New Wuhan Data Confirm High Hypertension Rate in COVID-19 Deaths

The majority of patients who die of COVID-19 have at least one comorbidity, with hypertension being a frequent culprit, a case series confirms.

During a 10-day span in January in Wuhan, China, nearly three-quarters of patients hospitalized with COVID-19-induced pneumonia who died (74.4%) had one or more comorbidities, lead author Jianfeng Xie, MD, PhD (Zhongda Hospital, Southeast University, Nanjing, China), and colleagues report in a research letter published today in JAMA Network Open.

For hospitals around the globe still bracing for a surge in admissions, the brief report offers a real-world glimpse, from the original epicenter of this pandemic, of just how often cardiometabolic risk factors were present in patients with the most severe infections.

Hypertension was the most common (observed in 50.0%), followed by diabetes (25.0%) and ischemic heart disease (18.5%). Smaller percentages of patients had ischemic stroke and congestive heart failure.The investigators note that a prior case series demonstrated an increased rate of hypertension among patients with COVID-19 who were versus were not admitted to an intensive care unit.

“However, hypertension usually is not an independent risk factor associated with mortality in patients with sepsis,” they write. “According to a study from earlier this year, severe acute respiratory syndrome coronavirus infects the lungs through the angiotensin-converting enzyme II receptor. Further research is needed to find the mechanism of COVID-19.”

Moreover, Xie et al say, additional research is needed determine whether ACE inhibitors and angiotensin receptor blockers might be helpful for patients with COVID-19. Debate continues about whether these agents are beneficial or harmful in the context of SARS-CoV-2 infection.

For the study, which pulled data from 21 hospitals in Wuhan, the investigators examined the clinical characteristics of 168 patients hospitalized with COVID-19-induced pneumonia who died between January 21 and 30, 2020. Three-quarters of patients were men and the median age was 70; 95.8% of patients were older than 50.

In addition to assessing the comorbidity burden, Xie et al evaluated the level of respiratory support provided. Although all patients received oxygen therapy, only nasal or face mask oxygen was required in 27.4%. About one-third (34.5%) received high-flow nasal oxygen therapy and 42.9% received noninvasive ventilation. Invasive mechanical ventilation was used in only 20.2%, and two patients (1.2%) were treated with extracorporeal membrane oxygenation.

“The results of this case series show that only approximately one-fifth of patients who died of COVID-19 received invasive mechanical ventilation and further aggressive respiratory support prior to death, indicating that many patients had delayed intubation,” the authors write, noting that “potential reasons for the delay include lack of invasive mechanical ventilators and lack of specific clinical training for respiratory support.”