Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
Universitat Autonoma de Barcelona, Barcelona, Spain.
BMJ Open. 2021 Dec 22;11(12):e057632. doi: 10.1136/bmjopen-2021-057632.
To characterise patients with and without prevalent hypertension and COVID-19 and to assess adverse outcomes in both inpatients and outpatients.
This is a retrospective cohort study using 15 healthcare databases (primary and secondary electronic healthcare records, insurance and national claims data) from the USA, Europe and South Korea, standardised to the Observational Medical Outcomes Partnership common data model. Data were gathered from 1 March to 31 October 2020.
Two non-mutually exclusive cohorts were defined: (1) individuals diagnosed with COVID-19 (diagnosed cohort) and (2) individuals hospitalised with COVID-19 (hospitalised cohort), and stratified by hypertension status. Follow-up was from COVID-19 diagnosis/hospitalisation to death, end of the study period or 30 days.
Demographics, comorbidities and 30-day outcomes (hospitalisation and death for the 'diagnosed' cohort and adverse events and death for the 'hospitalised' cohort) were reported.
We identified 2 851 035 diagnosed and 563 708 hospitalised patients with COVID-19. Hypertension was more prevalent in the latter (ranging across databases from 17.4% (95% CI 17.2 to 17.6) to 61.4% (95% CI 61.0 to 61.8) and from 25.6% (95% CI 24.6 to 26.6) to 85.9% (95% CI 85.2 to 86.6)). Patients in both cohorts with hypertension were predominantly >50 years old and female. Patients with hypertension were frequently diagnosed with obesity, heart disease, dyslipidaemia and diabetes. Compared with patients without hypertension, patients with hypertension in the COVID-19 diagnosed cohort had more hospitalisations (ranging from 1.3% (95% CI 0.4 to 2.2) to 41.1% (95% CI 39.5 to 42.7) vs from 1.4% (95% CI 0.9 to 1.9) to 15.9% (95% CI 14.9 to 16.9)) and increased mortality (ranging from 0.3% (95% CI 0.1 to 0.5) to 18.5% (95% CI 15.7 to 21.3) vs from 0.2% (95% CI 0.2 to 0.2) to 11.8% (95% CI 10.8 to 12.8)). Patients in the COVID-19 hospitalised cohort with hypertension were more likely to have acute respiratory distress syndrome (ranging from 0.1% (95% CI 0.0 to 0.2) to 65.6% (95% CI 62.5 to 68.7) vs from 0.1% (95% CI 0.0 to 0.2) to 54.7% (95% CI 50.5 to 58.9)), arrhythmia (ranging from 0.5% (95% CI 0.3 to 0.7) to 45.8% (95% CI 42.6 to 49.0) vs from 0.4% (95% CI 0.3 to 0.5) to 36.8% (95% CI 32.7 to 40.9)) and increased mortality (ranging from 1.8% (95% CI 0.4 to 3.2) to 25.1% (95% CI 23.0 to 27.2) vs from 0.7% (95% CI 0.5 to 0.9) to 10.9% (95% CI 10.4 to 11.4)) than patients without hypertension.
COVID-19 patients with hypertension were more likely to suffer severe outcomes, hospitalisations and deaths compared with those without hypertension.
描述同时患有和不患有高血压和 COVID-19 的患者，并评估住院患者和门诊患者的不良结局。
这是一项回顾性队列研究，使用了来自美国、欧洲和韩国的 15 个医疗保健数据库（初级和二级电子医疗记录、保险和国家索赔数据），这些数据库已经标准化为观察性医疗结果伙伴关系的通用数据模型。数据收集时间为 2020 年 3 月 1 日至 10 月 31 日。
定义了两个非互斥队列：（1）被诊断为 COVID-19 的个体（诊断队列）和（2）因 COVID-19 住院的个体（住院队列），并根据高血压情况进行分层。随访时间从 COVID-19 诊断/住院到死亡、研究结束或 30 天。
我们确定了 2851035 名被诊断为 COVID-19 的患者和 563708 名因 COVID-19 住院的患者。后者高血压更为普遍（各数据库的范围从 17.4%（95%CI 17.2 至 17.6）到 61.4%（95%CI 61.0 至 61.8），从 25.6%（95%CI 24.6 至 26.6）到 85.9%（95%CI 85.2 至 86.6））。两个队列中患有高血压的患者年龄均较大，且多数为女性。患有高血压的患者常被诊断为肥胖、心脏病、血脂异常和糖尿病。与没有高血压的患者相比，COVID-19 诊断队列中患有高血压的患者住院治疗的比例更高（范围从 1.3%（95%CI 0.4 至 2.2）到 41.1%（95%CI 39.5 至 42.7），从 1.4%（95%CI 0.9 至 1.9）到 15.9%（95%CI 14.9 至 16.9）），死亡率也更高（范围从 0.3%（95%CI 0.1 至 0.5）到 18.5%（95%CI 15.7 至 21.3），从 0.2%（95%CI 0.2 至 0.2）到 11.8%（95%CI 10.8 至 12.8））。COVID-19 住院患者中患有高血压的患者更有可能患有急性呼吸窘迫综合征（范围从 0.1%（95%CI 0.0 至 0.2）到 65.6%（95%CI 62.5 至 68.7），从 0.1%（95%CI 0.0 至 0.2）到 54.7%（95%CI 50.5 至 58.9））、心律失常（范围从 0.5%（95%CI 0.3 至 0.7）到 45.8%（95%CI 42.6 至 49.0），从 0.4%（95%CI 0.3 至 0.5）到 36.8%（95%CI 32.7 至 40.9））和死亡率更高（范围从 1.8%（95%CI 0.4 至 3.2）到 25.1%（95%CI 23.0 至 27.2），从 0.7%（95%CI 0.5 至 0.9）到 10.9%（95%CI 10.4 至 11.4））。
与没有高血压的患者相比，COVID-19 合并高血压的患者更有可能出现严重结局、住院和死亡。
