key: cord-025481-ljs80v45
authors: Hu, Jianhua; Zhang, Xiaoli; Zhang, Xuan; Zhao, Hong; Lian, Jiangshan; Hao, Shaorui; Jia, Hongyu; Yang, Meifang; Lu, Yingfeng; Xiang, Dairong; Cai, Huan; Zhang, Shanyan; Gu, Jueqing; Ye, Chanyuan; Yu, Guodong; Jin, Ciliang; Zheng, Lin; Yang, Yida; Sheng, Jifang
title: COVID-19 patients with hypertension have more severity condition, and ACEI/ARB treatment have no infulence on the clinical severity and outcome
date: 2020-05-28
journal: J Infect
DOI: 10.1016/j.jinf.2020.05.056
sha: 
doc_id: 25481
cord_uid: ljs80v45

nan

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2); Coronavirus disease 2019 (COVID-19); Hypertention; Angiotensin-converting enzyme inhibitor (ACEI); Angiotensin receptor blocker (ARB); Outcome A number of pneumonia cases of unknown causes have emerged in Wuhan, Hubei, China since December 2019. (1) After sequencing analysis of samples from the lower respiratory tract, a coronavirus, (2) which was last named as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). (3) On February 11, 2020, the World Health Organization (WHO) announced a new name for the disease caused by 2019-nCoV: coronavirus disease 2019 (COVID-19). (4) With the arrival of the Spring Festival, an epidemic SARS-CoV-2 infection has spread rapidly. It has swept across China and all over the world, and became a major global health concern. Chinese scientists found that SARS-CoV-2, like the SARS virus in 2003, enters human cells by recognizing angiotensin-converting enzyme 2 (ACE2) protein, which is the key to the invasion of the "new coronavirus" into the body. (5) Decreased ACE2 expression is a cause of hypertension because ACE2 is identified as a major angiotensin 1-7 (Ang1-7)-forming enzyme. (6) Based on studies of COVID-19, we found that hypertension initially occurs in many complications in COVID-19 patients. (7) However, limited reports on COVID-19 patients with hypertension are available in literature. Whether patients with hypertension who undergo angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) therapy are more likely to suffer SARS-CoV-2 infection and whether ACEI/ARB therapy would have an influence on the clinical outcomes of patients with COVID-19 are controversy. (8, 9) Moreover, the epidemiologic and clinical features of COVID-19 patients with hypertension are also not completely elucidated. Thus, in this study, we describe the demographic, epidemiologic, and clinical characteristics of COVID-19 patients with hypertension. And we also attempted to analyze whether ACEI/ARB treatment would have an influence on the clinical severity and outcomes of COVID-19 patients.

Altogether, 884 COVID-19 patients between January 17, 2020 and February 8, 2020, who confirmed with SARS-CoV-2 infection in Zhejiang Province, diagnosed as having COVID-19 according to WHO interim guidance (10) were enrolled in this study.

Among various coexisting conditions, the proportion of patients with hypertension (149 patients, 16.86%) was higher than that of others. Compared with COVID-19 patients without hypertension, those patients with hypertension had a higher percentage of male sex (59.06% vs 49.93%, P=0.042), were older (57.00 years vs 43.00 years, P=0.000) and had a higher percentage of age ≥60 years (43.62% vs 13.88%, P=0.000). In this study, 723 patients were diagnosed to have a mild type; 123 patients, severe type; and 37 patients, critical type. Patients with hypertension had a lower rate of mild type (59.06% vs 86.39%, P=0.000), but had a higher rate of severe (26.17% vs 11.43%, P=0.001) and critical types (14.77% vs 2.04%, P=0.000) than patients without hypertension. Compared with patients without hypertension, patients with hypertension had a higher incidence of acute respiratory distress syndrome(ARDS) (24.16% vs 6.67%, P=0.000), were more likely to use glucocorticoids (31.54% vs 12.79%, P=0.000), antibiotic (50.33% vs 39.32%, P=0.013), and intravenous immune globulin therapy (21.48% vs 6.67%, P=0.000) and more likely to need mechanical ventilation (14.77% vs 2.04%, P=0.000) and intensive care unit (ICU) admission (16.11% vs 2.31%, P=0.000), extracorporeal membrane oxygenation (ECMO) (4.03% vs 0.82%, P=0.007) and continuous renal replacement therapy (CRRT) (2.01%vs 0.14%, P=0.016) therapy. The time intervals from illness onset to discharge and from admission to discharge in patients with hypertension (median 25.00 days and 20.00 days, respectively) were longer than those in patients without hypertension (median 22.00 days and 18.00 days, respectively) (P=0.000, P=0.002) ( Table 1 ).

We found that the level of leukocyte count (median 5.40×10 9 /L vs 4.70×10 9 /L, P=0.000) and neutrophil count (median 3.60×10 9 /L vs 2.90×10 9 /L, P=0.000) was higher, but the level of lymphocyte count (median 1.00×10 9 /L vs 1. In summary, we reported the largest cases of COVID-19 patients with hypertension. This study showed that patients with hypertension might have more severe respiratory symptoms, more abnormality laboratory indication, and more proportion of severe/critical type of COVID-19. Moreover, they may need more antibiotic, hormone, and intravenous immune globulin therapy and intensive care unit admission and have a longer hospital stay. Treatment with ACEI/ARB have no influence on the severity and the clinical outcome of COVID-19 patients. 

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Note 1: *, P value of comparison between ACEI/ARB and non-ACEI/ARB

Note 2: Alb, Albumin; ALT, Alanine aminotransferase; AST: Aspartate aminotransferase; BUN, Blood urea nitrogen; CK, Creatine kinase; COPD, Chronic obstructive pulmonary disease

Extracorporeal membrane oxygenation; INR: International normalized ratio; LDH: Lactate dehydrogenase

We would like to thank Editage (www.editage.cn) for English language editing. 

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