High blood pressure, or hypertension, is a condition where the force of the blood pushing against the artery walls is consistently too high. It is a major public health concern globally, increasing the risk of heart attacks and strokes. Emerging data show that many individuals who recover from the initial infection later experience new or worsened blood pressure problems. This connection has led researchers to investigate whether the SARS-CoV-2 virus itself can trigger long-lasting changes to the cardiovascular system. Understanding this relationship is important for mitigating future health risks in the millions of people who have survived COVID-19.
The Established Connection Between COVID-19 and Hypertension
The relationship between COVID-19 infection and blood pressure changes is observed in two phases: acute effects during the illness and chronic issues that develop afterward. During the acute phase, hospitalized patients often experience temporary blood pressure spikes, linked to the physical stress of the illness or the use of certain treatments. These transient elevations are generally expected during any severe systemic infection.
A more concerning finding is the development of new-onset persistent hypertension (PCNH) months after recovery. Studies show COVID-19 survivors have a significantly higher risk for new, lasting high blood pressure compared to individuals who had influenza. One large analysis found that non-hospitalized COVID-19 patients were approximately 1.5 times more likely to develop persistent hypertension compared to non-hospitalized influenza patients. This suggests the cardiovascular impact is not limited to the most severe cases.
The risk of developing this chronic condition is notably higher among those who experienced severe illness. Individuals hospitalized with COVID-19 had an incidence of new-onset persistent hypertension hovering around 20.6% within six months of infection. This is more than twice the risk compared to hospitalized influenza patients in the same study. Overall, recovered COVID-19 patients show an estimated 70% higher likelihood of developing new high blood pressure within seven months compared to control groups.
Biological Pathways Driving Blood Pressure Changes
The SARS-CoV-2 virus affects the cardiovascular system through several biological mechanisms that ultimately lead to elevated blood pressure. One primary pathway involves the angiotensin-converting enzyme 2 (ACE2) receptor, which the virus uses as its entry point into human cells. When the virus binds to ACE2, the receptor is internalized and downregulated from the cell surface, disrupting the body’s natural blood pressure regulation system.
ACE2 normally converts the vasoconstrictor Angiotensin II (Ang II) into the blood-vessel-relaxing molecule Angiotensin (1-7). Reducing functional ACE2 tips the balance, allowing Ang II levels to increase unchecked. This overabundance of Ang II promotes sustained vasoconstriction—the narrowing of blood vessels—which directly raises systemic arterial pressure. This imbalance also contributes to inflammation and cellular damage within the blood vessels.
Beyond this receptor interaction, the infection triggers systemic inflammation that damages the lining of blood vessels, called the endothelium. The excessive immune response, sometimes referred to as a “cytokine storm,” floods the circulation with inflammatory molecules that impair endothelial function. This endothelial dysfunction reduces the ability of blood vessels to relax and dilate, leading to vessel stiffness and increased resistance to blood flow.
The virus also causes direct vascular injury, resulting in a hypercoagulable state and microvascular damage. The infection can injure endothelial cells (endotheliitis) and promote the formation of tiny blood clots called microthrombi. These microthrombi obstruct the smallest blood vessels, increasing peripheral resistance. This combination of ACE2 dysregulation, inflammation, and microvascular clotting provides a strong mechanistic link to the later development of chronic high blood pressure.
Recommendations for Monitoring and Management
Individuals who have recovered from COVID-19, especially those who experienced a severe case, should prioritize regular blood pressure monitoring. Since hypertension often has no noticeable symptoms, checking readings at home with a reliable device is important for early detection. Take readings at the same times each day, such as morning and evening, to provide a consistent picture for a healthcare provider.
Sustained readings above the normal range should prompt a consultation with a healthcare professional. Management often begins with non-pharmacological strategies aimed at mitigating vascular damage. Lifestyle adjustments are key:
- Adopting a diet low in sodium and rich in fruits and vegetables.
- Engaging in regular physical activity to strengthen the heart and maintain blood vessel flexibility.
- Maintaining a healthy weight and avoiding smoking, as both decrease the risk of further cardiovascular complications.
- Using stress reduction techniques, such as meditation or yoga, to manage psychological pressure.
If lifestyle changes are insufficient, a doctor may recommend medication adjustments or new prescriptions to prevent long-term damage.