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Changes in Blood Pressure Outcomes Among Hypertensive Individuals During the COVID-19 Pandemic: A Time Series
Hiroshi Gotanda1, Nadia Liyanage-Don2, Andrew E Moran2
1Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (H.G., T.K.N.).
Insights
The COVID-19 pandemic worsened blood pressure control in hypertensive patients, with increased systolic and diastolic blood pressure (BP) and decreased BP control rates. Telemedicine and home BP monitoring may help mitigate future impacts.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic may have disrupted medical care and self-management for chronic hypertension.
- This study investigated the pandemic's impact on blood pressure (BP) control in hypertensive individuals.
Purpose of the Study:
- To examine the effect of the COVID-19 pandemic on blood pressure levels and control among adults with hypertension.
- To compare BP outcomes before and after the declaration of the public health emergency and stay-at-home orders.
Main Methods:
- An interrupted time series analysis was employed using data from 137,593 adult patients with hypertension across three large health systems.
- Systolic and diastolic BP measurements and the proportion of patients with BP <140/90 mmHg were compared between the prepandemic period (August 2018-January 2020) and the pandemic period (April-November 2020).
Main Results:
- Blood pressure measurements decreased significantly early in the pandemic.
- During the pandemic, both systolic BP (increased by 1.79 mmHg) and diastolic BP (increased by 1.30 mmHg) were significantly higher compared to the prepandemic period.
- The proportion of patients with controlled BP decreased by 3.43 percentage points, and the positive trend in BP control observed prepandemic flattened significantly.
Conclusions:
- The initial eight months of the COVID-19 pandemic were associated with a deterioration in BP control among individuals with hypertension.
- Strategies such as telemedicine and home BP monitoring are crucial for maintaining ongoing healthcare access and mitigating adverse BP control during future public health emergencies.
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.
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