Does ongoing inflammation in recovered COVID-19 pneumonia cases aggravate underlying hypertension or unmasks new onset hypertension? A single center experience of 800 cases
Authors: Kulkarni Devang , Patil Shital Vishnu , Gondhali Gajanan 
Published: January 2025

<b>Introduction:</b> New onset hypertension and aggravation of hypertension during the post-COVID-19 period are issues of concern having very limited data published on them. Hence, the current study was conducted with the aim of studying the blood pressure profiles as new onset hypertension, pre-existent hypertension and an aggravation of pre-existent hypertension in post-COVID-19 patients.<br />
<b>Methods:</b> Retrospective cohort study conducted between October 2021 to March 2022, included 800 post-COVID-19 patients above 18 years of age treated at the dedicated COVID-19 care center irrespective of their disease severity and comorbidity after a valid written consent. All the study cases were followed after six months of discharge from hospital. Protocolled recording of covariates such as blood pressure, anthropometric indices, ECG, blood sugar, lipid profile and uric acid were done at entry point. Retrospective data collection of indoor records was done such CT severity assessment as mild (score &lt; 8), moderate (score 9-15) and severe (score &gt; 15); inflammatory markers IL-6, Ferritin, CRP, LDH and D-dimer, interventions used during hospitalization such as oxygen supplementation and oxygen plus BIPAP/NIV. Statistical analysis was done by using a Chi-square test.<br />
<b>Results:</b> In study of 800 post-COVID-19 cases, pre-existent hypertension in 10% (80/800), new onset hypertension in 8.5% (68/800), aggravation of pre-existent hypertension in 47.5% (38/80) cases. Significant association was observed between interventions used as hypertension profile such as cases with oxygen requirement new onset HTN 32/68 (47.05%), pre-existent hypertension in 10/42 (23.80%), aggravation of pre-existent hypertension in 16/38 (42.10%) and oxygen plus BIPAP/NIV requirement in new onset HTN 27/68 (39.70%), pre-existent hypertension in 10/42 (23.80%), aggravation of pre-existent hypertension in 16/38 (42.10%) cases (p &lt; 0.0001). Significant association was observed in blood pressure switch during pre-COVID-19 to post-COVID-19 state during follow up from normotensive to hypertensive range (p &lt; 0.00001). Comorbidities such as DM, hyperlipidemia and IHD showed significant association with blood pressure profile in study cases in post-COVID-19 setting (p &lt; 0.00001). Inflammatory markers during hospitalization (IL-6, CRP, LDH, ferritin, and D-dimer) and uric acid analysis during follow-up documented significant association with new onset HTN, pre-existent hypertension, aggravation of pre-existent hypertension and no hypertension or normal blood pressure cases during post-COVID-19 follow-up (p &lt; 0.00001).<br />
<b>Conclusions:</b> COVID-19 infection is probably a risk factor for new onset hypertension and increased prevalence of hypertension was observed in the post-COVID-19 period and considered as unmasking effect on hypertension. Additionally, disease related inflammatory burden, stress and anxiety are associated with aggravation of hypertension in pre-existent cases.