A multicenter research team from China and Ireland conducted a retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital, an emergency field hospital built between January 23 and February 2, 2020 in response to the COVID-19 pandemic in the Caidian District in Wuhan, China. With results recently published in European Heart Journal, the investigators found that those patients with hypertension faced considerably higher risks of mortality associated with COVID-19. A bright note appears that if patients are treated with antihypertension medications outcomes may improve.
Between January 23 and February 2, 2020 the Huo Shen Shan Hospital was built in Wuhan as an emergency field hospital in response to the deadly outbreak of SARS-CoV-2, which has led to the COVID-19 pandemic. Located in the Caidian District in Wuhan, the hospital itself has been run under the jurisdiction and management of the People’s Liberation Army since its completion. This hospital design led to the building of another hospital called Leishenshan Hospital.
The actual hospital design was modeled after another emergency provisional hospital after the 2003 SARS epidemic known as the Xiaotangshan Hospital. With 1,400 medical personnel sent by the PLA (950 from hospitals affiliated with Joint Logistics Support Force of Central Military Commission) and 450 from medical universities of PLA deployed to Wuhan) the hospital also used medical robots in daily operations for medical delivery, test sample transport, etc.
A research team from Xijing Hospital, Huo Shen Shan Hospital, Central Hospital of Wuhan, 940 Hospital and National Hospital of Ireland Galway designed the retrospective observational study of all patients admitted with COVID-19 to Huo Shen Shan Hospital during the dates identified previously. The study team was able to collect and analyze data on 2,877 patients who were treated at the Wuhan-based facility. 29.5% of the total patients (n=850/2877) reported a history of hypertension: this patient demographic segment faced two-fold greater relative risk of death as compared to the COVID-19 patients without hypertension.
Medications Made a Difference
Apparently, hypertension is independently associated with mortality from SARS-CoV-2, when patients that had a history of hypertension discontinued or stopped taking thee medications such as renin-angiotensin-aldosterone system (RAAS) inhibitors represented by therapies such as Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) faced far higher death rates as compared to those patients who maintained adherence to their medications.
Fei Li, MD, PhD with Xijing Hospital reported, “It is important that patients with high blood pressure realize that they are at increased risk of dying from COVID-19.” Dr. Li suggests that these patients be mindful of this reality during the pandemic and urged that if someone is in fact on an anti-hypertensive and contracts SARS-CoV-2 that they need to stay on that medication or face a higher risk of death.
Observational Study has Limits
As this was not a randomized controlled trial the findings are noteworthy. First they found that those patients with hypertension that discontinued use of their medication were at greater risk for death. They noted that patients with RAAS inhibitors were not at higher risk and after the research team pooled previous research data for a study-level meta-analysis they found that the use of RAAS inhibitors actually lowered the risk of mortality. The results are observational and must be “interpreted cautiously” commented the researchers.
Hypertension in the USA & COVID-19
A dangerous situation builds in the United States as almost half of the adults in America (108 million, or 45%) have hypertension has defined as systolic blood pressure ≥ 130mm Hg or a diastolic blood pressure of ≥80 mm Hg or are taking medication for hypertension. Only about 1 in 4 adults in the United States (24%) with hypertension actually have the condition under control according to the U.S. Center for Disease Control and Prevention.
Back in April, in The Hospitalist, Richard Frank depicted a scary chart of the leading comorbidities among COVID-19 deaths in New York. By far, the number one element was hypertension at over 50%.
Ling Tao, Department of Cardiology, Xijing Hospital, Corresponding Author
Fei, Li, Department of Cardiology, Xijing Hospital; Huo Shen Shan Hospital, Wuhan China
Call to Action: COVID-19 is a massive wake-up call for America and elsewhere. The American health care system really is more of a “sick care” system in that it is geared to treat people that must try to manage these severe and dangerous conditions. Until a deadly pathogen such as SARS-CoV-2 comes along. The fact that the U.S. spends orders of magnitude more than any other nation (technology, drugs devices & diagnostics, large health system and payer bureaucracy, regulatory, lawsuits, and common seven figure executive salaries) on health care and nearly 50% of adults face hypertension as their health reality can only amount to a failure on the part of all of us. Reform must happen and it should be intensely focused on prevention; wellness and healthy living; deterrence and for those that are too far along, a far more rigorous care management. 114,149 have passed as of this writing due to the virus in what is essentially four months and we are nowhere near the end. Reform should focus on financial incentives, which will be a subject of a different story.