ROLE OF BLOOD PRESSURE DYSREGULATION ON KIDNEY AND MORTALITY OUTCOMES IN COVID-19

Background: Since February 2020 COVID-19 infection spread in Italy, violently hitting the Lombardy region. Despite high diffusion, only a subset of patients developed severe COVID-19: around 25% of them developed AKI and one-third of them died. Elderly patients and patients with high comorbidity have been identified as at higher risk of severe COVID-19.
Methods: In a prospective observational cohort study 392 consecutive patients hospitalized for COVID-19 in Milan (age 67 years, 75% male) were included. We evaluated the relationship between blood pressure at presentation, presence of AKI at Emergency Room presentation and during hospitalization, and total in-hospital mortality (24%).
Results: Despite 58% reported a history of hypertension (86% treated) 30% of patients presented with low blood pressure levels. Only 5.5% were diagnosed with AKI on admission; 75% of hypertensive patients discontinued therapy during hospitalization (only 20% were treated at discharge).
Gender and hypertension were strongly associated with AKI at admission time (odds ratio 11). Blood pressure was inversely correlated with increased risk of AKI upon admission, independently of the severity of respiratory distress. Age over 65, history of hypertension, and severity of respiratory distress were the main predictors of AKI during hospitalization (developed in 34.7% of the cases).
AKI was associated with increased in-hospital mortality. Hypertension and low levels of blood pressure at presentation were the main predictors of in-hospital mortality, together with age over 65, baseline pulmonary involvement, and severity of illness.
Conclusions: In patients hospitalized for COVID-19, hypertension and low levels of blood pressure at presentation are important risk factors for AKI and mortality. Early reduction of antihypertensive therapy may improve outcomes in SARS-CoV-2 infection.

doi: 10.17632/2kj8jfgndw.1