Hypertension and sex related diff erences in mortality of COVID-19 infection: A systematic review and Meta-analysis

Abstract

Background: Hypertension is the leading cause of cardiovascular diseases and premature deaths. Hypertension plays a striking role in mortality and morbidity in case of Coronavirus Disease 2019 (COVID-19) infection; however, numerous studies have reported contradictory fi ndings. Objective: To assess the relationship of hypertensive disease and mortality of COVID-19 infection and to assess the sex and age diff erentials on the association. Methods: We have conducted a systematic review of published literatures that identifi ed the relationship between hypertension and mortality of COVID-19 infections. Nineteen articles were selected following structured inclusion and exclusion criteria for systematic review and analyses.

A total of 21,684 hospital admitted COVID-19 patients were included in this review and meta- analysis from 19 studies. The studies covered the six months of the pandemic from December

2019 to May 2020. Results: In the pooled analysis, the median age of patients was 58 years, and the proportion of male patients was 58.8%. In contrast, we estimated 33.26% of hypertensive and 19.16% of diabetes mellitus patients in the studies. Hypertension was found to be associated with COVID-19 mortality (“Risk ratio (RR) = 1.45, [95% confi dence interval (CI): 1.35 - 1.55]; I2 = 77.1%, p - value < 0.001”). The association in the meta-regression was aff ected by sex (p - value = 0.050). The association was found to be stronger in the studies with males ≥ 55% and age ≥ 55 years (“RR = 1.65, [95% CI: 1.52 - 1.78]; I2 = 77.1%, p - value < 0.001”) compared to male < 55% or age < 55 years (“RR = 1.11, [95% CI: 0.94 - 1.28]; I2 = 72.2%, p - value < 0.001”). Conclusion: Hypertension was signifi cantly strong associated with COVID-19 mortality which may account for the contradiction in the many studies. The association between hypertension and mortality was aff ected by sex and there were signifi cantly higher fatalities among older male patients.