Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study

Abstract

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 62,020 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 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.

Perceptions of COVID–19-related Risks and Deaths Among Health Care Professionals During COVID-19 Pandemic in Pakistan: A Cross-sectional Study

“…Similar findings have been reported in studies where the COVID-19-related mortality is reported to be associated with comorbid health conditions. 24,25 Although our participants working in the wards/ICUs rated these places as high-risk workplaces, the literature showed that working in the intensive care unit was not associated with increased risk of infection possibly due to protection afforded by high levels of PPEs and a decrease in infectivity that occurs in the later stages of illness although among critically ill patients. 26,27 To the best of our knowledge, this study about the perceptions of HCPs and particularly doctors in Pakistan about risks and deaths associated with COVID-19 is the first survey conducted in Pakistan.…”

Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review

“…Four studies found preexisting CVD was associated with higher COVID-19 mortality, including 2 high-quality studies using databases from South Africa to pool together large samples. 10,11,31,32 In a national hospital registry across South Africa with 219 265 COVID-19 patients, 39% had hypertension and 23% died. 32 Both hypertension and CVD were associated with a higher adjusted odds of COVID-19 mortality (hypertension: aOR, 1.1 [95% CI, 1.0-1.1]; CVD: aOR, 2.2 [95% CI, 2.1-2.3]) after adjusting for age, race, diabetes, chronic cardiac disease, chronic renal disease, malignancy, tuberculosis, HIV, admission month, health sector, and province.…”

“…The largest and highest quality evidence from SSA indicates a strong association between preexisting hypertension and CVD and COVID-19 severity and death. 10,11,31,32 Studies on preexisting hypertension or CVD on emerging viral infections showed that hypertension and CVD increased the chance of severe COVID-19 (RR, 2.5) in studies on the individual level but no association on the country level in ecological studies, perhaps because average country summary measures are often inaccurate in SSA. The association between hypertension or CVD on COVID-19 mortality was more thoroughly explored, with higher odds and RRs for CVD (2.2-6.6) than for hypertension (1.1-2.3) after multivariable adjustment in South Africa, Nigeria, Burkina Faso, and Guinea.…”

“…Four large studies found a statistically significant association between preexisting hypertension, CVD, and higher COVID-19 infection rates or severity with median age ranging from 28 to 41 years and female sex ranging from 30% to 37% of study populations. [9][10][11][12] In a retrospective cohort of 2617 patients identified through community screening in Ethiopia, 3% had hypertension or CVD, and these were associated with a higher risk ratio (RR) for severe COVID-19 (RR, 2.5 [95% CI, 1.5-4.2]). 9 A cohort study among isolation centers in urban Nigeria found among 2071 patients, 18% had hypertension and 0.7% had CVD.…”

Obstructive lung diseases burden and COVID-19 in developing countries: a perspective

“…The ongoing 2019 coronavirus disease (COVID- 19) pandemic results from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At the time of undertaking this review, the global burden of COVID-19 exceeded 225 million (about 2.9% of the world population) [1].…”