Clinical Management of Hypertension, Inflammation and Thrombosis in Hospitalized COVID-19 Patients : Impact on Survival and Concerns

The most severe clinical manifestations of the Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are due to an unbalanced immune response and a pro-thrombotic hemostatic disturbance, with arterial hypertension or diabetes as acknowledged risk factors. While waiting for a specific treatment, the clinical management of hospitalized patients is still a matter of debate, and the effectiveness of treatments to manage clinical manifestations and comorbidities has been questioned. In this study, we aim to assess the impact of the clinical management of arterial hypertension, inflammation and thrombosis on the survival of COVID-19 patients. The Spanish cohorts included in this observational retrospective study are from HM Hospitales (2035 patients) and from Hospital Universitario Central de Asturias (72 patients). Kaplan Meier survival curves, Cox regression and propensity score matching analyses were employed, considering demographic variables, comorbidities and treatment arms (when opportune) as covariates. The management of arterial hypertension with angiotensin-converting enzyme 2 (ACE2) inhibitors or angiotensin receptor blockers is not detrimental, as was initially reported, and neither was the use of non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, our analysis shows that the use on itself of corticosteroids is not beneficial. Importantly, the management of COVID-19 patients with low molecular weight heparin (LMWH) as an anticoagulant significantly improves the survival of hospitalized patients. These results delineate the current treatment options under debate, supporting the effectiveness of thrombosis prophylaxis on COVID-19 patients as a first-line treatment without the need for compromising the treatment of comorbidities, while suggesting cautiousness when administering corticosteroids.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

Journal of clinical medicine - Vol. 10, No. 5 (2021)

Language:

English

Contributors:

Martínez-Botía, Patricia
Bernardo, Ángel
Acebes-Huerta, Andrea
Caro, Alberto
Leoz, Blanca
Martínez-Carballeira, Daniel
Palomo-Antequera, Carmen
Soto, Inmaculada
Gutiérrez, Laura

Urls:

Volltext

Keywords:

Antihypertensive agents
COVID-19
Clinical manifestation
Comorbidity
Corticosteroids
Journal Article
Thrombosis

Notes:

Date Revised 08.04.2021

published: Electronic

Citation Status PubMed-not-MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.3390/jcm10051073

PMID:

33806709

PPN (Catalogue-ID):

NLM324713096