Impact of аrterial hypertension and coronary heart disease on the course and outcomes of COVID‑19 in patients of different age groups

Objective. To assess the significance of the influence of arterial hypertension (AH) and coronary artery disease (CAD) on the course and outcome of the novel coronavirus infection in patients of different age groups.

Materials and methods: The study included 808 patients with COVID‑19, 452 men and 356 women, hospitalized in the intensive care unit of the infectious diseases department of the N.V. Sklifosovsky Research Institute for Emergency Medicine during the period from 01.10 to 21.12.2020. Patients were divided into groups according to age: young (18–45 years, n=121), middle-aged (46–60 years, n=268), elderly (61–75 years, n=314), and senile (over 75 years, n=105). In all patients, stage II and III AH, CAD with angina pectoris, previous and acute myocardial infarction were taken into account; indicators of clinical and laboratory studies, electrocardiography, echocardiography, and computed tomography (CT) of the chest organs were evaluated considering the degree of lung involvement. In 110 deceased patients, the severity of lung involvement and the immediate cause of death were assessed.

Results. Of the total number of hospitalized patients, those of young, middle-aged, elderly, and senile age accounted for 15 %, 33%, 39%, and 13%, respectively. Among patients under 45 years of age, 68% had no concomitant pathology, 24% had stage II AH and 5% stage III AH, and only isolated patients had chronic and acute forms of CAD. In the age group of 45–60 years, the number of patients without cardiovascular diseases (CVD) decreased to 41%, those with stage II and III AH increased to 33% and 17%, and those with chronic and acute forms of CAD accounted for 6% and 3%. In the age group of 60–75 years, patients without CVD accounted for only 16%, those with stage II and III AH 43% and 17%, and those with chronic and acute forms of CAD17% and 7%, respectively. Finally, among people older than 75 years, only isolated patients had no concomitant pathology; those with stage II and III AH accounted for 40% and 19%, and the number of individuals with acute and chronic forms of CAD increased significantly to 23% and 16%, respectively. Analysis of the influence of the age factor on mortality revealed a statistically significant relationship: in the age groups under 45, 46–60, 61–75, and over 75 years the rates were 3.3%, 9.3%, 15.0%, and 32.4%, respectively. The mortality rate demonstrated an exponential increase with increasing age, which may be associated with a relatively uniform distribution of patients with AH across all age groups, while patients with CAD were predominantly represented among elderly and senile individuals.

Conclusion. Age is one of the key factors determining the mortality rate in COVID‑19; however, its determining role is indirect. The extent of lung involvement and the severity of concomitant AH and CAD exert a direct influence on the course and outcome of coronavirus infection. With increasing patient age, not only is there an increase in the frequency of subtotal lung involvement, but also an accumulation of severe stages and forms of AH and CAD complicated by circulatory failure. The risk of a fatal outcome, increasing exponentially with each decade of life, is determined by the stage of AH, the form of CAD, and the degree of severity of heart failure.

1. Vosko I, Zirlik A, Bugger H. Impact of COVID‑19 on cardiovascular disease. Viruses. 2023; 15 (2): 508. https://doi.org/10.3390/v15020508

2. Tajmirriahi M, Masjedi Esfahani M, Amouaghaei Z, Mansori N, Miralaei P, Lalehzar SS, e al. Cardioembolic stroke, the most common subtype of stroke in COVID19: A single center experience from Isfahan, Iran. J Res Med Sci. 2023; 28: 10. https://doi.org/10.4103/jrms.jrms_594_21

3. Zhang JJ, Dong X, Liu GH, Gao YD. Risk and Protective Factors for COVID‑19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol. 2023; 64 (1): 90–107. https://doi.org/10.1007/s12016‑022‑08921‑5

4. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID‑19 patients: A review. Allergy. 2021; 76 (2): 428–455. https://doi.org/10.1111/all.14657

5. Mughal MS, Kaur IP, Jaffery AR, Dalmacion DL, Wang C, Koyoda S, et al. COVID‑19 patients in a tertiary US hospital: Assessment of clinical course and predictors of the disease severity. Respir Med. 2020; 172: 106130. https://doi.org/10.1016/j.rmed.2020.106130

6. Pijls BG, Jolani S, Atherley A, Derckx RT, Dijkstra JIR, Franssen GHL, et al. Demographic risk factors for COVID‑19 infection, severity, ICU admission and death: a meta-analysis of 59 studies. BMJ Open. 2021; 11 (1): e044640. https://doi.org/10.1136/bmjopen‑2020–044640

7. Shaw AC, Joshi S, Greenwood H, Panda A, Lord JM. Aging of the innate immune system. Curr Opin Immunol. 2010; 22 (4): 507–13. https://doi.org/10.1016/j.coi.2010.05.003

8. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, et al. Risk factors of critical & mortal COVID‑19 cases: A systematic literature review and meta-analysis. J Infect. 2020; 81 (2): e16-e25. https://doi.org/10.1016/j.jinf.2020.04.021

9. Bonanad C, García-Blas S, Tarazona-Santabalbina F, Sanchis J, Bertomeu-González V, Fácila L, et al. The Effect of Age on Mortality in Patients With COVID‑19: A Meta-Analysis With 611,583 Subjects. J Am Med Dir Assoc. 2020; 21 (7): 915–918. https://doi.org/10.1016/j.jamda.2020.05.045

10. Wu JT, Leung K, Bushman M, Kishore N, Niehus R, de Salazar PM, et al. Estimating clinical severity of COVID‑19 from the transmission dynamics in Wuhan, China. Nat Med. 2020; 26 (4): 506–510. https://doi.org/10.1038/s41591‑020‑0822‑7

11. Azevedo RB, Botelho BG, Hollanda JVG, Ferreira LVL, Junqueira de Andrade LZ, Oei SSML, et.al. Covid‑19 and the cardiovascular system: a comprehensive review. J Hum Hypertens. 2021; 35 (1): 4–11. https://doi.org/10.1038/s41371‑020‑0387‑4

12. Keshtova M. U., Gazaryan G.A., Petrikov S.S. The impact of arterial hypertension and coronary heart disease on the course and outcome of COVID19. Medical alphabet. Cardiology. Emergency medicine. 2025; (3): 7–11. (In Russ.). https://doi.org/10.33667/2078‑5631‑2025‑3‑7‑11

13. Keshtova MU, Gazaryan GA, Petrikov SS. The effect of arterial hypertension and coronary heart disease on the course and outcome of COVID‑19. Medical alphabet. Cardiology. Emergency Medicine. 2025;(3):7–11. (In Russ.) https://doi.org/10.33667/2078‑5631‑2025‑3‑7‑11

14. Ameratunga R, Edwards ESJ, Lehnert K, Leung E, Woon ST, Lea E, et al. The Rapidly Expanding Genetic Spectrum of Common Variable Immunodeficiency-Like Disorders. J Allergy Clin Immunol Pract. 2023; 11 (6): 1646–1664. https://doi.org/10.1016/j.jaip.2023.01.048

15. Fried JA, Ramasubbu K, Bhatt R, Topkara VK, Clerkin KJ, Horn E, et al. The variety of cardiovascular presentations of COVID‑19. Circulation. 2020; 141 (23): 1930–1936. https://doi.org/10.1161/CIRCULATIONAHA.120.047164