Hypertension and COVID-19 (multiple reviews)
What is this? Some patients with COVID-19 will have pre-existing high blood pressure or hypertension, which may affect the impact of COVID-19 on them. Several relevant systematic reviews have been done and their findings are summarised here. More details of these reviews, including citations and links to their full text, are available lower down this page.
What was found: Several reviews have noted that hypertension was associated with poorer outcomes for COVID-19 patients. These include more severe infection and disease progression, increased need for ICU admission and higher mortality.
Four reviews assessed the impact of a particular antihypertensive treatment group (RAS inhibitors, including ACE inhibitors and angiotensin II receptor blockers (ARBs), which are often prescribed for hypertension). These reviews did not report any increased risk of COVID-19 infection, severity of infection or mortality from infection with the use of these medications, and some reviews reported a protective effect from ACE inhibitors or ARB antihypertensive treatment in COVID-19 patients.
What are the reviews:
Citation: Borges do Nascimento IJ, Cacic N, Abdulazeem HM, et al. Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis. Journal of Clinical Medicine. 2020;9:941
In this rapid scoping review, the authors searched for observational research on the clinical, epidemiological, testing and imaging characteristics of SARS-CoV-2. They did not restrict their searches by type or language of publication and searched for studies published between 1 January 2019 and 24 February 2020. They identified a total of 60 observational studies (59,254 patients) and did meta-analysis of clinical and laboratory data, including that relating to hypertension.
Citation: Emami A, Javanmardi F, Pirbonyeh N, et al. Prevalence of underlying diseases in hospitalized patients with COVID-19: A systematic review and meta-analysis. Archives of Academic Emergency Medicine. 2020;8(1):e35
In this rapid systematic review, the authors searched for articles reporting clinical characteristics or epidemiological information for hospitalized patients with COVID-19. They did not restrict their searches by type or language of publication (but only evaluated the abstracts for articles published in Chinese) and did the search up to 16 February 2020. They included 7 cross-sectional studies that reported on the prevalence of hypertension in COVID-19 patients.
Citation: Hu Y, Sun J, Dai Z, et al. Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis. Journal of Clinical Virology. 2020 April 14:104371.
Free to view: No
In this rapid review, the authors searched for research evaluating the prevalence and severity of illness for COVID-19 patients. They did not restrict their searches by language of publication and did the search on 10 March 2020. They included a total of 21 clinical studies (total: 47,344 patients), which were from China (20 studies) and Singapore (1); some of which reported on hypertension.
Citation: Mackey K, King VJ, Gurley S, et al. Risks and Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers on SARS-CoV-2 Infection in Adults: A Living Systematic Review. Annals of Internal Medicine. 2020;173(3):195-203.
In this living systematic review, the authors searched for studies that examined associations and effects of ACE inhibitors s or ARBs on risk for SARS-CoV-2 infection and COVID-19 disease severity and mortality in adults. They did not restrict their searches by language of publication and did the search for this version of the review on 4 May 2020. They included 14 observational studies and identified 4 ongoing randomized trials testing ACEIs or ARBs as treatments for COVID-19.
Citation: Parveen R, Sehar N, Bajpai R, et al. Association of diabetes and hypertension with disease severity in COVID-19 patients: A systematic literature review and exploratory meta-analysis. Diabetes Research and Clinical Practice. 2020 Aug 1;166:108295.
In this rapid review, the authors searched for studies that evaluated the association between diabetes and hypertension, and COVID-19 severity and outcomes. They included studies published in English up to 31 March 2020. They identified 3 cohort studies and 4 case series (total: 2018 participants), all conducted in China.
Citation: Pirola CJ, Sookoian S. Estimation of RAAS-Inhibitor effect on the COVID-19 outcome: A Meta-analysis. Journal of Infection. 2020:81(2);276-81.
In this rapid review, the authors searched for studies assessing the association between ACE inhibitors and ARB treatments for hypertension and COVID-19 severity. They restricted their search to studies published in English and searched from December 2019 to 9 May 2020. They included 16 studies from a range of countries (total: 24,676 participants).
Citation: Pranata R, Lim MA, Huang I, et al. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression. Journal of the renin-angiotensin-aldosterone system: JRAAS. 2020 Apr-Jun;21(2).
In this rapid review, the authors searched for research studies enrolling adult COVID-19 patients with information on hypertension and outcomes of interest (mortality, severe disease, acute respiratory distress syndrome, intensive care unit care and disease progression). They restricted their searches to studies with at least 20 patients that were published in English and did the search on 7 April 2020. They included 30 observational studies, most of which were published as pre-prints at the time of the review.
Citation: Tian W, Jiang W, Yao J, et al. Predictors of mortality in hospitalized COVID‐19 patients: A systematic review and meta‐analysis. Journal of Medical Virology. 2020 Oct;92(10):1875-83.
In this rapid review, the authors searched for studies on predictors of mortality in hospitalized COVID-19 patients. They did not restrict their searches by language and searched for articles published between 1 January 2020 and 24 April 2020. They included 11 studies with information on hypertension.
Citation: Usman MS, Siddiqi TJ, Khan MS, et al. A Meta-Analysis of the Relationship Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19. American Journal of Cardiology. 2020 Jun 2:130;159-61.
For this meta-analysis, the authors searched for studies examining the risk of testing positive for COVID-19 or the risk of mortality in COVID-positive patients for hypertensive patients prescribed RAAS inhibitors versus those not using these drugs. They did the search in May 2020. They included 8 studies (total: 62,706 patients) from China (4 studies), Italy (1) and USA (3).
Citation: Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. International Journal of Infectious Diseases. 2020;94:91-5.
In this rapid review, the authors searched for studies which described the epidemiological, clinical features of COVID-19, and the prevalence of chronic diseases in COVID-19 patients. They restricted their search to articles published since January 2019 and did the search on 25 February 2020. They included 4 studies which provided data on the prevalence of hypertension in COVID-19 patients.
Citation: Zhang J, Wu J, Sun X, et al. Association of hypertension with the severity and fatality of SARS-CoV-2 infection: A meta-analysis. Epidemiology & Infection. 2020;148:e106.
In this meta-analysis, the authors searched for research studies exploring the relationship between hypertension and clinically severe COVID-19 patients in China. They restricted their searches to articles published in English and Chinese, between December 2019 and 20 March 2020. They included 18 retrospective studies, 12 analyzing COVID-19 severity and 6 analyzing COVID-19 mortality in patients with hypertension.
Citation: Zhang X, Yu J, Pan LY, et al. ACEI/ARB use and risk of infection or severity or mortality of COVID-19: a systematic review and meta-analysis. Pharmacological Research. 2020 May 15:104927.
In this systematic review and meta-analysis, the authors searched for research into the effects of ACE inhibitors and ARB treatments compared to other anti-hypertensives in COVID-19 patients. They did not restrict their searches by type or language of publication and searched for articles published between January 2020 and 9 May 2020. They included 7 cohort studies and 5 case-control studies, with more than 19,000 patients included.
Citation: Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of Infection 2020 Aug:81(2):e16-e25.
Free to view: No
In this rapid review, the authors searched for research into risk factors for the progression of COVID-19 disease. They did not limit by language of publication and did their search on 20 March 2020. They identified a total of 13 studies (3027 patients).
Other reviews of this topic:
Citation: Pranata R, Permana H, Huang I, et al. The use of renin angiotensin system inhibitor on mortality in patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020:14(5);983-90.
Citation: Zaki N, Alashwal H, Ibrahim S. Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: a systematic review. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2020 Sep 1;14(5):1133-42.
Other combined summary topics related to this topic: