Patients with COVID-19 are more likely to develop new-onset persistent hypertension (HTN) than patients with influenza, according to study findings published in Hypertension.

Researchers sought to determine the incidence of and identify risk factors for new-onset persistent HTN after COVID-19 infection vs influenza, and compared them in both hospitalized and nonhospitalized patients.

A retrospective observational study was conducted and included 28,576 patients with COVID-19 (from March 2020 to August 2022) infection and 13,864 patients with influenza (from January 2018 to August 2022) without a medical history of HTN from the Montefiore health system in New York. Of the total patients with COVID-19 and patients with influenza, only 5562 and 619 were hospitalized, respectively.

The primary outcome was the development of new-onset persistent HTN from time of admission to the 6-month follow-up. This was defined as either a minimum systolic blood pressure (SBP) above 140 mm Hg or a diastolic blood pressure (DBP) above 90 mm Hg, a new ICD-10 HTN code diagnosis, or a new antihypertensive medication prescription at the follow-up visit. Risk factors for new-onset persistent HTN were assessed using a logistic regression model. The odds ratio was calculated and adjusted for age, sex, intensive care unit status, C-reactive protein, lactate dehydrogenase, and D-dimer test at admission.

At the 6-month follow-up visit, 1455 hospitalized patients and 5565 nonhospitalized patients with COVID-19 returned, and 147 hospitalized and 2400 nonhospitalized patients with influenza returned.

Compared with patients with influenza, both hospitalized (adjusted odds ratio [aOR], 2.23; 95% CI, 1.48-3.54; P <.001) and nonhospitalized (aOR, 1.52; 95% CI, 1.22-1.90; P <.01) patients with COVID-19 had a significantly higher incidence of new-onset persistent HTN at the 6-month follow-up visit. Incidence of new-onset persistent HTN in hospitalized patients with COVID-19 infection and influenza was 20.60% and 16.30%, respectively. Incidence of new-onset persistent HTN in nonhospitalized patients with COVID-19 infection and influenza was 10.85% and 4.40%, respectively.

The most significant risk factors for new-onset HTN in nonhospitalized and hospitalized patients with COVID-19 were age (P =.000), Black race (P =.000), chronic kidney disease (P =.005), chronic obstructive pulmonary disease (P =.008), and coronary artery disease (P =.015).

Among patients who later developed persistent hypertension, hospitalized patients with COVID-19 were more likely to be older, be men, be Black, have congestive heart failure or chronic kidney disease or coronary artery disease, and be prescribed corticosteroids and vasopressors during hospitalization (all P <.05). Nonhospitalized patients with COVID-19 were more likely to be older, men, White or Black, and less likely to be Hispanic (all P <.05). Hospitalized patients with influenza were more likely to be older, have higher SBP and DBP, and have lower respiratory rate during admission.

A sensitivity analysis was also conducted using a 130/80 mm Hg cutoff. The results were similar to the trend found in the primary outcome. The incidence of new-onset persistent HTN was higher in both hospitalized and nonhospitalized patients infected with COVID-19 compared with influenza (hospitalized patients, 34.8% vs 19.3%; nonhospitalized patients, 25.7% vs 9.1%).

A key study limitation is that the results for the incidence of HTN are restricted to only patients who returned for follow-up visit. Other factors that may affect the incidence of HTN (eg. vaccination rate, strain of SARS-CoV-2, testing rate, population profile, and disease severity) were not reliably recorded.

“…the incidence of new-onset persistent hypertension in patients with COVID-19 was significantly higher compared with patients with influenza,” the study authors wrote. “The mass number of people affected by COVID-19 suggests that new-onset persistent hypertension could be a major postinfection cardiovascular sequela at the population level.”

References:

Zhang V, Fisher M, Hou W, Zhang L, Duong TQ. Incidence of new-onset hypertension post-COVID-19: comparison with influenza. Hypertension. Published online August 21, 2023. doi:10.1161/HYPERTENSIONAHA.123.21174