{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T13:48:59Z","timestamp":1776088139594,"version":"3.50.1"},"reference-count":16,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T00:00:00Z","timestamp":1680134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100019592","name":"Veterans Administration Medical Center","doi-asserted-by":"publisher","award":["1I01BX003015"],"award-info":[{"award-number":["1I01BX003015"]}],"id":[{"id":"10.13039\/100019592","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Hypertension (HTN) is associated with severe COVID-19 infection; however, it remains unknown if the level of blood pressure (BP) predicts mortality. We tested whether the initial BP in the emergency department of hospitalized patients portends mortality in COVID-19 positive(+) patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from COVID-19(+) and negative (-) hospitalized patients at Stony Brook University Hospital from March to July 2020 were included. The initial mean arterial BPs (MABPs) were categorized into tertiles (T) of MABP (65\u201385 [T1], 86\u201397 [T2] and \u226598 [T3] mmHg). Differences were evaluated using univariable (t-tests, chi-squared) tests. Multivariable (MV) logistic regression analyses were computed to assess links between MABP and mortality in hypertensive COVID-19 patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>1549 adults were diagnosed with COVID-19 (+) and 2577 tested negative (-). Mortality of COVID-19(+) was 4.4-fold greater than COVID-19(-) patients. Though HTN prevalance did not differ between COVID-19 groups, the presenting systolic BP, diastolic BP, and MABP were lower in the COVID-19(+) vs (-) cohort. When subjects were categorized into tertiles of MABP, T2 tertile of MABP had the lowest mortality and the T1 tertile of MABP had greatest mortality compared to T2; however, no difference in mortality was noted across tertiles of MABP in COVID-19 (-). MV analysis of COVID-19 (+) subjects exposed death as a risk factor for T1 MABP. Next, the mortality of those with a historic diagnosis of hypertension or normotension were studied. On MV analysis, T1 MABP, gender, age, and first respiratory rate correlated with mortality while lymphocyte count inversely correlated with death in hypertensive COVID-19 (+) patients while neither T1 nor T3 categories of MABP predicted death in non-hypertensives.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Low-normal admitting MABP in COVID-19 (+) subjects with a historical diagnosis of HTN is associated with mortality and may assist in identifying those at greatest mortality risk.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0283331","type":"journal-article","created":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T17:49:22Z","timestamp":1680198562000},"page":"e0283331","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Initial mean arterial blood pressure (MABP) measurement is a risk factor for mortality in hypertensive COVID-19 positive hospitalized patients"],"prefix":"10.1371","volume":"18","author":[{"given":"Tenzin","family":"Yangchen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6974-5674","authenticated-orcid":true,"given":"Farrukh M.","family":"Koraishy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5524-4550","authenticated-orcid":true,"given":"Chang","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1480-5216","authenticated-orcid":true,"given":"Rajeev","family":"Rohatgi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,3,30]]},"reference":[{"issue":"8","key":"pone.0283331.ref001","doi-asserted-by":"crossref","first-page":"3025","DOI":"10.1080\/07391102.2020.1754293","article-title":"A review on the cleavage priming of the spike protein on coronavirus by angiotensin-converting enzyme-2 and furin","volume":"39","author":"A Hasan","year":"2021","journal-title":"J Biomol Struct Dyn"},{"issue":"10","key":"pone.0283331.ref002","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1161\/CIRCRESAHA.120.317015","article-title":"Angiotensin-Converting Enzyme 2: SARS-CoV-2 Receptor and Regulator of the Renin-Angiotensin System: Celebrating the 20th Anniversary of the Discovery of ACE2","volume":"126","author":"M Gheblawi","year":"2020","journal-title":"Circ Res"},{"key":"pone.0283331.ref003","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/1471-2350-11-124","article-title":"Associations between genetic variations in the FURIN gene and hypertension","volume":"11","author":"N Li","year":"2010","journal-title":"BMC Med Genet"},{"issue":"6","key":"pone.0283331.ref004","doi-asserted-by":"crossref","first-page":"F1488","DOI":"10.1152\/ajprenal.00439.2005","article-title":"Furin cleavage activates the epithelial Na+ channel by relieving Na+ self-inhibition","volume":"290","author":"S Sheng","year":"2006","journal-title":"Am J Physiol Renal Physiol"},{"issue":"11","key":"pone.0283331.ref005","doi-asserted-by":"crossref","first-page":"2829","DOI":"10.1111\/all.14429","article-title":"Distribution of ACE2, CD147, CD26, and other SARS-CoV-2 associated molecules in tissues and immune cells in health and in asthma, COPD, obesity, hypertension, and COVID-19 risk factors","volume":"75","author":"U Radzikowska","year":"2020","journal-title":"Allergy"},{"issue":"4","key":"pone.0283331.ref006","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1093\/infdis\/jiaa332","article-title":"ACE2 Expression Is Increased in the Lungs of Patients With Comorbidities Associated With Severe COVID-19","volume":"222","author":"BGG Pinto","year":"2020","journal-title":"J Infect Dis"},{"issue":"10","key":"pone.0283331.ref007","doi-asserted-by":"crossref","first-page":"1875","DOI":"10.1002\/jmv.26050","article-title":"Predictors of mortality in hospitalized COVID-19 patients: A systematic review and meta-analysis","volume":"92","author":"W Tian","year":"2020","journal-title":"J Med Virol"},{"issue":"8","key":"pone.0283331.ref008","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1038\/s41440-020-0485-2","article-title":"COVID-19 patients with hypertension have more severe disease: a multicenter retrospective observational study","volume":"43","author":"S Huang","year":"2020","journal-title":"Hypertens Res"},{"key":"pone.0283331.ref009","first-page":"55","article-title":"Arterial hypertension and the risk of severity and mortality of COVID-19","author":"CE Leiva Sisnieguez","year":"2020","journal-title":"Eur Respir J"},{"issue":"2","key":"pone.0283331.ref010","doi-asserted-by":"crossref","first-page":"1470320320926899","DOI":"10.1177\/1470320320926899","article-title":"Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: A systematic review, meta-analysis and meta-regression","volume":"21","author":"R Pranata","year":"2020","journal-title":"J Renin Angiotensin Aldosterone Syst."},{"issue":"22","key":"pone.0283331.ref011","doi-asserted-by":"crossref","first-page":"2058","DOI":"10.1093\/eurheartj\/ehaa433","article-title":"Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study","volume":"41","author":"C Gao","year":"2020","journal-title":"Eur Heart J"},{"issue":"7","key":"pone.0283331.ref012","first-page":"e27438","article-title":"A Review of COVID-19 in Relation to Metabolic Syndrome: Obesity, Hypertension, Diabetes, and Dyslipidemia","volume":"14","author":"E Makhoul","year":"2022","journal-title":"Cureus"},{"issue":"11","key":"pone.0283331.ref013","doi-asserted-by":"crossref","first-page":"e24018","DOI":"10.2196\/24018","article-title":"Machine Learning to Predict Mortality and Critical Events in a Cohort of Patients With COVID-19 in New York City: Model Development and Validation.","volume":"22","author":"A Vaid","year":"2020","journal-title":"J Med Internet Res"},{"issue":"2","key":"pone.0283331.ref014","doi-asserted-by":"crossref","first-page":"e23458","DOI":"10.2196\/23458","article-title":"Using Automated Machine Learning to Predict the Mortality of Patients With COVID-19: Prediction Model Development Study.","volume":"23","author":"K Ikemura","year":"2021","journal-title":"J Med Internet Res"},{"issue":"3","key":"pone.0283331.ref015","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/S2213-2600(20)30558-0","article-title":"Continuation versus discontinuation of renin-angiotensin system inhibitors in patients admitted to hospital with COVID-19: a prospective, randomised, open-label trial","volume":"9","author":"JB Cohen","year":"2021","journal-title":"Lancet Respir Med"},{"issue":"3","key":"pone.0283331.ref016","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1001\/jama.2020.25864","article-title":"Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19: A Randomized Clinical Trial","volume":"325","author":"RD Lopes","year":"2021","journal-title":"JAMA"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283331","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,30]],"date-time":"2023-03-30T17:49:40Z","timestamp":1680198580000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0283331"}},"subtitle":[],"editor":[{"given":"Yuyan","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,3,30]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0283331","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,30]]}}}