Clinical factors associated with hospitalization and mortality from COVID-19 in hypertensive patients in primary care: a multicenter study in Spain

To identify clinical factors independently associated with COVID-19–related hospitalization and short-term mortality among hypertensive patients managed in Primary Care in Spain. Multicenter retrospective cohort study including 1,372 hypertensive adults (≥ 18 years) with PCR-confirmed SARS-CoV-2 infection between May 2021 and February 2022. Multivariable logistic regression models adjusted for predefined confounders (age, sex, smoking status, and obesity) were used to evaluate factors independently associated with hospital admission and 3-month all-cause mortality. Hospital admission occurred in 29.2% of patients, ICU admission in 5.0%, and 3-month mortality was 4.0%. Chronic kidney disease (aOR 1.52; 95% CI 1.08–2.14), heart failure (aOR 2.55; 95% CI 1.74–3.74), atrial fibrillation (aOR 2.16; 95% CI 1.50–3.12), diabetes in patients aged < 60 years (aOR 2.54; 95% CI 1.41–4.60), peripheral arterial disease (aOR 2.17; 95% CI 1.31–3.58), chronic obstructive pulmonary disease (aOR 1.83; 95% CI 1.33–2.51), and immunocompromised status (aOR 3.19; 95% CI 1.89–5.53) were independently associated with hospital admission. A significant interaction between smoking and chronic kidney disease was observed (aOR 6.80; 95% CI 2.37–19.48). RAAS inhibitor use was not associated with hospitalization. For mortality, chronic kidney disease (aOR 4.34; 95% CI 2.37–7.94), atrial fibrillation (aOR 4.09; 95% CI 2.18–7.68), heart failure (aOR 3.66; 95% CI 1.91–7.02), chronic obstructive pulmonary disease (aOR 2.95; 95% CI 1.59–5.47), and peripheral arterial disease (aOR 2.05; 95% CI 1.21–3.47) were independently associated with death. Estimates for mortality should be interpreted in light of the limited number of events. In hypertensive patients with COVID-19 managed in Primary Care, cardiovascular and renal comorbidities were independently associated with hospitalization and short-term mortality. Chronic kidney disease and heart failure showed the strongest and most consistent associations across outcomes. RAAS inhibitor use was not associated with increased risk.