{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:28:50Z","timestamp":1784248130598,"version":"3.55.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T00:00:00Z","timestamp":1667952000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Cambridge BHF CRE non-clinical PhD Studentship"},{"name":"Innovative Medicines Initiatice-2","award":["116074"],"award-info":[{"award-number":["116074"]}]},{"name":"BHF-Turing Cardiovascular Data Science Award","award":["BCDSA\\100005"],"award-info":[{"award-number":["BCDSA\\100005"]}]},{"name":"UK MRC","award":["MR\/L003120\/1"],"award-info":[{"award-number":["MR\/L003120\/1"]}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/13\/13\/30194; RG\/18\/13\/33946"],"award-info":[{"award-number":["RG\/13\/13\/30194; RG\/18\/13\/33946"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018956","name":"NIHR Cambridge Biomedical Research Centre","doi-asserted-by":"publisher","award":["BRC-1215-20014"],"award-info":[{"award-number":["BRC-1215-20014"]}],"id":[{"id":"10.13039\/501100018956","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018956","name":"NIHR Cambridge Biomedical Research Centre","doi-asserted-by":"publisher","award":["BRC-1215-20014"],"award-info":[{"award-number":["BRC-1215-20014"]}],"id":[{"id":"10.13039\/501100018956","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018956","name":"NIHR Cambridge Biomedical Research Centre","doi-asserted-by":"publisher","award":["BRC-1215-20014"],"award-info":[{"award-number":["BRC-1215-20014"]}],"id":[{"id":"10.13039\/501100018956","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Imperial College London Biomedical Research Centre Award"},{"name":"NIHR Applied Research Collaboration (ARC) West"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Hypertension appears to be one of the commonest comorbidities in COVID-19 patients, although whether hypertensive individuals have a higher risk of severe COVID-19 compared with non-hypertensives is unclear. It is also unclear whether the absolute level of systolic blood pressure, or the type of anti-hypertensive medication is related to this risk. Analyses were conducted using data from the UK Biobank and linked health records. Logistic regression models were fitted to assess the impact of hypertension, systolic blood pressure (SBP) and medications on the risk of severe COVID-19. 16,134 individuals tested positive for severe acute respiratory syndrome-coronavirus, 22% (n = 3,584) developed severe COVID-19 and 40% (n = 6,517) were hypertensive. Hypertension was associated with 22% higher odds of severe COVID-19 (Odds ratio (OR) 1.22; 95% confidence interval (CI) 1.12, 1.33), compared with normotension after adjusting for confounding variables. In those taking anti-hypertensive medications, elevated SBP showed a dose-response relationship with severe COVID-19 (150-159mmHg versus 120-129mmHg (OR 1.91; 95% CI 1.44, 2.53), &gt;180+mmHg versus 120-129mmHg (OR 1.93; 95% CI 1.06, 3.51)). SBP &lt;120mmHg was associated with greater odds of severe COVID-19 (OR 1.40; 95% CI 1.11, 1.78). Angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers were not associated with altered risk of severe COVID-19. Hypertension is an important risk factor for COVID-19. A better understanding of the underlying mechanisms is warranted in case of more severe strains or other viruses in the future.<\/jats:p>","DOI":"10.1371\/journal.pone.0276781","type":"journal-article","created":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T18:42:07Z","timestamp":1668019327000},"page":"e0276781","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Primary hypertension, anti-hypertensive medications and the risk of severe COVID-19 in UK Biobank"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5014-5118","authenticated-orcid":true,"given":"Holly","family":"Pavey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2827-214X","authenticated-orcid":true,"given":"Spoorthy","family":"Kulkarni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Ben-Shlomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Sever","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmel","family":"McEniery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Wilkinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,11,9]]},"reference":[{"issue":"10229","key":"pone.0276781.ref001","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study","volume":"395","author":"F Zhou","year":"2020","journal-title":"Lancet (London, England)"},{"issue":"4","key":"pone.0276781.ref002","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/S2213-2600(20)30116-8","article-title":"Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?","volume":"8","author":"L Fang","year":"2020","journal-title":"Lancet Respir Med"},{"issue":"5","key":"pone.0276781.ref003","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/ajh\/hpaa057","article-title":"Hypertension and COVID-19","volume":"33","author":"EL Schiffrin","year":"2020","journal-title":"Am J Hypertens"},{"issue":"18","key":"pone.0276781.ref004","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1056\/NEJMoa2002032","article-title":"Clinical Characteristics of Coronavirus Disease 2019 in China","volume":"382","author":"W Guan","year":"2020","journal-title":"N Engl J Med"},{"issue":"17","key":"pone.0276781.ref005","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1056\/NEJMsr2005760","article-title":"Renin\u2013Angiotensin\u2013Aldosterone System Inhibitors in Patients with Covid-19","volume":"382","author":"M Vaduganathan","year":"2020","journal-title":"N Engl J Med"},{"issue":"7","key":"pone.0276781.ref006","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1111\/all.14238","article-title":"Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China","volume":"75","author":"J Zhang","year":"2020","journal-title":"Allergy"},{"issue":"7","key":"pone.0276781.ref007","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1001\/jamainternmed.2020.0994","article-title":"Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China","volume":"180","author":"C Wu","year":"2020","journal-title":"JAMA Intern Med"},{"issue":"12","key":"pone.0276781.ref008","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/j.jiph.2020.07.014","article-title":"COVID-19 and comorbidities: Deleterious impact on infected patients","volume":"13","author":"H Ejaz","year":"2020","journal-title":"J Infect Public Health"},{"issue":"8","key":"pone.0276781.ref009","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1080\/00325481.2020.1786964","article-title":"COVID-19 and comorbidities: a systematic review and meta-analysis","volume":"132","author":"MS Gold","year":"2020","journal-title":"Postgrad Med"},{"key":"pone.0276781.ref010","year":"2019","journal-title":"Health Survey for England 2018 Adults\u2019 Health"},{"issue":"6965","key":"pone.0276781.ref011","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1038\/nature02145","article-title":"Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus","volume":"426","author":"W Li","year":"2003","journal-title":"Nature"},{"issue":"1","key":"pone.0276781.ref012","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1080\/22221751.2020.1746200","article-title":"Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension","volume":"9","author":"J Meng","year":"2020","journal-title":"Emerg Microbes Infect"},{"issue":"18","key":"pone.0276781.ref013","first-page":"1769","article-title":"COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence?","volume":"323","author":"AB Patel","year":"2020","journal-title":"JAMA"},{"issue":"6","key":"pone.0276781.ref014","doi-asserted-by":"crossref","DOI":"10.1002\/prp2.666","article-title":"A systematic review and meta-analysis of the use of renin-angiotensin system drugs and COVID-19 clinical outcomes: What is the evidence so far?","volume":"8","author":"A Kurdi","year":"2020","journal-title":"Pharmacol Res Perspect"},{"key":"pone.0276781.ref015","article-title":"Mortality and Disease Severity Among COVID-19 Patients Receiving Renin-Angiotensin System Inhibitors: A Systematic Review and Meta-analysis","author":"SS Hasan","year":"2020","journal-title":"Am J Cardiovasc Drugs"},{"key":"pone.0276781.ref016","article-title":"Use of inhibitors of the renin-angiotensin system in hypertensive patients and COVID-19 severity: A systematic review and meta-analysis","author":"J Barochiner","year":"2020","journal-title":"J Clin Pharm Ther"},{"issue":"8","key":"pone.0276781.ref017","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1111\/jch.13948","article-title":"Use of distinct anti-hypertensive drugs and risk for COVID-19 among hypertensive people: A population-based cohort study in Southern Catalonia, Spain","volume":"22","author":"A Vila-Corcoles","year":"2020","journal-title":"J Clin Hypertens"},{"key":"pone.0276781.ref018","article-title":"Risk of severe COVID-19 in hypertensive patients treated with renin-angiotensin-aldosterone system inhibitors","author":"R Golpe","year":"2020","journal-title":"Med Clin (Barc)"},{"key":"pone.0276781.ref019","article-title":"Anti-hypertensive Angiotensin II receptor blockers associated to mitigation of disease severity in elderly COVID-19 patients","author":"Y Liu","year":"2020","journal-title":"medRxiv"},{"issue":"25","key":"pone.0276781.ref020","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1056\/NEJMoa2006923","article-title":"Renin\u2013Angiotensin\u2013Aldosterone System Blockers and the Risk of Covid-19","volume":"382","author":"G Mancia","year":"2020","journal-title":"N Engl J Med"},{"key":"pone.0276781.ref021","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ahj.2020.05.002","article-title":"Continuing versus suspending angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: Impact on adverse outcomes in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)\u2014The BRACE CORONA Trial","volume":"226","author":"RD Lopes","year":"2020","journal-title":"Am Heart J"},{"issue":"8","key":"pone.0276781.ref022","doi-asserted-by":"crossref","first-page":"e192","DOI":"10.1016\/S1473-3099(20)30483-7","article-title":"A minimal common outcome measure set for COVID-19 clinical research","volume":"20","author":"JC Marshall","year":"2020","journal-title":"Lancet Infect Dis"},{"key":"pone.0276781.ref023","author":"A Randomized Trial of Intensive versus Standard Blood-Pressure Control","year":"2015","journal-title":"N Engl J Med"},{"issue":"388","key":"pone.0276781.ref024","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1016\/S0140-6736(16)31326-5","article-title":"Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study","volume":"29","author":"E Vidal-Petiot","year":"2016","journal-title":"Lancet"},{"key":"pone.0276781.ref025","article-title":"ACE-inhibitors and Angiotensin-2 Receptor Blockers are not associated with severe SARS- COVID19 infection in a multi-site UK acute Hospital Trust","author":"D Bean","year":"2020","journal-title":"medRxiv"},{"key":"pone.0276781.ref026","first-page":"395","article-title":"Use of renin\u2013angiotensin\u2013aldosterone system inhibitors and risk of COVID-19 requiring admission to hospital: a case-population study","author":"J de Abajo","year":"2020","journal-title":"Lancet"},{"issue":"25","key":"pone.0276781.ref027","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1056\/NEJMoa2008975","article-title":"Renin\u2013Angiotensin\u2013Aldosterone System Inhibitors and Risk of Covid-19","volume":"382","author":"HR Reynolds","year":"2020","journal-title":"N Engl J Med"},{"issue":"7","key":"pone.0276781.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1099\/mgen.0.000397","article-title":"Dynamic linkage of covid-19 test results between public health england\u2019s second generation surveillance system and uk biobank","volume":"6","author":"J Armstrong","year":"2020","journal-title":"Microb Genomics"},{"key":"pone.0276781.ref029","doi-asserted-by":"crossref","first-page":"m131","DOI":"10.1136\/bmj.m131","article-title":"Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis","volume":"368","author":"GD Batty","year":"2020","journal-title":"BMJ"},{"key":"pone.0276781.ref030","article-title":"Collider bias undermines our understanding of COVID-19 disease risk and severity","author":"G Griffith","year":"2020","journal-title":"medRxiv"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276781","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,9]],"date-time":"2022-11-09T18:42:45Z","timestamp":1668019365000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0276781"}},"subtitle":[],"editor":[{"given":"Sadashiva S.","family":"Karnik","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,11,9]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,11,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0276781","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,9]]}}}