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<p>Patients with hypertension have worse acute COVID-19 outcomes, but the long-term effects of SARS-CoV-2 infection is unclear. We conducted a retrospective cohort study of adults with hypertension and no prior cardiovascular events in the Montefiore Health System, comparing those with and without COVID-19 over up to 4.5 years post-infection. Outcomes included first-time myocardial infarction (MI), heart failure (HF), stroke, all-cause mortality, and major adverse cardiovascular events (MACE). Multivariate regression and inverse-probability weighting adjusted for demographics, comorbidities, socioeconomic status, and COVID-19 vaccination. Adjusted hazard ratios (HRs) with 95% confidence intervals were calculated. Sub-analyses examined hypertension stage and acute COVID-19 blood biomarkers in relation to outcomes. Among 75,180 hypertensive patients, hospitalized COVID-19 was associated with increased risk of first-time MI (adjusted HR = 1.40 [1.21–1.63]), HF (1.59 [1.45–1.75]), stroke (1.35 [1.17–1.57]), all-cause mortality (2.51 [2.17–2.90]), and MACE (1.65 [1.54–1.77]) compared to COVID-negative individuals. Non-hospitalized COVID-19 patients had elevated risks of HF (1.17 [1.06–1.30]) and MACE (1.14 [1.05–1.23]). Hospitalized COVID-19 was associated with an increase in MACE risk by 75% in those with normal blood pressure, and by 126% and 148% in those with elevated blood pressure and stage 1 hypertension, respectively. Abnormal C-reactive protein, creatinine, lactate dehydrogenase, D-dimer, hemoglobin, and neutrophil-to-lymphocyte ratio predicted higher MACE risk. COVID-19, irrespective of disease severity, puts hypertensive patients at greater risks of worse cardiovascular outcomes, especially those with more advanced hypertension. These findings underscore the importance of long-term cardiovascular monitoring in this vulnerable population.</p>

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COVID-19 and cardiovascular outcomes in patients with pre-existing hypertension

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月9日

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  • Roham Hadidchi,
  • Suhani Pahuja,
  • Shiv Mehrotra-Varma,
  • William Zhao,
  • Ryan C. Lee,
  • Sonya Henry,
  • Tim Q. Duong

摘要

Patients with hypertension have worse acute COVID-19 outcomes, but the long-term effects of SARS-CoV-2 infection is unclear. We conducted a retrospective cohort study of adults with hypertension and no prior cardiovascular events in the Montefiore Health System, comparing those with and without COVID-19 over up to 4.5 years post-infection. Outcomes included first-time myocardial infarction (MI), heart failure (HF), stroke, all-cause mortality, and major adverse cardiovascular events (MACE). Multivariate regression and inverse-probability weighting adjusted for demographics, comorbidities, socioeconomic status, and COVID-19 vaccination. Adjusted hazard ratios (HRs) with 95% confidence intervals were calculated. Sub-analyses examined hypertension stage and acute COVID-19 blood biomarkers in relation to outcomes. Among 75,180 hypertensive patients, hospitalized COVID-19 was associated with increased risk of first-time MI (adjusted HR = 1.40 [1.21–1.63]), HF (1.59 [1.45–1.75]), stroke (1.35 [1.17–1.57]), all-cause mortality (2.51 [2.17–2.90]), and MACE (1.65 [1.54–1.77]) compared to COVID-negative individuals. Non-hospitalized COVID-19 patients had elevated risks of HF (1.17 [1.06–1.30]) and MACE (1.14 [1.05–1.23]). Hospitalized COVID-19 was associated with an increase in MACE risk by 75% in those with normal blood pressure, and by 126% and 148% in those with elevated blood pressure and stage 1 hypertension, respectively. Abnormal C-reactive protein, creatinine, lactate dehydrogenase, D-dimer, hemoglobin, and neutrophil-to-lymphocyte ratio predicted higher MACE risk. COVID-19, irrespective of disease severity, puts hypertensive patients at greater risks of worse cardiovascular outcomes, especially those with more advanced hypertension. These findings underscore the importance of long-term cardiovascular monitoring in this vulnerable population.