COVID-19 infection has been linked to an increased risk of developing new high blood pressure, also known as hypertension, especially among certain vulnerable groups1 . Studies show that adults with no prior history of hypertension who contract COVID-19 are more likely to develop persistent high blood pressure compared to those infected with influenza2 . This emerging complication may have significant public health implications given the large number of people affected by the pandemic1 .
💡 Did You Know? COVID-19 may trigger new-onset high blood pressure. SARS-CoV-2 infection is significantly associated with the development of high blood pressure in adults with preexisting heart conditions or those who were older, Black, or male1 .
Risk Factors for COVID-Related Hypertension
A large 7-year longitudinal cohort study involving 45,000 COVID-19 patients and 14,000 influenza patients who were initially free of hypertension found that new-onset hypertension occurred more frequently after COVID-19 infection2 . At six months post-infection, 20% of hospitalized COVID-19 patients and 11% of non-hospitalized COVID-19 patients developed hypertension, compared to 16% and 4% of hospitalized and non-hospitalized influenza patients, respectively2 . Hospitalized COVID-19 patients were more than twice as likely, and non-hospitalized patients 1.5 times as likely, to develop persistent hypertension compared to their influenza counterparts1 3.
“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”
— Tim Q. Duong, Albert Einstein College of Medicine and Montefiore Health System1
Several demographic and clinical factors independently predicted the risk of new-onset hypertension after COVID-19 infection2 3:
- Black race2 3
- Male sex2 3
- Age over 40 years2 3
- Preexisting coronary artery disease2 3
- Chronic obstructive pulmonary disease (COPD) 23
- Chronic kidney disease3
Additional factors associated with higher risk include treatment with vasopressor and corticosteroid medications during COVID-19 illness3 . The mechanisms behind post-COVID hypertension may involve persistent inflammation, immune system dysregulation, endothelial cell injury, and activation of the renin-angiotensin-aldosterone system (RAAS) 43. Acute kidney injury, a common complication in hospitalized COVID-19 patients, may also contribute to hypertension through fluid retention3 . Psychosocial stress, reduced physical activity, unhealthy diet, and weight gain during the pandemic may further exacerbate blood pressure elevation3 .
“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.”
— Tim Q. Duong, Albert Einstein College of Medicine and Montefiore Health System1
| Patient Group | New-Onset Hypertension Incidence at 6 Months | Relative Risk vs Influenza Counterpart |
|---|---|---|
| Hospitalized COVID-19 Patients | 20% 2 | 2.23 times higher3 |
| Non-hospitalized COVID-19 Patients | 11% 2 | 1.52 times higher3 |
| Hospitalized Influenza Patients | 16% 2 | Reference |
| Non-hospitalized Influenza Patients | 4% 2 | Reference |
Preventing High Blood Pressure After COVID-19
“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.”
— Tim Q. Duong, Albert Einstein College of Medicine and Montefiore Health System1
Preventing COVID-19 infection remains the most effective strategy to reduce the risk of developing post-COVID hypertension2 . Recommended preventive measures include vaccination, hand hygiene, and social distancing to minimize exposure to SARS-CoV-22 . Vaccination has been associated with reduced risk of severe COVID-19 outcomes and may potentially lower the incidence of long-term complications such as hypertension, although this has not been conclusively studied2 .
Post-COVID new-onset hypertension (PCNH) is an increasingly reported complication among COVID-19 survivors. PCNH can emerge up to 12 months after infection, highlighting the need for ongoing monitoring of blood pressure in this population. 45
Early identification and management of hypertension in patients recovering from COVID-19 are critical to preventing cardiovascular and kidney complications2 . Healthcare providers should screen patients who are at higher risk—such as older adults, males, Black individuals, and those with preexisting heart or lung conditions—for new-onset hypertension after COVID-19 illness2 1.
The role of antiviral treatments like Paxlovid in preventing post-COVID hypertension is not yet established and requires further research2 . Meanwhile, lifestyle modifications remain important to control blood pressure and overall cardiovascular health3 :
- Maintain a healthy diet low in sodium and rich in fruits and vegetables3
- Engage in regular physical activity appropriate for your health status3
- Manage stress through mindfulness, counseling, or relaxation techniques3
- Avoid tobacco and limit alcohol consumption3
- Monitor blood pressure regularly, especially if you had COVID-192
