June Cardiology collaborates on breakthrough in high blood pressure study linked to increased risk of dying from COVID-19

<>Findings based on Chinese data also indicate even greater risk of dying from COVID-19 if high blood pressure not treated by medication

A team of five global cardiology experts at NUI Galway have collaborated to interpret a study into high blood pressure linked to increased risk of dying from COVID-19.

The study has found that patients with raised blood pressure have a two-fold increased risk of dying from the coronavirus COVID-19 compared to patients without high blood pressure, according to new research published in the European Heart Journal today (Friday, 5 June) as a fast track publication.

In addition, the study found that patients with high blood pressure who were not taking medication to control the condition were at even greater risk of dying from COVID-19.

Professors Patrick W. Serruys, Osama Soliman and Yoshi Onuma recently enhanced the contingent of global experts in the field of cardiology at NUI Galway, which includes Professor William Wijns and Professor McEvoy, all co-authors on this paper.

The expert team at NUI Galway collaborated with a team in China and have analysed data from 2866 patients with COVID-19 who were admitted to Huo Shen Shan hospital in Wuhan, China, between 5 February and 15 March 2020. Of these patients, 29.5% (850) had a medical history of high blood pressure (hypertension). They found that 34 out of 850 hypertensive patients (4%) with coronavirus died compared to 22 out of 2027 patients without hypertension (1.1%) – a 2.12-fold increased risk after adjustment for factors that could affect the results, such as age, sex and other medical conditions.

Among the patients with hypertension who were not taking medication for the condition, 11 out 140 (7.9%) died from coronavirus compared to 23 out of 710 (3.2%) of those who were taking medication – 2.17-fold increased risk after adjusting for confounding factors.

As fewer cases of COVID-19 are being diagnosed now in China, a grant for a randomised clinical trial has been submitted at NUI Galway by Professors J. William McEvoy and Patrick Serruys, who are co-authors of the EHJ paper.

In a meta-analysis, the researchers pooled the data from the Huo Shen Wan patients with data from nearly 2,300 patients in three other studies to investigate the death rates in patients being treated with drugs to control blood pressure levels by targeting the renin-angiotensin-aldosterone system (RAAS). These drugs include angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Other, non-RAAS inhibiting drugs used for treating high blood pressure include beta blockers, calcium channel blockers (CCBs) or diuretics.  They found a lower risk of death among the 183 patients treated with RAAS inhibitors than in 527 patients treated with other drugs. However, the researchers say this result should be treated with caution as the number of patients in this analysis was small and so it could be due to chance.

Professor Patrick W. Serruys said: “There are three remaining questions, and we hope our clinical trial in Ireland will answer the first two: what kind of medication should be given to COVID-19 patients with hypertension – RAAS inhibitors or non-RAAS inhibitors – and could these medications mitigate the risk of dying in these patients? The last question is whether or not RAAS inhibitors influence the risk of infection for COVID-19.”

“As for the last question, a recent population-based study in the New England Journal of Medicine has suggested that antihypertensive medications, such as ACE inhibitors and ARBs are not associated with an increased risk of testing positive for COVID-19.”

As this is a retrospective and observational study, it cannot show a causal relationship between RAAS inhibitors and the risk of dying from COVID-19. Other limitations include the inability to include all relevant confounding factors; some data, such as electrocardiograms (ECGs) were not recorded in detail; and the impact of antihypertensive medications can only be assessed in the short-term, with prospective studies needed to see longer-term effects.

Professor Patrick W. Serruys took up the role of Established Professor of Interventional Medicine and Innovation at NUI Galway in recent months. He is an expert in interventional cardiology since 1979 and he has held many of the most senior roles in his field throughout his career. Through his many innovations he has been instrumental in changing the course and treatment of coronary artery disease over the last three decades. His innovations include the introduction of the use of drug-eluting stents into clinical practice for the first time and in 2006 the discovery of fully biodegradable drug-eluting scaffolds so that a permanent metallic stent would no longer need to be implanted in patients. He has been a Principal Investigator on more than 80 European and Multinational cardiovascular clinical trials.

Professor Serruys has been joined by Professor Osama Soliman as Medical Director of the CORRIB Corelab for Structual Heart Imaging, Heart Failure and Cardio-oncology, and by Professor Yoshi Onuma as Medical Director of the CORRIB Corelab of Coronary Imaging and Atherosclerosis Research. Professors Soliman and Onuma bring decades of experience in the field of noninvasive and invasive coronary imaging, novel coronary devices, cardiovascular imaging, clinical trials, innovation in medicine and education of cardiologist researchers. These three brought a group of cardiologist researchers (academic team) who are originated from various countries including Japan and China; the academic team triggered the current intercontinental collaborative research between Ireland and China.

Professor David Wood, former President of the World Heart Foundation, also joined NUI Galway as Adjunct Professor of Preventive Cardiology last year. Professor Wood is a cardiologist committed to prevention of cardiovascular disease. He has contributed to international policy and guidelines on cardiovascular disease (CVD) prevention through the World Health Organisation, World Heart Federation and the European Society of Cardiology.

Professors Serruys, Wood and Wijns have all received the Gold Medal of the European Society of Cardiology, which is the highest honour the Society can bestow on exceptional scientists for their contribution to cardiovascular medicine. Professor William McEvoy has also recently returned to Ireland from John Hopkins University School of Medicine USA and has been appointed as Professor of Preventive Cardiology, Consultant Cardiologist at NUI Galway and Galway University Hospitals and also hold the role of Research & Medical Director National Institute for Prevention and Cardiovascular Health (NIPC)in partnership with Croí.

Speaking on the appointments Professor Timothy O’Brien, Dean of the College of Medicine, Nursing and Health Sciences at NUI Galway and lead Consultant Endocrinologist for Saolta University Healthcare Group has welcomed this new research. “NUI Galway is developing a leading role in advancing cardiovascular healthcare globally aligned with Government and agency strategy to promote Ireland as a global cluster of medical device research. Research, such as this study on high blood pressure linked to increased risk of dying from COVID-19, shows that by bringing together global experts we can make significant advances in healthcare. We have expanded our team to provide the full suite of cardiovascular expertise - prevention, imaging, treatment, and of course, technology innovation. These appointments provide an incredible opportunity for clinicians and researchers to collaborate to advance patient care.  The investigators will also participate in CURAM, the SFI Centre in Medical Device Research.”

NUI Galway President, Professor Ciarán Ó hÓgartaigh, said: “The appointments of Professors Patrick W. Serruys, Osama Soliman and Yoshi Onuma epitomises NUI Galway’s respect for and commitment to excellent research in the health sector. Research advances of real value to people will result from the combination of their expertise in the field of cardiology and the exceptional research teams currently in NUI Galway. This study into high blood pressure linked to increased risk of mortality from COVID-19 is an example of this combination and commitment. I welcome their appointments with great anticipation of the opportunities to ultimately deliver better health outcomes for patients, for the public good.”

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