Hypertension Doubles the Risk of Hospitalization in Recent COVID-19 Patients
Even as more Americans are vaccinated against COVID-19 and virus variants became more contagious, but seemingly less severe, some patients still end up being hospitalized in severe cases. Find out how a recent study determined that people with hypertension fall into that high-risk group, which is especially concerning because high blood pressure is so common.
LOS ANGELES – It will come as no surprise to pharmacists that half of U.S. adults have some level of hypertension, considering how many prescriptions they fill every day for blood pressure-lowering medications.
What might give them pause, however, is the news that hypertension more than doubles the risk of hospitalization from infection with COVID-19’S Omicron variant, even in people who are fully vaccinated and boosted. That is according to a new study from the Smidt Heart Institute at Cedars-Sinai, published recently in the journal Hypertension.
https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.122.19694
“The take-home message is that avoiding infection is extremely important—even when the circulating viral variant is presumed to cause mild disease in most people,” said first author Joseph E. Ebinger, MD, a clinical cardiologist and director of clinical analytics at the Smidt Heart Institute.
The authors write, “Concerns regarding waning immunity and the risk of emerging new variants, including Omicron, prompted recommendations for a third booster vaccine dose after completion of a 2-dose mRNA vaccine regimen, given its efficacy at further reducing risk for severe illness by up to 70%.1 However, a proportion of individuals who received 3 mRNA vaccine doses still required hospitalization for COVID-19 during the Omicron surge.”
The study conducted a retrospective cohort study of adults who received at least 3 mRNA vaccine doses but were subsequently treated for confirmed COVID-19 infection in its academic healthcare system during the Omicron surge onset to help determine what characteristics predispose vaccine recipients to more severe cases.
The researchers report that their findings “reveal a persistent and marked association between hypertension and risk for severe COVID19 illness, even among a fully vaccinated patient population. The Omicron variant of SARS-CoV-2 has led to overall less severe COVID-19 illness in most affected individuals when compared with prior variants—with morbidity and mortality even further reduced by receiving 3 doses of vaccine.”
Study authors point out that their findings were consistent with prior studies demonstrating greater hospitalization risk with advanced age and time since the last vaccine dose, adding, “Even when controlling for these and other clinical variables, the risk of hospitalization related to breakthrough Omicron infection was more than doubled by the presence of hypertension.”
The risk persisted even when the analysis excluded patients with chronic kidney disease, myocardial infarction and heart failure, the study notes.
“Our findings extend from prior reports of equivocal or potentially confounded associations of hypertension with COVID-19 illness severity that were based on analyzing early pandemic and particularly pre-Omicron outcomes data,” according to the study. “In the context of shifts in the risk factors associated with more severe forms of COVID-19 during the course of the pandemic, our results indicate persistence and even accentuation of hypertension-related risk in the setting of a more transmissible albeit generally less virulent strain of SARS-CoV-2 and in the era of multidose vaccination.”
Nothing that the mechanism for hypertension associated COVID-19 risk remains unclear, researchers note that previous studies point to delayed SARS-CoV-2 viral clearance and prolonged inflammatory response among hypertensive patients as factors contributing to greater disease severity.
“Given that hypertension is one of the most prevalent chronic medical conditions, affecting individuals across the age spectrum, concordant findings would suggest the need for further investigations focused on understanding the hypertension-specific risks from SARS-CoV-2 and on identifying individual- and population-level strategies for mitigating these risks as the pandemic transitions to an endemic,” the researchers add.
“We were surprised to learn that many people who were hospitalized with COVID-19 had hypertension and no other risk factors,” said Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and a senior author of the study. “This is concerning when you consider that almost half of American adults have high blood pressure.”
Hair, Libido Loss Added to Common Long COVID Symptoms
The ever-expanding list of Long COVID complaints now includes hair loss and reduced libido, according to a new study. Authors point out that the most common symptoms are anosmia, shortness of breath, chest pain and fever, however. Here are more details.
.BIRMINGHAM, UK – Add hair loss and sexual dysfunction to the list of symptoms suffered by recovered COVID-19 patients who continue to have effects from the virus.
A study published in Nature Medicine reports that patients with a primary care record of infection with the SARS CoV-2 virus reported 62 symptoms much more frequently 12 weeks after initial infection than those who hadn’t been infected.
https://www.nature.com/articles/s41591-022-01909-w
UK researchers from the University of Birmingham and colleagues used anonymized electronic health records of 2.4 million people in Britain to reach those conclusions. Included in the study from January 2020 to April 2021 were 486,49 people with prior infection but no hospitalization, and 1.9 million people with no indication of past COVID-19.
The study team was able to identify three categories of distinct symptoms reported after infection. Those were respiratory symptoms, mental health and cognitive problems, and then a broader range of symptoms.
The most common symptoms include anosmia, shortness of breath, chest pain and fever. Researchers identified others, including:
- amnesia,
- apraxia (inability to perform familiar movements or commands),
- bowel incontinence,
- erectile dysfunction,
- hallucinations,
- limb swelling
“This research validates what patients have been telling clinicians and policy makers throughout the pandemic, that the symptoms of Long Covid are extremely broad and cannot be fully accounted for by other factors such as lifestyle risk factors or chronic health conditions, said senior author Shamil Haroon, MBChB, PhD, MPH.
“The symptoms we identified should help clinicians and clinical guideline developers to improve the assessment of patients with long-term effects from Covid-19, and to subsequently consider how this symptom burden can be best managed.”
The study found that risk factors for long COVID include female sex, belonging to an ethnic minority, socioeconomic deprivation, smoking, obesity and a wide range of comorbidities.
“The risk of developing long COVID was also found to be increased along a gradient of decreasing age,” the article notes.
“Our data analyses of risk factors are of particular interest because it helps us to consider what could potentially be causing or contributing to Long Covid,” points out lead author Anuradhaa Subramanian, MSc. “ We already know that certain modifiable traits such as smoking and obesity put people at increased risk of various diseases and conditions, including Long Covid. However, others such as biological sex and ethnicity also appear to be important.”
Subramanian adds, “Women are for example more likely to experience autoimmune diseases. Seeing the increased likelihood of women having Long Covid in our study increases our interest in investigating whether autoimmunity or other causes may explain the increased risk in women. These observations will help to further narrow the focus on factors to investigate that may be causing these persistent symptoms after an infection, and how we can help patients who are experiencing them.”
COVID-19 Vaccination Doesn’t Affect Placenta in Pregnant Women
In a somewhat different study, pathologists determined that the placenta was not affected when pregnant women were vaccinated against COVID-19. The study provides further reassurance for expectant mothers that vaccination can help protect them and their babies against COVID-19 without concerning side effects. Here is more information.
NEW YORK – Pharmacists can reassure expectant mothers that COVID-19 vaccines do not affect the health of their placentas.
The research letter in the American Journal of Obstetrics & Gynecology is just the latest in a series of studies finding that vaccination against the SARS-CoV-2 virus is safe for pregnant women and their babies.
https://www.ajog.org/article/S0002-9378(22)00515-4/fulltext
The study was led by pathologists at Weill Cornell Medicine and New York-Presbyterian who took a different approach than focusing solely on maternal and infant outcomes. The researchers examined 18 indicators of placental health, such as the presence of lesions, blood clots and inflammation associated with a higher risk of adverse health issues for the mothers and their offspring.
The investigation also included data on the babies’ birth weights and the Apgar score. Information on 431 women who gave birth to single babies at New York-Presbyterian/Weill Cornell Medical Center between April 2020 and July 2021 was used in the study.
Of the study group, 164 women were fully vaccinated during pregnancy, defined as having received at least two doses of an mRNA COVID-19 vaccine (Pfizer or Moderna), and 267 were unvaccinated. None of the mothers had evidence of current or prior SARS-CoV-2 infection.
Results indicate no significant differences in placental health indicators, birth weights or Apgar scores between vaccinated and unvaccinated women.
The other good news is that 95% of babies born to vaccinated mothers had detectable antibodies against SARS-CoV-2 in umbilical cord blood, meaning that both mothers and babies had protection against COVID-19.
The national Centers for Disease Control and Prevention recommends COVID-19 vaccination for everyone 6 months and older. That includes women who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. The CDC warns that pregnant women who contract COVID-19 are more likely to become severely ill and could endanger their babies.
Public health officials also emphasize that vaccination during pregnancy builds antibodies that can help protect the baby. They also point to new data showing that completing a two-dose primary mRNA COVID-19 vaccine series during pregnancy can help protect babies younger than 6 months old from hospitalization due to COVID-19.
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