Are medical experts finding any correlation between continued high blood pressure after recovery from COVID-19 if there is no prior medical history of hypertension?

To date there is paucity of the data/published literature to support  persistent hypertension or high blood pressure after recovery from COVID-19 in patients with no prior history of hypertension. The published articles regarding hypertension and COVID-19 infection focus on whether pre-existing hypertension or anti-hypertensive medications increase  the risk of contracting COVID-19 and or the severity of COVID-19.  One article by Somani et al found 36% of patients who returned to the hospital after an initial hospitalization for COVID-19 -had hypertension versus 22% who were not re-hospitalized, but these patients may have had have preexisting hypertension.1 

In the US, as of May 30, 2020, among COVID-19 cases, the most common underlying health conditions were cardiovascular disease (including hypertension) (32%), diabetes (30%), and chronic lung disease (18%). Hospitalizations were six times higher and deaths 12 times higher among those with reported underlying conditions compared with those with none reported.5

The frequency with which COVID-19 patients are hypertensive does not necessarily imply a causal relationship between hypertension and COVID-19 or its severity, since hypertension is noted frequently in the elderly. Age may be a confounder.  Older people appear to be at particular risk of being infected with SARS-CoV-2 virus and of experiencing severe forms and complications of COVID-19. There has been as of yet no evidence that hypertension is related to COVID-19 disease sequelae either.6 

A review of 1,000 COVID-19 patients in New York showed 33.9% of hospitalized COVID-19 patients developed acute kidney injury and 13.8% of these required dialysis.2  Other COVID-19 studies have also shown acute renal failure or kidney injury with COVID-19 infections. 

Multisystem Inflammatory Syndrome has also been described in children associated with COVID-19 and children can develop fever, hypotension and multiorgan failure, including renal insufficiency.3 

If this renal insufficiency or renal failure persists after recovery from COVID-19, then this may cause elevated blood pressure or hypertension in those patients who have not had prior hypertension. However, the long-term sequelae of COVID-19 or SARS-CoV-2 are not as well documented as the acute clinical course. There is a longitudinal study of COVID-19 sequelae and immunity underway in the U.S. sponsored by the National Institute of Allergy and Infectious Disease. The study summary notes that very little is known about possible clinical sequelae or immunity that may persist  after resolution of the acute infection.4 Hopefully as time goes along, there will be more information available regarding long term sequelae of COVID-19 infections. To date causal relationship between COVID-19 and hypertension is unclear but it could be related to long term clinical sequelae of the disease.

Citations

  1. Sulaiman S, Richter F, Fuster V et al. Characterization of Patients Who Return to Hospital Following Discharge from Hospitalization for COVID-19. medRxiv May 22, 2020. Preprint. https://www.medrxiv.org/content/10.1101/2020.05.17.20104604v1
  2. Argenziano MG, Bruce SL, Slater CL et al. Characterization and clinical course of 1,000 patients with coronavirus disease 2019 ion New York: retrospective case series. BMJ 2020. May 29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7256651/?report=printable.
  3. CDC. Multisystem Inflammatory Syndrome in Children (MIS) associated with Coronavirus Disease 2019. May 29, 2020. https://emergency.cdc.gov/han/2020/han00432.asp
  4. National Institute of Health. A Longitudinal Study of COVID-19 Sequelae and Immunity. https://clinicaltrials.gov/ct2/show/NCT04411 https://emergency.cdc.gov/han/2020/han00432.asp14
  5. Stokes, E. K., Zambrano, L. D., Anderson, K. N., Marder, E. P., Raz, K. M., Felix, S. E. B., ... & Fullerton, K. E. (2020). Coronavirus Disease 2019 Case Surveillance—United States, January 22–May 30, 2020. Morbidity and Mortality Weekly Report, 69(24), 759.
  6. Ernesto L Schiffrin, John M Flack, Sadayoshi Ito, Paul Muntner, R Clinton Webb, Hypertension and COVID-19, American Journal of Hypertension, Volume 33, Issue 5, May 2020, Pages 373–374, https://doi.org/10.1093/ajh/hpaa057

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