key: cord-0717609-ztutho6p authors: Kinge, Kirti V.; Chavhan, Smita S.; Adsul, Balkrishna B.; Kumbhar, Maharudra A.; Gokhale, Chinmay N.; Ingale, Aniket R. title: An observational study to find association between Hypertension and severe and fatal COVID-19 infection in COVID dedicated hospital, Mumbai date: 2022-01-31 journal: J Family Med Prim Care DOI: 10.4103/jfmpc.jfmpc_254_21 sha: 65405bfa480fb57874bcf93cde18180f87d93a63 doc_id: 717609 cord_uid: ztutho6p INTRODUCTION: World Health Organization (WHO) has declared COVID-19 outbreak as a “public health emergency of international concern” on January 31, 2020. After that the epidemic spread rapidly around the world. Chronic non-communicable diseases were identified as risk factors for SARS-CoV-2. Hypertension (HTN) is one of the most common cardiovascular diseases with a prevalence ranging from 10% to 20% among adult population. After COVID-19 outbreak, identification of risk factors for severe or fatal disease is necessary to allocate limited resources. For primary care physicians, this is of vital importance to know the association between hypertension and severe and fatal COVID-19 infection as hypertension is affecting millions of people all over the world and primary health care is of immense importance in a country like India. Duration of stay in hospital which will be taken as proxy measure of duration of illness, symptomatic status, need of ICU care and death will be taken as indicators of severe and fatal COVID-19 infection. There are few researches to find an association between Hypertension and severe and fatal COVID-19 infection. There is a need to assess the same. OBJECTIVES: To find an association of hypertension and severe and fatal COVID-19 infection. METHODOLOGY: A hospital-based cross-sectional study was carried out at a COVID dedicated hospital, Mumbai in 9 months from 1 April 2020 to 31 December 2020. All patients admitted in hospital were included in the study by universal sampling. ETHICAL APPROVAL: The permission to conduct the study was taken by Institutional Ethics Committee. RESULTS: There was a significant association between hypertension and severe and fatal COVID-19 infection defined by more duration of stay in hospital, admission to ICU and mortality. CONCLUSIONS: It is concluded from this study that hypertension is associated with severe and fatal COVID-19 infection. It gives a clear idea for primary care physicians to give more focus towards patients with hypertension with COVID-19 infection. Blood pressure monitoring should be strictly practiced during COVID-like illnesses. Special attention is to be given as far as treatment and early referral to higher centre with ICU is concerned for better outcome. Hypertensive patients should be protected more by adopting COVID appropriate behaviour. World Health Organization (WHO) has declared COVID-19 outbreak as a "public health emergency of international concern" on January 31, 2020. [1] After that the epidemic spread rapidly around the world. Chronic non-communicable diseases were identified as risk factors for SARS-CoV-2. Hypertension (HTN) is one of the most common cardiovascular diseases with a prevalence ranging from 10% to 20% among adult population. After COVID-19 outbreak, identification of risk factors for severe or fatal disease are necessary to allocate limited resources. For primary care physicians, this is of vital importance to know the association between hypertension and severe and fatal COVID-19 infection as hypertension is affecting millions of people all over the world and primary health care is of immense importance in a country like India. Duration of stay in hospital which will be taken as proxy measure of duration of illness, symptomatic status, need of ICU care and death will be taken as indicators of severe and fatal COVID-19 infection. There are few researches to find association between Hypertension and severe and fatal COVID-19 infection. There is a need to assess the same. To find association of hypertension and severe and fatal COVID-19 infection in COVID dedicated hospital. A hospital-based retrospective study was carried out at a COVID dedicated hospital, Mumbai. All admitted patients of COVID-19 in a COVID Dedicated Hospital, Mumbai were selected in 9 months (1 April 2020 to 31 December 2020) by universal sampling technique. 1. Patients admitted in hospital (as their outcome is not certain yet). The permission to conduct the study was taken by Institutional Ethics Committee. The study subjects were divided into 7 groups. The mean age of study subjects was 46 years. 64.4% patients were male and 35.6% patients were female. There was significant association between Hypertension and duration of hospital stay in COVID cases as the P value was less than 0.05. Association between Hypertension and Symptomatic status in COVID cases needed to be identified so that patients can be prioritized as per the requirement of hospitalization and ICU care etc. In our study, duration of stay in hospital was taken as proxy measure of duration of illness. It was significantly associated with presence of hypertension in COVID-19 cases. Similar results were obtained in the study conducted by Chiam et al. [2] While duration of stay in hospital is not significantly associated with presence of hypertension in COVID-19 in the study done by Guo et al. [3] This might be due to other factors responsible for stay in hospital. Duration in stay in hospital gives an idea of bed occupancy in the hospital. In our study, need for ICU care was significantly associated with presence of hypertension in COVID-19 cases. Similar results were seen in WHO scientific brief 2021. [4] In this study, mortality was significantly associated with presence of hypertension in COVID-19 cases. In some studies, hypertension, was one of the parameters in COVID death patients. [5, 6] Thus, hypertensive patients are more prone to develop complications in COVID-19. The study conducted by Liang et al. [7] sug gests that hypertension is an independent risk factor for severity and mortality of COVID-19 patients. The comorbidity like hypertension greatly affects the prognosis of the COVID-19 patients as seen in the study conducted by Zheng et al. [8] and de Souza et al. [9] In this study, symptomatic status of COVID-19 patients is not significantly associated with severity of COVID-19 infection. Similar findings were seen in the study done by Wu et al. [10] Thus findings of this study are comparable to those from previously published literature. So, more preventive and therapeutic focus should be given to patients with hypertension during COVID pandemic. This prognostic significance of hypertension and severe and fatal COVID-19 infection is not independent of other risk factors. It is concluded from this study that hypertension is associated with severe and fatal COVID-19 infection. It gives a clear idea for primary care physicians to give more focus towards patients with hypertension with COVID-19 infection. Blood pressure monitoring should be strictly practiced during COVID like illnesses. Special attention is to be given as far as treatment and early referral to higher centre with ICU is concerned for better outcome. Hypertensive patients should be protected more by adopting COVID appropriate behaviour. Out of 345 hypertensive patients 260 i.e., 75.4% cases were symptomatic. Out of 2538 non-hypertensive subjects 1993 i.e., 78.5% cases were symptomatic. There was no significant association between them as the P value was more than 0.05. Out of 345 hypertensive patients 13 i.e., 3.8% cases were in need of ICU care. Out of 2538 non-hypertensive subjects 50 i.e., 2.0% cases were in need of ICU care. There was significant association between them as the P value was less than 0.05. Out of 345 hypertensive patients 81 i.e., 23.5% patients were died. Out of 2538 non-hypertensive subjects 106 i.e., 4.2% patients were died. There was significant association between them as the P value was less than 0.05. After the COVID-19 outbreak, healthcare system was overwhelmed. Various factors like associated co-morbidities A novel coronavirus from patients with pneumonia in China Hospital length of stay among COVID-19-positive patients Risk factors on admission associated with hospital length of stay in patients with COVID-19: A retrospective cohort study Scientific brief Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy The association of hypertension with the severity and mortality of COVID-19 patients: Evidence based on adjusted effect estimates Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis Clinical manifestations and factors associated with mortality from COVID-19 in older adults: Retrospective population-based study with 9807 older Brazilian COVID-19 patients Understanding factors influencing the length of hospital stay among non-severe COVID-19 patients: A retrospective cohort study in a Fangcang shelter hospital We would like to acknowledge the entire administrative and data handling team of this Dedicated Covid-19 hospital for their contribution to this study. Nil. There are no conflicts of interest.