COVID-19 may trigger new-onset high blood pressure

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A study today of 45,398 COVID-19 patients diagnosed from March 2020 to August 2022 suggests a SARS-CoV-2 infection is linked to new-onset high blood pressure, especially in adults with preexisting heart conditions or those who are older, Black, or male. The study is published in Hypertension.

Though preexisting hypertension has been a known factor is poor outcomes during COVID-19, this is one of the largest studies to suggest hypertension may be triggered by a COVID infection.

The study compared high blood pressure—or hypertension—outcomes among those hospitalized for COVID-19 with 13,864 people hospitalized for influenza from January 2018 to February 20, 2022. The authors found that 21% of people hospitalized with COVID-19 developed high blood pressure, compared with 16% for influenza.

A fifth of hospital patients developed hypertension

Hypertension was assessed during a follow-up within 3 and 9 months after a positive COVID-19 or flu test, with the one closest to 6 months taken for both COVID-19 and flu patients, the authors said. Hypertension was defined as a blood pressure reading greater than or equal to 130/80 mm Hg (millimeters of mercury).

Given the sheer number of people affected by COVID-19 compared to influenza, these statistics are alarming.

New-onset persistent high blood pressure was seen in 20.6% of hospitalized patients with COVID-19 and 10.9% of nonhospitalized patients with COVID-19. Hospitalized patients with COVID-19 were 2.23 (95% confidence interval [CI], 1.48 to 3.54) times and nonhospitalized patients with COVID-19 were 1.52 (95% CI, 1.22 to 1.90] times more likely to develop persistent hypertension than their influenza counterparts.

The risk for developing high blood pressure was most significant among older, Black, or male COVID-19 patients. Black patients made up 38.6% of COVID patients at follow-up who had developed persistent high blood pressure. And 63.1% of patients with high blood pressure were between the ages of 40 and 79.

Chronic obstructive pulmonary disease, coronary artery disease, chronic kidney disease, and those who were treated with corticosteroid medications were also at an increased risk of developing high blood pressure.

The rates of persistent high blood pressure decreased across the pandemic in the nonhospitalized cohort from March 2020 to October 2020, likely as more effective COVID-19 treatments became available, the authors said.

All patients included in the study were seen at the Montefiore Health System in Bronx, New York, an ethnically diverse healthcare system serving a significant percentage of New York's population.

"Given the sheer number of people affected by COVID-19 compared to influenza, these statistics are alarming and suggest that many more patients will likely develop high blood pressure in the future, which may present a major public health burden," said senior study author Tim Q. Duong, PhD, a professor of radiology at Albert Einstein College of Medicine and Montefiore Health System in New York City, in an American Heart Association press release.

Heart of kidney injury may play role

Twenty-one percent of hospitalized patients with COVID-19 with no history of high blood pressure developed in-hospital hypertension, and risk factors were similar to those who developed persistent hypertension, the authors said.

While no one knows how COVID-19 infections could cause high blood pressure, it is possible that SARS-CoV-2 causes cardiac dysfunction and blood pressure dysregulation via the ACE2 receptors.

Alternatively, other studies have shown that acute kidney injury is common among those hospitalized with COVID-19 and can be linked to developing hypertension.

Patients seen at the Montefiore Health System were also more likely to be of low socioeconomic status, which has been linked to high blood pressure. Other reasons for possible developing high blood pressure after COVID include psychosocial stress, reduced physical activity, unhealthy diet and weight gain.

"These findings should heighten awareness to screen at-risk patients for hypertension after COVID-19 illness to enable earlier identification and treatment for hypertension-related complications, such as cardiovascular and kidney disease," Duong said.

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