Hypertension Raises the Risk for COVID-19 Hospitalization

A recent study conducted at the Smidt Heart Institute at Cedars-Sinai and published in the journal Hypertension found that even fully vaccinated and boosted individuals had double the risk of hospitalization related to Omicron if they had high blood pressure. Nearly 1 in 2 American adults deals with hypertension, so the risk is very high according to the CDC. Although the viral variant may only cause mild symptoms in most people, it’s really important to avoid the infection, notes Joseph E. Ebinger, MD, a clinical cardiologist and director of clinical analytics at the Smidt Heart Institute and first author of the study.The researchers at Cedars-Sinai reviewed medical records and found 912 fully vaccinated and boosted patients that experienced COVID-19 during the Omicron surge in Southern California between Dec 1, 2021, and April 20, 2021. In this group, 145 needed to be hospitalized."We were surprised to learn that many people who were hospitalized with COVID-19 had hypertension and no other risk factors," said Susan Cheng, MD, MPH, director of the Institute for Research on Healthy Aging in the Department of Cardiology at the Smidt Heart Institute and a senior author of the study. "This is concerning when you consider that almost half of American adults have high blood pressure."Researchers also discovered that having a previous heart attack, heart failure or chronic kidney disease dramatically increased the hospitalization risk following infection. "These findings were expected considering that these are chronic medical conditions that are well established to be associated with worse outcomes," said Ebinger, an assistant professor in the Department of Cardiology in the Smidt Heart Institute.As high blood pressure is common in those with chronic kidney disease, heart failure and heart attack, the researchers did an analysis that left out individuals diagnosed with these conditions. In those diagnosed solely with hypertension, the risk for hospitalization was still very high. In addition, the risk of hospitalization due to COVID-19 increased with age and time between a study subject’s last vaccination and infection. Having high blood pressure is still linked with the greatest chance of risk: 2.6-fold.This data adds to earlier reports on the pandemic that also saw a connection between severe COVID-19 and hypertension. Conditions including obesity and diabetes that were discovered as risks early on in the pandemic were not as strongly linked with hospitalization in the Omicron surge. Hypertension risk, however, continued. Additional research is necessary to understand the biological conditions that may result in more severe COVID-19 illness in those with high blood pressure and how to lower this risk. "Uncovering why hypertension is linked to COVID-19 could help us better understand how SARS-CoV-2 affects the body and provide clearer targets for prevention and treatment," said Cheng, the Erika J. Glazer Chair in Women's Cardiovascular Health and Population Science at Cedars-Sinai.Ebenger asserts that in the meantime, those with hypertension who catch COVID-19 should be made aware of their higher risk of being hospitalized and should discuss antiviral therapy with their medical providers. Clinicians can give the following tips to their clients with hypertension:

1. Encourage clients to take medication when it’s prescribed. Hypertension is known as the “silent killer” for a reason.
2. Add more high-potassium fruits and vegetables to meals as part of the DASH diet. Add kale, spinach, or chopped tomatoes to soups, salads, and sandwiches. Choose seasonal fruit such as peaches, melon, kiwi and citrus for dessert.
3. Include low-fat dairy or non-dairy products for adequate calcium and vitamin D.
4. Avoid fad diets that may impact blood pressure and kidney function.
5. Take COVID-19 seriously. Maintain vaccination status and masking.

By Lisa Andrews, MEd, RD, LDReference:

1. Joseph Ebinger, Matthew Driver, Sandy Joung, Teresa Tran, Denisse Barajas, Min Wu, Patrick Botting, Jesse Navarrette, Nancy Sun, Susan Cheng. Hypertension and Excess Risk for Severe COVID-19 Illness Despite Booster Vaccination. Hypertension, July 20, 2022; DOI: 10.1161/HYPERTENSIONAHA.122.19694