Early prediction for severe COVID-19 with hypertension and intervention

Abstract

Background To identify the early predictors of severe coronavirus disease 2019 (COVID-19) with hypertension,explore antihypertensive drugs with potential therapeutic effects, and provide a basis for clinical prediction and treatment decisions. Method: A retrospective study was performed on all included cases. Results A total of 68 COVID-19 patients with hypertension were included,27 (39.7%) was severe and 41 (60.3%) was non-severe. Between the non-severe group (n = 41) and the severe group (n = 27),number of elevated B-type natriuretic peptide (BNP) and abnormal renal function,and albumin,lactate dehydrogenase,ultrasensitive troponin I,PH Value,arterial carbon dioxide partial pressure,sodium,osmotic pressure (OP),blood sugar (BS) and oxygenation index (OI) are significantly different.While age, male gender,comorbidities with diabetes or atherosclerotic cardiovascular disease,smoking history,number of abnormal liver function,heart rate,respiratory rate, blood pressure,white blood cell count,hematocrit,potassium and lactic acid are statistically insignificant.Four independent predictors of BNP (P = .026),OP (P = .004),BS (P = .017) and OI (P = .001) are obtained through multivariate binary logistic regression model.The area under curve (AUC) of receiver operating characteristic (ROC) of model is 0.904 ([95%CI] [0.832–0.976];P = .000),with excellent performance.Compared with blank control group (n = 27) and other antihypertensive drugs group (n = 20),OP ([287.3 ± 5.7] vs [283.5 ± 6.1];P = .045) ([287.3 ± 5.7] vs [281.9 ± 5.4];P = .007) in renin-angiotensin-aldosterone system (RAS) inhibitors group (n = 21) have increased significantly.Compared with controlled blood pressure group (n = 30),OP ([285.7 ± 6.2] vs [282.2 ± 5.2];P = .012) of uncontrolled group (n = 38) increased significantly. Conclusion Decreased OP and OI, increased BNP and BS are early predictors for severe COVID-19 patients with hypertension.For poorly controlled blood pressure,targeting RAS and OP,early use of RAS inhibitors or combination with loop diuretics may be an effective treatment.