Impact of long covid on resistant hypertension: a 2-year cohort study using ambulatory blood pressure monitoring

The aim of this prospective 2-year cohort study was to determine the long-term effect of long COVID on blood pressure control in patients with resistant hypertension using the gold standard of ambulatory blood pressure monitoring (ABPM). Out of the study cohort, 186 patients between 30-75 years with a confirmed diagnosis of resistant hypertension and history of long COVID (symptoms persisting ≥2 months after acute infection) were included. Baseline, 12 months, and 24 months measurements were performed using 24-hour ABPM (monitored every 30 minutes during the day and every 60 minutes during the night), echocardiogram, and tests of autonomic function. The outcomes indicated an increasing trend in blood pressure across all the parameters: 24-hour systolic pressure from 138.4 to 145.6 mmHg, nocturnal systolic pressure from 129.8 to 137.0 mmHg (increase of 7.2 mmHg), and significant fall in mean nocturnal fall from 5.8% to 3.2% (p<0.001). Circadian rhythm disturbance was aggravated, the proportion of patients with normal nocturnal dips decreased from 36.6% to 13.1% and reverse dippers increased from 8.6% to 19.2% (p<0.001). At the same time, left ventricular mass index (LVMI) also increased significantly, and 34.4% of patients exhibited a >10% increase in LVMI. Autonomic dysfunction (decreased heart rate response to deep breathing and 2.5-fold higher incidence of postural hypotension) also increased. To control blood pressure, 68.8% of patients required intensification of their drug regimen and the mean number of antihypertensive drugs increased from 3.4 to 3.9 (p<0.001). Clinical significance of these alterations was the emergence of 18 major cardiovascular events (9.7%), mostly in subjects with abnormal nocturnal blood pressure and autonomic dysfunction. This study proves that long COVID as an isolated risk factor, through mechanisms such as autonomic dysfunction and chronic vascular inflammation, leads to deterioration of resistant hypertension, disruption of nocturnal pressure profile, need for more aggressive therapy, and increased cardiovascular risk, and thus merits more vigilant monitoring by ABPM and modification of treatment regimens in these patients.