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Hypertension, medications, and risk of severe COVID-19: A Massachusetts community-based observational study.
Bauer, AZ, Gore, R, Sama, SR, Rosiello, R, Garber, L, Sundaresan, D, McDonald, A, Arruda, P, Kriebel, D
Journal of clinical hypertension (Greenwich, Conn.). 2021;(1):21-27
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Abstract
It remains uncertain whether the hypertension (HT) medications angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) mitigate or exacerbate SARS-CoV-2 infection. We evaluated the association of ACEi and ARB with severe coronavirus disease 19 (COVID-19) as defined by hospitalization or mortality among individuals diagnosed with COVID-19. We investigated whether these associations were modified by age, the simultaneous use of the diuretic thiazide, and the health conditions associated with medication use. In an observational study utilizing data from a Massachusetts group medical practice, we identified 1449 patients with a COVID-19 diagnosis. In our study, pre-infection comorbidities including HT, cardiovascular disease, and diabetes were associated with increased risk of severe COVID-19. Risk was further elevated in patients under age 65 with these comorbidities or cancer. Twenty percent of those with severe COVID-19 compared to 9% with less severe COVID-19 used ACEi, 8% and 4%, respectively, used ARB. In propensity score-matched analyses, use of neither ACEi (OR = 1.30, 95% CI 0.93 to 1.81) nor ARB (OR = 0.94, 95% CI 0.57 to 1.55) was associated with increased risk of severe COVID-19. Thiazide use did not modify this relationship. Beta blockers, calcium channel blockers, and anticoagulant medications were not associated with COVID-19 severity. In conclusion, cardiovascular-related comorbidities were associated with severe COVID-19 outcomes, especially among patients under age 65. We found no substantial increased risk of severe COVID-19 among patients taking antihypertensive medications. Our findings support recommendations against discontinuing use of renin-angiotensin system (RAS) inhibitors to prevent severe COVID-19.
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Initial impact of the COVID-19 pandemic on physical activity and sedentary behavior in hypertensive older adults: An accelerometer-based analysis.
Browne, RAV, Macêdo, GAD, Cabral, LLP, Oliveira, GTA, Vivas, A, Fontes, EB, Elsangedy, HM, Costa, EC
Experimental gerontology. 2020;:111121
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Abstract
BACKGROUND This study reports the accelerometer-based physical activity (PA) and sedentary behavior (SB) before and during the COVID-19 pandemic in hypertensive older adults. METHODS Thirty-five hypertensive older adults were included in this observational study. Accelerometer-based PA and SB measures were assessed before (January to March 2020) and during (June 2020) the COVID-19 pandemic. Linear mixed models were used to assess within-group changes in PA and SB measures, adjusted by accelerometer wear time. RESULTS Before COVID-19 pandemic participants presented: 5809 steps/day (SE = 366), 303.1 min/day (SE = 11.9) of light PA, 15.5 min/day (SE = 2.2) of moderate-vigorous PA, and 653.0 min/day (SE = 12.6) of SB. During COVID-19 pandemic there was a decrease in steps/day (β = -886 steps/day, SE = 361, p = 0.018), in moderate-vigorous PA (β = -2.8 min/day, SE = 2.4, p = 0.018), and a trend in light PA (β = -26.6 min/day, SE = 13.4, p = 0.053). In addition, SB increased during the COVID-19 pandemic (β = 29.6 min/day, SE = 13.4, p = 0.032). The magnitude of changes was greater on the weekend, mainly for steps/day (β = -1739 steps/day, SE = 424, p < 0.001) and the SB pattern (more time spent in bouts of ≥10 and 30 min, less breaks/day and breaks/h). CONCLUSIONS The COVID-19 pandemic may elicit unhealthy changes in movement behavior in hypertensive older adults. Lower PA, higher and more prolonged SB on the weekend are the main features of the behavioral changes.