Risk of Incident New-Onset Arterial Hypertension After COVID-19 Recovery: A Systematic Review and Meta-analysis

Abstract

Introduction Arterial Hypertension (HT) has been described as a common comorbidity and independent risk factor of short-term outcome in COVID-19 patients. However, data regarding the risk of new-onset HT during the post-acute phase of COVID-19 are scant. Aim We assess the risk of new-onset HT in COVID-19 survivors within one year from the index infection by a systematic review and meta-analysis of the available data. Methods Data were obtained searching MEDLINE and Scopus for all studies published at any time up to February 11, 2023, and reporting the long-term risk of new-onset HT in COVID-19 survivors. Risk data were pooled using the Mantel–Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI). Heterogeneity among studies was assessed using I 2 statistic. Results Overall, 19,293,346 patients (mean age 54.6 years, 54.6% males) were included in this analysis. Of them, 758,698 survived to COVID-19 infection. Over a mean follow-up of 6.8 months, new-onset HT occurred to 12.7 [95% CI 11.4–13.5] out of 1000 patients survived to COVID-19 infection compared to 8.17 [95% CI 7.34–8.53] out of 1000 control subjects. Pooled analysis revealed that recovered COVID-19 patients presented an increased risk of new-onset HT (HR 1.70, 95% CI 1.46–1.97, p < 0.0001, I 2 = 78.9%) within seven months. This risk was directly influenced by age (p = 0.001), female sex (p = 0.03) and cancer (p < 0.0001) while an indirect association was observed using the follow-up length as moderator (p < 0.0001). Conclusions Our findings suggest that new-onset HT represents an important post-acute COVID-19 sequelae. Supplementary Information The online version contains supplementary material available at 10.1007/s40292-023-00574-5.

Effect of COVID-19 on Blood Pressure Profile and Oxygen Pulse during and after the Cardiopulmonary Exercise Test in Healthy Adults

“…They proposed some possible explanations for the abnormalities mentioned above: (1) activation of the RAAS or the sympathetic nervous system, (2) endothelial dysfunction, (3) delayed resolution of inflammation, or (4) hypoxia and ischemia. A meta-analysis of over 19 million people reported that post-COVID-19 individuals had an additional 70% risk of developing new-onset hypertension within 7 months of acute infection [ 40 ]. Although we could not diagnose hypertension in our post-COVID population, they tended to have higher SBP, DBP, and MBP in all exercise steps, which may be due to this cohort being relatively young (average age under 40 years) and having suffered a mild infection that did not require hospitalization.…”

Elevated Arterial Blood Pressure as a Delayed Complication Following COVID-19—A Narrative Review

“…While our systematic review aimed to broaden the discussion on the influence of SARS-CoV-2 on blood pressure elevation, it is noteworthy that, despite discovering three studies contradicting the impact of COVID-19 on blood pressure, the majority of the analyzed studies align with the conclusions presented by Zuin et al [109]. Given the limited availability of studies specifically delineating arterial hypertension as a complication of COVID-19 infection, we opted to include all studies demonstrating blood pressure elevation as a consequence of COVID-19 infection.…”

“…Recognizing the inherent limitations of this systematic review is crucial. Throughout our investigation, we identified only one meta-analysis by Zuin et al [109] that addressed the risk of developing hypertension in individuals with COVID-19. They proposed that newly diagnosed hypertension could be a noteworthy complication of severe COVID-19 infection, citing five supporting studies within their review.…”

Persistent high mortality rates for Diabetes Mellitus and Hypertension after excluding deaths associated with COVID-19 in Brazil, 2020–2022

“…decreased physical activity, poor glycemic control and adherence to therapy) may have had an impact on aMR in the population without COVID-19 [ 21 ]. Moreover, some studies pointed to newly diagnosed HTN and DM after acute COVID-19 diagnosis, especially in severe cases [ 22 , 23 ].…”