Do you have hypertension?
This study in Nature suggests that for people who already had hypertension before getting COVID, the infection was linked to a higher long-term risk of serious cardiovascular events.🧵
This study in Nature suggests that for people who already had hypertension before getting COVID, the infection was linked to a higher long-term risk of serious cardiovascular events.🧵
In people with hypertension, an infection can leave behind - or speed up - processes that raise the risk of cardiovascular disease over the months and years that follow.
The excess risk was more pronounced in people with poorer blood pressure control at baseline, and that signs of a stronger acute inflammatory response during infection predicted worse long-term outcomes.
The strongest signal was in patients who were hospitalized with COVID. Compared with COVID-negative patients with hypertension, their adjusted risks were
heart attack +40%
heart failure +59%
stroke +35%
all-cause mortality +151%
MACE +65%
heart attack +40%
heart failure +59%
stroke +35%
all-cause mortality +151%
MACE +65%
Even in non-hospitalized patients, the risk increase was not zero. The study found
heart failure +17%
MACE +13%
heart failure +17%
MACE +13%
In simple terms, COVID does not look like just a short-lived acute event here. It looks more like an amplifier of pre-existing vascular and cardiac risk.
And another important point. The effect was not the same for everyone. Among hospitalized patients, the risk of MACE was higher
with normal BP about 1.75×
with elevated BP about 2.26×
with stage 1 hypertension about 2.48×
with stage 2 hypertension about 1.69×
with normal BP about 1.75×
with elevated BP about 2.26×
with stage 1 hypertension about 2.48×
with stage 2 hypertension about 1.69×
So the worse the baseline blood pressure profile, the more COVID seems to magnify existing cardiovascular vulnerability. The strongest signal appeared in people with elevated BP and stage 1 hypertension.
In hospi patients, several markers of more intense acute inflammatory stress also predicted worse long-term outcomes - higher CRP, creatinine, LDH, D-dimer, a higher neutrophil-to-lymphocyte ratio, and lower hemoglobin.
Clinically - a patient with hypertension is not automatically fine after COVID just because the acute infection has passed. Closer long-term follow-up and tighter control of cardiovascular risk factors make sense.
A retrospective observational study. But as a warning signal for long-term cardiovascular monitoring, it is a strong one. Probably nothing new, but a good reminder.
Hadidchi at al., COVID-19 and cardiovascular outcomes in patients with pre-existing hypertension. nature.com/articles/s4137…
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