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Long before COVID-19 was wreaking havoc across the globe, high blood pressure already had its grip on nearly half of all adults in the United States. High blood pressure, also known as hypertension, is essentially too much blood flow and too much pressure in your arteries at a given time.
Think of it in plumbing terms: too much water puts stress on the pipes. This can lead to leaks or other damage to the rest of the house.
In the human body, it can lead to heart disease, heart attack, or even stroke.
Unlike the faulty plumbing in the household, high blood pressure often has no visible signs, which is why one in three adults with the condition don’t even know that they have it.
Because of its lack of symptoms, the condition has been dubbed by medical professionals as the “silent killer.” Hypertension can be a result of a poor diet, a family history, a lack of physical activity, old age, or even stress. Nearly two years into the pandemic, the exact relationship between one of the United States’ most common pre-existing medical conditions and COVID-19 is still largely a mystery.
“It’s so tough to tease out since half of people have hypertension, and since it often goes hand in hand with a lot of other major risk factors for COVID, which seems to really be more prominent and stand out as clearer risk factors,” Dr. Jordana Cohen said.
Cohen is an assistant professor of medicine in the Perelman School of Medicine at Penn Med (you have her to thank for the plumbing analogy).
She specializes in hypertension and does research on how best to manage it and how to reduce disparities in hypertension, kidney disease, and heart disease. For Cohen, high blood pressure hits close to home.
“My whole family has it, and I’m waiting to get it. And so it’s something that’s very, very common,” Cohen said.
Does hypertension lead to worse COVID-19 outcomes? It’s complicated.
At the beginning of the pandemic, experts were in a frenzy about the relationship between the condition and the virus. She added that it is because of a tiny molecule on the cells called the angiotensin-converting enzyme 2 (ACE2) receptor.
“It’s sort of a receiving molecule on our cells for the SARS-CoV-2 — the virus that causes COVID. That ACE2 molecule is actually very closely related to the pathway in our bodies that causes hypertension,” Cohen said. “It’s something that a lot of people were very worried that hypertensive patients might be at more risk for COVID-19, because of the fact that COVID-19 happens to be linked to the hypertensive pathway in a way that we’ve only seen with the original SARS.”
The unusual observation caused a big concern early on. There was even some belief that blood pressure medication could impact COVID-19 outcomes either positively or negatively. A Penn study found the medications to be neither beneficial nor harmful in the treatment of hospitalized patients. Whether hypertension directly led to a worse case of coronavirus was much harder to determine for researchers.
“Originally, a lot of the studies that came out in big, big medical journals back in the spring of 2020 suggested that hypertension was a major risk factor for COVID-19,” Cohen said, pointing to research done on the initial nursing homes impacted by the first wave of United States cases.
But since then, Cohen said, scientists have learned that the answer is far more complicated than previously thought. Hypertension is not solely leading to deadlier outcomes.
“It’s not hypertension alone. It’s actually probably older age, and people with more severe obesity, or having a lot of extra body fat on them, that are really the ones who are at the most risk. And that those things happen to go hand in hand with hypertension,” Cohen said.
However, she reiterated the difficulty of separating hypertension from the other risk factors, because they are often closely related.
Long COVID’s potentially ‘devastating’ impact on blood pressure
Cohen is a part of a massive five-year study at the University of Pennsylvania that follows people who were hospitalized with COVID to understand the effects on the individual long term.
While the relationship between hypertension and COVID-19 outcomes remains somewhat cloudy, there is seemingly some scientific evidence that the virus is causing some odd changes in the way the body regulates its blood pressure, especially for those dealing with long COVID.
“So far, we’ve observed that in COVID-19, and that in long COVID, especially, it seems that there are quite a lot of people who’ve been at risk for such for issues with their blood vessels related to COVID, probably related to the mechanisms of how COVID impacts our body and some of the inflammation that’s caused by COVID and other factors too. So, it can affect our blood vessels, which may cause worse hypertension and worse heart disease long term,” Cohen said. “And we’ll only know that by watching people longer to really understand.”
Another area that experts like Cohen are seeing as a cause for concern in the brain of COVID long haulers is known as autonomic dysfunction, which is an issue with the nerves that regulate bodily functions, such as sweating, heart rate — and blood pressure.
Those with long COVID who have this issue can often have “wildly fluctuating” blood pressures in short time intervals, Cohen said. They lack the normal controls to be able to tell the body when to slightly raise or lower blood pressure.
She used stress or just the act of changing positions from standing to sitting as examples of moments when this dysfunction can be “devastating” for people.
“For instance, just trying to stand up from sitting, your blood pressure can plummet and you can potentially faint very quickly. Things like that are some of the differences that are being seen with long COVID. And the work is now underway, but we’re only starting to understand why that’s happening and how to potentially treat and prevent it,” Cohen said.
She concluded that “there’s no question that there is a link long term with COVID and factors related to blood pressure, but we don’t know if hypertension per se is a risk for that.”
A nationwide rise in blood pressure during the pandemic
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