COVID-19 survivors remain prone to hypertension, CVD

Survivors of COVID-19 remain at risk of long-term cardiovascular events, including elevated blood pressure (BP) and endothelial dysfunction, reveals a study.

“Persistent vascular dysfunction and BP increase post-COVID-19 underscore the need for further studies on the long-term risk of hypertension and cardiovascular disease (CVD),” the researchers said.

Individuals with no history of hypertension participated in this single-centre longitudinal study, with hospital-admitted COVID-19 survivors and controls with negative SARS-CoV-2 antibody tests. The researchers assessed ambulatory BP monitoring, flow-mediated dilatation (FMD), 6-min walk test (6MWT), and quality of life (QoL) at baseline and 12 months.

Furthermore, the research team conducted RAAS phenotyping at baseline and data analysis using paired t-tests and multivariable regression on full (n=97, median age 49.0 years) and per-protocol datasets (n=66, median age 50.0 years).

RAAS parameters were comparable at baseline. [J Hypertens 2025;43:1057-1065]

Participants with COVID-19 in the per-protocol group showed a 12-month increase in mean systolic BP (4.57 mm Hg, 95 percent confidence interval [CI], ‒0.04 to 9.18; p=0.052), diastolic BP (4.46 mm Hg, 95 percent CI, 1.01‒7.90; p=0.012), decrease in FMD (‒3.15 percent, 95 percent CI, ‒6.33 to 0.04; p=0.053), and improvement in 6WMT (145.6 m, 95 percent CI, 49.1‒242.1; p=0.004) compared with controls.

“Despite this improvement in physical function, QoL parameters assessment revealed that even after 12 months recovery, the SARS-CoV-2 positive group had persisting impairment of perceived QoL,” the researchers said.

Hypertension

In an earlier study involving 200,000 adults, new-onset hypertension significantly increased during the COVID-19 pandemic. The incidence rate rose from 2.11 to 6.76 per 100 person-years, which stressed the need for hypertension screening beyond those diagnosed with COVID-19. [BMC Med 2024;22:127]

Such findings highlighted the need for further studies with robust designs and extended follow-up periods to better understand the association between hypertension and COVID-19, according to the researchers.

Moreover, the findings on FMD supported those of another study that reported higher FMD among control participants than those with COVID-19 at a single visit. [Arq Bras Cardiol 2022;119:319-325]

A previous study on women with (n=12) and without COVID-19 (n=11) also found an increased brachial BP (systolic BP: 126 vs 109 mm Hg; p=0.01) and reduced FMD (4.69 percent vs 5.73 percent; p=0.381). However, the sample size was small. [Am J Physiol Heart Circ Physiol 2023;324:H713-H720]

“These results align with our observation of reduced FMD in COVID-19 survivors, indicating persistent endothelial dysfunction,” the researchers said. “This may be associated, in part, to endothelial inflammation induced by SARS-CoV-2.” [Sci Rep 2023;13:14086]

Furthermore, the decrease in FMD could be a sign of persistent lung injury following an acute infection with SARS-CoV-2, according to a previous study. [Lancet 2020;395:1417-1418]

“[The current] study highlights the importance and will raise awareness about the potential long-term cardiovascular effects of COVID-19,” the researchers said.

“It underscores the importance of long-term cardiovascular monitoring for COVID-19 survivors, vigilant screening and proactive management of hypertension, a focus on endothelial health, and the need for validation and further research,” they added.