Coronavirus patients with high blood pressure face TWICE the risk of dying from the disease, study finds
- Researchers combed through the data of some 2,900 patients in China
- The risk of death was even higher in those who were not taking their medication
- They also show that certain drugs for hypertension may be protective
- Previously its been feared these common drugs may be dangerous
- Here’s how to help people impacted by Covid-19
Coronavirus patients with high blood pressure face twice the risk of dying from the disease, according to a study.
Researchers combed through the data of 2,900 patients in China, almost a third of whom had hypertension - the medical term for high blood pressure.
Results showed the risk of death was even higher for patients who were not taking medication to control their blood pressure.
The findings add to the wealth of evidence that points towards high blood pressure as a significant risk factor for Covid-19 mortality.
They also show ACE inhibitors and ARBs - hypertension drugs - do not increase the risk of Covid-19, contrary to claims made early on in the crisis.
The pills, prescribed to millions of people a year under the names Ramipril, Losartan, Lisinopril and Candesartan, may even be protective.
The study, published in the European Heart Journal, revealed how many patients with high blood pressure died compared to those without. It also showed that those who were not taking their medication were even more at risk of death
The study was published in the European Heart Journal today, and was conducted by two teams in China and Ireland.
Researchers led by Professors Fei Li and Professor Ling Tao from the Xijing Hospital analysed a total of 2,866 patients.
They had all been admitted to Huo Shen Shan hospital in Wuhan, China, where the coronavirus first appeared, between February 5 and March 15.
Of these patients, 29.5 per cent (850) had a medical history of high blood pressure.
Out of those, four per cent (34) with coronavirus died compared to 1.1 per cent (22) of the 2,027 patients without hypertension.
Statistical analysis found this was a 2.12-fold increased risk, after other factors taht may have affected the results, such as age, sex and underlying conditions, were taken into account.
Patients whose blood pressure was too high but were not taking medication for the condition, were at a 2.17-fold increased risk.
Almost eight per cent (11 out 140) of those patients died, compared to 3.2 per cent of those who were taking medication (23 out of 710).
Professor Li said: 'It is important that patients with high blood pressure realise that they are at increased risk of dying from COVID-19. They should take good care of themselves during this pandemic and they need more attention if they are infected with the coronavirus.
'In addition, there were 140 patients admitted to hospital with COVID-19 who had discontinued their anti-hypertensive treatment due to various reasons. We found that this was associated with a greater risk of dying from the coronavirus.'
A previous study in China found that high blood pressure increases the risk of death in Covid-19 patients by 70 per cent. While another showed a 3-fold increase of death in hospitalised Covid-19 patients.
Experts have explained that people with high blood pressure have narrower vessels, which may worsen Covid-19 symptoms.
Dr Hajira Dambha-Miller, a GP and clinical lecturer, told MailOnline this means immune cells in the blood are not able to reach the virus as quickly as needed.
It may also slow the route of oxygen to vital organs which are having to work harder to fight the virus.
The second part of the research pooled data from 2,300 patients who were involved with three separate studies.
The team hypothesised that angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) would put patients at further risk.
But they could not prove this, and even found some sort of protective effect.
Scientists at University Hospital Basel, in Switzerland, and the University of Thessaloniki in Greece were the first to raise concerns earlier in the pandemic that these drugs may make the coronavirus worse.
They said data suggest that diabetes and treatment with ACE inhibitors and ARBs increases the expression of ACE2 receptors.
It's these receptors that coat the cells of the body that the coronavirus sticks to in order to infiltrate cells.
'Consequently, the increased expression of ACE2 would facilitate infection with COVID-19,' the researchers wrote in their paper published in the prestigious British medical journal The Lancet Respiratory Medicine.
But other experts said there was no solid proof of the link, and people on the drugs should not stop taking them.
The research into whether ACE inhibitors and ARBs affect the expression of ACE-2 is limited.
And even if it does, whether this increases the likelihood of picking up the coronavirus isn't proven.
A study published by the Centers for Disease Control and Prevention of more than 72,000 patients in China found six per cent of people with high blood pressure (one in 16.6 people) died. This compared with 0.9 per cent in people who did not have a condition
Research of almost 1,600 hospital patients in China found ICU, ventilation or death risk rose by 60 per cent for Covid-19 patients who had high blood pressure
ACE inhibitors and ARBS both work to block angiotensin II, a chemical that narrows blood vessels. By doing so, they help widen blood vessels to allow blood to flow more easily, which lowers blood pressure.
These hormones are regulated by the renin-angiotensin-aldosterone system (RAAS), so the drugs are known as RAAS inhibitors.
Other, non-RAAS inhibiting drugs used for treating high blood pressure include beta blockers, calcium channel blockers (CCBs) or diuretics, which work in other ways.
Professor Li said: 'We were quite surprised these results did not support our initial hypothesis.
'In fact, the results were in the opposite direction, with a trend in favour of ACE inhibitors and ARBs.
'We think this is exactly why practice based on clinical evidence is more vital than ever.'
Professor Tao said: 'These data should be interpreted cautiously. However, they support recommendations for the European Society of Cardiology that patients should not discontinue or change their normal, antihypertensive treatment.'
The study is observational which means a correlation was found but it cannot prove a cause and effect.
More results from randomised controlled clinical trials - deemed the gold-standard type of research - are needed to look at the role played by RAAS inhibitors.
One is being conducted at the National University of Ireland Galway by researchers who co-authored this paper.
- Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis | European Respiratory Society
- Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention | Global Health | JAMA | JAMA Network
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