Study Finds Contracting COVID-19 Could Lead to High Blood Pressure

Tim Q. Duong, PhD
Credit: Albert Einstein College of Medicine

An analysis of more than 45,000 people by a New York City-based team is sounding the alarm on a concerning trend: contracting COVID-19 could trigger new onset high blood pressure, with 1 in 5 hospitalized patients and 1 in 10 nonhospitalized patients developing hypertension within 6 months of infection.

Billed by investigators as the first study to investigate development and risk factors associated with hypertension in people with COVID-19 infection, results suggest people hospitalized for COVID-19 were more than twice as likely to develop hypertension and those not hospitalized are 1.5 times more likely to develop persistent hypertension compared to people hospitalized and nonhospitalized with influenza, respectively.¹

“While COVID-19 is typically more severe in patients with preexisting high blood pressure, including higher rates of hospitalization and mortality compared to people with normal blood pressure, it is unknown whether the SARS-CoV-2 virus may trigger the development of high blood pressure or worsen preexisting hypertension,” said senior investigator Tim Q. Duong, PhD, professor of radiology and 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.²

With the world seeking a return to normalcy as they become further removed from the peak of the COVID-19 pandemic, the medical community has acknowledged an inconvenient truth: the effects of COVID-19 would be evident and researched for decades. With research performed during the pandemic peak elucidating the adverse effects on cardiovascular health, it has become continued to be a prominent research focus in the post-pandemic period.¹

In the current study, Duong and a team of colleagues sought to estimate incidence of new-onset persistent hypertension following COVID-19, risk factors associated with new-onset persistent hypertension in patients with COVID-19, and whether the incidence was higher than the incidence following infection with influenza. With this in mind, investigators designed their study as a retrospective observational analysis of data obtained from the electronic medical record of the Montefiore Health System for March 2020-August 2022.¹

Limiting their study to those with a confirmed diagnosis of COVID-19 or influenza, investigators identified 45,398 patients for their COVID-19 cohort and 13,864 patients for their influenza cohort. After exclusion of those with a history of hypertension, investigators identified 28,576 with a COVID-19 infection and 11,516 with an influenza infection for inclusion in their analyses. Among the COVID-19 cohort, 5562 were hospitalized and 23,014 were not hospitalized. Among the influenza cohort, 619 were hospitalized and 10,897 were not hospitalized.¹

All patients included in the study had a follow-up between 3 and 9 months after a positive test for COVID-19 or influenza. For the purpose of analysis, the closest to 6 months was used for the investigators’ primary analysis. Investigators defined persistent hypertension as 130/80 mmHg and estimated adjusted odds ratios (ORs) for new-onset hypertension using logistic regression analysis, with prediction model performance assessed using receiver-operating-characteristic area under the curve.¹

In the 6-month analysis, 20.6% of those hospitalized with COVID-19 developed hypertension and 10.9% of the nonhospitalized patients with COVID-19 also developed hypertension. In comparison, 16.3% of those hospitalized with influenza developed hypertension and 4.4% of the nonhospitalized patients with COVID-19 developed hypertension.¹

Analysis of the likelihood for developing hypertension revealed hospitalized patients with COVID-19 were 2.23 (aOR, 2.23; 95% confidence interval [CI], 1.48-3.54; P < .001) times more likely than those hospitalized with influenza. Among nonhospitalized patients, those with COVID-19 were 1.52 (aOR, 1.52; 95% CI, 1.22-1.90; P < .01) times more likely to develop hypertension than nonhospitalized influenza patients. Investigators noted hypertension was more common among older adults, males, patients with preexisting comorbidities, and those treated with pressor or corticosteroid medications.¹

Further analysis suggested hypertension incidence among nonhospitalized patients did not vary across the pandemic. In contrast, incidence among hospitalized patients decreased from 20% in March 2020 to ≈10% in October 2020 (R2 = .79, P = .003) and then plateaued. Investigators also pointed out 21.0% of hospitalized patients with COVID-19 developed hypertension during COVID-19 hospitalization.¹

“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,” Duong said.² “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.”

References:

1. Zhang V, Fisher M, Hou W, Zhang L, Duong T. Incidence of New-Onset Hypertension Post–COVID-19: Comparison With Influenza. Hypertension. Published online August 21, 2023. doi:10.1161/HYPERTENSIONAHA.123.21174
2. Covid-19 may trigger new-onset high blood pressure. American Heart Association. August 21, 2023. Accessed August 21, 2023. https://newsroom.heart.org/news/covid-19-may-trigger-new-onset-high-blood-pressure.