Background: The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened in hypertensive patients with COVID-19. The morbidity and mortality of the disease among hypertensive patients in Africa have yet to be well described.
Methods: In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos between February 27 to July 6 2020 were included. Demographic, clinical and outcome data were extracted from electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included dying or being discharged by July 6, 2020. Variables were compared between hypertensive and non-hypertensives using univariable and multivariable logistic regression, cox regression and Kaplan Meier survival analysis methods to assess hypertension as a risk factor associated with worsened disease severity and death.
Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension was 17.8% and it was the most common comorbidity followed by diabetes (7.2%) and asthma (2.0%). Overall mortality from COVID-19 was 4.2% while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher among the hypertensives and survival rates were significantly lowered by the presence of an additional comorbidity to 50% from 91% for those with hypertension alone and from 98% for all other patients (P<0.001). After adjustment for confounders, severe COVID-19 disease and death were higher for hypertensives (severe/critical illness: HR=2.41, P=0.001, 95%CI=1.4–4.0, death: HR=2.30, P=0.001, 95%CI=1.2–4.6, for those with hypertension only). Hypertension posed an increased risk of severe morbidity and death from coronavirus disease in the presence of other comorbidities (severe/critical illness: HR=3.76, P=0.001, 95%CI=2.1–6.4, death: crude HR=6.63, P=0.001, 95%CI=3.4–1.6, for those with additional comorbidities).
Conclusion: The potential morbidity and mortality risks of hypertension especially with other comorbidities in COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future antiviral interventions.