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.

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Journal
BMC Primary Care
Published
2026-03-16
DOI
https://doi.org/10.1186/s12875-026-03263-z
Primary Topic
COVID-19 Clinical Research Studies
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article
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article

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

Gloria García Conejo, Emiliano Rodríguez SÁNCHEZ, Jesús Martín González, Rafael Crespo Sabarís et al.
BMC Primary Care
COVID-19 Clinical Research Studies
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Clinical factors associated with hospitalization and mortality from COVID-19 in hypertensive patients in primary care: a multicenter study in Spain

Gloria García Conejo, Emiliano Rodríguez SÁNCHEZ, Jesús Martín González, Rafael Crespo Sabarís, Guillermo Ferrer García, María del Carmen Latorre Aliaga, MARGARITA PINEL MONGE, Laura Martín Piedra, Maravillas Sánchez-Macarro, Laura Montero García, Francisco Valls Roca, Karen Ruth Barroso López, Paz Castro Fernández, Antonio Martínez Pastor, Fernando García Romanos, Gregorio Mediavilla Tris, Lorena González Rodríguez, Josefa Sánchez Sánchez, Juan Fernando Peiró Morant, Carmen Zárate Oñate, Carmen Martínez Sanz, Clara Isabel Soria López, Benigna Sánchez Salgado, Inés Marcos Romero, Juan Francisco Martínez García, Alba Alegre Fernández, Lorena Herráez García, José Basilio Gómez Castaño, Ana Fátima Navarro Oliver, Mohamed Hamdi Djatri, Mariluz Alarcia Ceballos, María José Gómez González, Esperanza Moral Berrio, Alcibíades Segundo Díaz Vera, Inmaculada Torres Fernández, Ángeles Velasco Soria, Inmaculada López Carrillo, Francisco Javier González García, Lidia Ruiz Albaladejo, Susana Martínez Palli, Ana Moyá Amengual, Marina Sánchez Solano, Roger Abduvar Cox Conforme, Elena Pascual Roquet-Jalmar, He Zhang Lin, Ainara Bayle Mayor, Irene Lluch Verdú, Alberto Díaz Cáceres, Manuel Angel Gómez Marcos, María Luisa Mateos, Susana González Sánchez, José Abellán Alemán, P Jara, Nuria Suárez Moreno, Javier Guinea Castanares, Javier Sobrino Martínez, Susana Garrote Pascual, Lydia María Pérez Carbayo, Raúl Lapeña Gómez, Javier Nieto Iglesias, Javier Alonso Moreno, María Pilar Torres Rodríguez, Francisco Manuel Lafuente Salanova, Luisa Mª Fernández Rodríguez, Cristina Rojas de Teresa, Pedro Juan Tárraga López, Miren Arrazola Vallejo, Pedro Javier Martínez Sánchez, Alejandro Serrán Jiménez, Ana Gabriela Espinosa García, Paz Muriel Díaz, Alberto Romero Galán, Ramón López Guillén, Cristina Muñoz Martín, Isabel Moreno Sánchez, Elena González Garrido, Yuniel Valerón Menéndez, Arantzazu Igoa Erro, Lourdes Montejo Perrino, Manuel Mejías Gil, María Rocío Cubino Luis, Nicolás Morel Alba, Domingo José Rubira López, Francisca Castaño Pérez, José Manuel Calleja Pascual, Marta Román Garrido, Irene Mestres Maza, Alejandro Domínguez Bejarano, Mónica García San José, Francisca Díaz Ortega, José Antonio Gómez Miguel, Fátima López Valls, Esther Pozuelo, Mar López Miralles, Carolina Domínguez Acosta, Jesús Iturralde Iriso, Beatriz Claudia Arostegui Castillo de la Flor, Joaquín Timón Olea, Ángela Boloufer Pérez, María José Recio Calzada, Maialen Ormazábal Iñiguez de Heredia, Luis García Ortiz, M Auxiliadora Velasco Ramos, Saray Porras Sáez, Esperanza Sastre Menor, Sara García Saorín, M. Pilar Martín Sánchez, Isabela Borrajo Brunete, Quintín Campistegui Ramírez, Laura Caro Pérez, Aarón Hernández Sánchez, Juan Lobato Carrasco, Raquel Carpio Marcos, Olaya Tamayo Morales, Cristina Lugones Sánchez, Mª del Mar Manchado Reinoso, H. T. A.-COVID-19 Study, Nuria Porto Millara, Alberto Vicente Prieto, Fernando Hernández Menárguez, Fernando José Juárez Bonilla, Ana Isabel Alonso Ruiz, Manuel A. Gómez Marcos, María Isabel Ruiz Martínez, Francisco J. Fuentes Jiménez, Fátima María Ballesta Selma, María Isabel Orlandis Vázquez, Ekiñe Zorrilla Amirola, Danele Barandiarán Abaroa, María Isabel González Sánchez, Ana Isabel Bas
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Abstract

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.

BMC Primary Care
Universidad Pública de Navarra (UPNA) (ES), Basque Government (ES), Servei de Salut de les Illes Balears (ES), Conselleria de Sanitat Universal i Salut Pública (ES), Hospital de l'Esperança (ES), Hospital General Universitario de Ciudad Real (ES), Navarrabiomed (ES), Hospital Universitario Reina Sofía (ES), Instituto de Investigación Biomédica de Salamanca (ES), Servicio de Salud de Castilla La Mancha (ES), Servicio Murciano de Salud (ES), Institut Català de la Salut (ES), Gobierno de La Rioja (ES), Universidad Católica de Murcia (ES), University of Castilla-La Mancha (ES), Universidad de Murcia (ES)
Good health and well-being
Openalex Percentile: Top 21%
COVID-19 Clinical Research Studies
DOIOpen Access PDFOpenAlex
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