Infectious Disease

BP control, management worsened during COVID-19 pandemic

November 02, 2022

2 min read

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Disclosures:
The NHLBI funded this study. The authors report no relevant financial disclosures.

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Electronic records from three large health care systems showed that the first 8 months of the COVID-19 pandemic were associated with worsening BP outcomes among people with hypertension across all socioeconomic backgrounds.

“The COVID-19 pandemic had a negative impact on BP control among adults with hypertension, likely due to multiple factors, including decreased physical activity, disrupted sleep, unhealthy diets, greater alcohol consumption, hesitancy to seek medical care, limited access to medical care and medication nonadherence,” Hiroshi Gotanda, MD, PhD, assistant professor of medicine at Cedars-Sinai, told Healio. “Worsened BP control can increase long-term risks for CVD, such as heart attack and stroke. However, the size of change in BP was smaller than expected, perhaps because health systems responded rapidly by using telemedicine and home monitoring of BP.”

Hiroshi Gotanda

Gotanda and colleagues analyzed electronic health record data from three large health systems — Cedars-Sinai in Los Angeles, Columbia University Irving Medical Center in New York and Ochsner Health in New Orleans — from August 2018 to November 2020. Researchers defined three distinct periods: the pre-pandemic period (August 2018-January 2020; 18 months), the transition period (February-March 2020; 2 months), and the pandemic period (April-November 2020; 8 months). Researchers analyzed data from 137,593 adults with at least one primary care visit with a diagnosis of hypertension during the first 6 months of the pre-pandemic period and compared the level and trend (slope) of BP outcomes before the public health emergency declaration vs. after the stay-at-home orders. Outcomes included systolic and diastolic BP recorded in the EHRs and the proportion of adults with a BP greater than 140/90 mm Hg.

The findings were published in Hypertension.

The number of BP measurements dropped substantially early in the pandemic and then gradually increased. During the pandemic period, systolic and diastolic BP increased by a mean of 1.79 mm Hg (95% CI, 1.57-2.01; P < .001) and 1.3 mm Hg (95% CI, 1.18-1.42; P < .001), respectively, compared with the pre-pandemic period.

Similarly, the proportion of patients with controlled BP decreased by 3.43 percentage points (95% CI, -3.97 to -2.9; P < .001). A trend showing increasing control in the pre-pandemic period (mean, 3.19 percentage points per year; 95% CI, 2.96-3.42; P < .001) flattened during the pandemic period (mean, 0.27 percentage points per year; 95% CI , -0.81 to -1.37; P = .62).

“A small increase like that at a population level can have a significant effect, sometimes leading to an increase in heart attacks and stroke,” Gotanda said in the release.

The researchers noted that the data did not include BP values ​​that might have been obtained via home self-monitoring, an increasingly common practice in recent years that has accelerated in the context of the pandemic.

Health systems and primary care physicians should consider the potential impact of pandemic-related disruptions in care and have contingency plans in case surges continue to affect health care staffing and patients’ abilities to come in for appointments,” Gotanda told Healio. “This could occur again this winter. Additionally, ensuring access to technologies like telemedicine for those with limited resources might help ensure patients have continued access to care for high BP.”

The report is in line with similar recent data. As Healio previously reported, the BP Track study, which assessed data from 24 health systems, showed BP control declined among US adults in 2020 compared with 2019, due to the COVID-19 pandemic.

For more information:

Hiroshi Gotanda, MD, PhD, can be reached at hiroshi.gotanda@cshs.org.

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