Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study.
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Date
2021
Authors
Abayomi, A
Osibogun, A
Kanma-Okafor, O
Idris, J
Bowale, A
Wright, O
Adebayo, B
Balogun, M
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: The current pandemic of coronavirus disease (COVID-19) caused by the severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) has shown epidemiological and clinical characteristics that appear worsened
in hypertensive patients. The morbidity and mortality of the disease among hypertensive patients in Africa have yet
to be well described.
Methods: In this retrospective cohort study all confirmed COVID-19 adult patients (≥18 years of age) in Lagos
between February 27 to July 62,020 were included. Demographic, clinical and outcome data were extracted from
electronic medical records of patients admitted at the COVID-19 isolation centers in Lagos. Outcomes included
dying, being discharged after recovery or being evacuated/transferred.
Descriptive statistics considered proportions, means and medians. The Chi-square and Fisher’s exact tests were used
in determining associations between variables. Kaplan–Meier survival analysis and Cox regression were performed
to quantify the risk of worse outcomes among hypertensives with COVID-19 and adjust for confounders. P-value
≤0.05 was considered statistically significant.
Results: A total of 2075 adults with COVID-19 were included in this study. The prevalence of hypertension, the
most common comorbidity, was 17.8% followed by diabetes (7.2%) and asthma (2.0%). Overall mortality was 4.2%
while mortality among the hypertensives was 13.7%. Severe symptoms and mortality were significantly higher
among the hypertensives and survival rates were significantly lowered by the presence of additional comorbidity to
50% from 91% for those with hypertension alone and from 98% for all other patients (P < 0.001). After adjustment
for confounders (age and sex), severe COVID-19and death were higher for hypertensives {severe/critical illness:
HR = 2.41, P = 0.001, 95%CI = 1.4–4.0, death: HR = 2.30, P = 0.001, 95%CI = 1.2–4.6, for those with hypertension only}
{severe/critical illness: HR = 3.76, P = 0.001, 95%CI = 2.1–6.4, death: crude HR = 6.63, P = 0.001, 95%CI = 3.4–1.6, for
those with additional comorbidities}. Hypertension posed an increased risk of severe morbidity (approx. 4-fold) and
death (approx. 7-fold) from COVID-19 in the presence of multiple comorbidities.
Conclusion: The potential morbidity and mortality risks of hypertension especially with other comorbidities in
COVID-19 could help direct efforts towards prevention and prognostication. This provides the rationale for
improving preventive caution for people with hypertension and other comorbidities and prioritizing them for future
antiviral interventions.
Description
Keywords
COVID-19, Nigeria, Hypertension, Comorbidities, Coronavirus, SARS-CoV-2 virus, Pandemic
Citation
Abayomi A, Osibogun A, Kanma-Okafor O, Idris J, Bowale A, Wright O, Adebayo B, Balogun M, et al. Morbidity and mortality outcomes of COVID-19 patients with and without hypertension in Lagos, Nigeria: a retrospective cohort study. Glob Health Res Policy. 2021 Jul 29;6(1):26. doi: 10.1186/s41256-021-00210-6.