Hypertension more than doubles the risk for infection with the Omicron variant requiring hospitalization, even among individuals who have received standard 2-dose COVID-19 vaccination plus at least 1 booster dose, investigators reported in Hypertension. It appears to be a stronger risk factor than type 2 diabetes, chronic kidney disease (CKD), and heart failure.
“Breakthrough Omicron infection severe enough to cause hospitalization can happen to an adult of any age, especially if a person has high blood pressure, even if they have no other major chronic disease,” lead author Joseph E. Ebinger, MD, MS, an assistant professor of cardiology and director of clinical analytics of the Smidt Heart Institute at the Cedars-Sinai Medical Center in Los Angeles stated in a release from the American Heart Association. “The people who are most at risk are not necessarily who we think they are. They are not the sickest of the sick, and this was a surprising finding.”
Dr Ebinger and colleagues studied outcomes from 912 adults who received at least 3 doses of an mRNA vaccine and were subsequently infected with Omicron. Of the 912 patients, 145 (15.9%) required hospitalization.
The likelihood of hospitalization for Omicron infection significantly increased 2.3-, 2.2-, and 2.2-fold among patients with hypertension, myocardial infarction or heart failure, or CKD, respectively, the investigators reported. Hypertension significantly increased the likelihood of infection-related hospitalization by 2.6-fold among patients without CKD, myocardial infarction, and heart failure. Use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and statins did not influence risk.
For every 10-day lapse since the last mRNA booster dose, the odds of Omicron infection requiring hospitalization in the overall cohort significantly increased by 7%, the investigators reported. Among patients without a history of myocardial infarction, heart failure, and CKD, the investigators found no significant increase in Omicron hospitalization risk due to time lapse.
For every 10-year increase in age, the odds of infection requiring hospitalization significantly increased 1.3-fold in the overall cohort and 1.4-fold among patients without a history of myocardial infarction, heart failure, and CKD. Male sex and obesity did not emerge as risk factors. The investigators adjusted all analyses for race and ethnicity. Diabetes, cancer, chronic obstructive pulmonary disease, and asthma also did not significantly increase risks.
“Although the mechanism for hypertension-associated COVID-19 risk remains unclear, prior studies have identified delayed SARS-CoV-2 viral clearance and prolonged inflammatory response among hypertensive patients, which may contribute to greater disease severity,” Dr Ebinger’s team noted.
Ebinger J, Driver M, Joung S, et al. Hypertension and excess risk for severe COVID-19 illness despite booster vaccination. Published online July 20, 2022. Hypertension. doi:10.1161/HYPERTENSIONAHA.122.19694
High blood pressure may double the risk of severe COVID, even after full vaccination. News release. American Heart Association. July 20, 2022. Accessed July 21, 2022. https://newsroom.heart.org/news/high-blood-pressure-may-double-the-risk-of-severe-covid-even-after-full-vaccination