Trends and Outcomes of COVID-19 Hospitalizations Among Patients with Hypertension: Insights from United States National Inpatient Sample, 2020–2022

Abstract

COVID-19 has resulted in more than 100 million reported infections in the United States. Hypertension is a highly prevalent comorbidity among adults hospitalized with COVID-19 and is commonly associated with cardiovascular disease, chronic kidney disease, endothelial dysfunction, and systemic inflammation. Our study aimed to evaluate the impact of hypertension on outcomes among COVID-19 hospitalizations. We conducted a retrospective study using the National Inpatient Sample. We included 5.9 million adult hospitalizations with confirmed COVID-19 between 2020 and 2022, of which 3.7 million had concomitant HTN and 2.2 million did not. After multivariable adjustment, HTN was associated with higher odds of noninvasive ventilation (aOR 1.40, 95% CI 1.37–1.43), acute kidney injury (aOR 1.64, 95% CI 1.62–1.67), renal replacement therapy (aOR 4.17, 95% CI 4.02–4.34), atrial fibrillation (aOR 1.76, 95% CI 1.74–1.79), acute myocardial infarction (aOR 1.52, 95% CI 1.48–1.56), ischemic stroke (aOR 1.50, 95% CI 1.44–1.57), cardiac arrest (aOR 1.21, 95% CI 1.17–1.25), severe COVID-19 (aOR 1.78, 95% CI 1.75–1.80), and critical COVID-19 (aOR 1.65, 95% CI 1.63–1.67). HTN was also associated with a slightly longer adjusted length of stay and higher adjusted total charges. The hypertension group had higher crude in-hospital mortality (12.6% vs. 9.3%); however, after multivariable adjustment, hypertension was associated with lower odds of in-hospital mortality (aOR 0.92, 95% CI 0.90–0.93; p < 0.001). Overall, hypertension was associated with increased inpatient morbidity and a complicated hospital course among hospitalizations with COVID-19, despite lower adjusted odds of in-hospital mortality.