High blood pressure, also known as hypertension, occurs when the force of blood against your vessel walls remains consistently elevated. This condition often presents without noticeable symptoms, leading to its description as a “silent killer.” Coronavirus disease 2019 (COVID-19) is an infectious illness caused by the SARS-CoV-2 virus, which primarily affects the respiratory system but can influence multiple bodily systems. This article explores the relationship between COVID-19 and blood pressure, clarifying how the virus can influence blood pressure and how pre-existing hypertension affects COVID-19 outcomes. High blood pressure is not a direct symptom of COVID-19, but rather a factor with significant interactions.
How COVID-19 Can Affect Blood Pressure
An acute COVID-19 infection can influence blood pressure through several interconnected mechanisms. The body’s immune response to SARS-CoV-2 often triggers widespread inflammation. This systemic inflammation can impact the endothelium, the delicate lining of blood vessels, affecting their function and blood pressure regulation. Elevated inflammatory markers are observed in severe cases, contributing to these vascular changes.
Physiological and psychological stress from a severe infection also plays a role in blood pressure fluctuations. The body’s stress response releases hormones like adrenaline and cortisol, temporarily increasing heart rate and constricting blood vessels, which raises blood pressure. This can lead to transient elevations during illness.
The SARS-CoV-2 virus can directly affect blood vessels. It uses ACE2 receptors on cells, including those lining blood vessels, to enter. This interaction can damage the vascular endothelium, causing endothelial dysfunction and increased arterial stiffness, sometimes called early vascular aging. Such damage disrupts the balance of substances controlling vessel constriction and relaxation, altering blood pressure.
Certain medications administered during COVID-19 treatment can also influence blood pressure. Corticosteroids, for example, often used for severe inflammation, can increase blood pressure as a side effect. While some blood pressure medications like ACE inhibitors and ARBs were initially a concern due to ACE2 interaction, studies show they are generally safe and beneficial. Blood pressure can fluctuate during the acute phase of illness due to these combined factors.
Why Pre-existing High Blood Pressure Increases COVID-19 Risk
Individuals with pre-existing high blood pressure face increased risk for severe COVID-19 outcomes. Hypertension chronically strains the cardiovascular system, causing arterial stiffness and endothelial dysfunction, where the lining of blood vessels does not function optimally. This compromised cardiovascular health means the body is less equipped to handle the additional stress and inflammation from a SARS-CoV-2 infection. The heart and blood vessels, already working harder, have less reserve to combat the virus.
Hypertension can also alter immune responses, contributing to a more severe COVID-19 reaction. Individuals with high blood pressure may have a pre-activated immune system, leading to an exaggerated inflammatory response when infected. This heightened inflammation can worsen tissue damage and contribute to a “cytokine storm,” an immune system overreaction linked to severe COVID-19. This immune dysregulation can hinder the body’s ability to clear the virus.
The SARS-CoV-2 virus interacts with the Renin-Angiotensin-Aldosterone System (RAAS). The virus enters human cells by binding to the ACE2 receptor, a RAAS component that regulates blood pressure. In hypertensive individuals, the RAAS is often already dysregulated, and the virus’s ACE2 interaction can further disrupt this balance, potentially leading to more severe disease. This disruption can increase substances promoting inflammation and blood vessel constriction.
Chronic hypertension can damage various organs like the kidneys and heart, reducing their functional reserve. Weakened organs are more susceptible to COVID-19 injury, increasing complications like acute kidney injury, heart injury, and blood clot formation. This cumulative organ damage contributes to higher rates of hospitalization, intensive care unit admission, and mortality in hypertensive COVID-19 patients. Hypertension acts as a risk factor for severe illness, not a symptom of the infection itself.
Long-term Blood Pressure Changes After COVID-19
Beyond the acute phase of illness, COVID-19 can lead to long-term blood pressure changes, including new-onset hypertension or worsening pre-existing high blood pressure. A significant percentage of individuals, even after mild COVID-19, developed persistent high blood pressure months later. Some research indicates new-onset hypertension in over 20% of hospitalized and over 10% of non-hospitalized patients at six months, a rate higher than observed after influenza.
Persistent inflammation following COVID-19 contributes to lasting blood pressure changes. The immune system may remain in an activated state, leading to ongoing inflammation that affects blood vessels and blood pressure regulation. This sustained response can perpetuate vascular changes from the acute illness.
Blood vessel damage during the infection also has long-term consequences. SARS-CoV-2 can directly injure the vessel lining, increasing arterial stiffness, sometimes called accelerated vascular aging. This stiffening reduces artery elasticity, making it harder for them to expand and contract efficiently, leading to elevated blood pressure over time.
Dysfunction of the autonomic nervous system (ANS) is another contributing factor. The ANS controls involuntary functions like heart rate and blood pressure. COVID-19 has been linked to dysautonomia, where the ANS doesn’t function properly, potentially causing fluctuating blood pressure or orthostatic hypotension.
Lifestyle changes adopted during the pandemic, such as reduced physical activity, altered diet, and increased stress, may also indirectly contribute to long-term blood pressure elevations. These factors, combined with the virus’s direct effects, highlight the complex nature of post-COVID blood pressure changes and their cardiovascular impact.
Managing Blood Pressure During and After Infection
Managing blood pressure effectively during and after a COVID-19 infection is important for overall health. Regularly monitoring blood pressure, especially at home, helps detect changes early. Home monitoring provides a complete picture of trends, allowing for timely treatment adjustments by a healthcare professional. Take readings at consistent times, such as morning and evening.
Individuals on blood pressure medications should continue them as prescribed by their doctor, even if they contract COVID-19. Discontinuing medications without medical advice can lead to blood pressure spikes, increasing the risk of heart attack, stroke, or kidney damage. The benefits of continuing prescribed medications generally outweigh any potential risks.
Lifestyle modifications are key to blood pressure management. A heart-healthy diet, low in salt and rich in fruits, vegetables, and whole grains, helps maintain healthy blood pressure. Regular physical activity, like at least 30 minutes of moderate exercise most days, also supports cardiovascular health.
Managing stress through techniques like meditation or yoga can help mitigate stress-induced blood pressure fluctuations. Maintaining a moderate weight and avoiding excessive alcohol consumption are additional factors supporting healthy blood pressure. These measures aid blood pressure management and overall well-being during recovery.
Consult healthcare providers for personalized advice, especially if blood pressure fluctuates or new symptoms arise after infection. Telemedicine appointments can facilitate regular check-ups and medication adjustments, offering a convenient way to stay connected. Early identification and management of blood pressure changes can help prevent serious complications.