Patients with COVID-19 More Likely to Develop Hypertension than Those with Influenza, Shows New Study

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The incidence of new-onset persistent hypertension (HTN) is higher in patients with COVID-19 than in those with influenza, according to a new retrospective observational study published in Hypertension.¹

Authors of an analysis of electronic medical records for more than 45 000 patients hospitalized with COVID-19 and nearly 14 000 patients hospitalized with influenza found that approximately 21% of those hospitalized with COVID-19 and 11% of those who were not hospitalized for COVID-19 developed persistent HTN compared to 16% of those hospitalized with influenza and 4% of those not hospitalized for influenza.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,” said senior author Tim Duong, PhD, professor of radiology, 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, in an American Heart Association (AHA) press release.²

Duong and colleagues conducted the current study to investigate the incidence and risk factors associated with new-onset persistent HTN in persons hospitalized with COVID-19 compared to those with influenza.¹ They analyzed health data from electronic medical records at the Montefiore Health System in Bronx, New York, which has a large, racially, and ethnically diverse patient population, according to the AHA press release.²

Participants included 45 398 persons with COVID-19—hospitalized between March 2020 and February 2022—and 13 864 individuals with influenza—hospitalized between January 2018 and February 2022 — who returned to the hospital system for any medical reasons within an average follow-up period of 6 months. There was no history of HTN among participants in either cohort.¹

FINDINGS

At 6-month follow-up, the investigators observed new-onset persistent HTN in 20.6% of patients hospitalized with COVID-19 and 10.85% of nonhospitalized patients with COVID-19. The rates were 16.3% in those hospitalized with influenza and 4.4% in those with influenza who were not hospitalized, according to the study investigators.¹

In the COVID-19 group specifically, researchers noted that the rate of new-onset persistent HTN did not change during the pandemic among hospitalized patients, however in the nonhospitalized group, the rate decreased from 20% in March 2020 to approximately 10% in October 2020 (R2=0.79; P=.003), followed by a plateau.¹

Individuals hospitalized with COVID-19 were 2.23-times (95% CI, 1.48-3.54; P<.001) and nonhospitalized patients with COVID-19 were 1.52-times (95% CI, 1.22-1.90; P<.01) more likely to develop persistent HTN than their influenza counterparts, noted Duong and colleagues.¹

Persistent HTN was more common among older adults, men, patients with preexisting comorbidities—including chronic obstructive pulmonary disease, coronary artery disease, and chronic kidney disease—and those who were treated with pressor and corticosteroid medications.¹

Investigators also noted that 21% of participants hospitalized with COVID-19 with no prior HTN developed HTN during hospitalization, and 13.7% of those hospitalized with influenza developed HTN.¹

“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,” said Duong in the release.²

Limitations to the current study include the fact that the findings were restricted to individuals who interacted with the health system during 6 months of follow up and who might be more likely to have severe COVID-19; some participants may have had undiagnosed HTN; vaccine status may not have been recorded in the health system database if COVID-19 vaccines were administered outside the health system; and the potential for unintended patient selection bias.²

References:

1. Duong TQ, Zhang V, Fisher M, Hou W, Zhang L. Incidence of new-onset hypertension post-COVID-19: Comparison with influenza. Hypertension. Published online August 21, 2023. Accessed August 21, 2023. doi:10.1161/HYPERTENSIONAHA.123.21174.
2. COVID-19 may trigger new-onset high blood pressure. AHA News Release. Published August 21, 2023. Accessed August 21, 2023. https://newsroom.heart.org/news/covid-19-may-trigger-new-onset-high-blood-pressure