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• Posted August 21, 2023

COVID May Help Trigger High Blood Pressure in Folks Already at Risk

COVID-19 patients face a markedly greater risk for developing persistently high blood pressure, even if they never had blood pressure concerns before, new research indicates.

The rise in risk seen among otherwise heart-healthy patients also appeared to be notably greater among COVID patients than in influenza patients.

The findings, said senior study author Tim Duong, are the “first to my knowledge.” Duong is a vice chair of research at the Albert Einstein College of Medicine and Montefiore Medical Center in New York City.

He stressed that the increased risk seen among COVID patients is not limited to those with severe illness.

At an average six months after initial infection, just over a fifth of patients who had been hospitalized with COVID developed high blood pressure, despite no prior blood pressure problems, the study found.

That figure fell to just below 11% among COVID patients who were never hospitalized, Duong said.

The findings were published Aug. 21 in the journal Hypertension.

A prior history of high blood pressure does tend to boost the risk of more serious COVID symptoms and hospitalization. The new study focused on patients with no prior heart or vascular complications.

Researchers reviewed the medical records of more than 45,000 COVID patients. Of those, roughly 28,500 had no history of high blood pressure.

All were initially infected with COVID between March 2020 and August 2022. All had a follow-up exam three to nine months after their initial diagnosis.

Of the 5,562 hospitalized COVID patients with no prior blood pressure issues, nearly 1,500 returned for a follow-up. Among that group, nearly 21% had developed persistently high blood pressure.

Of the 23,000 non-hospitalized COVID patients with no prior blood pressure concerns, just over 5,500 were seen at follow-up. Among this group, nearly 11% had also newly developed persistently high blood pressure.

Researchers then compared that data to nearly 14,000 influenza patients. None had been infected with COVID during the study time frame, and about 11,500 had no history of high blood pressure.

Of roughly 600 influenza patients who had been hospitalized, nearly 150 returned for a follow-up exam. Of these, about 16% had developed persistently high blood pressure.

Of roughly 11,000 non-hospitalized influenza patients, 2,400 had a follow-up exam. Just over 4% of them had developed persistent high blood pressure.

Persistent high blood pressure was more common among older adults, men, patients with other preexisting conditions including chronic kidney and coronary artery disease, as well as chronic obstructive pulmonary disease, the study found.

"The incidence of persistent hypertension [high blood pressure] in COVID-19 patients is unusually high, and is higher than that in flu patients,” Duong said.

As to why COVID appears to drive up blood pressure in the first place -- or why the risk was so much higher among COVID patients than influenza patients -- Duong said simply: "Nobody knows."

He speculated that the coronavirus might lead to overall "dysfunction" of heart health, alongside a specific “dysregulation” of blood pressure.

An array of COVID-related issues might explain escalating blood pressure, Duong said, citing psychological distress, plummeting activity levels, poor diet, kidney injury, respiratory problems and widespread inflammation.

No matter the underlying cause, Duong said "these statistics are alarming, given the sheer number of people affected by COVID-19.”

That thought was seconded by Amitava Banerjee, a professor of clinical data science and consultant cardiologist with the Institute of Health Informatics at the University College London in England.

“It is definitely a concern,” he agreed, noting that the Global Burden of Disease Study has declared high blood pressure the No. 1 risk factor for disease and premature death worldwide. "Therefore, due to COVID, the further increased risk of hypertension will have a major impact, not least in terms of increasing risk of other cardiovascular diseases, such as heart attacks and strokes.”

So what must be done?

"Health systems need to strengthen and prioritize blood pressure screening before and after COVID, and need to ensure that treatment services are also emphasized, which has not necessarily happened in the COVID era,” Banerjee said.

Dr. Davey Smith is head of the infectious diseases and global public health at the University of California, San Diego.

He described the findings as “a harbinger of future COVID-related deaths.”

High blood pressure is already responsible for about 13% of all deaths worldwide, Smith noted. So, he added, if COVID drives up high blood pressure risk, it stands to reason that death risk will rise in tandem.

He called on public health agencies to monitor for long-term conditions associated with COVID, including high blood pressure.

"We need to better understand how COVID is affecting overall population health,” Smith said.

“As a physician, I need to monitor my patients for diabetes and hypertension after they recover from COVID," he said. "And I need to aggressively treat hypertension and diabetes when I find it in my patients.”

More information

Learn more about high blood pressure risk and COVID-19 at the American Heart Association.

SOURCES: Tim Duong, PhD, vice chair, research, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, N.Y.; Amitava Banerjee, MA, MPH, DPhil, professor, clinical data science and honorary consultant cardiologist, Institute of Health Informatics, University College London, U.K.; Davey Smith, MD, MAS, head, Division of Infectious Diseases and Global Public Health, and professor/vice chair, research, Department of Medicine, University of California, San Diego; Hypertension, Aug. 21, 2023