Vol. 5, No. 4, April 2024
E-ISSN: 2723-6692
P-ISSN: 2723-6595
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Jurnal Indonesia Sosial Sains, Vol. 5, No. 4, April 2024 935
The Relationship of Hypertension with Death in Covid-19
Patients Treated at Tugurejo Hospital Semarang
Nanindya Ailsa Pramudhita, Setyoko, Susilo Budi Pratama
Universitas Muhammadiyah Semarang. Indonesia
Email: nanindyaa[email protected]m
Correspondence: nanindyaailsa@gmail.com
*
KEYWORDS
ABSTRACT
Covid-19; Hipertensi;
Daeth
Covid-19 is a disease caused by SARS-CoV-2. Hypertension is
a comorbidity that can be experienced by COVID-19 patients
and is associated with an increased risk of severity and death.
The purpose of this study is to look at the relationship
between hypertension and death in COVID-19 patients
treated at Tugurejo Hospital Semarang. This study is a
quantitative study that uses an analytical observational
design and a cross-sectional approach. The sampling
technique was purposive sampling (judgment sampling) on
84 COVID-19 patients treated at Tugurejo Hospital Semarang
for the May-November 2021 period. Data were obtained from
medical records and analyzed univariately and bivariately
with the Chi-Square test. Most patients were aged ≥50 years
(40.5%), male (53.6%), high school educated (51.2%),
employed as private employees (42.9%), suffered from
hypertension (53.6%) and did not experience death (51.2%).
The Chi-Square test resulted in a significant association
between hypertension and death of COVID-19 patients (p =
0.031). There is an essential relationship between
hypertension and death in COVID-19 patients at Tugurejo
Hospital Semarang.
Attribution-ShareAlike 4.0 International (CC BY-SA 4.0)
1. Introduction
Covid-19 is a disease caused by SARS-CoV-2, which infects the respiratory tract. The first case
was discovered in December 2019 in China, specifically in Wuhan, with 41 cases. This virus has a
growing spread and reaches almost all countries globally, thus, WHO announced on March 11, 2020,
that COVID-19 is a pandemic (Alkautsar, 2021; Fathoni, 2019). Indonesia itself reported this case for
the first time on March 2, 2020 (Aeni, 2021). There were 2 cases, and it continued to grow until June
20, 2023, when there were 6,811,429 confirmed cases with 161,918 deaths (Putra & Fenty, 2022).
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Meanwhile, in Semarang, the total confirmed cases from 2020 to January 1, 2023, recorded 108,396
confirmed cases with 1,652 deaths (Levani et al., 2021).
Hypertension is a disease that is found in many people with Covid-19. This disease places a
relatively high risk in the COVID-19 infection process (Putra & Fenty, 2022; Susilo et al., 2022; Yuliana,
2020). Hypertension itself is a condition of increased diastolic blood pressure >90mmHg and systolic
>140mmHg with a number of two measurements for five minutes when in calm conditions.
Hypertension is a comorbidity, where COVID-19 patients are the most likely to experience this case,
reaching a percentage of 52.1% with 13.2% death. Hypertension is also an inflammatory disease that
has characteristics in the form of endothelial dysfunction. There is a higher expression of angiotensin
two syndromes (ACE 2) in people with hypertension. Therefore, this can make the risk of severity
increase to cause mortality in COVID-19 patients (Choirunnisa & Helda, 2021).
The hadith narrated by Imam Bukhari and Muslim No.5288 conveys that the Prophet (peace
be upon him) said:
ُ
“Infectious disease outbreaks or commonly called tha'un, are warnings originating from Allah
SWT to give tests to His servants. So, when you hear that a country has a contagious disease, don't
enter it. And if this is in your land, do not flee from it.” (Hadith Narrated Muslim and Bukhari from
Osama bin Zayd).
Referring to the high number of COVID-19 cases and deaths cases, especially experienced by
COVID-19 patients with hypertension, this matter triggered the author's interest in researching the
title "The Relationship of Hypertension with Death in Covid-19 Patients at Tugurejo Hospital
Semarang." Due to the need for knowledge to patients with hypertension related to the relationship
between hypertension and death in COVID-19 patients, therefore people with hypertension will be
able to carry out hypertension control or action preventive so that the risk of death if contracting
COVID-19 can decrease.
2. Materials and Methods
The research was held at Tugurejo Hospital Semarang and implemented from October 2023 to
March 2024. It is related to the discipline of Internal Medicine. Quantitative methods using an
analytical observational research design and a cross-sectional approach were used in this study. The
population involved in the study was COVID-19 patients at Tugurejo Hospital Semarang from May
2021 to November 2021. The data obtained was then analyzed using the SPSS Statistical data
processing application version 27 for Windows.
3. Result and Discussion
Table 1 Overview of Respondent Characteristics
Characteristic
Frequency
Percentage
Age
21-30 years
7
8.3
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31-40 years
41-50 years
≥ 50 years
17
26
34
20.2
31.0
40.5
Gender
Male
Female
45
39
53.6
46.4
Educator
Bachelor / Associate’s Degree
Senior High School
Junior High School
Elementary School
No School
19
43
12
5
5
22.6
51.2
14.3
6.0
6.0
Work
Civil Servants
Self-employed
Private employees
Merchant
Farmer
Does not work
Other
7
12
36
6
3
9
11
8.3
14.3
42.9
7.1
3.6
10.7
13.1
Hypertensive
Hypertensive
No hypertension
45
39
53.6
46.4
Death
Experiencing death
No death
41
43
48.8
51.2
Based on table 4.1 shows that the overwhelming majority of COVID-19 patients in this study
(40.5%) were ≥ 50 years old. The gender of the majority of Covid-19 patients is male, with a
percentage of 53.6%. Most Covid-19 patients had the last high school education (51.2%), with most
working as private employees (42.9%). Covid-19 patients in this study had hypertension (53.6) and
no deaths (51.2%).
Table 2 Chi-Square test relationship of hypertension with death of COVID-19 patients
Hypertensi
on
Death
Total
p
Experiencing
death
No death
Hypertensi
on
27
(60.0%)
18
(40.0%)
45
(100.0%)
0,031
Non
Hypertensi
on
14
(35.9%)
25
(64.1%)
39
(100.0%)
Based on Table 2, some covid patients who have hypertension experience 27 (60.0%) deaths.
While most of the non-hypertensive Covid-19 patients did not die, 25 (64.1%). Chi-square produces
p worth 0.031 < 0.05, which means that hypertension to the death of COVID-19 patients is
significantly related.
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Discussion
This study obtained results that hypertension is significantly related to the death of COVID-19
patients at Tugurejo Hospital Semarang, namely COVID patients experiencing hypertension
experiencing death as much as 27 (60.0%). At the same time, most % of the non-hypertensive Covid-
19 patients did not die, 25 (64.1%). The chi-square test obtained p with a value of 0.031 (p < 0.05),
which means that hypertension against the death of Covid-19 patients is significantly related. This is
in line with research from Zhang et al. in China in 2020, obtained the results of the analysis obtained
statistical test results with a value = 0.04 (p < 0.05), meaning that hypertension is significantly related
to COVID-19 death (Zhang et al., 2020).
Hypertension is an inflammatory disease that has characteristics in the form of endothelial
dysfunction. There is more expression of ACE 2 in people with hypertension when infected with
COVID-19 (Roeroe et al., 2021). How SARS-CoV-2 enters cells by binding to ACE2. Antihypertensive
drugs, including angiotensin receptor blockers (ARBs) and ACE inhibitors, are associated with
increased ACE2 expression on the cell surface, supplying SARS-CoV-2 in large quantities of cell
infections. Some hypertensive patients undergoing RAAS, especially those using ACEis, will be
susceptible to propagation to host cells and virus entry in hypertensive patients, which will ultimately
increase the risk of progression to ARDS, which is due to negative COVID-19. These conditions can
increase the severity risk and increase mortality (Rauf et al., 2020; Zhang et al., 2020).
This result is also in line with research from Choirunnisa & Helda in South Tangerang in 2021,
obtained the results of statistical test analysis with a p-value of 0.000 (p < 0.05) or has meant that
hypertension is significantly related to COVID-19 death (Choirunnisa & Helda, 2021).
SARS-CoV-2 infection can stimulate an immune response to the host, increasing cytokines and
decreasing lymphocytes excessively in patients (Choirunnisa & Helda, 2021). There is an interaction
between SARS-CoV-2 proteins and RNA with receptors that make the antivirus immune response
active and regulate the spread and replication of the virus in the host in vivo. However, very active
and excessive immune responses can damage immunity and cause tissue trafficking (Direktorat et al.,
2020; Hidayati & Adnan, 2023).
In the SARS-CoV-2 pandemic, if proinflammatory cytokines or cytokine storms continue to be
produced, it can make the prognosis and course of the disease worse, and patients infected with SARS-
CoV-2 may die. These characteristics make proinflammatory cytokines accumulate, thus affecting the
cellular system. Because of this condition, hypertension patients tend to have weak immunity
(Choirunnisa & Helda, 2021). In this case, the RAAS system will also be affected; therefore, it will give rise
to major physiological disorders, such as hemostatic, in the nervous system. The COVID-19 virus will
then be bound by ACE2 spread receptors throughout the organs; therefore, it can support additional
organ failure, which causes COVID-19 patients to have worse conditions that trigger death (Baskoro,
2023; Peng et al., 2021).
4. Conclusion
Referring to the data obtained and analyzed in this study, it can be concluded, namely: Covid-
19 patients with hypertension as many as 45 people (53.6%) and non-hypertensive as many as 39
people (46.4%); Covid-19 patients who had hypertension experienced 27 deaths (60.0%), and 18
deaths (40.0%). Meanwhile, 14 nonhypertensive Covid-19 patients died (25.9%) and did not die, 25
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Jurnal Indonesia Sosial Sains, Vol. 5, No. 4, April 2024 939
(64.1%); There is a relationship between hypertension and death of Covid-19 patients at Tugurejo
Hospital Semarang p = 0.031 (p < 0.05).
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