The association of hypertension and diabetes pharmacotherapy with COVID-19 severity and immune signatures: an observational study

Rinkoo Dalan, Li Wei Ang, Wilnard Y T Tan, Siew-Wai Fong, Woo Chiao Tay, Yi-Hao Chan, Laurent Renia, Lisa F P Ng, David Chien Lye, Daniel E K Chew, Barnaby E Young
2020 European Heart Journal - Cardiovascular Pharmacotherapy  
Coronavirus disease 2019 in patients with co-existing diabetes and hypertension is associated with an increased risk of severe infections and mortality (1). There is a paucity of data on the association of pharmacotherapy of these conditions with COVID-19 disease severity. Methods: We conducted a retrospective, observational cohort study of 717 patients with PCR-confirmed COVID-19 who were hospitalised at the National Centre of Infectious diseases (NCID), Singapore up to April 15, 2020. Data
more » ... l 15, 2020. Data collected included demographics, co-morbidities, concomitant medications, and clinical outcomes. Primary outcomes were hypoxia (requirement for supplemental oxygen to maintain blood oxygen saturations >93%), intensive care unit (ICU) admission, mechanical ventilation or death. The study was conducted in accordance with institutional guidelines; study protocols were reviewed and approved, by the Ministry of Health, Singapore and the institutional ethics committee (ref: 2012/00917). Plasma immune mediator concentrations were measured using multiplex microbead-based immunoassay: Cytokine/Chemokine/Growth Factor 45-plex Human ProcartaPlex TM panel 1 (ThermoFisher Scientific). We used the modified Poisson regression approach (2) to calculate the relative risk (RR) for the association between requirement for supplementary oxygen, ICU admission, mechanical ventilation, and death with diabetes, hypertension and pharmaco-therapeutics. RR was adjusted for demographics, comorbidities and co-medications. Multivariable linear regression models were used to assess the association between inflammatory markers, and the use of medications. All statistical tests were two-sided, and statistical significance was taken as p<0.05. All statistical analyses were performed using Stata version 15. Cytokine levels across groups were compared using two-tailed Mann Whitney U test. . Statistical analyses and data plotting were performed using GraphPad Prism (Version 8.2.1) Downloaded from https://academic.oup.com/ehjcvp/advance-article/doi/10.1093/ehjcvp/pvaa098/5885084 by guest on 05 September 2020 4 Results : In this cohort, 139 (19.4%) had hypertension and 76 (10.6%) had type 2 diabetes mellitus (Table 1). Hypoxia was reported in 91 (12.7%), ICU admission in 47 patients (6.6%), mechanical ventilation in 25 (3.5%) and 12 patients (1.67%) died. Diabetes and hypertension were associated with hypoxia (Diabetes: adjusted RR [aRR] 1.76, 95% confidence interval [CI] 1.18-2.63; Hypertension: aRR 1.96, 95% CI 1.25-3.07) and ICU admission (Diabetes: aRR 2.17, 95% CI 1.23-3.83; Hypertension: aRR 2.23, 95% CI 1.17-4.24). In the hypertension subgroup ACE-I treatment was associated with a lower risk of ICU admission (aRR 0.26, 95% CI 0.10-0.68) and mechanical ventilation (aRR 0.09, 95% CI 0.02-0.36), whereas ARBs were associated with a higher risk of ICU admission (aRR 2.19, 95% CI
doi:10.1093/ehjcvp/pvaa098 pmid:32766831 fatcat:g33stblaarcd5n5c7nvo63k6fy