COVID-19 infection can cause or worsen high blood pressure, known as hypertension. Hypertension is a chronic condition defined by a persistent elevation of pressure in the arteries and is a major risk factor for cardiovascular disease. The SARS-CoV-2 virus affects more than the respiratory system, influencing the body’s vascular and immune systems that regulate blood pressure. Understanding this link is important for managing health during and after an infection.
Observed Patterns: Acute vs. Persistent Elevation
Blood pressure changes related to COVID-19 occur in both the immediate, acute phase and the longer-term, post-acute phase. During an active, severe infection, temporary blood pressure spikes are common. These acute elevations can result from the physical and emotional stress of the illness, fever, or the use of medications like vasopressors given to hospitalized patients.
A more concerning pattern is the development of persistent high blood pressure months after the initial infection resolves. This suggests COVID-19 may have a lasting impact on cardiovascular health, contributing to Long COVID. Studies show a significant association between SARS-CoV-2 infection and the development of persistent hypertension in individuals with no prior history. For example, people hospitalized for COVID-19 were more than twice as likely to develop persistent hypertension compared to those hospitalized with influenza.
Biological Pathways Linking COVID-19 and Hypertension
The biological mechanisms connecting COVID-19 to elevated blood pressure involve the body’s vascular system and inflammatory response. A primary mechanism involves the Angiotensin-Converting Enzyme 2 (ACE2) receptor, which the SARS-CoV-2 virus uses to enter human cells. ACE2 is a component of the Renin-Angiotensin System (RAS), which regulates blood pressure.
Normally, ACE2 helps lower blood pressure by converting Angiotensin II, a potent vasoconstrictor, into compounds that promote vasodilation. When SARS-CoV-2 binds to the ACE2 receptor, it decreases the availability and function of ACE2 on the cell surface. This reduction shifts the RAS balance, leading to an unopposed increase in Angiotensin II. The resulting buildup of Angiotensin II promotes vasoconstriction and fluid retention, directly contributing to higher blood pressure.
The virus also causes widespread endothelial dysfunction, which is damage to the inner lining of the blood vessels. SARS-CoV-2 can directly injure these cells, leading to endotheliitis. This damage makes blood vessels stiffer and less able to relax, increasing resistance to blood flow and raising pressure. Endothelial dysfunction is worsened by systemic inflammation, as the virus triggers a release of pro-inflammatory signaling molecules called cytokines.
This generalized immune response impairs vascular function and promotes clotting, exacerbating vessel constriction and stiffness. The physical and emotional stress of the illness, combined with the virus’s impact on the central nervous system, can overactivate the sympathetic nervous system. This overactivity releases stress hormones that cause the heart to pump harder and blood vessels to constrict, contributing to blood pressure elevation.
Risk Factors, Monitoring, and Clinical Guidance
Certain populations face a higher risk of developing or worsening hypertension following a COVID-19 infection. Individuals with pre-existing conditions like diabetes, chronic obstructive pulmonary disease, or chronic kidney disease are more vulnerable. Those who experienced a severe acute illness requiring hospitalization are at an increased risk of developing persistent high blood pressure. Age, being male, and being of Black ancestry have also been identified as associated risk factors.
Monitoring blood pressure at home is recommended for anyone recovering from COVID-19, especially those in high-risk groups. Measurements should be taken at the same time each day, such as morning and evening, using a calibrated home monitor. Consistent readings of 130/80 mm Hg or higher should prompt a consultation with a healthcare provider, particularly if this is a new finding. Prolonged stress, reduced physical activity, and weight gain may also contribute to high blood pressure, and these factors should be discussed with a doctor.
Patients currently taking blood pressure medications, such as ACE inhibitors or Angiotensin Receptor Blockers (ARBs), should not stop their regimen without medical consultation. Professional medical societies recommend continuing these medications, as stopping them significantly increases the risk of serious cardiovascular events. If new or worsening hypertension is detected, a healthcare provider can adjust the treatment plan, which may involve lifestyle changes or new medication.