Coronavirus and High Blood Pressure: What’s the Link?

If you have high blood pressure, it's a good idea to take extra care to protect yourself during the coronavirus (COVID-19) outbreak. Early research shows that people with the condition may be more likely to:

  • Get COVID-19
  • Have worse symptoms
  • Die from the infection

High Blood Pressure Risks

Data from China and Italy -- countries hit early by the virus -- show higher risk of COVID-19 infections and complications in people with high blood pressure.

In China, 25% to 50% of people who came to hospitals with coronavirus had high blood pressure or another health condition like cancer, diabetes, or lung disease. In Italy, a report said that more than 99% of people who had died from the virus had one of these conditions -- and 76% of them had high blood pressure.

Other research shows that people with high blood pressure are also slightly more likely to die from coronavirus. Their risk is about twice as high as that of the overall population.

What's the Link?

A weaker immune system is one reason people with high blood pressure and other health problems are at higher risk for coronavirus. Long-term health conditions and aging weaken your immune system so it's less able to fight off the virus. Nearly two-thirds of people over 60 have high blood pressure.

Another possibility is that the higher risk comes not from high blood pressure itself, but from certain drugs used to treat it -- ACE inhibitors and angiotensin receptor blockers (ARBs).

The theory is based on the fact that ACE inhibitors and ARBs raise levels of an enzyme called ACE2 in your body. And to infect cells, the COVID-19 virus must attach itself to ACE2.

Some large studies found no ties between the use of these drugs and how severe COVID-19 is. Other research suggests that they may make COVID-19 less severe. There’s also no proof that people have less severe illness after stopping them.

Stopping these medications may make heart and kidney disease worse. It can also raise your risk of death.

The American College of Cardiology and American Heart Association recommend that you keep taking your high blood pressure medicine as prescribed. If you don’t, it could raise your risk for a heart attack or stroke, putting you in the hospital just as coronavirus cases are coming in.

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How Coronavirus Affects People With High Blood Pressure

While pneumonia is the most common complication of the virus, it can also damage the cardiovascular system. 

High blood pressure damages arteries and reduces the flow of blood to your heart. That means your heart has to work harder to pump enough blood. Over time, this extra work can weaken your heart to the point where it can't pump as much oxygen-rich blood to your body.

Coronavirus can also damage the heart directly, which can be especially risky if your heart is already weakened by the effects of high blood pressure. The virus may cause inflammation of the heart muscle called myocarditis, which makes it harder for the heart to pump.

If you also have plaque buildup in your arteries, the virus may make those plaques more likely to break apart and cause a heart attack. Past studies have shown that people with heart disease who get a respiratory illness like the flu or earlier types of coronavirus are at higher risk for a heart attack.

What Should You Do?

Everyone needs to take precautions to prevent coronavirus. People with high blood pressure and other health conditions need to be extra careful.

The CDC offers this advice:

  • Make sure you have enough medicine on hand to treat high blood pressure and other health conditions.
  • Stock up on over-the-counter medicines to treat a fever and other symptoms if you get sick.
  • Stay at home and limit contact with other people as much as you can.
  • Avoid crowds and anyone who looks sick. Wear a cloth face mask if you have to be in a public place where you can’t stay at least 6 feet away from others.
  • Wash your hands often with soap and warm water.
  • Clean and disinfect all frequently touched surfaces like countertops and doorknobs.

A coronavirus vaccine isn't available yet, but the American College of Cardiology recommends that you stay up to date on your other vaccines. The pneumococcal vaccine will prevent you from catching pneumonia on top of coronavirus. Also get a flu vaccine. Its symptoms are easy to confuse with coronavirus, which could make it harder for doctors to diagnose you if you do get sick.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on July 02, 2020

Sources

SOURCES:

American College of Cardiology: "ACC Clinical Bulletin Focuses on Cardiac Implications of Coronavirus (COVID-19)," "COVID-19 Clinical Guidance for the Cardiovascular Care Team," "HFSA/ACC/ACA Statement Addresses Concerns Re: Using RAAS Antagonists in COVID-19."

American Heart Association: "How High Blood Pressure Can Lead to a Heart Attack," "What heart patients should know about coronavirus."

CDC: "Hypertension Prevalence and Control Among Adults: United States, 2015 – 2016," "Transcript - CDC Media Telebriefing: Update on COVID-19." “Use of Cloth Face Coverings to Help Slow the Spread of COVID-19."

European Society of Cardiology: "Position Statement of the ESC Council on Hypertension on ACE-Inhibitors and Angiotensin Receptor Blockers."

Istitute Superiore di Sanita (ISS): "Report sulle caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia Il presente report è basato sui dati aggiornati al 17 Marzo 2020."

Journal of the American College of Cardiology: "Cardiovascular considerations for patients, health care workers, and health systems during the coronavirus disease 2019 (COVID-19) pandemic."

Mayo Clinic: "Myocarditis."

Science Media Centre: "Expert reaction to questions about high blood pressure, diabetes, and ACE inhibitor drugs, and risk of COVID-19 infection."

The Lancet: "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?"

UpToDate: “Coronavirus disease 2019 (COVID-19): Issues related to kidney disease and hypertension.”

European Heart Journal: “Association of hypertension and antihypertensive treatment with COVID-19 mortality: a retrospective observational study.”

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