New Onset Hypertension After COVID

There has been concern that we may be seeing the development of high blood pressure (hypertension) as yet another long-term health consequence of COVID-19. If true, this would be concerning for many reasons. First, I have written previously that people are at increased risk of quite a number of cardiovascular signs, symptoms and conditions for at least a year following their SARS-CoV-2 infection, including heart attacks and strokes, and of course, hypertension can be a contributor to both.

Second, if in fact COVID is associated with the development of hypertension, unless it resolves over time, people will be at risk for all the potential long-term complications of hypertension (heart attacks, heart failure, stroke, kidney disease, etc.) unless their blood pressure is brought under control and remains well controlled. That may mean more frequent medical visits and the need for medications (that sometimes are expensive and that have various side effects).

A recent study- “Incidence and predictors of development of new onset hypertension post COVID-19 disease” – ScienceDirect – revealed concerning findings.

I have written before and again recently, that the SARS-CoV-2 virus is more than just a respiratory virus – most of us would consider it a vascular virus in that the virus damages blood vessels. In my blog posts this past week, I reminded readers that SARS-CoV-2 can cause endothelial dysfunction, or what you may see referred to as vasculopathy or endotheliopathy, in simple terms – damage to and resulting dysfunction of the cells that line blood vessels, called endothelial cells (you likely have heard of epithelium or epithelial cells – literally, cells on the top or outside of the skin; endothelial cells are on the inside of tissues, including blood vessels). I have also alluded to, but not yet gone into, some of the ways the SARS-CoV-2 virus can cause dysfunction of a number of our endocrine glands (these are tissues that make hormones). Probably the most common, after disturbances of the renin-angiotensin system (which is too complicated for us to discuss here) is thyroid disease that can result from COVID (and after that may be diabetes). It is certainly possible that the SARS-CoV-2 virus’ effects on either the blood vessels or the endocrine glands of our body, or both, could contribute to the development of hypertension.

This recent study followed 248 patients (ages 30 – 74) who had been diagnosed with and hospitalized for COVID-19 between March 27, 2020 and May 27, 2021 at a specialized hospital providing advanced cardiac care services, and had no prior record of hypertension, kidney, liver or heart disease and were not taking any medication to reduce blood pressure prior to hospitalization. These patients were followed for 1-year post-infection and hospitalization.

To my surprise (you would think that I wouldn’t be getting surprised by now), 32.3% of these subjects developed new onset hypertension by the time of their 1-year follow-up evaluation. The criteria for diagnosing hypertension were an average blood pressure greater than or equal to 140 mmHg (systolic bp) and/or 90 mmHg (diastolic bp). Those in the group who developed hypertension were more likely to have had more severe COVID-19 and more likely to have experienced complications of COVID-19. They also were more likely to have received steroids while in the hospital (that makes sense, because severe disease is one of the criteria for initiating steroid treatment. BTW, for those of you who are impressing me by pointing out in your minds that treatment with steroids can increase blood pressure, I give you extra credit, but then remind you that steroid-induced high blood pressures would resolve within days to weeks of stopping the steroids. Current recommendations for duration of treatment with steroids for severe COVID-19 is 6 days, so this would not account for high blood pressure 1-year post recovery. This study took place in India, and we do know that doctors in that country tended to treat patients with severe disease with steroids longer than is currently recommended or was common practice in the U.S. Nevertheless, one would still expect any elevation of blood pressures due to steroids to resolve spontaneously once the steroids were discontinued.)

I still have many questions:

1. At what rate does new onset hypertension occur in those with mild or moderate COVID-19 in the following year? Because the authors of this study found higher rates of hypertension among those with more severe disease, I would expect that the rate of new onset hypertension in those with mild or moderate disease might be less.
2. For those who have preexisting hypertension, does infection worsen blood pressures or make control of blood pressures more difficult?
3. The Indian population has higher rates of underlying diabetes than the U.S. population. Would that result in a lower rate of new onset hypertension following COVID-19 in Americans, especially those without preexisting diabetes?
4. India did provide their population with different COVID vaccines than the U.S. used. Does vaccination prior to COVID-19 reduce the chances of developing new onset hypertension following COVID-19?
5. The time period of this study was prior to the Delta and Omicron variants. Is the risk for post-COVID new onset hypertension different depending upon which variant one is infected with?
6. Is the hypertension following COVID-19 persistent, or does it tend to resolve with time?
7. Do reinfections increase the risk for or severity of hypertension?
8. Does early treatment with Paxlovid reduce the likelihood of developing hypertension following COVID-19?

For now, be sure to seek medical evaluation for any new symptoms that develop after you appear to have recovered from COVID, even symptoms that aren’t severe and you might have tended to ignore previously. We need to be extra vigilant for any number of long-term health consequences that have been reported following COVID, especially in the first year following infection. Before you resume vigorous exercise following COVID, be sure to get checked out by your medical provider, including a measurement of your blood pressure. Take any symptoms you develop with exercise more seriously if you have had COVID in the prior year than you might otherwise have. Let your doctor know and get checked out. It is a good idea for anyone who has recovered from COVID-19 to get a check-up at the 1-year mark of your infection, even if you are without symptoms.