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Meta-Analysis
. 2020 Apr-Jun;21(2):1470320320926899.
doi: 10.1177/1470320320926899.

Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression

Raymond Pranata  1 , Michael Anthonius Lim  1 , Ian Huang  1   2   3 , Sunu Budhi Raharjo  4   5 , Antonia Anna Lukito  1   6
Affiliations
Meta-Analysis

Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression

Raymond Pranata et al. J Renin Angiotensin Aldosterone Syst. 2020 Apr-Jun.

Abstract

Objective: To investigate the association between hypertension and outcome in patients with Coronavirus Disease 2019 (COVID-19) pneumonia.

Methods: We performed a systematic literature search from several databases on studies that assess hypertension and outcome in COVID-19. Composite of poor outcome, comprising of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care unit (ICU) care and disease progression were the outcomes of interest.

Results: A total of 6560 patients were pooled from 30 studies. Hypertension was associated with increased composite poor outcome (risk ratio (RR) 2.11 (95% confidence interval (CI) 1.85, 2.40), p < 0.001; I2, 44%) and its sub-group, including mortality (RR 2.21 (1.74, 2.81), p < 0.001; I2, 66%), severe COVID-19 (RR 2.04 (1.69, 2.47), p < 0.001; I2 31%), ARDS (RR 1.64 (1.11, 2.43), p = 0.01; I2,0%, p = 0.35), ICU care (RR 2.11 (1.34, 3.33), p = 0.001; I2 18%, p = 0.30), and disease progression (RR 3.01 (1.51, 5.99), p = 0.002; I2 0%, p = 0.55). Meta-regression analysis showed that gender (p = 0.013) was a covariate that affects the association. The association was stronger in studies with a percentage of males < 55% compared to ⩾ 55% (RR 2.32 v. RR 1.79).

Conclusion: Hypertension was associated with increased composite poor outcome, including mortality, severe COVID-19, ARDS, need for ICU care and disease progression in patients with COVID-19.

Keywords: COVID-19; Hypertension; coronavirus; mortality; severity.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flowchart.
Figure 2.
Figure 2.
Hypertension and poor outcome. Forest plot shows that hypertension was associated with increased composite poor outcome and its sub-group which comprises of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care unit (ICU) care and disease progression in patients with COVID-19.
Figure 3.
Figure 3.
Meta-regression analysis showed that the association between hypertension and increased composite poor outcome was influenced by (a) gender, but not (b) age. (c) Sub-group analysis based on meta-regression results showed that studies of the association between hypertension and composite poor outcome was stronger in studies with a percentage of male
Figure 4.
Figure 4.
Publication bias analysis. (a) The funnel-plot analysis showed a qualitatively symmetrical funnel plot for the association between hypertension and increased composite poor outcome. (b) Regression-based Harbord’s test showed no indication of small-study effects for hypertension and increased composite poor outcome.
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