Evaluation of the relationship of hypertension and mortality in COVID-19 patients addressed to the intensive care unit

Purpose: Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus (SARS-CoV-2). It is known that this disease, which affects millions of people worldwide, causes higher mortality and morbidity, especially in elderly people and people with known hypertension, diabetes and obesity. In this study, we aimed to evaluate the relationship between hypertension and mortality in COVID-19 patients in our pandemic hospital. Methods: In our study, demographic information, additional diseases, antihypertensive drugs used, vital signs, and laboratory values of 434 patients diagnosed with COVID-19 and hospitalized in the Intensive Care Unit of Dicle University Pandemic Hospital between March 2020 and September 2021 were retrospectively analyzed. As a result of the intensive care observation, the clinical results of the patients were recorded according to whether they were discharged or exited, and the relationship between hypertension, ACEi use, and additional diseases with mortality in patients with a diagnosis of COVID-19 was evaluated. Results: Of the 434 patients included in the study, 256 (59%) were male and 178 (41%) were female. The mean age was 66.4 ±14.7 years. When the comorbidities of the patients were evaluated, 50.9% of the cases were diagnosed with HT, 24.9% with DM, 10.9% with Lung Diseases (Asthma-COPD-Bronchiectasis), 18.9% with Heart diseases (CAD-HF). , 11.5% had CKD, 9.9% had malignancies, 29.5% of the cases had no additional disease. It was determined that the hypertensive patients used ACEi/ARB in 29.8%, calcium channel blockers in 73.3%, beta-blockers in 44.7%, alpha-blockers in 7.6% and diuretics in 12.2%. When antihypertensive use was evaluated as monotherapy and multiple therapy, it was seen that 54.7% of hypertensive patients used single antihypertensive, 27.1% dual antihypertensive, 15.8% triple antihypertensive, 2.2% quadruple antihypertensive use. When the blood pressure measurements of the COVID-19 patients participating in our study were classified according to JNC 7, it was found that 29.5% Normal, 19.6% Pre-hypertensive, 35.3% Stage-1 HT, 15.7% Stage-2 HT. Considering the relationship between the presence of additional disease and mortality, 54.6% of those with comorbid disease and 44.5% of those without comorbid disease were found to be dead, the difference was statistically significant (p=0.05).When the relationship between the presence of hypertension and mortality among the patients participating in the study was evaluated; Of 221 patients with hypertension, 56.6% died and 43.4% were discharged. A statistically significant relationship was found between the two groups (p<0.03). When the classification of the blood pressure measurements of the patients according to JNC-7 and the mortality relationship were evaluated, 47.7% of the patients with normal blood pressure, 44.7% of the patients with pre-hypertensive, 56.9% of the patients with stage-1 and 55.9% of the patients with stage-2 were found to be dead. There was no statistically significant difference between the groups. When the correlation between the anti-hypertensive drugs used by the hypertensive patients participating in our study and the mortality was evaluated; It was observed that 42.4% of the patients using ACEi and 62.6% of the non-users were dead, the difference was statistically significant (p<0.02). Conclusion: The presence of comorbidity in COVID-19 patients is one of the most important factors in terms of mortality. Hypertension represents one of the most common comorbidities in COVID-19 patients. Patients with COVID-19 have a higher mortality rate when hypertension is accompanied. Patients with RAAS inhibitors were not exposed to a higher risk of mortality in our study, and the use of RAAS inhibitors has been shown to be associated with a lower risk of mortality. However, it should be considered that there is no significant additional risk for continuing RAAS inhibitors in patients with COVID-19 infection. Keywords: COVID-19, Hypertension, RAAS, ACEi, Mortality