Changes in Blood Pressure Outcomes Among Hypertensive Individuals During the COVID-19 Pandemic: A Time Series Analysis in Three US Healthcare Organizations

Abstract

Background: The COVID-19 pandemic may have negatively affected medical care for and self-management of chronic hypertension. We sought to examine the impact of the pandemic on blood pressure (BP) among individuals with hypertension. Methods: Using an interrupted time series analysis, we compared the level and trend (slope) of BP outcomes before the public health emergency declaration (prepandemic period: August 2018 through January 2020) versus after the stay-at-home orders (pandemic period: April 2020 through November 2020) among adults with hypertension followed at 3 large health systems (n=137 593). Outcomes include systolic and diastolic BP recorded in electronic health records and the proportion of individuals with BP <140/90 mm Hg. Results: The number of BP measurements substantially dropped early in the pandemic and then gradually increased. During the pandemic period, systolic and diastolic BP increased by 1.79 mm Hg (95% CI, 1.57–2.01; P <0.001) and 1.30 mm Hg (95% CI, 1.18–1.42; P <0.001), respectively, compared with the prepandemic period. Similarly, the proportion of patients with controlled BP decreased by 3.43 percentage points (95% CI, −3.97 to −2.90; P <0.001). A trend showing increasing control in the prepandemic period (+3.19 percentage points per year [95% CI, +2.96 to +3.42]; P <0.001) flattened during the pandemic period (+0.27 percentage points per year [95% CI, −0.81 to −1.37]; P =0.62). Conclusions: The first 8 months of the pandemic were associated with worsening BP outcomes among individuals with hypertension. Opportunities to ensure ongoing access to health care with telemedicine and home BP monitoring may mitigate adverse impacts on BP control for future disasters/emergencies.

Counter-regulatory renin-angiotensin system in hypertension: Review and update in the era of COVID-19 pandemic

“…Another major challenge in determining the relationship between hypertension and COVID-19 is the lack of blood pressure information prior to hospital admission. Although a large-scale longitudinal study in the US showed that blood pressure among US adults increased during the COVID-19 pandemic, the rise in the number of cases of hypertension was probably related to stress or alterations in lifestyle during the pandemic [287] , [292] .…”

“…Although hypertension is linked to an increased risk of severe COVID-19 and higher mortality, the effects of COVID-19 on pre-existing and newly diagnosed hypertension are still incompletely understood. Elevated BP and even spontaneous hypertension were observed in COVID-19 patients with respiratory failure during the hospitalization [284] , [285] , [286] , and individuals with pre-existing hypertension were also found to have worsening BP outcomes, severe respiratory symptoms and excessive inflammatory response [218] , [287] . A recent prospective case-control study in hospitalized patients also shows that COVID-19 pneumonia individuals have a higher probability of a persistent elevated BP [288] .…”

Impact of COVID-19 on Cardiovascular Disease

“…Several, but not all, studies reported an increase in systolic and diastolic blood pressure, or an increased proportion of hypertensive patients with poor blood pressure control, during the pandemic versus prepandemic [ 121 , 122 , 123 ]. Gotanda et al reported that the first 8 months of the COVID-19 pandemic were associated with worsening blood pressure control among individuals with preexisting hypertension [ 124 ]. Furthermore, a retrospective study of 153 patients also reported that 12% of patients had new-onset hypertension in the post-COVID period [ 125 ].…”

“…Since ACE2 negatively regulates RAAS activation mainly by converting angiotensin 1 and 2 into angiotensin 1–9 and 1–7, respectively, a downregulation of ACE2, accompanied by a simultaneous increase of pro-hypertensive angiotensin 2 levels in COVID-19 patients, have been suggested to contribute to increased blood pressure in the post-COVID period [ 104 , 125 ]. Worsening of blood pressure control may potentially be related to decreased physical activity, disrupted sleep, unhealthy diets, increased psychosocial stress, and limited access to healthcare during the pandemic [ 124 ]. It will now be important to further confirm these alarming results on CVD and cardiovascular risk factors and to determine whether such risk actually persists in the long term (after 12 months).…”

COVID-19 and metabolic syndrome

“…COVID-19 pandemic posed unprecedented challenges to health care systems. People with metabolic syndrome experienced weight gain [95] , variable effects on glucose control [96] , deteriorating blood pressure control [97] , anxiety, uncertainty, isolation and other mental health issues [98] .…”