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

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.

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.

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.

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.