More severe COVID-19 outcomes are likely to occur in patients with higher blood pressure (BP) and higher hemoglobin A1c (HbA1c), according to study findings published in the Journal of the American Heart Association.

Investigators sought to evaluate the independent association between hypertension control or diabetes control and severe COVID-19 outcomes in adults.

The investigators conducted a cross-sectional retrospective cohort study in 43 United States health systems in the National Patient-Centered Clinical Research Network from March 2020 through February 2022. They included almost 1.5 million adults (at least 20 years of age) with COVID-19 infection, of whom 43% had hypertension and 12% had diabetes. COVID-19 infection was confirmed by SARS-CoV-2 positive polymerase chain reaction test (98%) or antigen test (3%) in an outpatient care setting or ambulatory, emergency department.

Hypertension control was stratified by levels of BP (<130 />

Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID-19.

Among all patients with COVID-19 infection (median age [SD], 46.7 [17.5] years; 56% women; 63% White, 16% Black; 17% Hispanic) 13% required hospitalization, 2% had to be mechanically ventilated, and there was 2% mortality within 60 days of COVID-19 index. COVID-19 infection early in the pandemic, a greater number of comorbidities prior to COVID-19 infection, Black race, being male, and older age were all disproportionately represented among patients with severe COVID-19 outcomes (hospitalization, mechanical ventilation, critical care, 60-day mortality).

The investigators found that, among patients with hypertension, those with the highest baseline BP (≥160/100 mm Hg vs <130 />

Among patients with diabetes, those with the highest HbA1c (≥9% vs <7%>

Independent of comorbidities and control of hypertension or diabetes, Hispanic and Black adults vs White adults were more likely to experience severe COVID-19 outcomes.

Study limitations include inclusion bias for patients at higher risk for more severe COVID-19 and possible collider bias, missing data, and misclassification of hypertension or diabetes control status.

“Among 1.5million patients with COVID-19, higher BP and glycated hemoglobin were associated with more severe COVID-19 outcomes,” the study authors wrote. “Findings suggest that adults with poorest control of hypertension or diabetes might benefit from efforts to prevent and initiate early treatment of COVID-19.”

This article originally appeared on The Cardiology Advisor


Jackson SL, Woodruff RC, Nagavedu K, et al.; on behalf of the PCORnet Collaboration Authors. Association between hypertension and diabetes control and COVID-19 severity: national patient-centered clinical research network, United States, March 2020 to February 2022. J Am Heart Assoc. Published online October 18, 2023. doi:10.1161/JAHA.122.030240