MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, Hunan Province, 410081, China.
Key Laboratory of Molecular Epidemiology, Medical College of Hunan Normal University, Changsha, Hunan Province, 410013, China.
Nutr Metab Cardiovasc Dis. 2021 Mar 10;31(3):745-755. doi: 10.1016/j.numecd.2020.12.009. Epub 2020 Dec 11.
As reported, hypertension may play an important role in adverse outcomes of coronavirus disease-2019 (COVID-19), but it still had many confounding factors. The aim of this study was to explore whether hypertension is an independent risk factor for critical COVID-19 and mortality.
The Medline, PubMed, Embase, and Web of Science databases were systematically searched until November 2020. Combined odds ratios (ORs) with their 95% confidence interval (CIs) were calculated by using random-effect models, and the effect of covariates was analyzed using the subgroup analysis and meta-regression analysis. A total of 24 observational studies with 99,918 COVID-19 patients were included in the meta-analysis. The proportions of hypertension in critical COVID-19 were 37% (95% CI: 0.27 -0.47) when compared with 18% (95% CI: 0.14 -0.23) of noncritical COVID-19 patients, in those who died were 46% (95%CI: 0.37 -0.55) when compared with 22% (95% CI: 0.16 -0.28) of survivors. Pooled results based on the adjusted OR showed that patients with hypertension had a 1.82-fold higher risk for critical COVID-19 (aOR: 1.82; 95% CI: 1.19 - 2.77; P = 0.005) and a 2.17-fold higher risk for COVID-19 mortality (aOR: 2.17; 95% CI: 1.67 - 2.82; P < 0.001). Subgroup analysis results showed that male patients had a higher risk of developing to the critical condition than female patients (OR: 3.04; 95%CI: 2.06 - 4.49; P < 0.001) and age >60 years was associated with a significantly increased risk of COVID-19 mortality (OR: 3.12; 95% CI: 1.93 - 5.05; P < 0.001). Meta-regression analysis results also showed that age (Coef. = 2.3×10, P = 0.048) had a significant influence on the association between hypertension and COVID-19 mortality.
Evidence from this meta-analysis suggested that hypertension was independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.
据报道，高血压可能在 2019 年冠状病毒病（COVID-19）的不良结局中起重要作用，但仍存在许多混杂因素。本研究旨在探讨高血压是否是 COVID-19 重症和死亡的独立危险因素。
系统检索了 Medline、PubMed、Embase 和 Web of Science 数据库，直至 2020 年 11 月。采用随机效应模型计算合并优势比（OR）及其 95%置信区间（CI），并采用亚组分析和荟萃回归分析来分析协变量的影响。荟萃分析共纳入 24 项观察性研究，共 99918 例 COVID-19 患者。与非重症 COVID-19 患者（95%CI：0.14-0.23）相比，重症 COVID-19 患者中高血压的比例为 37%（95%CI：0.27-0.47），死亡患者中高血压的比例为 46%（95%CI：0.37-0.55），而幸存者中高血压的比例为 22%（95%CI：0.16-0.28）。基于调整后的 OR 的汇总结果表明，高血压患者发生 COVID-19 重症的风险增加 1.82 倍（aOR：1.82；95%CI：1.19-2.77；P=0.005），COVID-19 死亡的风险增加 2.17 倍（aOR：2.17；95%CI：1.67-2.82；P<0.001）。亚组分析结果表明，男性患者发展为重症的风险高于女性患者（OR：3.04；95%CI：2.06-4.49；P<0.001），年龄>60 岁与 COVID-19 死亡风险显著增加相关（OR：3.12；95%CI：1.93-5.05；P<0.001）。荟萃回归分析结果还表明，年龄（Coef. = 2.3×10，P = 0.048）对高血压与 COVID-19 死亡率之间的关联有显著影响。
本荟萃分析的证据表明，高血压与 COVID-19 重症和 COVID-19 住院死亡率显著增加独立相关。
