A team of five global cardiology experts at NUI Galway have collaborated to interpret a study into high blood pressure linked to increased risk of dying from COVID-19.
The study has found that patients with raised blood pressure have a two-fold increased risk of dying from the coronavirus COVID-19 compared to patients without high blood pressure, according to new research published in the European Heart Journal today (Friday, 5 June) as a fast track publication.
In addition, the study found that patients with high blood pressure who were not taking medication to control the condition were at even greater risk of dying from COVID-19.
Professors Patrick W. Serruys, Osama Soliman and Yoshi Onuma recently enhanced the contingent of global experts in the field of cardiology at NUI Galway, which includes Professor William Wijns and Professor McEvoy, all co-authors on this paper.
The expert team at NUI Galway collaborated with a team in China and have analysed data from 2866 patients with COVID-19 who were admitted to Huo Shen Shan hospital in Wuhan, China, between 5 February and 15 March 2020. Of these patients, 29.5% (850) had a medical history of high blood pressure (hypertension). They found that 34 out of 850 hypertensive patients (4%) with coronavirus died compared to 22 out of 2027 patients without hypertension (1.1%) – a 2.12-fold increased risk after adjustment for factors that could affect the results, such as age, sex and other medical conditions.
Among the patients with hypertension who were not taking medication for the condition, 11 out 140 (7.9%) died from coronavirus compared to 23 out of 710 (3.2%) of those who were taking medication – 2.17-fold increased risk after adjusting for confounding factors.
As fewer cases of COVID-19 are being diagnosed now in China, a grant for a randomised clinical trial has been submitted at NUI Galway by Professors J. William McEvoy and Patrick Serruys, who are co-authors of the EHJ paper.
In a meta-analysis, the researchers pooled the data from the Huo Shen Wan patients with data from nearly 2,300 patients in three other studies to investigate the death rates in patients being treated with drugs to control blood pressure levels by targeting the renin-angiotensin-aldosterone system (RAAS). These drugs include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Other, non-RAAS inhibiting drugs used for treating high blood pressure include beta blockers, calcium channel blockers (CCBs) or diuretics. They found a lower risk of death among the 183 patients treated with RAAS inhibitors than in 527 patients treated with other drugs. However, the researchers say this result should be treated with caution as the number of patients in this analysis was small and so it could be due to chance.
Professor Patrick W. Serruys said: “There are three remaining questions, and we hope our clinical trial in Ireland will answer the first two: what kind of medication should be given to COVID-19 patients with hypertension – RAAS inhibitors or non-RAAS inhibitors – and could these medications mitigate the risk of dying in these patients? The last question is whether or not RAAS inhibitors influence the risk of infection for COVID-19.”
“As for the last question, a recent population-based study in the New England Journal of Medicine has suggested that antihypertensive medications, such as ACE inhibitors and ARBs are not associated with an increased risk of testing positive for COVID-19.”
As this is a retrospective and observational study, it cannot show a causal relationship between RAAS inhibitors and the risk of dying from COVID-19. Other limitations include the inability to include all relevant confounding factors; some data, such as electrocardiograms (ECGs) were not recorded in detail; and the impact of antihypertensive medications can only be assessed in the short-term, with prospective studies needed to see longer-term effects.