Monday, August 21, 2023

AHA: COVID-19 May Trigger New-Onset High Blood Pressure

Hypertension - Credit CDC
 

#17,626

Between lingering vestiges of partial post-COVID or vaccine acquired immunity, and nearly two years of less virulent Omicron variants, the death rate from acute COVID infection has fallen sharply since 2021. 

Perhaps not as low as the `official numbers' would suggest, given that 90% of the world's nations no longer regularly report cases. but substantially lower than it was. 

For economic, political, and societal reasons most countries continue to move towards `normalizing' COVID infection, and treating it as if it is the `flu'. But the evidence continues to mount that COVID infections - and particularly repeated infections - can take a considerable toll on a person's health. 

Not everyone experiences post-COVID complications, but studies suggest between 10% and 30% of people report lingering - and sometimes permanent - sequelae; commonly referred to as `Long COVID', Post-COVID Syndrome, or sometimes post-acute sequelae of COVID-19 (PASC).

 

Post-COVID sequelae may include cardiovascular, renal, pulmonary, neurological, and endocrine disorders. A few (of many) studies we've looked at over the past few months include:

Today the American Heart Association has released a study showing that COVID infection is significantly more likely to trigger new-onset hypertension when compared to influenza infection.  

This link was most pronounced in adults with preexisting heart conditions or those who were older (>40), Black or male. They also found that persistent high blood pressure was more common among patients who received vasopressor and corticosteroid treatments during the pandemic.  

First, some excerpts from a much longer press release, followed by a link to the study.  I'll have a postscript after the break. 

NEWS RELEASE 21-AUG-2023
COVID-19 may trigger new-onset high blood pressure

A new study in the journal Hypertension finds 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 male
Peer-Reviewed Publication

AMERICAN HEART ASSOCIATION

Research Highlights:
  • An analysis of more than 45,000 people infected with SARS-CoV-2 found a significant association between the virus and the development of persistent high blood pressure among those with no prior history of high blood pressure.
  • In addition, people with COVID-19 infection and no history of high blood pressure were significantly more likely to develop persistent high blood pressure compared to people with the influenza virus.
  • People with COVID-19 who are over age 40, men, Black adults or those with preexisting conditions, such as chronic obstructive pulmonary disease, coronary artery disease or chronic kidney disease, had an elevated risk of developing high blood pressure, according to the study.
Embargoed until 4 a.m. CT/5 a.m. ET Monday, Aug. 21, 2023
DALLAS, Aug. 21, 2023 — An analysis of electronic medical records for more than 45,000 people found that COVID-19 infection was significantly associated with the development of high blood pressure, according to new research published today in Hypertension, an American Heart Association journal.

“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,” said senior study author Tim Q. Duong, Ph.D., professor of radiology and 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.

This retrospective observational study is the first to investigate the development and risk factors associated with persistent high blood pressure in people with COVID-19 infection compared to influenza, a similar respiratory virus. According to the 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, hypertension is classified as having top and bottom numbers greater than or equal to 130/80 mm Hg.

Health data were analyzed from electronic medical records at the Montefiore Health System in Bronx, New York, which serves a large, racially and ethnically diverse population. The study included 45,398 people with COVID-19 — hospitalized between March 1, 2020 and February 20, 2022 — and 13,864 people with influenza without COVID-19 — hospitalized between January 2018 and February 20, 2022 — who returned to the hospital system for any medical reasons within an average follow-up period of six months.

The analysis found:
  • 21% of people hospitalized with COVID-19 and 11% of those who were not hospitalized for COVID-19 developed high blood pressure, compared to 16% of people hospitalized with influenza and 4% of those not hospitalized for influenza.
  • People hospitalized for COVID-19 were more than twice as likely and those not hospitalized are 1.5 times more likely to develop persistent hypertension compared to people hospitalized and non-hospitalized with influenza, respectively.
  • People infected with SARS-CoV-2 who were over 40 years old, Black adults or those with preexisting conditions, such as chronic obstructive pulmonary disease, coronary artery disease or chronic kidney disease, had an elevated risk of developing high blood pressure.
  • Persistent high blood pressure was more common among people infected with SARS-CoV-2 who were treated with vasopressor and corticosteroid medications during the pandemic.

        (Continue . . . ) 


Incidence of New-Onset Hypertension Post–COVID-19: Comparison With Influenza
Vincent ZhangMolly FisherWei HouLili Zhang and Tim Q. Duong
Originally published 21 Aug 2023 

There can be little doubt that Post-COVID syndrome is real, and for an as-yet unquantified percentage of the population, it can prove severe enough to cause permanent disability and even premature death. 

Some experts have even suggested we may see huge increases in COVID-19 related heart failure and neurological diseases in the years ahead.

Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
 
Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms
Emily A. Troyer, Jordan N. Kohn, and Suzi Hong  

We saw heart attack rates jump very early in the pandemic, and they remain elevated, even in young adults. The $64 question is how big of a problem this is likely to become. 

And frankly, we may not know that for another 5 or 10 years.  

With COVID once again on the rise, and new variants in the mix, it continues to make sense to limit your exposure, and try to avoid infection if you can.