What question did this study set out to answer?

The study aims to explore the relationship between COVID-19 infection and the incidence of new hypertension diagnoses.

January 10, 2026American Journal of Epidemiology0 citations

COVID-19 Infection and Risk of Incident Hypertension: A Case-Control Time-to-Event Study

JGJeremy David Goldhaber-FiebertStanford Health Care SPS PHILLIPSStanford Health Care KLKimberley D Lucas

Key Result

COVID-19 infection increased the incidence of hypertension by 44% (HRR 1.44) compared to unexposed individuals, with stronger associations in those with higher BMI and age.

Key Points

The study aims to explore the relationship between COVID-19 infection and the incidence of new hypertension diagnoses.
Conducted a case-control time-to-event study with 39,746 incarcerated individuals.
Monitored participants from pre-pandemic until March 2023.
Excluded individuals with pre-existing hypertension and blood pressure-affecting medications.
Evaluated hypertension diagnosis using multivariate Cox proportional hazards models.
Crude hypertension incidence rate was 32.5 per 1,000 person-years for those COVID-19 positive, compared to 27.1 for unexposed individuals.
COVID-19 infection increased hypertension incidence, with a hazard ratio of 1.44.
Stronger associations were noted for individuals with higher BMI, higher pre-pandemic blood pressure, and older ages.

Structured PICO

Does COVID-19 infection increase the risk of incident hypertension in previously normotensive individuals?

Population

39,746 individuals continuously incarcerated from January 1, 2019 to March 1, 2020 in 31 California state prisons, with no pre-pandemic hypertension diagnosis, no blood pressure-altering medication prescriptions, who had BMI and blood pressure measurements before and during the pandemic, and were tested for COVID-19.

Intervention

COVID-19 infection (exposure defined as beginning 31 days after COVID-19 positivity)

Comparator

No COVID-19 infection (unexposed)

Outcome

Incident hypertension established by clinical diagnosishard clinical

COVID-19 infection is associated with a significantly increased risk of developing incident hypertension, with stronger associations seen in older individuals and those with higher baseline BMI or blood pressure.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Most previous studies of increased hypertension (HTN) incidence following COVID-19 infection lack longitudinal testing and diagnostic information and under-represent minorities. We examined this relationship using a case-control time-to-event-study of 39,746 individuals continuously incarcerated from January 1, 2019 to March 1, 2020 (pandemic start), followed until March 1, 2023 in 31 California state prisons. Those included had no pre-pandemic HTN diagnosis and no blood pressure-altering medication prescriptions; had BMI and blood pressure measurements before and during the pandemic; and were tested for COVID-19. Exposure began 31 days after COVID-19 positivity. Clinical diagnosis established incident HTN. Multivariate Cox proportional hazards models adjusted for age, sex, race/ethnicity, BMI, baseline blood pressure, and frequency of healthcare contacts and COVID-19 testing. We assessed confounding from changes in HTN testing post-COVID. 21,480 individuals tested COVID-19 positive prior to HTN diagnosis (or censoring). The subsequent crude HTN incidence rate was 32.5 per 1,000 person-years (exposed) 95%CI: 30.5-34.6 versus 27.1 (unexposed) 25.8-28.5. COVID-19 infection was associated with significantly increased HTN incidence (main effects HRR: 1.44 1.32-1.57; including interactions: HRR: 2.05 1.50-2.79), with stronger association for higher BMI, higher pre-pandemic blood pressure, and older age. Potential confounding from post-COVID increases in HTN diagnostic testing cannot explain these results.

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