Fresán Ujué, Guevara Marcela, Trobajo-Sanmartín Camino, Burgui Cristina, Ezpeleta Carmen, Castilla Jesús
Instituto de Salud Pública de Navarra, 31003 Pamplona, Spain.
CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
J Clin Med. 2021 Mar 12;10(6):1194. doi: 10.3390/jcm10061194.
The independent role of hypertension for COVID-19 outcomes in the population remains unclear. We aimed to estimate the independent effect of hypertension and hypertension-related conditions, i.e., cardiovascular, cerebrovascular and chronic kidney diseases, as potential risk factors for COVID-19 hospitalization and severe COVID-19 (i.e., intensive care unit admission or death) in the population. The risk for severe COVID-19 among hospitalized patients was also evaluated. A Spanish population-based cohort of people aged 25-79 years was prospectively followed from March to May 2020 to identify hospitalizations for laboratory-confirmed COVID-19. Poisson regression was used to estimate the adjusted relative risk (aRR) for COVID-19 hospitalization and severe COVID-19 among the whole cohort, and for severe COVID-19 among hospitalized patients. Of 424,784 people followed, 1106 were hospitalized by COVID-19 and 176 were severe cases. Hypertension was not independently associated with a higher risk of hospitalization (aRR 0.96, 95% CI 0.83-1.12) nor severe COVID-19 (aRR 1.12, 95% CI 0.80-1.56) in the population. Persons with cardiovascular, cerebrovascular and chronic kidney diseases were at higher risk for COVID-19 hospitalization (aRR 1.33, 95% CI 1.13-1.58; aRR 1.41, 95% CI 1.04-1.92; and aRR 1.52, 95% CI 1.21-1.91; respectively) and severe COVID-19 (aRR 1.61, 95% CI 1.13-2.30; aRR 1.91, 95% CI 1.13-3.25; and aRR 1.78, 95% CI 1.14-2.76; respectively). COVID-19 hospitalized patients with cerebrovascular diseases were at higher risk of mortality (aRR 1.80, 95% CI 1.00-3.23). The current study shows that, in the general population, persons with cardiovascular, cerebrovascular and chronic kidney diseases, but not those with hypertension only, should be considered as high-risk groups for COVID-19 hospitalization and severe COVID-19.
高血压在人群中对新冠病毒疾病（COVID-19）结局的独立作用仍不明确。我们旨在评估高血压及与高血压相关的疾病，即心血管疾病、脑血管疾病和慢性肾脏病，作为人群中COVID-19住院和重症COVID-19（即入住重症监护病房或死亡）潜在危险因素的独立影响。还评估了住院患者中发生重症COVID-19的风险。对西班牙一个基于人群的25至79岁队列进行前瞻性随访，时间为2020年3月至5月，以确定实验室确诊的COVID-19住院病例。采用泊松回归估计整个队列中COVID-19住院和重症COVID-19以及住院患者中重症COVID-19的调整相对风险（aRR）。在随访的424,784人中，1106人因COVID-19住院，176人为重症病例。在人群中，高血压与更高的住院风险（aRR 0.96，95%置信区间0.83 - 1.12）或重症COVID-19（aRR 1.12，95%置信区间0.80 - 1.56）无独立相关性。患有心血管疾病、脑血管疾病和慢性肾脏病的人发生COVID-19住院的风险更高（aRR分别为1.33，95%置信区间1.13 - 1.58；aRR 1.41，95%置信区间1.04 - 1.92；aRR 1.52，95%置信区间1.21 - 1.91）以及重症COVID-19的风险更高（aRR分别为1.61，95%置信区间1.13 - 2.30；aRR 1.91，95%置信区间1.13 - 3.25；aRR 1.78，95%置信区间1.14 - 2.76）。患有脑血管疾病的COVID-19住院患者死亡风险更高（aRR 1.80，95%置信区间1.00 - 3.23）。当前研究表明，在一般人群中，患有心血管疾病、脑血管疾病和慢性肾脏病的人，而非仅患有高血压的人，应被视为COVID-19住院和重症COVID-19的高危人群。
