Prevalence, Clinical Manifestations, and Biochemical Data of Hypertensive versus Normotensive Symptomatic Patients with COVID-19: A Comparative Study Running title: Hypertension and COVID-19

Main Article Content

Vincenzo De Sanctis


COVID- 19, hypertension, prevalence, clinical manifestations, biochemical data, outcome.


Background: There is a scarcity of data regarding the effect of hypertension on the clinical presentation and outcome of symptomatic patients with COVID-19 infection in comparison with non-hypertensive patients. Aim of the study: To describe the clinical presentation, radiological and hematological data of a cohort of symptomatic COVID-19 positive hypertensive patients (n=50) in comparison with another cohort of normotensive symptomatic COVID-19 positive patients (n=250) diagnosed at the same time and managed in the same health facilities (from Jan 2020 to May 2020). Associated comorbidities were assessed, and the Charlson Comorbidity Index was calculated. The outcomes, including duration of hospitalization, length of ICU stay, duration of mechanical ventilation, and duration of O2 supplementation, were also assessed. Results: The prevalence of hypertension in symptomatic COVID-19 positive patients was 50/300 (16%; the prevalence of hypertension in Qatari adults is ~30%). Hypertensive patients had a higher prevalence of DM, CKD, and cardiac dysfunction compared to normotensive patients (p<0.01).They had a higher Charlson Co-morbidity score (2.3±1.8) compared to the normotensive patients (0.4±0.9) (p<0.01). Clinically and radiologically, hypertensive patients had significantly higher percentage of pneumonia, severe pneumonia, and ARDS versus normotensive patients (p<0.01). CBC and differential WBC did not differ between hypertensive and normotensive patients. Hypertensive patients had significantly higher CRP(58.5±84), compared to normotensive patients (28±59) (p<0.01). Furthermore, a longer duration of hospitalization, intensive care unit (ICU) stay, mechanical ventilation and oxygen therapy versus normotensive patients was also observed. CRP was correlated significantly with the duration of stay in the ICU and the duration for oxygen supplementation (r=0.56 and 0.61, respectively; p<0.01). Conclusions: Hypertensive patients with COVID-19 had a higher inflammatory response (higher CRP levels), a significant increase of comorbidities, and a more aggressive course of the disease necessitating a higher rate of ICU admission, longer requirement for hospitalization and oxygen use compared to normotensive patients.


Download data is not yet available.


Metrics Loading ...
Abstract 110 | PDF Downloads 34


1. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. 2020;382:1199-1207.
2. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382:727-733.
3. Corman VM, Muth D, Niemeyer D, Drosten C. Hosts and Sources of Endemic Human Coronaviruses. Adv. Virus Res. 2018; 100:163–188.
4. Yan Y, Chang L, Wang L. Laboratory testing of SARS-CoV, MERS-CoV, and SARS-CoV-2 (2019-nCoV): Current status, challenges, and countermeasures. Rev Med Virol. 2020;30(3):e2106. doi:10.1002/rmv.2106.
5. Jin Y, Yang H, Ji W, et al. Virology, Epidemiology, Pathogenesis, and Control of COVID-19. Viruses. 2020;12(4):372. Published 2020 Mar 27. doi:10.3390/ v12040372.
6. Coronavirus Update (Live): 15,842,118 Cases and 639,892 Deaths from COVID-19 Virus Pandemic - Worldometer. 2020 [cited 24 July 2020]. Available from:
7. COVID19 Home [Internet]. 2020 [cited 24 July 2020]. Available from:
8. Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect. 2020;81:e16-e25.
9. Wang D, Hu B, Hu C. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020;323:1061-1069.
10. Wang Z, Yang B, Li Q. Clinical Features of 69 Cases with Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71:769-777.
11. Wu C, Chen X, Cai Y. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:1-11.
12. Clinical management of COVID-19. 2020 [cited 24 July 2020]. Available from:
13. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis.1987;40:373-383.
14. Bener A, Al-Suwaidi J, Al-Jaber K, Al-Marri S, Dagash MH, Elbagi IE. The prevalence of hypertension and its associated risk factors in a newly developed country. Saudi Med J. 2004;25:918-922.
15. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta Analysis. Arch Acad Emerg Med. 2020;8(1):e35.
16. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708–1720.
17. Noh J, Kim HC, Shin A, et al. Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013. Korean Circ J. 2016;46:672-680.
18. Wang J, Ma JJ, Liu J, Zeng DD, Song C, Cao Z. Prevalence and Risk Factors of Comorbidities among Hypertensive Patients in China. Int J Med Sci. 2017;14:201-212.
19. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
20. Gold MS, Sehayek D, Gabrielli S, Zhang X, McCusker C, Ben-Shoshan M. COVID-19 and comorbidities: a systematic review and meta- analysis. Postgrad Med. 2020;1-7. doi:10.1080/00325481.2020.1786964.
21. Lian J, Jin X, Hao S, et al. Analysis of Epidemiological and Clinical Features in Older Patients With Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Clin Infect Dis. 2020;71:740-747.
22. Tadic M, Cuspidi C, Grassi G, Mancia G. COVID-19 and arterial hypertension: Hypothesis or evidence? J Clin Hypertens (Greenwich). 2020;10.1111/jch.13925. doi:10.1111/jch.13925.
23. Jain V, Yuan JM. Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis. Int J Public Health. 2020;65:533-546.
24. Zhang J, Wu J, Sun X, et al. Association of hypertension with the severity and fatality of SARS-CoV-2 infection: A meta-analysis. Epidemiol Infect. 2020;148:e106. doi:10.1017/S095026882000117X.
25. Tian W, Jiang W, Yao J, et al. Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis. J Med Virol. 2020;10.1002/ jmv.26050. doi:10.1002/jmv.26050.
26. Wu Z, McGoogan JM. 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. JAMA. 2020;10.1001/jama.2020.2648. doi:10.1001/jama.2020.2648.
27. Zuin M, Rigatelli G, Zuliani G, Rigatelli A, Mazza A, Roncon L. Arterial hypertension and risk of death in patients with COVID-19 infection: Systematic review and meta-analysis. J Infect. 2020;81:e84–86.
28. Huang S, Wang J, Liu F, et al. COVID-19 patients with hypertension have more severe disease: a multicenter retrospective observational study. Hypertens Res. 2020;43:824-831.
29. Zhang P, Zhu L, Cai J, et al. Association of Inpatient Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Mortality Among Patients With Hypertension Hospitalized With COVID-19. Circ Res. 2020;126:1671-1681.
30. Wang X, Xu W, Hu G, et al. Retraction Note to: SARS-CoV-2 infects T lymphocytes through its spike protein-mediated membrane fusion [retraction of: Cell Mol Immunol. 2020 Apr 7]. Cell Mol Immunol. 2020;17(8):894. doi:10.1038/s41423-020-0498-4.
31. Li W, Moore MJ, Vasilieva N, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426:450–454.
32. Mancia G, Rea F, Ludergnani M, Apolone G, Corrao G. Renin–angiotensin–aldosterone system blockers and the risk of Covid‐19. N Engl J Med. 2020;382: 2431-2440.
33. Mehta N, Kalra A, Nowacki AS, et al. Association of use of angiotensin‐converting enzyme inhibitors and angiotensin II receptor blockers with testing positive for coronavirus disease 2019 (COVID‐19). JAMA Cardiol. 2020;e201855. doi:10.1001/ jamacardio.2020.1855.
34. Reynolds HR, Adhikari S, Pulgarin C, et al. Renin–angiotensin–aldosterone system inhibitors and risk of Covid‐19. N Engl J Med. 2020; 382: 2441-2448.
35. Liu F, Li L, Xu M, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol. 2020;127:104370. doi:10. 1016/j.jcv.2020.104370.
36. Blake GJ, Rifai N, Buring JE, Ridker PM. Blood pressure, C-reactive protein, and risk of future cardiovascular events. Circulation. 2003;108:2993-2999.
37. Ogura S, Latapati R, Shimosawa T and Nakayama T. Vascular Inflammation and Hypertension Austin J Cardiovasc Dis Atherosclerosis. 2016; 3(1):1017.
38. Case AJ, ZimmermanMC. Sympathetic-mediated activation versus suppression of the immune system: consequences for hypertension. J Physiol. 2016;594:527–536.
39. Caillon A, Schiffrin EL. Role of inflammation and immunity in hypertension: recent epidemiological, laboratory, and clinical evidence. Curr Hypertens Rep. 2016;18(3) : 21.doi:10.1007/s11906-016-0628-7.
40. Pushkarsky T, Zybarth G, Dubrovsky L, et al. CD147 facilitates HIV-1 infection by interacting with virus-associated cyclophilin A. Proc Natl Acad Sci U S A. 2001; 98:6360-6365.
41. Radzikowska U, Ding M, Tan G, et al. Distribution of ACE2, CD147, CD26 and other SARS-CoV-2 associated molecules in tissues and immune cells in health and in asthma, COPD, obesity, hypertension, and COVID-19 risk factors. Allergy. 2020;10.1111/all.14429. doi:10.1111/all.14429
42. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95:834-847.

Most read articles by the same author(s)

1 2 3 > >>