Hypertension but Not Medication Type Affects Risk for Severe COVID-19

Hypertension is associated with a 22% greater risk for severe COVID-19, and the odds of severe illness is not affected by medication type.

Hypertension was associated with the risk for severe COVID-19 and use of angiotensin-converting enzyme inhibitors (ACE inhibitors or ACEi) or angiotensin-II receptor blockers (ARB) did not mitigate the associated risk. These are the findings of a study published in PLOS One.

An important and established risk factor for more severe COVID-19 is hypertension. However, it remains unclear whether there is a relationship between severity of hypertension and risk. To evaluate this association more precisely, researchers from the University of Cambridge in the United Kingdom (UK) sourced data from the UK Biobank. Individuals (N=16,134) who were enrolled in the UK Biobank since 2006 and had evidence of COVID-19 infection were evaluated through April 2021 for COVID-19 severity and mortality on the basis of hypertension history and antihypertensive medications.

The study population comprised individuals who were mean age, 65.3 (standard deviation [SD], 8.7) years; 47% men; and 90% White. Study participants also had a body mass index (BMI) of 28.5 (SD, 5.5) kg/m2; systolic blood pressure (BP) of 131 (SD, 15) mmHg; diastolic BP of 78 (SD, 10) mmHg; and 60% had hypertension.

A total of 3584 (22%) individuals had severe COVID-19. Among the severe and non-severe COVID-19 groups, 44% and 64% had hypertension (P <.001) among whom 42% and 23% were receiving hypertension treatment, and 14% and 13% were not, respectively.

Hypertension is a risk factor for COVID-19, the association between hypertension and COVID-19 was amplified if the individuals were treated and their BP remained uncontrolled.

A total of 6517 (40%) had a diagnosis of essential hypertension, among whom 67% were receiving treatment, in which 59% received combinatorial therapy and 41% monotherapy. Stratified by treatment, a similar proportion of individuals taking ACEi, ARB, or other medications had severe COVID-19 (34%-36%).

Severe COVID-19 was associated with hypertension after adjusting for all cofounders (adjusted odds ratio [aOR], 1.15; 95% CI, 1.05-1.26; P <.001). No associations between severe COVID-19 risk and ACEi or ARB medications were observed.

Among patients receiving treatment for hypertension, a J-shaped relationship was observed between BP and severe COVID-19 risk, in which patients with systolic BP 150-159 mmHg had a 91% higher risk for severe COVID-19 comapred with patients who had systolic BP 120-129 mmHg (odds ratio [OR], 1.91; 95% CI, 1.44-2.53; P <.001). This relationship of increased risk had an infection point at 150 mmHg, however, patients with low systolic BP (<120 mmHg) were also at increased risk for severe COVID-19 (OR, 1.40; 95% CI, 1.11-1.8; P =.005).

Similar findings were observed in a sensitivity analysis which used a broader definition of hypertension (systolic BP ³140 mmHg or diastolic BP ³90 mmHg).

The study limitations included the fact that the UK Biobank population is generally “healthier” than the general population in the UK and the lack of diversity.

The researchers concluded, “Hypertension is a risk factor for COVID-19, the association between hypertension and COVID-19 was amplified if the individuals were treated and their BP remained uncontrolled. The odds of severe COVID-19 was not affected by medication type.”


Pavey H, Kulkarni S, Wood A, et al. Primary hypertension, anti-hypertensive medications and the risk of severe COVID-19 in UK Biobank. PLoS One. Published online November 9, 2022. doi:10.1371/journal.pone.0276781