Long‐COVID Associated With Incident Hypertension: A Population‐Based Cohort Study

Background Long COVID has been linked to persistent autonomic and vascular abnormalities, but its impact on hypertension among non‐hospitalized COVID‐19 convalescents remains unclear. Given the link between blood pressure and cardiovascular morbidity, understanding how long COVID modifies the risk of incident hypertension is clinically important. Methods We conducted a longitudinal population‐based study using MIRACLE‐S (Multimorbidity Integrated Registry Across Care Levels in Stockholm). Adults aged 18 to 65 years without prior hypertension or hospitalization for acute COVID‐19 were followed from October 2020 to January 2025. Long COVID was defined by a physician‐assigned U09.9 diagnosis. The outcome was new‐onset hypertension ( International Classification of Diseases, Tenth Revision [ICD‐10] I10). Cox proportional hazards models estimated hazard ratios (HRs), adjusted for age, socioeconomic status, comorbidities, mental health, and pre‐pandemic health care utilization. Analyses were stratified by sex. Results Among 1 221 570 adults, 8365 (0.7%) were diagnosed with long COVID, and 18% developed incident hypertension during follow‐up. Individuals with long COVID (women: n=5578, 16%; men: n=2787, 24%) showed an early and consistently higher cumulative incidence than unexposed individuals ( P <0.0001). Long COVID was associated with increased hypertension risk overall (HR 1.14, 95% CI 1.09–1.20; P <0.001), and in women (HR 1.13, 95% CI 1.05–1.22; P =0.001) and men (HR 1.15, 95% CI 1.05–1.27; P =0.002), with stable estimates across models. Conclusion Long COVID was associated with elevated risk of incident hypertension in non‐hospitalized COVID‐19 convalescents. These findings suggest SARS‐CoV‐2 infection may contribute to vascular and autonomic dysregulation affecting blood pressure, supporting structured monitoring and risk management in individuals with persistent post‐COVID symptoms.