	0.014^a
Blood urea		0.095
Serum ferritin	-	0.081
Serum interleukin 6	0.97 (0.96-0.99)	0.009^a

^aP< 0.05.

ACEI: Angiotensin-converting enzyme inhibitor; ARB: Angiotensin receptor blocker; CI: Confidence interval; ESR: Erythrocyte sedimentation rate; hs-CRP: High-sensitivity C-reactive protein.

Table 5 Performance criteria of the duration of antihypertensive therapy in discriminating the outcome of coronavirus disease 2019

Parameter	AUC (95%CI)	Sensitivity	Specificity	Cut of value of years	P value
Duration of antihypertensive therapy	0.670 (0.574-0.767)	70.8	55.7	4.5	0.007

AUC: Area under the curve; CI: Confidence interval.

Citation: Varatharajan S, Bohra GK, Bhatia PK, Khichar S, Meena M, Palanisamy N, Gaur A, Garg MK. Outcome of COVID-19 infection in patients on antihypertensives: A cross-sectional study. World J Crit Care Med 2024; 13(3): 96882
URL: https://www.wjgnet.com/2220-3141/full/v13/i3/96882.htm
DOI: https://dx.doi.org/10.5492/wjccm.v13.i3.96882