{"paper_id":"3946ae1f-775d-4467-9820-15e18e1328bb","body_text":"The Effect of Hypertension Comorbidities on the Higher Income of Cardiovascular Disease Commorbides in Covid-19 Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Hypertension Comorbidities on the Higher Income of Cardiovascular Disease Commorbides in Covid-19 Patients Yusra Pintaningrum, Baiq Zulhaeni Aprilia Lestari, Romi Ermawan, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9026055/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Covid-19 cases with cardiovascular comorbidities are associated with a high risk of morbidity and mortality in COVID-19 patients. Hypertension is one of the comorbidities found in people with COVID-19. In several studies, it was found that hypertension has the highest incidence rate in cases of COVID-19. Patients with cardiovascular comorbidities are more susceptible to SARS-CoV-2 infection and can experience more severe clinical manifestations presumably because it is associated with increased expression of ACE2, a functional coronavirus receptor that can bind to spike proteins on the viral surface directly. So that SARS-CoV-2 can enter host cells through the ACE2 receptor. Objective: To determine the effect of comorbid hypertension on the incidence of comorbid cardiovascular disease in Covid-19 patients. Methods: The data used in this study are secondary data by examining data from recaps of patients diagnosed with Covid-19 with heart disease in the isolation treatment room of the NTB Provine Hospital in the period March - December 2020. And analyzing research articles on the effect of hypertension on worsening and a high incidence of comorbid hypertension in Covid-19 patients. Results: The use of anti-hypertensive drugs such as the ACE inhibitor and ARB class of drugs is often associated with the severity of the symptoms of COVID-19, but until now ACE inhibitors and ARBs are still recommended for hypertensive patients because there is no clear evidence that these drugs can aggravate the clinical manifestation of COVID-19 patients. Conclusion: Hypertension is a comorbid that is often found in COVID-19 patients and can worsen the condition of COVID-19 patients. The use of ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) can reset ACE2 thereby increasing the susceptibility of cells to viruses. Hypertension COVID-19 Angiotensin Converting Enzyme 2 (ACE2) Angiotensin converting enzyme inhibitor (ACEI) Angiotensin receptor blockers (ARBs) INTRODUCTION Background Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2).¹ This disease was first reported in Wuhan, Hubei Province, China, in December 2019. The emergence of this novel virus caused widespread concern across various parts of the world.² Subsequently, on 30 January 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC), and on 11 March 2020, WHO officially designated COVID-19 as a pandemic due to its rapid global spread.¹ COVID-19 cases with cardiovascular comorbidities are associated with a higher risk of morbidity and mortality compared with COVID-19 patients without comorbid conditions.¹ Patients with cardiovascular comorbidities are more susceptible to SARS-CoV-2 infection and may experience more severe clinical manifestations, which is thought to be related to increased expression of angiotensin-converting enzyme 2 (ACE2). ACE2 functions as a coronavirus functional receptor that can directly bind to the spike protein on the viral surface, thereby allowing SARS-CoV-2 to enter host cells through ACE2 receptors. ACE2 receptors are widely expressed in the lungs (particularly in type II alveolar cells), heart, intestinal epithelium, vascular endothelium, and kidneys. This distribution underlies the mechanism of multiorgan dysfunction that may occur in SARS-CoV-2 infection.¹ Hypertension is one of the most common comorbid conditions found in patients with COVID-19. Hypertension is closely associated with COVID-19, as it can exacerbate the severity of COVID-19 infection and may even contribute to the pathogenesis of SARS-CoV-2 infection.² Studies on SARS-CoV-2 have identified several factors related to the prognosis of infected individuals. Comorbidities, advanced age, higher Sequential Organ Failure Assessment (SOFA) scores, and elevated D-dimer levels are recognized risk factors for poorer COVID-19 outcomes. In a study involving 1,099 patients with COVID-19, hypertension was identified as the most common underlying disease among patients with severe COVID-19. Another study analyzing 140 confirmed cases reported that 30% of patients had comorbid hypertension and 12% had diabetes mellitus.³ In a study conducted in Wuhan, China, among 191 hospitalized patients, 30% had hypertension and 8% had heart disease.⁴ Another cohort study reported that among 138 patients admitted to the intensive care unit, 72% had comorbid conditions, including hypertension in 31% and heart disease in 15% of patients.⁵ Data from the National Health Commission of China indicated that 35% of patients had comorbid hypertension and 15% had comorbid coronary heart disease.⁶ A study conducted at the Regional General Hospital of West Nusa Tenggara Province reported a total of 826 patients diagnosed and hospitalized with COVID-19, of whom eighty-four patients had comorbid conditions. The most common comorbidity was hypertension, affecting fifty patients (6%).⁷ The high incidence of COVID-19 cases with hypertensive comorbidity motivated the authors to conduct a study entitled “The Effect of Hypertension as a Comorbidity on the High Incidence of Comorbid Heart Disease in Patients with COVID-19.” Problem Statement Why does hypertension represent the highest incidence among cardiovascular comorbidities in COVID-19 cases? Research Objectives To determine the effect of hypertension as a comorbidity on the incidence of cardiovascular disease comorbidities in patients with COVID-19. Research Benefits The benefits that may be obtained from this study include: Providing an explanation of the incidence of cardiovascular disease comorbidities in patients with COVID-19. Providing an explanation of the effect of hypertension as a comorbidity on the incidence of cardiovascular disease comorbidities in patients with COVID-19. Serving as a source of information for researchers to conduct further studies. RESEARCH METHODS Study Design This study is a descriptive study with a retrospective research design. Study Location and Period The study was conducted at the Regional General Hospital of West Nusa Tenggara Province. Data collection was carried out in March 2021 at the Regional General Hospital of West Nusa Tenggara Province. Study Population The study population consisted of patients with COVID-19 and cardiovascular disease who were treated in the isolation wards during the period March–December 2020 at the Regional General Hospital of West Nusa Tenggara Province. Sample The study sample included all patients diagnosed with COVID-19 who were treated in the isolation wards of the Regional General Hospital of West Nusa Tenggara Province. The sample comprised secondary data obtained from summarized records of COVID-19 patients undergoing isolation treatment. Sample Criteria The sample criteria for this study were patients diagnosed with COVID-19 with cardiovascular disease comorbidities, particularly hypertension, who were treated in isolation wards during the period March–December 2020 and registered in the summarized patient records. Research Variables The variable examined in this study was the diagnosis of heart disease based on the ICD-10 classification. Operational Definitions No. Variable Operational Definition 1. ICD-10 Diagnosis ICD-10 is a guideline and coding system developed by the World Health Organization (WHO) for signs, symptoms, abnormal findings, complaints, social conditions, and all causes of injury or disease. 2. Diagnosis of Heart Disease Diagnosis based on the ICD-10 classification, in which the codes for heart diseases range from I00 to I52. 3. Diagnosis of Hypertension Diagnosis based on the ICD-10 classification, in which the codes for hypertensive diseases range from I10 to I16. Research Data Collection The data used in this study were secondary data obtained by reviewing summarized records of patients diagnosed with COVID-19 and heart disease who were treated in the isolation wards of the Regional General Hospital of West Nusa Tenggara Province during the period March–December 2020. In addition, research articles examining the effect of hypertension on disease severity and the high incidence of hypertensive comorbidity in patients with COVID-19 were analyzed. A total of ten research articles were included in this analysis. RESULTS AND DISCUSSION Based on the results obtained from the medical records of patients treated in the COVID-19 isolation wards of the Regional General Hospital of West Nusa Tenggara Province during the period March 2020–December 2020, a total of 826 individuals were confirmed and diagnosed with COVID-19. Among these patients, eighty-four had comorbid conditions. The most prevalent comorbidity was hypertension, affecting fifty patients (6%), followed by coronary heart disease in ten patients (1.2%), congestive heart failure in ten patients (1.2%), hypertensive heart disease (HHD) with congestive heart failure (CHF) in four patients (0.5%), HHD without CHF in four patients (0.5%), secondary hypertension in one patient (0.1%), renal hypertension in one patient (0.1%), complete atrioventricular (AV) block in one patient (0.1%), ischemic cardiomyopathy in one patient (0.1%), left bundle branch block in one patient (0.1%), and sick sinus syndrome in one patient (0.1%). Data regarding cardiovascular comorbidities among patients with COVID-19 treated at the Regional General Hospital of West Nusa Tenggara Province during the period March–December 2020 are presented in Table 1 . Table 1. Description of the Incidence of Cardiovascular Comorbidities in Patients with COVID-19 Heart Disease Number Percentage ICD-10 Code Hypertension 50 6% I10 Coronary Heart Disease 10 1.2% I25 Congestive Heart Failure 10 1.2% I50 HHD with CHF 4 0.5% I11 HHD without CHF 4 0.5% I11.9 Secondary Hypertension 1 0.1% I15 Renal Hypertension 1 0.1% I12.9 Complete AV Block 1 0.1% 426.0 Ischemic Cardiomyopathy 1 0.1% I25.5 Left Bundle Branch Block 1 0.1% I44.7 Sick Sinus Syndrome 1 0.1% I49.5 Total 84 Table 2. Description of the Incidence of Hypertensive Comorbidities in Patients with COVID-19 Condition Number Percentage ICD-10 Code Hypertension 29 58% I10 Hypertension with Pneumonia 3 6% I10, J18.9 Hypertension with Type II Diabetes Mellitus without complications 3 6% I10, E11.9 Hypertension with Hypokalemia 2 4% I10, E87.6 Hypertension with Type II Diabetes Mellitus without complications and Functional Dyspepsia 1 2% I10, E11.9, K30 Hypertension with HHD 1 2% I10, I11 Hypertension with Chronic Lower Respiratory Disease 1 2% I10, J46 Hypertension with Unspecified Respiratory Failure 1 2% I10, J96.9 Hypertension with Unspecified Hyperlipidemia 1 2% I10, E78.5 Hypertension with Unspecified Coccidioidomycosis 1 2% I10, E14.9 Hypertension with Unspecified Thyrotoxicosis 1 2% I10, E05.9 Hypertension with Type II Diabetes Mellitus and Native Coronary Artery CAD 1 2% I10, E11.0, I25.1 Hypertension with Encephalitis, Myelitis, Unspecified Encephalomyelitis, Cerebral Edema, Acute Nephritic Syndrome with Unspecified Morphological Changes, and Bronchopneumonia 1 2% I10, G04.9, G93.6, N00.9, J18.0 Hypertension with Type II Diabetes Mellitus and Glaucoma 1 2% I10, E11, H40.9 Hypertension with Dyspepsia and Fatty Liver 1 2% I10, K30, K76.0 Hypertension with Type II Diabetes Mellitus with Specific Complications 1 2% I10, E11.6 Hypertension with ARDS, Sepsis, and Hyperglycemia 1 2% I10, J80, A41.9, R73.9 Total 50 100% Among patients treated in the COVID-19 isolation wards of the Regional General Hospital of West Nusa Tenggara Province during the period March–December 2020, hypertension was the most prevalent comorbidity, affecting fifty patients (6%). Of these patients, twenty-nine (58%) had hypertension alone, while the remaining patients had hypertension accompanied by various additional conditions, as detailed in Table 2. Cardiovascular disease is an indicator of accelerated immunological dysfunction associated with aging and is indirectly correlated with the prognosis of COVID-19.⁸ A study from China analyzing 72,314 medical records reported 44,672 confirmed cases (61.8%), 16,186 suspected cases (22.4%), and 889 asymptomatic cases (1.2%). Among confirmed cases, approximately 12.8% had hypertension. Several studies have demonstrated that the severity and mortality of COVID-19 are influenced by comorbid diseases, including hypertension.² Several studies have reported a high incidence of hypertension among COVID-19 cases. Guan et al. (2020) reported that approximately 23.7% of confirmed COVID-19 patients had at least one comorbid condition, such as hypertension or chronic obstructive pulmonary disease.⁸ Lippi, Wong, and Henry (2020), through a pooled literature analysis, suggested that pre-existing hypertension may increase the severity of COVID-19 by up to 2.5-fold, particularly in older individuals. Wu et al. (2020) reported that among 66 COVID-19 patients (32.8%), 19.4% had hypertension as a comorbidity. Liu et al. (2020) found that 20 patients (25.6%) had comorbid diseases, with hypertension being the most frequently observed.² Risk factors for worsening COVID-19 infection include hypertension, male sex, diabetes mellitus, and smoking, which are thought to contribute to increased ACE2 receptor expression.² The severity of COVID-19 has also been associated with the use of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), as these medications may regulate ACE2 receptors.⁹ The mechanisms by which comorbidities worsen patient outcomes remain unclear, but proposed hypotheses include advanced age, immune system dysfunction, increased ACE2 expression, and a possible association between COVID-19 and cardiovascular disease.⁹ Hypertension is a common condition among patients with COVID-19 and may exacerbate disease severity. The use of antihypertensive medications such as ACE inhibitors and ARBs has often been linked to COVID-19 severity; however, these medications continue to be recommended for hypertensive patients, as no clear evidence has demonstrated that ACE inhibitors or ARBs worsen outcomes in COVID-19 patients.² One study demonstrated that SARS-CoV-2 recognizes ACE2 via its spike protein, enabling viral entry into host cells. This process leads to activation of CD4⁺ T cells, which proliferate and differentiate into Th1 cells that secrete proinflammatory cytokines such as interleukin-6 (IL-6), interferon-gamma (γ-IFN), and granulocyte–macrophage colony-stimulating factor (GM-CSF). This cascade may culminate in a cytokine storm, potentially leading to acute respiratory distress syndrome (ARDS), multiorgan failure, and death. Therefore, IL-6 and GM-CSF released by T lymphocytes and monocytes may be key factors in triggering cytokine storms in patients with COVID-19. The cytokine storm mechanism may be closely related to an imbalance between specific and nonspecific immunity. Substantial evidence suggests that hypertension can skew T cells toward a Th1 phenotype, indicating that hypertension may contribute to cytokine storms in patients with COVID-19. In addition, depletion of CD4⁺ and CD8⁺ T cells has been observed in critically ill COVID-19 patients, which may be associated with poor prognosis.³ A study reported that patients with hypertension are more likely to experience immune dysfunction, as evidenced by higher levels of C-reactive protein (CRP), procalcitonin, IL-10, and IL-6, as well as lower CD8⁺ T-cell counts. Moreover, hypertensive patients exhibit higher white blood cell and neutrophil counts and lower lymphocyte levels. These findings suggest that immune dysfunction may contribute to severe disease and poor outcomes in COVID-19 patients with hypertension.³ The administration of renin–angiotensin–aldosterone system (RAAS) inhibitors is an important strategy for protecting against heart failure, myocardial infarction, and hypertension. Other studies have demonstrated that RAAS inhibitors regulate ACE2 receptor expression, which may facilitate cellular invasion by SARS-CoV-2.³ Several studies have examined the association between RAAS inhibitor use and mortality among hospitalized COVID-19 patients with hypertension. Zhang et al. reported that inpatient use of RAAS inhibitors was associated with a reduced risk of all-cause mortality.¹⁰ Mancia et al. also found that RAAS inhibitors were unlikely to affect the risk of SARS-CoV-2 infection and were not associated with severe or fatal infection. RAAS inhibitor use was not associated with increased in-hospital mortality. Yang et al. reported that patients receiving RAAS inhibitors had a lower proportion of critical illness and lower mortality rates than those receiving non-RAAS inhibitors, although these differences were not statistically significant. Pan et al. reported that patients who were regularly treated with RAAS inhibitors prior to hospital admission may have a better prognosis than those who were not previously treated with RAAS inhibitors.³ CONCLUSION SARS-CoV-2 has major implications for the cardiovascular system. Patients with cardiovascular risk factors or established cardiovascular disease represent a high-risk population when infected with COVID-19. Risk factors for COVID-19 include impaired immunity, advanced age, smoking, and comorbid diseases such as hypertension. Patients with COVID-19 and hypertension experience more severe inflammation, greater depletion of CD8⁺ T cells, and more extensive organ damage than non-hypertensive patients. Hypertension may serve as an independent risk factor for all-cause mortality in patients with COVID-19. The use of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may modulate ACE2 expression, thereby increasing cellular susceptibility to viral entry. However, several studies suggest that hypertensive patients with prior ACEI/ARB use may have a better prognosis than those treated with other antihypertensive medications. Currently, insufficient data exist to conclusively determine the relationship between ACEI/ARB use and worsening outcomes in COVID-19 patients. Further research is recommended to evaluate and clarify the relationship between hypertension, various therapeutic backgrounds, and the progression of COVID-19. Additional high-quality studies are needed to strengthen the available evidence. Abbreviations ACE2: Angiotensin-converting enzyme 2 ACEI: Angiotensin-converting enzyme inhibitor ARB: Angiotensin receptor blocker ARDS: Acute respiratory distress syndrome CAD: Coronary artery disease CHF: Congestive heart failure COVID-19: Coronavirus disease 2019 ICD-10: International Classification of Diseases, 10th Revision RAAS: Renin–angiotensin–aldosterone system SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2 Declarations Ethics approval and consent to participate This study used retrospective secondary data obtained from medical record recapitulations of patients with COVID-19 treated at the Regional General Hospital of West Nusa Tenggara Province between March and December 2020. Ethical approval for this study was obtained from the Health Research Ethics Committee of the Faculty of Medicine, University of Mataram . The study was conducted in accordance with the principles of the Declaration of Helsinki . Because this study used anonymized retrospective medical record data , the requirement for informed consent to participate was waived by the Ethics Committee . Approval No: 00.9.1/31/KEP/2026 Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions YP conceived and designed the study. YP, BZAL, and RE collected and analyzed the data. YI, BR, and AASMMP contributed to data interpretation and manuscript preparation. All authors read and approved the final manuscript. Acknowledgements The authors would like to thank the staff of the Regional General Hospital of West Nusa Tenggara Province for their support in facilitating access to the data used in this study. References Willim, HA et al. Dampak Coronavirus Disease 2019 terhadap Sistem Kardiovaskular. 2020. https://doi.org/10.35790/ecl.8.2.2020.30540 Gunawan, A et al. Pengaruh Komorbid Hipertensi Terhadapa Severitas Pasien Coronavirus Disease 2019. 2020. Vol 1 No 2. http://Jurnal.umsu.ac.id/index.php/JIH Pan, W et al. Clinical Features of COVID-19 in Patients With Essential Hypertension and the Impacts of Renin-angiotensin-aldosterone System Inhibitors on the Prognosis of COVID-19 Patients. 2020. American Heart Association. Available at https://www.ahajournals.org/doi/suppl/10.1161/HYPERTENSIONAHA.120.15289 Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–1062. doi: 10.1016/S0140-6736(20)30566-3. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–1069. doi: 10.1001/jama.2020.1585 Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020. https://doi.org/10.1038/s41569-020-0360-5 Pintaningrum, Y & Pratama, I. Angka Kejadian Komorbid Penyakit jantung Pada Pasien COVID-19 Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat Periode Maret-Desember 2020. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, Liu XQ, Chen RC, Tang CL, Wang T, et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: a Nationwide Analysis. Eur Respir J . 2020;55:2000547. doi: 10.1183/13993003.00547-2020 Hasanah, DY et al., Gangguan Kardiovaskular pada Infeksi COVID 19. 2020. Vol. 41, Issue 2. Indonesian J of Cardiology. doi: 10.30701/ijc.994 Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensinconverting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med . 2020;46:586–590. doi: 10.1007/s00134-020-05985-9 Additional Declarations No competing interests reported. Supplementary Files covid19dataraw.xlsx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 Apr, 2026 Reviews received at journal 12 Apr, 2026 Reviewers agreed at journal 09 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor assigned by journal 31 Mar, 2026 Editor invited by journal 11 Mar, 2026 Submission checks completed at journal 10 Mar, 2026 First submitted to journal 10 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9026055\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":618769449,\"identity\":\"5fcaa76a-06c5-4202-85e0-3427da3b005f\",\"order_by\":0,\"name\":\"Yusra Pintaningrum\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYNCCCgSTh+EAUVrOkKyFsQ2ZR0iLwY30Zx9+zjucZ95+OoHhRw2DDB9hLTnGM3u3HS6WOZO7gbHnGAOPJBFamBl4tx1OnMGQu4GBt4GBx4AIhz1m/DsHqIX/7QbGv8RpSTBm5m0AapHI3cBMlC2SZ94YM8scSwdqebvhsMwxCcJ+4TsOdNibGmugw3I3PnxTY2NPMMQUkBUA2RIE1AOBfANhNaNgFIyCUTDSAQBsLELyZNvE+AAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"University of Mataram\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Yusra\",\"middleName\":\"\",\"lastName\":\"Pintaningrum\",\"suffix\":\"\"},{\"id\":618769454,\"identity\":\"4d406d8b-4794-4b72-9f42-3070de6502f9\",\"order_by\":1,\"name\":\"Baiq Zulhaeni Aprilia Lestari\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Mataram\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Baiq\",\"middleName\":\"Zulhaeni Aprilia\",\"lastName\":\"Lestari\",\"suffix\":\"\"},{\"id\":618769455,\"identity\":\"d6020c9c-1067-4f3b-b551-df02d489477c\",\"order_by\":2,\"name\":\"Romi Ermawan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Mataram\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Romi\",\"middleName\":\"\",\"lastName\":\"Ermawan\",\"suffix\":\"\"},{\"id\":618769456,\"identity\":\"6795b1cc-3aaa-4b2a-8f08-1d7676efa676\",\"order_by\":3,\"name\":\"Yanna Indrayana\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Mataram\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yanna\",\"middleName\":\"\",\"lastName\":\"Indrayana\",\"suffix\":\"\"},{\"id\":618769457,\"identity\":\"777e357f-4ac3-4c36-96a3-bda81e652aba\",\"order_by\":4,\"name\":\"Basuki Rahmat\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Mataram\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Basuki\",\"middleName\":\"\",\"lastName\":\"Rahmat\",\"suffix\":\"\"},{\"id\":618769459,\"identity\":\"e14b7244-18b8-49c8-8999-676f3b509425\",\"order_by\":5,\"name\":\"AA. 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The emergence of this novel virus caused widespread concern across various parts of the world.\\u0026sup2; Subsequently, on 30 January 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a Public Health Emergency of International Concern (PHEIC), and on 11 March 2020, WHO officially designated COVID-19 as a pandemic due to its rapid global spread.\\u0026sup1;\\u003c/p\\u003e\\n\\u003cp\\u003eCOVID-19 cases with cardiovascular comorbidities are associated with a higher risk of morbidity and mortality compared with COVID-19 patients without comorbid conditions.\\u0026sup1; Patients with cardiovascular comorbidities are more susceptible to SARS-CoV-2 infection and may experience more severe clinical manifestations, which is thought to be related to increased expression of angiotensin-converting enzyme 2 (ACE2). ACE2 functions as a coronavirus functional receptor that can directly bind to the spike protein on the viral surface, thereby allowing SARS-CoV-2 to enter host cells through ACE2 receptors. ACE2 receptors are widely expressed in the lungs (particularly in type II alveolar cells), heart, intestinal epithelium, vascular endothelium, and kidneys. This distribution underlies the mechanism of multiorgan dysfunction that may occur in SARS-CoV-2 infection.\\u0026sup1;\\u003c/p\\u003e\\n\\u003cp\\u003eHypertension is one of the most common comorbid conditions found in patients with COVID-19. Hypertension is closely associated with COVID-19, as it can exacerbate the severity of COVID-19 infection and may even contribute to the pathogenesis of SARS-CoV-2 infection.\\u0026sup2; Studies on SARS-CoV-2 have identified several factors related to the prognosis of infected individuals. Comorbidities, advanced age, higher Sequential Organ Failure Assessment (SOFA) scores, and elevated D-dimer levels are recognized risk factors for poorer COVID-19 outcomes. In a study involving 1,099 patients with COVID-19, hypertension was identified as the most common underlying disease among patients with severe COVID-19. Another study analyzing 140 confirmed cases reported that 30% of patients had comorbid hypertension and 12% had diabetes mellitus.\\u0026sup3;\\u003c/p\\u003e\\n\\u003cp\\u003eIn a study conducted in Wuhan, China, among 191 hospitalized patients, 30% had hypertension and 8% had heart disease.⁴ Another cohort study reported that among 138 patients admitted to the intensive care unit, 72% had comorbid conditions, including hypertension in 31% and heart disease in 15% of patients.⁵ Data from the National Health Commission of China indicated that 35% of patients had comorbid hypertension and 15% had comorbid coronary heart disease.⁶\\u003c/p\\u003e\\n\\u003cp\\u003eA study conducted at the Regional General Hospital of West Nusa Tenggara Province reported a total of 826 patients diagnosed and hospitalized with COVID-19, of whom eighty-four patients had comorbid conditions. The most common comorbidity was hypertension, affecting fifty patients (6%).⁷ The high incidence of COVID-19 cases with hypertensive comorbidity motivated the authors to conduct a study entitled \\u003cstrong\\u003e\\u0026ldquo;The Effect of Hypertension as a Comorbidity on the High Incidence of Comorbid Heart Disease in Patients with COVID-19.\\u0026rdquo;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eProblem Statement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWhy does hypertension represent the highest incidence among cardiovascular comorbidities in COVID-19 cases?\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResearch Objectives\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eTo determine the effect of hypertension as a comorbidity on the incidence of cardiovascular disease comorbidities in patients with COVID-19.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResearch Benefits\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe benefits that may be obtained from this study include:\\u003c/p\\u003e\\n\\u003col start=\\\"1\\\" type=\\\"1\\\"\\u003e\\n \\u003cli\\u003eProviding an explanation of the incidence of cardiovascular disease comorbidities in patients with COVID-19.\\u003c/li\\u003e\\n \\u003cli\\u003eProviding an explanation of the effect of hypertension as a comorbidity on the incidence of cardiovascular disease comorbidities in patients with COVID-19.\\u003c/li\\u003e\\n \\u003cli\\u003eServing as a source of information for researchers to conduct further studies.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"},{\"header\":\"RESEARCH METHODS\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStudy Design\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study is a descriptive study with a retrospective research design.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStudy Location and Period\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was conducted at the Regional General Hospital of West Nusa Tenggara Province. Data collection was carried out in March 2021 at the Regional General Hospital of West Nusa Tenggara Province.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStudy Population\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study population consisted of patients with COVID-19 and cardiovascular disease who were treated in the isolation wards during the period March\\u0026ndash;December 2020 at the Regional General Hospital of West Nusa Tenggara Province.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSample\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study sample included all patients diagnosed with COVID-19 who were treated in the isolation wards of the Regional General Hospital of West Nusa Tenggara Province. The sample comprised secondary data obtained from summarized records of COVID-19 patients undergoing isolation treatment.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eSample Criteria\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe sample criteria for this study were patients diagnosed with COVID-19 with cardiovascular disease comorbidities, particularly hypertension, who were treated in isolation wards during the period March\\u0026ndash;December 2020 and registered in the summarized patient records.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResearch Variables\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe variable examined in this study was the diagnosis of heart disease based on the ICD-10 classification.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eOperational Definitions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"3\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNo.\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eOperational Definition\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eICD-10 Diagnosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eICD-10 is a guideline and coding system developed by the World Health Organization (WHO) for signs, symptoms, abnormal findings, complaints, social conditions, and all causes of injury or disease.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eDiagnosis of Heart Disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eDiagnosis based on the ICD-10 classification, in which the codes for heart diseases range from I00 to I52.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e3.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eDiagnosis of Hypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eDiagnosis based on the ICD-10 classification, in which the codes for hypertensive diseases range from I10 to I16.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResearch Data Collection\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe data used in this study were secondary data obtained by reviewing summarized records of patients diagnosed with COVID-19 and heart disease who were treated in the isolation wards of the Regional General Hospital of West Nusa Tenggara Province during the period March\\u0026ndash;December 2020. In addition, research articles examining the effect of hypertension on disease severity and the high incidence of hypertensive comorbidity in patients with COVID-19 were analyzed. A total of ten research articles were included in this analysis.\\u003c/p\\u003e\"},{\"header\":\"RESULTS AND DISCUSSION\",\"content\":\"\\u003cp\\u003eBased on the results obtained from the medical records of patients treated in the COVID-19 isolation wards of the Regional General Hospital of West Nusa Tenggara Province during the period March 2020\\u0026ndash;December 2020, a total of 826 individuals were confirmed and diagnosed with COVID-19. Among these patients, eighty-four had comorbid conditions. The most prevalent comorbidity was hypertension, affecting fifty patients (6%), followed by coronary heart disease in ten patients (1.2%), congestive heart failure in ten patients (1.2%), hypertensive heart disease (HHD) with congestive heart failure (CHF) in four patients (0.5%), HHD without CHF in four patients (0.5%), secondary hypertension in one patient (0.1%), renal hypertension in one patient (0.1%), complete atrioventricular (AV) block in one patient (0.1%), ischemic cardiomyopathy in one patient (0.1%), left bundle branch block in one patient (0.1%), and sick sinus syndrome in one patient (0.1%).\\u003c/p\\u003e\\n\\u003cp\\u003eData regarding cardiovascular comorbidities among patients with COVID-19 treated at the Regional General Hospital of West Nusa Tenggara Province during the period March\\u0026ndash;December 2020 are presented in \\u003cstrong\\u003eTable 1\\u003c/strong\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 1. Description of the Incidence of Cardiovascular Comorbidities in Patients with COVID-19\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"0\\\" cellspacing=\\\"3\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eHeart Disease\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePercentage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eICD-10 Code\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eCoronary Heart Disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI25\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eCongestive Heart Failure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHHD with CHF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.5%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHHD without CHF\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.5%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI11.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eSecondary Hypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eRenal Hypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI12.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eComplete AV Block\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e426.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eIschemic Cardiomyopathy\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI25.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eLeft Bundle Branch Block\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI44.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eSick Sinus Syndrome\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e0.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI49.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e84\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003ctd\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable 2. Description of the Incidence of Hypertensive Comorbidities in Patients with COVID-19\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"3\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eCondition\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eNumber\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003ePercentage\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eICD-10 Code\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e58%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Pneumonia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, J18.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Type II Diabetes Mellitus without complications\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E11.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Hypokalemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E87.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Type II Diabetes Mellitus without complications and Functional Dyspepsia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E11.9, K30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with HHD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, I11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Chronic Lower Respiratory Disease\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, J46\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Unspecified Respiratory Failure\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, J96.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Unspecified Hyperlipidemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E78.5\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Unspecified Coccidioidomycosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E14.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Unspecified Thyrotoxicosis\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E05.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Type II Diabetes Mellitus and Native Coronary Artery CAD\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E11.0, I25.1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Encephalitis, Myelitis, Unspecified Encephalomyelitis, Cerebral Edema, Acute Nephritic Syndrome with Unspecified Morphological Changes, and Bronchopneumonia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, G04.9, G93.6, N00.9, J18.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Type II Diabetes Mellitus and Glaucoma\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E11, H40.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Dyspepsia and Fatty Liver\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, K30, K76.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with Type II Diabetes Mellitus with Specific Complications\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, E11.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eHypertension with ARDS, Sepsis, and Hyperglycemia\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003eI10, J80, A41.9, R73.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eTotal\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e50\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e100%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd\\u003e\\u003cbr\\u003e\\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;Among patients treated in the COVID-19 isolation wards of the Regional General Hospital of West Nusa Tenggara Province during the period March\\u0026ndash;December 2020, hypertension was the most prevalent comorbidity, affecting fifty patients (6%). Of these patients, twenty-nine (58%) had hypertension alone, while the remaining patients had hypertension accompanied by various additional conditions, as detailed in Table 2.\\u003c/p\\u003e\\n\\u003cp\\u003eCardiovascular disease is an indicator of accelerated immunological dysfunction associated with aging and is indirectly correlated with the prognosis of COVID-19.⁸ A study from China analyzing 72,314 medical records reported 44,672 confirmed cases (61.8%), 16,186 suspected cases (22.4%), and 889 asymptomatic cases (1.2%). Among confirmed cases, approximately 12.8% had hypertension. Several studies have demonstrated that the severity and mortality of COVID-19 are influenced by comorbid diseases, including hypertension.\\u0026sup2;\\u003c/p\\u003e\\n\\u003cp\\u003eSeveral studies have reported a high incidence of hypertension among COVID-19 cases. Guan et al. (2020) reported that approximately 23.7% of confirmed COVID-19 patients had at least one comorbid condition, such as hypertension or chronic obstructive pulmonary disease.⁸ Lippi, Wong, and Henry (2020), through a pooled literature analysis, suggested that pre-existing hypertension may increase the severity of COVID-19 by up to 2.5-fold, particularly in older individuals. Wu et al. (2020) reported that among 66 COVID-19 patients (32.8%), 19.4% had hypertension as a comorbidity. Liu et al. (2020) found that 20 patients (25.6%) had comorbid diseases, with hypertension being the most frequently observed.\\u0026sup2;\\u003c/p\\u003e\\n\\u003cp\\u003eRisk factors for worsening COVID-19 infection include hypertension, male sex, diabetes mellitus, and smoking, which are thought to contribute to increased ACE2 receptor expression.\\u0026sup2; The severity of COVID-19 has also been associated with the use of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), as these medications may regulate ACE2 receptors.⁹ The mechanisms by which comorbidities worsen patient outcomes remain unclear, but proposed hypotheses include advanced age, immune system dysfunction, increased ACE2 expression, and a possible association between COVID-19 and cardiovascular disease.⁹\\u003c/p\\u003e\\n\\u003cp\\u003eHypertension is a common condition among patients with COVID-19 and may exacerbate disease severity. The use of antihypertensive medications such as ACE inhibitors and ARBs has often been linked to COVID-19 severity; however, these medications continue to be recommended for hypertensive patients, as no clear evidence has demonstrated that ACE inhibitors or ARBs worsen outcomes in COVID-19 patients.\\u0026sup2;\\u003c/p\\u003e\\n\\u003cp\\u003eOne study demonstrated that SARS-CoV-2 recognizes ACE2 via its spike protein, enabling viral entry into host cells. This process leads to activation of CD4⁺ T cells, which proliferate and differentiate into Th1 cells that secrete proinflammatory cytokines such as interleukin-6 (IL-6), interferon-gamma (\\u0026gamma;-IFN), and granulocyte\\u0026ndash;macrophage colony-stimulating factor (GM-CSF). This cascade may culminate in a cytokine storm, potentially leading to acute respiratory distress syndrome (ARDS), multiorgan failure, and death. Therefore, IL-6 and GM-CSF released by T lymphocytes and monocytes may be key factors in triggering cytokine storms in patients with COVID-19. The cytokine storm mechanism may be closely related to an imbalance between specific and nonspecific immunity. Substantial evidence suggests that hypertension can skew T cells toward a Th1 phenotype, indicating that hypertension may contribute to cytokine storms in patients with COVID-19. In addition, depletion of CD4⁺ and CD8⁺ T cells has been observed in critically ill COVID-19 patients, which may be associated with poor prognosis.\\u0026sup3;\\u003c/p\\u003e\\n\\u003cp\\u003eA study reported that patients with hypertension are more likely to experience immune dysfunction, as evidenced by higher levels of C-reactive protein (CRP), procalcitonin, IL-10, and IL-6, as well as lower CD8⁺ T-cell counts. Moreover, hypertensive patients exhibit higher white blood cell and neutrophil counts and lower lymphocyte levels. These findings suggest that immune dysfunction may contribute to severe disease and poor outcomes in COVID-19 patients with hypertension.\\u0026sup3;\\u003c/p\\u003e\\n\\u003cp\\u003eThe administration of renin\\u0026ndash;angiotensin\\u0026ndash;aldosterone system (RAAS) inhibitors is an important strategy for protecting against heart failure, myocardial infarction, and hypertension. Other studies have demonstrated that RAAS inhibitors regulate ACE2 receptor expression, which may facilitate cellular invasion by SARS-CoV-2.\\u0026sup3;\\u003c/p\\u003e\\n\\u003cp\\u003eSeveral studies have examined the association between RAAS inhibitor use and mortality among hospitalized COVID-19 patients with hypertension. Zhang et al. reported that inpatient use of RAAS inhibitors was associated with a reduced risk of all-cause mortality.\\u0026sup1;⁰ Mancia et al. also found that RAAS inhibitors were unlikely to affect the risk of SARS-CoV-2 infection and were not associated with severe or fatal infection. RAAS inhibitor use was not associated with increased in-hospital mortality. Yang et al. reported that patients receiving RAAS inhibitors had a lower proportion of critical illness and lower mortality rates than those receiving non-RAAS inhibitors, although these differences were not statistically significant. Pan et al. reported that patients who were regularly treated with RAAS inhibitors prior to hospital admission may have a better prognosis than those who were not previously treated with RAAS inhibitors.\\u0026sup3;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\"},{\"header\":\"CONCLUSION\",\"content\":\"\\u003cp\\u003eSARS-CoV-2 has major implications for the cardiovascular system. Patients with cardiovascular risk factors or established cardiovascular disease represent a high-risk population when infected with COVID-19. Risk factors for COVID-19 include impaired immunity, advanced age, smoking, and comorbid diseases such as hypertension. Patients with COVID-19 and hypertension experience more severe inflammation, greater depletion of CD8⁺ T cells, and more extensive organ damage than non-hypertensive patients. Hypertension may serve as an independent risk factor for all-cause mortality in patients with COVID-19. The use of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may modulate ACE2 expression, thereby increasing cellular susceptibility to viral entry. However, several studies suggest that hypertensive patients with prior ACEI/ARB use may have a better prognosis than those treated with other antihypertensive medications. Currently, insufficient data exist to conclusively determine the relationship between ACEI/ARB use and worsening outcomes in COVID-19 patients.\\u003c/p\\u003e\\n\\u003cp\\u003eFurther research is recommended to evaluate and clarify the relationship between hypertension, various therapeutic backgrounds, and the progression of COVID-19. Additional high-quality studies are needed to strengthen the available evidence.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eACE2: Angiotensin-converting enzyme 2\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;ACEI: Angiotensin-converting enzyme inhibitor\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;ARB: Angiotensin receptor blocker\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;ARDS: Acute respiratory distress syndrome\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;CAD: Coronary artery disease\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;CHF: Congestive heart failure\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;COVID-19: Coronavirus disease 2019\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;ICD-10: International Classification of Diseases, 10th Revision\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;RAAS: Renin\\u0026ndash;angiotensin\\u0026ndash;aldosterone system\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cbr\\u003e\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study used \\u003cstrong\\u003eretrospective secondary data obtained from medical record recapitulations of patients with COVID-19\\u003c/strong\\u003e treated at the Regional General Hospital of West Nusa Tenggara Province between March and December 2020.\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval for this study was obtained from the \\u003cstrong\\u003eHealth Research Ethics Committee of the Faculty of Medicine, University of Mataram\\u003c/strong\\u003e. The study was conducted in accordance with the principles of the \\u003cstrong\\u003eDeclaration of Helsinki\\u003c/strong\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eBecause this study used \\u003cstrong\\u003eanonymized retrospective medical record data\\u003c/strong\\u003e, the requirement for \\u003cstrong\\u003einformed consent to participate was waived by the Ethics Committee\\u003c/strong\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eApproval No: 00.9.1/31/KEP/2026\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026rsquo; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eYP conceived and designed the study.\\u003cbr\\u003e\\u0026nbsp;YP, BZAL, and RE collected and analyzed the data.\\u003cbr\\u003e\\u0026nbsp;YI, BR, and AASMMP contributed to data interpretation and manuscript preparation.\\u003cbr\\u003e\\u0026nbsp;All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors would like to thank the staff of the Regional General Hospital of West Nusa Tenggara Province for their support in facilitating access to the data used in this study.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eWillim, HA et al. Dampak Coronavirus Disease 2019 terhadap Sistem Kardiovaskular. 2020. https://doi.org/10.35790/ecl.8.2.2020.30540 \\u003c/li\\u003e\\n\\u003cli\\u003eGunawan, A et al. Pengaruh Komorbid Hipertensi Terhadapa Severitas Pasien Coronavirus Disease 2019. 2020. Vol 1 No 2. http://Jurnal.umsu.ac.id/index.php/JIH\\u003cem\\u003e \\u003c/em\\u003e\\u003c/li\\u003e\\n\\u003cli\\u003ePan, W et al. Clinical Features of COVID-19 in Patients With Essential Hypertension and the Impacts of Renin-angiotensin-aldosterone System Inhibitors on the Prognosis of COVID-19 Patients. 2020. American Heart Association. Available at https://www.ahajournals.org/doi/suppl/10.1161/HYPERTENSIONAHA.120.15289 \\u003c/li\\u003e\\n\\u003cli\\u003eZhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054\\u0026ndash;1062. doi: 10.1016/S0140-6736(20)30566-3.\\u003c/li\\u003e\\n\\u003cli\\u003eWang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus\\u0026ndash;infected pneumonia in Wuhan, China. JAMA. 2020;323:1061\\u0026ndash;1069. doi: 10.1001/jama.2020.1585\\u003c/li\\u003e\\n\\u003cli\\u003eZheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol 2020. https://doi.org/10.1038/s41569-020-0360-5\\u003c/li\\u003e\\n\\u003cli\\u003ePintaningrum, Y \\u0026amp; Pratama, I. Angka Kejadian Komorbid Penyakit jantung Pada Pasien COVID-19 Rumah Sakit Umum Daerah Provinsi Nusa Tenggara Barat Periode Maret-Desember 2020. \\u003c/li\\u003e\\n\\u003cli\\u003eGuan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, Liu XQ,\\u003cbr\\u003e Chen RC, Tang CL, Wang T, et al. Comorbidity and its impact on 1590\\u003cbr\\u003epatients with Covid-19 in China: a Nationwide Analysis. \\u003cem\\u003eEur Respir J\\u003c/em\\u003e.\\u003cbr\\u003e 2020;55:2000547. doi: 10.1183/13993003.00547-2020\\u003c/li\\u003e\\n\\u003cli\\u003eHasanah, DY et al., Gangguan Kardiovaskular pada Infeksi COVID 19. 2020. Vol. 41, Issue 2. Indonesian J of Cardiology. doi: 10.30701/ijc.994\\u003c/li\\u003e\\n\\u003cli\\u003eZhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensinconverting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular\\u003cbr\\u003emechanisms and potential therapeutic target. \\u003cem\\u003eIntensive Care Med\\u003c/em\\u003e.\\u003cbr\\u003e 2020;46:586\\u0026ndash;590. doi: 10.1007/s00134-020-05985-9\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cardiovascular-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcar\",\"sideBox\":\"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcar/default.aspx\",\"title\":\"BMC Cardiovascular Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Hypertension, COVID-19, Angiotensin Converting Enzyme 2 (ACE2), Angiotensin converting enzyme inhibitor (ACEI), Angiotensin receptor blockers (ARBs)\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9026055/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9026055/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e Covid-19 cases with cardiovascular comorbidities are associated with a high risk of morbidity and mortality in COVID-19 patients. Hypertension is one of the comorbidities found in people with COVID-19. In several studies, it was found that hypertension has the highest incidence rate in cases of COVID-19. Patients with cardiovascular comorbidities are more susceptible to SARS-CoV-2 infection and can experience more severe clinical manifestations presumably because it is associated with increased expression of ACE2, a functional coronavirus receptor that can bind to spike proteins on the viral surface directly. So that SARS-CoV-2 can enter host cells through the ACE2 receptor.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eObjective:\\u003c/strong\\u003eTo determine the effect of comorbid hypertension on the incidence of comorbid cardiovascular disease in Covid-19 patients.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e The data used in this study are secondary data by examining data from recaps of patients diagnosed with Covid-19 with heart disease in the isolation treatment room of the NTB Provine Hospital in the period March - December 2020. And analyzing research articles on the effect of hypertension on worsening and a high incidence of comorbid hypertension in Covid-19 patients.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e The use of anti-hypertensive drugs such as the ACE inhibitor and ARB class of drugs is often associated with the severity of the symptoms of COVID-19, but until now ACE inhibitors and ARBs are still recommended for hypertensive patients because there is no clear evidence that these drugs can aggravate the clinical manifestation of COVID-19 patients.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion:\\u003c/strong\\u003eHypertension is a comorbid that is often found in COVID-19 patients and can worsen the condition of COVID-19 patients. The use of ACE inhibitors (ACEi) and angiotensin receptor blockers (ARB) can reset ACE2 thereby increasing the susceptibility of cells to viruses.\\u003c/p\\u003e\",\"manuscriptTitle\":\"The Effect of Hypertension Comorbidities on the Higher Income of Cardiovascular Disease Commorbides in Covid-19 Patients\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-04-08 16:17:45\",\"doi\":\"10.21203/rs.3.rs-9026055/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-04-13T12:28:19+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-04-13T03:31:52+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"189544571269455589275171755739001198344\",\"date\":\"2026-04-09T14:29:38+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"45361222143975786630605906300635390911\",\"date\":\"2026-04-07T08:40:35+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-04-02T10:23:54+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-03-31T04:56:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-03-11T04:22:01+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-03-10T14:23:59+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cardiovascular Disorders\",\"date\":\"2026-03-10T10:44:05+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cardiovascular-disorders\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcar\",\"sideBox\":\"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcar/default.aspx\",\"title\":\"BMC Cardiovascular Disorders\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"f6c08afb-08f6-4897-a11f-8f853ec00d6b\",\"owner\":[],\"postedDate\":\"April 8th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-08T16:17:45+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-04-08 16:17:45\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9026055\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9026055\",\"identity\":\"rs-9026055\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}