I have read with interest a report by Zuin et al., who conducted a meta-analysis to evaluate the risk of new-onset arterial hypertension (HT) in COVID-19 survivors over a mean follow-up of 6.8 months [1]. The pooled hazard ratio (HR) (95% confidence interval [CI]) of COVID-19 patients for new-onset HT was 1.70 (1.46–1.97). The HT risk was directly associated with age, female sex and cancer, and the follow-up length was a moderator on the association. I present comments regarding the study.

The authors pooled data from five retrospective cohort studies. Although causal association between COVID-19 infection and subsequent risk of HT cannot be determined by prospective studies, caution should be paid to the bias for compiling the data. There is a report on the mechanism of the association with special reference to the change of renin-angiotensin-aldosterone-system by COVID-19 infection [2], but many other factors may also contribute to incident HT. We have to understand the magnitude of contribution to incident HT after COVID-19 infection.

The authors observed no significant effect of diabetes mellitus on the new-onset risk of HT, but they did not evaluate the new-onset risk of diabetes mellitus in COVID-19 survivors. There is a need of evaluating changes in glucose levels, blood pressure readings and lipid profiles after recovery from COVID-19, which would lead to the risk assessment of new-onset diabetes mellitus, HT and dyslipidemia as a sequela of a COVID-19 infection [3]. Metabolic components interact with each other, and they are closely related to obesity. I think that further studies are needed to specify the inter-relationship of metabolic components in COVID-19 survivors.