Abstract
The association between hypertension (HTN) and COVID-19 in patients with chronic kidney disease (CKD) has not been completely elucidated. We aimed to study the effect of COVID-19 on HTN severity in patients with CKD. Included in the analysis were all adults, insured by Maccabi Healthcare Services, a large-scale Health Maintenance Organization, who were registered as having CKD on 1.7.2023. Patients in the study group had a confirmed SARS-CoV-2 infection during the study period (2020–2022), whereas patients in the control group did not. The infection date was defined as T0 for the study group, whereas T0-f-COVID denotes a matched time point for controls. We compared the differences in blood pressure values between pre- and post- T0 in both groups. A group of 85,502 CKD patients with documented COVID-19, of which 43,875 patients had at least two blood pressure (BP) measurements documented, both prior to and after T0 (study group). The control group of 136,645 CKD patients had no documented COVID-19 cases, and 58,874 had similarly documented BP measurements. On average, there were six BP measurements during the study period in both groups. The average BP values in the study group decreased by 1 mmHg systolic and 0.6 mmHg diastolic following COVID-19 (P value 0.03 and 0.004, respectively). The difference in BP values in the control group was −0.8 mmHg and −0.6 mmHg for systolic and diastolic BP (p < 0.001 for both values). Contrary to previous studies, our data demonstrated that BP does not increase following COVID-19 in patients with CKD.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Buy this article
- Purchase on SpringerLink
- Instant access to the full article PDF.
USD 39.95
Prices may be subject to local taxes which are calculated during checkout



Similar content being viewed by others
Data availability
All relevant data is included in the manuscript. Additional data may be available per request from the corresponding author.
References
Thakkar J, Chand S, Aboodi MS, Gone AR, Alahiri E, Schecter DE, et al. Characteristics, outcomes and 60-Day hospital mortality of ICU patients with COVID-19 and acute kidney injury. Kidney360. 2020;1:1339–44.
Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584:430–6.
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323:1574–81.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–9.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054–62.
Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med. 2020;46:586–90.
Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426:450–4.
Ferrario CM, Jessup J, Gallagher PE, Averill DB, Brosnihan KB, Ann Tallant E, et al. Effects of renin-angiotensin system blockade on renal angiotensin-(1-7) forming enzymes and receptors. Kidney Int. 2005;68:2189–96.
South AM, Tomlinson L, Edmonston D, Hiremath S, Sparks MA. Controversies of renin-angiotensin system inhibition during the COVID-19 pandemic. Nat Rev Nephrol. 2020;16:305–7.
Ahmadian E, Hosseiniyan Khatibi SM, Razi Soofiyani S, Abediazar S, Shoja MM, Ardalan M, et al. Covid-19 and kidney injury: Pathophysiology and molecular mechanisms. Rev Med Virol. 2021;31:e2176.
Kamalumpundi V, Kawasaki S, Cheng L, Meyers EE, Shams E, Ofori O, et al. Association between renin-angiotensin antagonism and COVID-19-related mortality in patients with essential hypertension: A single center, retrospective cohort study. J Clin Hypertens (Greenwich). 2024;26:1039–44.
Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022;28:583–90.
Petersen EL, Gossling A, Adam G, Aepfelbacher M, Behrendt CA, Cavus E, et al. Multi-organ assessment in mainly non-hospitalized individuals after SARS-CoV-2 infection: The Hamburg City Health Study COVID programme. Eur Heart J. 2022;43:1124–37.
Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383:1899–911.
Zuin M, Rigatelli G, Bilato C, Pasquetto G, Mazza A. Risk of incident new-onset arterial hypertension after COVID-19 recovery: a systematic review and meta-analysis. High Blood Press Cardiovasc Prev. 2023;30:227–33.
Delalic D, Jug J, Prkacin I. Arterial Hypertension Following Covid-19: a retrospective study of patients in a Central European Tertiary care center. Acta Clin Croat. 2022;61:23–7.
Zhang V, Fisher M, Hou W, Zhang L, Duong TQ. Incidence of new-onset hypertension Post-COVID-19: comparison with influenza. Hypertension. 2023;80:2135–48.
Georgianos PI, Agarwal R. Hypertension in chronic kidney disease-treatment standard 2023. Nephrol Dial Transplant. 2023;38:2694–703.
Trimarco V, Izzo R, Pacella D, Trama U, Manzi MV, Lombardi A, et al. Incidence of new-onset hypertension before, during, and after the COVID-19 pandemic: a 7-year longitudinal cohort study in a large population. BMC Med. 2024;22:127.
Gotanda H, Liyanage-Don N, Moran AE, Krousel-Wood M, Green JB, Zhang Y, et al. Changes in blood pressure outcomes among hypertensive individuals during the COVID-19 Pandemic: a time series analysis in three US healthcare organizations. Hypertension. 2022;79:2733–42.
Wojciechowska W, Rajzer M, Kreutz R, Weber T, Bursztyn M, Persu A, et al. The impact of the COVID-19 pandemic on blood pressure control in patients with treated hypertension-results of the European Society of Hypertension Study (ESH ABPM COVID-19 Study). J Hypertens. 2024;42:2065–74.
Schmidt-Lauber C, Alba Schmidt E, Hanzelmann S, Petersen EL, Behrendt CA, Twerenbold R, et al. Increased blood pressure after nonsevere COVID-19. J Hypertens. 2023;41:1721–9.
Bar-Or I, Indenbaum V, Weil M, Elul M, Levi N, Aguvaev I, et al. National scale real-time surveillance of SARS-CoV-2 variants dynamics by wastewater monitoring in Israel. Viruses. 2022;14:1229.
Russell CD, Lone NI, Baillie JK. Comorbidities, multimorbidity and COVID-19. Nat Med. 2023;29:334–43.
Force USPST, Krist AH, Davidson KW, Mangione CM, Cabana M, Caughey AB, et al. Screening for hypertension in adults: US Preventive Services task force reaffirmation recommendation statement. JAMA. 2021;325:1650–6.
Kim R, Nachman S, Fernandes R, Meyers K, Taylor M, LeBlanc D, et al. Comparison of COVID-19 infections among healthcare workers and non-healthcare workers. PLoS One. 2020;15:e0241956.
Stepanova M, Lam B, Younossi E, Felix S, Ziayee M, Price J, et al. The impact of variants and vaccination on the mortality and resource utilization of hospitalized patients with COVID-19. BMC Infect Dis. 2022;22:702.
Paiva AMG, Gomes M, Campana EMG, Feitosa ADM, Sposito AC, Mota-Gomes MA, et al. Impact of hypertension phenotypes on the office and 24-h pulse wave velocity and augmentation index in individuals with or without antihypertensive medication use. Hypertens Res. 2019;42:1989–95.
Acknowledgements
This work received support from Kahn Sagol Maccabi (KSM) Research & Innovation center.
Author information
Authors and Affiliations
Contributions
AAK planned the study and wrote the manuscript. OM analyzed the data. TBN helped in data analysis and manuscript editing. AL edited the original manuscript and revised all versions.
Corresponding author
Ethics declarations
Competing interests
The authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Angel-Korman, A., Mayer, O., Brosh-Nissimov, T. et al. Infection with COVID-19 does not increase blood pressure in patients with chronic kidney disease. J Hum Hypertens 39, 777–783 (2025). https://doi.org/10.1038/s41371-025-01068-8
Received:
Revised:
Accepted:
Published:
Version of record:
Issue date:
DOI: https://doi.org/10.1038/s41371-025-01068-8


