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

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; I-2, 44%) and its sub-group, including mortality (RR 2.21 (1.74, 2.81), p < 0.001; I-2, 66%), severe COVID-19 (RR 2.04 (1.69, 2.47), p < 0.001; I-2 31%), ARDS (RR 1.64 (1.11, 2.43), p = 0.01; I-2,0%, p = 0.35), ICU care (RR 2.11 (1.34, 3.33), p = 0.001; I-2 18%, p = 0.30), and disease progression (RR 3.01 (1.51, 5.99), p = 0.002; I-2 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.