What to Know If You Have COVID and High Blood Pressure

High blood pressure (hypertension) is a common medical condition in the U.S. If you’re one of the many Americans who have high blood pressure, you might wonder if this could raise your risk for severe COVID-19 symptoms. On the other hand, if you have COVID or long COVID, you might wonder if this could worsen your blood pressure numbers. 

We’ll take a look at the research on the link between COVID and high blood pressure. Keep on reading to learn the best steps to keep your blood pressure in a healthy range during and after infection.  

Does high blood pressure affect risk for COVID?  

High blood pressure seems to increase the risk for more severe symptoms if you get COVID. But it’s less clear if high blood pressure itself raises the risk, or if it’s just more common in people who have other risk factors for severe COVID. For example, the research shows that people with diabetes, obesity, or heart disease tend to get sicker with COVID. And many of these people also have high blood pressure.  

So does high blood pressure by itself worsen outcomes with COVID? Some studies suggest it does not. But a more recent study suggests that high blood pressure increases the risk of hospitalization from COVID — even when someone doesn’t have other medical conditions. However, these studies aren’t directly comparable. They were performed at different times during the pandemic, which means they looked at different variants and different levels of vaccination. 

Does COVID cause high blood pressure?

Possibly. One retrospective study looked at people who were hospitalized and didn’t have a prior history of high blood pressure. They had a 12% chance of developing new-onset high blood pressure at some point after their infection. Researchers did not see this increase in risk for other conditions — like diabetes, coronary artery disease, and COPD (chronic obstructive pulmonary disease). 

As always, it’s important to remember that linking two conditions does not mean that one causes the other. In other words, just because people registered a new high blood pressure didn’t necessarily mean that COVID caused the high blood pressure. 

But subsequent studies have shown the same outcome: People who got COVID had a significant risk of later developing high blood pressure. And people who already had high blood pressure found that COVID worsened their condition. 

What about long COVID and high blood pressure?

Since long COVID can cause many different health problems after infection, it’s reasonable to wonder if high blood pressure is one of them. The good news is that does not appear to be true. 

Here’s what research says about long COVID and blood pressure:

• High blood pressure might raise your risk of getting long COVID. One small observational study suggested that people with high blood pressure had a higher risk of developing long COVID. But more research needs to be done before we can say that with certainty.

• Long COVID does not cause high blood pressure. Fortunately, the reverse does not seem to be true. There’s no convincing evidence that long COVID can cause new high blood pressure. 

• Long COVID symptoms can cause variability in blood pressure and heart rate.  Frequently, long COVID can lead to POTS (postural orthostatic tachycardia syndrome). It can also cause POTS-like symptoms, even in people without a formal diagnosis. Symptoms can include lightheadedness, dizziness, heart palpitations, and a rapid heartbeat when you stand up. You might faint or feel like you temporarily black out.

Do you need to change your blood pressure medications if you have COVID?  

You probably do not need to change your blood pressure medications to avoid COVID complications. Read on for more details about specific blood pressure medications.

Lisinopril and other ACE inhibitors

Early on in the pandemic, some researchers questioned whether ACE inhibitors and ARBs might be dangerous for people who got COVID. This was based on the fact that the virus could use certain proteins that these medications affect to get into and infect the body’s cells. 

Thankfully, research has shown that taking ACE inhibitors or ARBs does not worsen COVID. In fact, newer studies suggest the opposite. For people who have high blood pressure, continuing ARBs or ACE inhibitors may have a neutral or even slightly beneficial effect.

Examples of ACE inhibitors include:

• Lisinopril

• Enalapril

• Benazepril 

Examples of ARBs include:

• Losartan

• Olmesartan

• Valsartan

Many medical associations, including the American Heart Association, have said that people who take ACE inhibitors or ARBs should continue taking them, whether or not they have COVID. 

Hydrochlorothiazide and other diuretics

Diuretics are frequently prescribed to treat high blood pressure. Common diuretics include:

• Hydrochlorothiazide (HCTZ)

• Furosemide

• Spironolactone

• Chlorthalidone

• Triamterene

There’s no evidence that using these medications worsens COVID. 

Calcium channel blockers

There’s good news if you already take a calcium channel blocker. Evidence suggests that they may reduce your risk of dying from COVID and having severe complications. Research suggests that these medications might help by decreasing inflammation and/or slowing down how fast the COVID virus multiplies in the body. 

Commonly prescribed calcium channel blockers include:

• Amlodipine

• Diltiazem

• Nifedipine

• Verapamil

What can you do at home if you have COVID and high blood pressure?

If you have high blood pressure and COVID, you’ll want to do everything possible to make sure you recover quickly and control your blood pressure. Even if you can’t get to your healthcare provider’s office in person, there’s plenty you can do to take care of your health: 

• Keep taking your blood pressure medications.

• Monitor your blood pressure at home. Use an arm cuff rather than a wrist cuff, and try to check your blood pressure around the same time each day when you’re resting. It’s normal for it to go up a little bit with fever, pain, illness, or stress. But if you’re concerned that it’s too high, call your healthcare provider for advice. 

• Keep eating fruits and vegetables. Assuming you have no other health conditions that prevent this, eating plenty of produce will do double duty in improving your immune system and controlling your blood pressure. 

• Get plenty of rest.

• Keep moving if you can, but listen to your body. Depending on how severe your symptoms are, you may not feel like staying active. Even if you don’t have the energy to go for a walk, moving even a little bit might help prevent blood clots and keep your health on track. 

• Consider quitting smoking for good. Some people have found COVID to be the best time to quit smoking. They don’t feel like smoking, so it’s an easy way to cut down on tobacco use. The harder part might come when you start to feel better. But by then you may be through the worst of the withdrawal symptoms. 

• Cut back on alcohol. Alcohol both increases blood pressure and impairs the body’s ability to fight off COVID infection.

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Written by:

Nicole Rowe, MD

Dr. Nicole Rowe, MD, is a telehealth family practice physician. She received her medical degree from the University of North Carolina School of Medicine and completed her residency in family medicine at University of Colorado’s Swedish Medical Center.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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