CORONAVIRUS UPDATE: As experts learn more about the novel coronavirus, news and information changes. For the latest on the COVID-19 pandemic, please visit the Centers for Disease Control and Prevention.

2020 has been a challenging year for a plethora of reasons, most notably because of the COVID-19 pandemic. As cases continue to spike around the world, there is a parallel increase in unexpected health issues—outside of symptoms caused by COVID-19. Anxiety disorders and mental health problems are on the rise. Sleep problems are rampant. Perhaps unsurprisingly, many are finding that their blood pressure is also climbing—and there are a number of reasons for that.

What is hypertension?

A blood pressure reading consists of two numbers—for example, 120/80 mmHg. The first number, the systolic, measures the pressure pushing the blood from a person’s heart, and the second number, the diastolic, measures a person’s heart when it is at rest between heartbeats. According to the National Institutes of Health (NIH), normal blood pressure is less than 120/80 for an adult. When readings are consistently higher than that, it’s considered hypertension.

“With higher uncontrolled blood pressure comes increased risk of stroke and heart attack,” explains Danh Ngo, DO, a board-certified family physician at Eden Health. Because of those health risks, it’s important to know what causes high blood pressure—and take steps to lower it, from medication to lifestyle changes.

Can stress cause high blood pressure?

Passing moments of stress and anxiety can cause temporary rises in blood pressure—which typically resolves in calmer times. When you find yourself in a difficult situation, your body releases stress hormones to help you deal with it. Adrenaline boosts heart rate, blood pressure, and energy. Cortisol increases blood sugar and your brain’s access to glucose to improve mental function. The goal? The fight-or-flight response primes you to cope with the perceived threat. When the danger has passed, your hormones—and the systems they impact—get back to normal.That’s a good thing, because when your stress response is constantly activated, it can cause a host of problems, including chronic hypertension. Research findings show that chronic stress can raise blood pressure more than just temporarily. Elevated blood pressure is several consistent readings of 120-129/<80, and hypertension is several consistent readings >=130/>80.

One study found preliminary evidence that experiencing, and even just thinking about, stressful events delays blood pressure recovery. Furthermore, another study published by the Journal of the American Heart Association, revealed that “higher perceived stress over time was associated with an increased risk of developing hypertension.” Some research even found a correlation between work-related stress and increased diastolic and systolic blood pressure readings in men. That daily stress has a cumulative, long-term impact on your health such as heart attack, stroke, kidney failure, or headaches.

A side effect of stress hormones constantly flooding your system is restricted blood flow. ”This is similar to you trying to drink from a stirring straw versus a regular size drinking straw,” according to LaTosha Flowers, MD, a family medicine physician and the founder of Med Concierge and More. When your heart has to work harder to push blood through the body, it increases blood pressure. “Simply put when cortisol is high, so is our blood pressure,” Dr. Flowers says.

The pandemic’s effect on blood pressure

The COVID-19 pandemic has increased stress levels and fear for people across the globe. The devastating fatality rate of the virus, the implications of country-wide lockdowns, and high rates of unemployment are just a few common worries. All of those big emotions affect your blood pressure—and poor coping mechanisms can make things even worse. On top of that, routine medical care is often delayed or even canceled as hospital systems become overwhelmed caring for people sick with the novel coronavirus.

Those factors put together are a recipe for flare-ups in those with existing hypertension and even new high blood pressure diagnoses for people previously unaffected. It’s a worrying trend because hypertension is on the list of the Centers for Disease Control and Prevention (CDC) risk factors for complications from COVID-19. Here are a few ways the pandemic—and its could impact your blood pressure:

1. Continuous stress and blood pressure

“As a primary care physician, I am definitely seeing people dealing with uncontrolled hypertension related to the effects of COVID-19,” Dr. Flowers explains what she’s seen in her practice. “First of all, there is a natural rise in our fear of the unknown, which leads to more people being anxious or nervous. Secondly, people have had to deal with the rapid deaths of family members, friends, coworkers, and associates due to the pandemic, and this also creates anxiety and depression.”

There is widespread uncertainty about what the future holds, along with major stressors such as financial instability, social isolation, and restrictions on daily activities, which have all “contributed to a rise in hypertension due to the COVID-19 pandemic,” Dr. Flowers says.

It’s also worth noting that it’s possible the pandemic is causing new high blood pressure spikes in patients without a pre-existing hypertension diagnosis.

“The global pandemic has caused major changes in people’s lives both from a social and economic standpoints,” explains Paris Sabo, MD, a breast cancer surgeon in Beverly Hills and co-founder of Dr. Brite. “These are major causes of stress and anxiety. Even though these feelings are not the cause of chronic high blood pressure, they can cause temporary spikes in blood pressure, even in healthy people.”

2. Bad coping mechanisms

Some of the short-term coping mechanisms we may turn to during times of uncertainty could also contribute to the development of long-term high blood pressure. “Stress and anxiety can cause people to take up unhealthy habits such as smoking, drinking and overeating, which can increase a person’s risk for hypertension long term,” Dr. Sabo says.

3. Gaps in preventive care

When annual physicals, or optional surgeries are postponed to avoid exposure to the virus, it’s more likely that blood pressure that was once in check could start to spiral out of control. Dr. Ngo notes: “Visit tracking showed a large drop in office visits during the peak of the pandemic and a corresponding bump in the percentage of patients with uncontrolled blood pressure. Along with the increase in stressful situations and uncertainties, blood pressure is spiking higher than usual during this period.” Even self monitoring can be difficult for those who do not have home blood pressure monitors, as most pharmacies and retail stores have restricted access to these services during the pandemic.

4. Vulnerability to COVID-19 complications

“Having hypertension does not increase your risk of getting COVID-19,” Dr. Flowers says, “but if one has extensive heart disease from uncontrolled hypertension, then one is physically more vulnerable to the complications of the infection and has a decreased survival rate.” Complications may include blood clots in the extremities or lungs, or stroke.

Additionally, having higher blood pressure results in a higher risk of developing cardiovascular disease. CDC findings suggest that COVID-19 can damage heart health, causing myocarditis, or inflammation of the covering of the heart, known as pericarditis. In other words, it jeopardizes a system that’s already weakened by hypertension.

How can you get your blood pressure under control?

If stress and anxiety are what’s causing your blood pressure fluctuations, it’s natural to think that anxiety medication is the best solution. While some research indicates that it’s useful in certain instances, it’s not considered a first line treatment. Instead, try these proven prescription and lifestyle changes to get things back under control.

1. Blood pressure medication

Your healthcare provider may recommend taking medication, such as ACE inhibitors, to manage high blood pressure and its ensuing symptoms. If your blood pressure readings are consistently higher than normal, speaking to a primary care professional is a matter of importance, even (and especially) during the pandemic.

2. Therapy

Getting your blood pressure readings under control is of the utmost importance, and if stress and anxiety are making you hypertensive, then stress management is essential. When your emotions feel out of control, a professional can help you build strategies to cope. “If you are noticing more signs of stress or anxiety, look for therapeutic support from your primary care provider or establish care with a therapist,” Dr. Ngo suggests.

3. Lifestyle changes

Diet modifications and physical activity can help to lower blood pressure. Dr. Ngo recommends that you:

Maintain a healthy, balanced diet low in salt with proper hydration
Do aerobic exercise daily to boost your mood and improve your blood pressure
Get adequate, regular scheduled sleep to allow your body to rest and recharge.
Quit or cut back on caffeine use
Meditate or practice mindfulness

Quitting smoking, vaping, or tobacco use, losing weight, and reducing alcohol consumption can also help to lower their blood pressure.

4. Daily monitoring

“Make sure you have an automatic blood pressure monitor to check your blood pressure at home daily,” Dr. Ngo recommends. Purchasing an at home monitoring kit, and sharing readings with your healthcare team, can help them adjust your medication to achieve blood pressure goals. “Call your healthcare provider with any concerns, and do not delay getting emergency help just because of COVID-19. And, importantly, make sure to schedule regular checkups and screenings whether via office visits or telemedicine visits.”

Living during a worldwide pandemic can be incredibly stressful, and the serious virus circulating can make more typical medical concerns seem less important. Don’t ignore new symptoms, and stay vigilant about your health. There are many ways to seek medical advice and treatment from your own home.