This preprint is under consideration at Global Health Research and Policy. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Research
Akin Osibogun
University of Lagos College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0788-9143
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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. 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, being discharged after recovery or being evacuated/transferred.
Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher’s exact tests were used in determining associations between variables. Kaplan–Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant.
Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality 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 (age and sex), severe COVID-19and 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} {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}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple 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.
Keywords
COVID-19, Nigeria, Hypertension, comorbidities, coronavirus, SARS-CoV-2 virus, pandemic
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Community comments: 1
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Received 05 Apr, 2021
Reviewer #1 agreed
On 08 Feb, 2021
Reviewers invited
Invitations sent on 20 Dec, 2020
Editor assigned
On 20 Dec, 2020
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On 20 Dec, 2020
Editor invited
On 20 Dec, 2020
First submitted
On 17 Dec, 2020
Editorial decision: Minor revision
On 28 Sep, 2020
No comments provided
Review #2 received
Received 02 Dec, 2020
Editorial decision: Minor revision
On 02 Dec, 2020
Reviewer #3 agreed
On 17 Nov, 2020
Reviewer #2 agreed
On 17 Nov, 2020
Review #1 received
Received 01 Nov, 2020
Reviewer #1 agreed
On 23 Oct, 2020
Editor assigned
On 22 Oct, 2020
Reviewers invited
Invitations sent on 22 Oct, 2020
Submission checks complete
On 21 Oct, 2020
Editor invited
On 21 Oct, 2020
No comments provided
Editorial decision: Major revision
On 29 Sep, 2020
Review #3 received
Received 24 Sep, 2020
Review #2 received
Received 23 Sep, 2020
Review #1 received
Received 21 Sep, 2020
Reviewer #2 agreed
On 09 Sep, 2020
Reviewer #3 agreed
On 09 Sep, 2020
Reviewer #1 agreed
On 08 Sep, 2020
Reviewers invited
Invitations sent on 07 Sep, 2020
Editor assigned
On 31 Aug, 2020
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Editor invited
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This preprint is under consideration at Global Health Research and Policy. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Akin Osibogun
University of Lagos College of Medicine
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0788-9143
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version (no preprint)
Posted 05 Jan, 2021
This version was not preprinted
Version 3
Posted 05 Jan, 2021
Community comments: 1
Review #1 received
Received 05 Apr, 2021
Reviewer #1 agreed
On 08 Feb, 2021
Reviewers invited
Invitations sent on 20 Dec, 2020
Editor assigned
On 20 Dec, 2020
Submission checks complete
On 20 Dec, 2020
Editor invited
On 20 Dec, 2020
First submitted
On 17 Dec, 2020
Editorial decision: Minor revision
On 28 Sep, 2020
No comments provided
Review #2 received
Received 02 Dec, 2020
Editorial decision: Minor revision
On 02 Dec, 2020
Reviewer #3 agreed
On 17 Nov, 2020
Reviewer #2 agreed
On 17 Nov, 2020
Review #1 received
Received 01 Nov, 2020
Reviewer #1 agreed
On 23 Oct, 2020
Editor assigned
On 22 Oct, 2020
Reviewers invited
Invitations sent on 22 Oct, 2020
Submission checks complete
On 21 Oct, 2020
Editor invited
On 21 Oct, 2020
No comments provided
Editorial decision: Major revision
On 29 Sep, 2020
Review #3 received
Received 24 Sep, 2020
Review #2 received
Received 23 Sep, 2020
Review #1 received
Received 21 Sep, 2020
Reviewer #2 agreed
On 09 Sep, 2020
Reviewer #3 agreed
On 09 Sep, 2020
Reviewer #1 agreed
On 08 Sep, 2020
Reviewers invited
Invitations sent on 07 Sep, 2020
Editor assigned
On 31 Aug, 2020
First submitted
On 30 Aug, 2020
Submission checks complete
On 30 Aug, 2020
Editor invited
On 30 Aug, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Policy
License:
This work is licensed under a CC BY 4.0 License. Read Full License
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. 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, being discharged after recovery or being evacuated/transferred.
Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher’s exact tests were used in determining associations between variables. Kaplan–Meier survival analysis and Cox regression were performed to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value ≤0.05 was considered statistically significant.
Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality 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 (age and sex), severe COVID-19and 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} {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}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and death (approx. 7-fold) from COVID-19 in the presence of multiple 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.
Figure 1
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