Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension: An Observational Cohort Study
Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients we...
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Veröffentlicht in: | Hypertension (Dallas, Tex. 1979) Tex. 1979), 2021-03, Vol.77 (3), p.846-855 |
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creator | Sheppard, James P. Nicholson, Brian D. Lee, Joseph McGagh, Dylan Sherlock, Julian Koshiaris, Constantinos Oke, Jason Jones, Nicholas R. Hinton, William Armitage, Laura Van Hecke, Oliver Lay-Flurrie, Sarah Bankhead, Clare R. Liyanage, Harshana Williams, John Ferreira, Filipa Feher, Michael D. Ashworth, Andrew J. Joy, Mark P. de Lusignan, Simon Hobbs, F.D. Richard |
description | Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent BP reading within 24 months of the index date (January 1, 2020). BP was defined as controlled ( |
doi_str_mv | 10.1161/HYPERTENSIONAHA.120.16472 |
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Richard</creator><creatorcontrib>Sheppard, James P. ; Nicholson, Brian D. ; Lee, Joseph ; McGagh, Dylan ; Sherlock, Julian ; Koshiaris, Constantinos ; Oke, Jason ; Jones, Nicholas R. ; Hinton, William ; Armitage, Laura ; Van Hecke, Oliver ; Lay-Flurrie, Sarah ; Bankhead, Clare R. ; Liyanage, Harshana ; Williams, John ; Ferreira, Filipa ; Feher, Michael D. ; Ashworth, Andrew J. ; Joy, Mark P. ; de Lusignan, Simon ; Hobbs, F.D. Richard</creatorcontrib><description>Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent BP reading within 24 months of the index date (January 1, 2020). BP was defined as controlled (<130/80 mm Hg), raised (130/80–139/89 mm Hg), stage 1 uncontrolled (140/90–159/99 mm Hg), or stage 2 uncontrolled (≥160/100 mm Hg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19–related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45 418 patients (mean age, 67 years; 44.7% male) included, 11 950 (26.3%) had controlled BP. These patients were older, had more comorbidities, and had been diagnosed with hypertension for longer. A total of 4277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (odds ratio, 0.76 [95% CI, 0.62–0.92]) compared with patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalization. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.</description><identifier>ISSN: 0194-911X</identifier><identifier>EISSN: 1524-4563</identifier><identifier>DOI: 10.1161/HYPERTENSIONAHA.120.16472</identifier><identifier>PMID: 33325240</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Antihypertensive Agents - therapeutic use ; Atherosclerosis - epidemiology ; Blood Pressure - drug effects ; Comorbidity ; COVID-19 - epidemiology ; COVID-19 - prevention & control ; England - epidemiology ; Ethnicity - statistics & numerical data ; Female ; Follow-Up Studies ; Hospitalization - statistics & numerical data ; Humans ; Hypertension - drug therapy ; Hypertension - epidemiology ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Original ; Pandemics ; Primary Health Care - statistics & numerical data ; Retrospective Studies ; Risk Factors ; SARS-CoV-2 ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome</subject><ispartof>Hypertension (Dallas, Tex. 1979), 2021-03, Vol.77 (3), p.846-855</ispartof><rights>American Heart Association, Inc</rights><rights>2020 The Authors. 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3614-4e194890432d49b61b3af013705a998927ca4295a0f29ab39fc04d61d8edaae93</cites><orcidid>0000-0002-5700-6337 ; 0000-0002-6772-2775 ; 0000-0002-0352-3785 ; 0000-0003-3467-6677 ; 0000-0002-4461-8756 ; 0000-0002-6229-5057 ; 0000-0002-4974-3724 ; 0000-0002-8553-2641 ; 0000-0001-7976-7172 ; 0000-0001-9738-6349 ; 0000-0002-6118-0434 ; 0000-0002-7717-8486</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33325240$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sheppard, James P.</creatorcontrib><creatorcontrib>Nicholson, Brian D.</creatorcontrib><creatorcontrib>Lee, Joseph</creatorcontrib><creatorcontrib>McGagh, Dylan</creatorcontrib><creatorcontrib>Sherlock, Julian</creatorcontrib><creatorcontrib>Koshiaris, Constantinos</creatorcontrib><creatorcontrib>Oke, Jason</creatorcontrib><creatorcontrib>Jones, Nicholas R.</creatorcontrib><creatorcontrib>Hinton, William</creatorcontrib><creatorcontrib>Armitage, Laura</creatorcontrib><creatorcontrib>Van Hecke, Oliver</creatorcontrib><creatorcontrib>Lay-Flurrie, Sarah</creatorcontrib><creatorcontrib>Bankhead, Clare R.</creatorcontrib><creatorcontrib>Liyanage, Harshana</creatorcontrib><creatorcontrib>Williams, John</creatorcontrib><creatorcontrib>Ferreira, Filipa</creatorcontrib><creatorcontrib>Feher, Michael D.</creatorcontrib><creatorcontrib>Ashworth, Andrew J.</creatorcontrib><creatorcontrib>Joy, Mark P.</creatorcontrib><creatorcontrib>de Lusignan, Simon</creatorcontrib><creatorcontrib>Hobbs, F.D. Richard</creatorcontrib><title>Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension: An Observational Cohort Study</title><title>Hypertension (Dallas, Tex. 1979)</title><addtitle>Hypertension</addtitle><description>Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent BP reading within 24 months of the index date (January 1, 2020). BP was defined as controlled (<130/80 mm Hg), raised (130/80–139/89 mm Hg), stage 1 uncontrolled (140/90–159/99 mm Hg), or stage 2 uncontrolled (≥160/100 mm Hg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19–related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45 418 patients (mean age, 67 years; 44.7% male) included, 11 950 (26.3%) had controlled BP. These patients were older, had more comorbidities, and had been diagnosed with hypertension for longer. A total of 4277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (odds ratio, 0.76 [95% CI, 0.62–0.92]) compared with patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalization. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Atherosclerosis - epidemiology</subject><subject>Blood Pressure - drug effects</subject><subject>Comorbidity</subject><subject>COVID-19 - epidemiology</subject><subject>COVID-19 - prevention & control</subject><subject>England - epidemiology</subject><subject>Ethnicity - statistics & numerical data</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - epidemiology</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Odds Ratio</subject><subject>Original</subject><subject>Pandemics</subject><subject>Primary Health Care - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>SARS-CoV-2</subject><subject>Severity of Illness Index</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0194-911X</issn><issn>1524-4563</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdUd1u0zAUthCIlcErIPMAGf7Lj7lACqWsk6a1okPAleUkJ8SQxJXttOrdbnkNHo0nwVthAmzJx9L5fs7Rh9ALSs4ozejL5ef14v314mpzsboql-UZZbGRiZw9QDOaMpGINOMP0YxQKRJJ6acT9MT7r4RQIUT-GJ1wzlnEkRn6UXpva6ODsSN-A2EPEGtvbYPXDryfHOC5HYOzPdZjE__Ojnpn3OTxW-NBe8As-uDVFGo7gMdmxCL9efNd0AJvDsM22CGq13gdXxiDxx9N6PDysAUXYPTR9xUuR7yqPLjd3Ry6jzaddQFvwtQcnqJHre49PPtdT9GHd4vr-TK5XJ1fzMvLpOYZjTtD3LaQRHDWCFlltOK6JZTnJNVSFpLltRZMppq0TOqKy7YmosloU0CjNUh-il4fdbdTNUBTx2Gd7tXWmUG7g7LaqH87o-nUF7tTeVEIJoooII8CtbPeO2jvuZSo2-DUf8GpGJy6Cy5yn_9tfs_8k1QEiCNgb_sAzn_rpz041YHuQ6dIPIJlRcIIo4THm5DbuPkvwsSqJQ</recordid><startdate>20210303</startdate><enddate>20210303</enddate><creator>Sheppard, James P.</creator><creator>Nicholson, Brian D.</creator><creator>Lee, Joseph</creator><creator>McGagh, Dylan</creator><creator>Sherlock, Julian</creator><creator>Koshiaris, Constantinos</creator><creator>Oke, Jason</creator><creator>Jones, Nicholas R.</creator><creator>Hinton, William</creator><creator>Armitage, Laura</creator><creator>Van Hecke, Oliver</creator><creator>Lay-Flurrie, Sarah</creator><creator>Bankhead, Clare R.</creator><creator>Liyanage, Harshana</creator><creator>Williams, John</creator><creator>Ferreira, Filipa</creator><creator>Feher, Michael D.</creator><creator>Ashworth, Andrew J.</creator><creator>Joy, Mark P.</creator><creator>de Lusignan, Simon</creator><creator>Hobbs, F.D. Richard</creator><general>American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5700-6337</orcidid><orcidid>https://orcid.org/0000-0002-6772-2775</orcidid><orcidid>https://orcid.org/0000-0002-0352-3785</orcidid><orcidid>https://orcid.org/0000-0003-3467-6677</orcidid><orcidid>https://orcid.org/0000-0002-4461-8756</orcidid><orcidid>https://orcid.org/0000-0002-6229-5057</orcidid><orcidid>https://orcid.org/0000-0002-4974-3724</orcidid><orcidid>https://orcid.org/0000-0002-8553-2641</orcidid><orcidid>https://orcid.org/0000-0001-7976-7172</orcidid><orcidid>https://orcid.org/0000-0001-9738-6349</orcidid><orcidid>https://orcid.org/0000-0002-6118-0434</orcidid><orcidid>https://orcid.org/0000-0002-7717-8486</orcidid></search><sort><creationdate>20210303</creationdate><title>Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension: An Observational Cohort Study</title><author>Sheppard, James P. ; Nicholson, Brian D. ; Lee, Joseph ; McGagh, Dylan ; Sherlock, Julian ; Koshiaris, Constantinos ; Oke, Jason ; Jones, Nicholas R. ; Hinton, William ; Armitage, Laura ; Van Hecke, Oliver ; Lay-Flurrie, Sarah ; Bankhead, Clare R. ; Liyanage, Harshana ; Williams, John ; Ferreira, Filipa ; Feher, Michael D. ; Ashworth, Andrew J. ; Joy, Mark P. ; de Lusignan, Simon ; Hobbs, F.D. 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Richard</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sheppard, James P.</au><au>Nicholson, Brian D.</au><au>Lee, Joseph</au><au>McGagh, Dylan</au><au>Sherlock, Julian</au><au>Koshiaris, Constantinos</au><au>Oke, Jason</au><au>Jones, Nicholas R.</au><au>Hinton, William</au><au>Armitage, Laura</au><au>Van Hecke, Oliver</au><au>Lay-Flurrie, Sarah</au><au>Bankhead, Clare R.</au><au>Liyanage, Harshana</au><au>Williams, John</au><au>Ferreira, Filipa</au><au>Feher, Michael D.</au><au>Ashworth, Andrew J.</au><au>Joy, Mark P.</au><au>de Lusignan, Simon</au><au>Hobbs, F.D. Richard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension: An Observational Cohort Study</atitle><jtitle>Hypertension (Dallas, Tex. 1979)</jtitle><addtitle>Hypertension</addtitle><date>2021-03-03</date><risdate>2021</risdate><volume>77</volume><issue>3</issue><spage>846</spage><epage>855</epage><pages>846-855</pages><issn>0194-911X</issn><eissn>1524-4563</eissn><abstract>Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent BP reading within 24 months of the index date (January 1, 2020). BP was defined as controlled (<130/80 mm Hg), raised (130/80–139/89 mm Hg), stage 1 uncontrolled (140/90–159/99 mm Hg), or stage 2 uncontrolled (≥160/100 mm Hg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19–related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45 418 patients (mean age, 67 years; 44.7% male) included, 11 950 (26.3%) had controlled BP. These patients were older, had more comorbidities, and had been diagnosed with hypertension for longer. A total of 4277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (odds ratio, 0.76 [95% CI, 0.62–0.92]) compared with patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalization. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>33325240</pmid><doi>10.1161/HYPERTENSIONAHA.120.16472</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5700-6337</orcidid><orcidid>https://orcid.org/0000-0002-6772-2775</orcidid><orcidid>https://orcid.org/0000-0002-0352-3785</orcidid><orcidid>https://orcid.org/0000-0003-3467-6677</orcidid><orcidid>https://orcid.org/0000-0002-4461-8756</orcidid><orcidid>https://orcid.org/0000-0002-6229-5057</orcidid><orcidid>https://orcid.org/0000-0002-4974-3724</orcidid><orcidid>https://orcid.org/0000-0002-8553-2641</orcidid><orcidid>https://orcid.org/0000-0001-7976-7172</orcidid><orcidid>https://orcid.org/0000-0001-9738-6349</orcidid><orcidid>https://orcid.org/0000-0002-6118-0434</orcidid><orcidid>https://orcid.org/0000-0002-7717-8486</orcidid><oa>free_for_read</oa></addata></record> |
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source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals |
subjects | Adult Aged Aged, 80 and over Antihypertensive Agents - therapeutic use Atherosclerosis - epidemiology Blood Pressure - drug effects Comorbidity COVID-19 - epidemiology COVID-19 - prevention & control England - epidemiology Ethnicity - statistics & numerical data Female Follow-Up Studies Hospitalization - statistics & numerical data Humans Hypertension - drug therapy Hypertension - epidemiology Logistic Models Male Middle Aged Odds Ratio Original Pandemics Primary Health Care - statistics & numerical data Retrospective Studies Risk Factors SARS-CoV-2 Severity of Illness Index Survival Analysis Treatment Outcome |
title | Association Between Blood Pressure Control and Coronavirus Disease 2019 Outcomes in 45 418 Symptomatic Patients With Hypertension: An Observational Cohort Study |
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