Impact of the first announced state of emergency owing to coronavirus disease 2019 on stress and blood pressure levels among patients with type 2 diabetes mellitus in Japan

Abstract

Aims/Introduction After the first coronavirus disease 2019 state of emergency announcement, there was an increase in stress that might have affected the self‐management of patients with type 2 diabetes mellitus. This study identified the changes in clinical findings and stress among patients with type 2 diabetes mellitus, and investigated the characteristics of patients who experienced an increase in blood pressure (BP) after the announcement. Materials and Methods Retrospectively, we scrutinized 310 patients with type 2 diabetes mellitus who were treated by the Sagamihara Physicians Association. After the announcement, 164 and 146 patients showed an increase (ΔBP >0 group) and decrease in BP (ΔBP ≤0 group), respectively. The propensity score matching method was used to compare the differences in clinical findings and stress‐related questionnaire responses between the two groups. Results After the announcement, 47% of patients experienced an increase in daily stress. Furthermore, 17% and 36% reported worsening dietary intake and a decrease in exercise, respectively. More patients reported that their dietary and salt intake had worsened in the ΔBP >0 group than in the ΔBP ≤0 group (9% vs 20%, P = 0.02, and 3% vs 10%, P = 0.04, respectively). Additionally, both systolic and diastolic BP measured in the office were significantly increased ( P = 0.02 and P = 0.03, respectively); however, systolic BP measured at home significantly decreased ( P = 0.01). The total stress scores were higher in the ΔBP >0 group than in the ΔBP ≤0 group (0.05 ± 2.61 and 0.93 ± 2.70, respectively, P = 0.03). Conclusions An increase in stress and, particularly, worsening dietary and salt intake were noted among patients with type 2 diabetes mellitus who experienced an increase in BP after the state of emergency announcement.

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“…They found that home BP decreased after the COVID-19 lockdown, and this was most evident in those patients with uncontrolled high BP before lockdown. This was consistent with findings in diabetic patients that home BP decreased significantly during the state of emergency in Japan [ 39 , 40 ]. A nationwide home BP monitoring study performed in Brazil also found no major adverse influence of the COVID-19 pandemic on office and home BP control [ 47 ].…”

“…Tamura and colleagues published two works about the impact of the state of emergency owing to COVID-19 on stress and BP in Japan in 2022 [ 39 , 40 ]. They found that office BP significantly increased during the state of emergency, accompanied by a higher ratio of white coat hypertension.…”

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“…These factors are difficult to identify in clinical records when health care utilization for chronic conditions decreases and documentation may be lacking. This is a drawback of the current study as other studies have reported associations between such factors and increases in BP during the pandemic; for example, Ito et al 12 demonstrated that worsening diet and salt intake were associated with increased BP after the state of an emergency announcement in a study in Japan. BP monitoring is one potentially helpful modifiable factor for hypertension control if it provides an opportunity for clinicians to alter treatment or address related lifestyle factors.…”

“…11 A study conducted in Japan focusing on individuals with diabetes reported significant increases in office-based BP measurements after the state of the emergency announcement. 12 In contrast, a study in Brazil reported slight reductions in office-based and home-based BP measurements during the early months of the pandemic versus the prior year for patients treated for hypertension; it is not clear whether this reduction was more pronounced among those who previously had controlled or uncontrolled hypertension. 13 Similarly, a study in Paris reported a decrease in home BP measurements during the lockdown period (March 17, 2020-May 11, 2020) relative to the earlier part of 2020.…”

“…A study within an integrated health care system in the US reported that among individuals with treated hypertension with a clinical BP measurement in the year pre-COVID-19, 72.6% had a clinical BP measurement in the first year of COVID-19, and in contrast to the other 2 studies 9,10 in the US reported that SBP and DBP did not change significantly between these times 11 . A study conducted in Japan focusing on individuals with diabetes reported significant increases in office-based BP measurements after the state of the emergency announcement 12 . In contrast, a study in Brazil reported slight reductions in office-based and home-based BP measurements during the early months of the pandemic versus the prior year for patients treated for hypertension; it is not clear whether this reduction was more pronounced among those who previously had controlled or uncontrolled hypertension 13 .…”