Unspoken Effects – Association between COVID-19 and the Emergence of Elevated Blood Pressure

A comprehensive examination of more than 45,000 individuals infected with SARS-CoV-2 has uncovered a significant connection between the virus and fresh instances of sustained hypertension. Particularly at risk are those infected with COVID-19 who are above 40 years old, male, Black adults, or those with certain underlying health conditions; they show a higher propensity to develop high blood pressure as opposed to those with the influenza virus.

Recent research has brought to light a substantial correlation between SARS-CoV-2 infection and the commencement of hypertension in adults with preexisting heart ailments or those who are older, Black, or male.

Investigation into more than 45,000 digital medical records has revealed a prominent association between COVID-19 infection and the appearance of high blood pressure. This research was lately published in Hypertension, a journal by the American Heart Association.

Tim Q. Duong, Ph.D., the senior author of the study, a professor of radiology, and the vice chair for radiology research and associate director of Integrative Imaging and Data Science at the Center for Health and Data Innovation at Albert Einstein College of Medicine and Montefiore Health System in New York City, stated, “While COVID-19 often manifests more severely in those with preexisting hypertension, resulting in higher hospitalization and mortality rates compared to individuals with normal blood pressure, it remains unclear if the SARS-CoV-2 virus might instigate the onset of high blood pressure or exacerbate existing hypertension.”

This backward-looking observational study stands as the pioneering examination into the genesis and risk factors connected to continual high blood pressure in persons with COVID-19 compared to influenza, another akin respiratory virus. Per the 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, hypertension is defined as having both top and bottom numbers equal to or greater than 130/80 mm Hg.

Medical information was analyzed from electronic records at the Montefiore Health System in Bronx, New York, catering to an extensive, ethnically and racially diverse populace. The study encompassed 45,398 people infected with COVID-19 — admitted between March 1, 2020, and February 20, 2022 — and 13,864 individuals with influenza but without COVID-19 — admitted between January 2018 and February 20, 2022 — who were readmitted to the hospital for any medical reasons within an average six-month follow-up duration.

The evaluation revealed:

• 21% of patients hospitalized with COVID-19 and 11% of non-hospitalized COVID-19 patients developed high blood pressure, contrasted with 16% of influenza patients hospitalized and 4% not hospitalized.
• Individuals hospitalized for COVID-19 were more than twice as likely, and those not hospitalized were 1.5 times more likely, to exhibit continual hypertension compared to individuals hospitalized and non-hospitalized for influenza, respectively.
• Individuals infected with SARS-CoV-2, particularly those above 40, Black adults, or those with preexisting ailments like chronic obstructive pulmonary disease, coronary artery disease, or chronic kidney disease, faced a heightened risk of hypertension.
• Continual high blood pressure was more prevalent among those infected with SARS-CoV-2 who were administered vasopressor and corticosteroid medications during the pandemic.

“Considering the vast number of individuals impacted by COVID-19 in comparison to influenza, these statistics are unsettling and imply that an extensive number of patients will likely manifest high blood pressure in the foreseeable future, potentially constituting a significant public health challenge,” noted Duong. “These revelations should amplify the vigilance to screen those at risk for hypertension subsequent to COVID-19 sickness to facilitate earlier detection and treatment of hypertension-related complications, like cardiovascular and kidney disease.”

The researchers emphasized that the study subjects mainly hailed from communities with low socioeconomic standing, possibly augmenting their vulnerability to hypertension after COVID-19 infection. Other contributing factors could encompass isolation effects, psychological stress, diminished physical activity, unhealthy eating habits, and weight gain throughout the COVID-19 pandemic. Extended follow-up studies will be necessary to ascertain if COVID-19-related complications on cardiac and blood pressure regulation may rectify autonomously or cause enduring impacts on patients’ cardiovascular systems.

Limitations of the study included its application only to those who engaged with the healthcare system during the follow-up span and those more prone to have severe COVID-19; the chance that some patients had undiagnosed hypertension; the uncertainty that vaccination status, which could affect COVID-19 severity, might not have been recorded if vaccinations were provided outside of the system; and the chance for unintended patient selection bias in a retrospective analysis.

Background:

The subjects involved 45,398 COVID-19 patients hospitalized from March 2020 to August 2022, and 13,864 influenza patients without prior hypertension, hospitalized from January 2018 to August 2022. Health data were derived from the Montefiore Health System, encompassing various hospitals in the Bronx and adjacent communities in the New York Metropolitan area, serving a broad, diverse patient base, including many from lower socio-economic backgrounds. Early in the pandemic, the Bronx and the greater New York City boroughs were a focal point of SARS-CoV-2 infection. The data was gathered at the time of hospital admission for COVID-19 and during follow-up, within a range of 3 to 9 months after testing positive for either COVID-19 or influenza, with the data nearest to 6 months being chosen for both sets of patients.

Reference: “Incidence of New-Onset Hypertension Post–COVID-19: Comparison With Influenza” by Vincent Zhang, Molly Fisher, Wei Hou, Lili Zhang, and Tim Q. Duong, published on 21 August 2023, in Hypertension.
DOI: 10.1161/HYPERTENSIONAHA.123.21174

Frequently Asked Questions (FAQs) about COVID-19 and high blood pressure

More about COVID-19 and high blood pressure

• Hypertension Journal
• Albert Einstein College of Medicine
• Montefiore Health System
• 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults