Characterization of COVID-19 in Hypertension and Evaluation of Effective Therapy in Hypertensive COVID-19 Patients: An Observational Study
Naveed Nazir Shah MD1, Khurshid Ahmad Dar MD2, Syed Quibtiya MS3, Aaliya Mohi Ud Din Azad MD4 and Showkat Ul Nabi*5
1Professor & Head Chest Medicine Govt. Medical College, Srinagar, India
2Professor Chest Medicine Govt. Medical College, Srinagar, India
3Surgery Department of General Surgery SKIMS Medical college Srinagar, India
4Pulmonary Medicine Senior Resident Department of chest Medicine GMC ,Srinagar, India
5Division of Veterinary Medicine Ethics and Jurisprudence Faculty of Veterinary Sciences and Animal Husbandry SKUAST-K, India
Citation: Shah NN, Dar KA, Quibtiya S, Ud Din Azad AM, Ul Nabi S (2021) Characterization of COVID-19 in Hypertension and Evaluation of Effective Therapy in Hypertensive COVID-19 Patients: An Observational Study. SciTech Central COVID-19
Received: February 18, 2021 Accepted: February 24, 2021 Published: February 24, 2021
Background: SARS-CoV-2 use ACE-2 receptor for cellular internalization similarly most of the hypertensive drugs interact with ACE receptors for therapeutic action. Due to this interplay potential association may be expected between hypertension and progression of COVID-19. So present study was carried out to characterize hypertensive COVID patients and evaluate therapeutic interventions used for their treatment.
Method: Chest disease hospital Srinagar, India reported 554 COVID positive cases from March 2020 to 24th August 2020. After exclusion of cases, 100 patients were found to be simultaneously affected with hypertension and COVID-19. Which were further divided into two groups as 61 patients with moderate and 39 patients with severe COVID-19. Present study being retrospective observational study hence hypertensive patients treated with or without doxycycline in moderate COVID and hypertensive patients treated with or without HA (hydroxychloroquine, azithromycin) combination therapy were compared on basis of clinical end points.
Observations: Patients with simultaneous hypertension and COVID-19 were found to be in advanced age group, more proportion of males, severe clinical presentation of disease, abnormal biochemical findings, more likely with co-morbidities. Of special interest Levels of WBC (White Blood Cells), LDH (Lactate Dehydrogenase), Hs-CRP (C-Reactive Protien) and ALP (Alkaline Phosphatase) were found to be significantly elevated in patients with hypertension compared to patients without hypertension. COX regression analysis revealed beneficial role of Doxycycline in moderately COVID-19 with hypertension (Crude analysis — hazard ratio of 2.852;95% CI-1.065-7.635; p -0.155). Similarly on basis of clinical endpoint COX regression analysis revealed reduced deaths in severe hypertensive patients treated with HA compared to patients treated without HA (Crude analysis — hazard ratio of 5.29; 95% CI-1.062-26.38; p -0.023).
Conclusion: Hypertensive patients have severe manifestation of COVID-19 disease and of special interest are WBC, LDH, Hs-CRP and ALP levels and altered radiological findings. Doxycline in hypertensive moderately COVID patients and HA in hypertensive severely COVID patients were found to have therapeutic justification outside randomly case control designed clinical trial.
Suggestion: Randomly, Case control, Triple blind clinical trial should be designed to evaluate role of Doxycycline and HA in hypertensive COVID population