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Hypertension Control During the Coronavirus Disease 2019 Pandemic: A Cohort Study Among US Veterans
Caroline Korves1, Aldo J Peixoto2, Brian P Lucas1,3
1Department of Veterans Affairs Medical Center, White River Junction, VT.
Insights
During the COVID-19 pandemic, longer intervals between hypertension check-ups reduced the likelihood of maintaining blood pressure control. However, individuals with uncontrolled hypertension were slightly more likely to achieve control during this period.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Epidemiology
Background:
- Healthcare disruptions were prevalent during the coronavirus disease 2019 (COVID-19) pandemic.
- Understanding the impact of these disruptions on chronic disease management, such as hypertension, is crucial.
Purpose of the Study:
- To investigate if delays in follow-up care affected hypertension control.
- To analyze the association between follow-up intervals and hypertension control during the pandemic.
Main Methods:
- A retrospective cohort study was conducted using data from the Veterans Health Administration.
- Included were individuals with hypertension from prepandemic (March 2019-February 2020) and pandemic (March 2020-February 2022) periods.
- Generalized estimating equations were used to analyze the association between follow-up intervals and hypertension control.
Main Results:
- A total of 1,648,424 individuals were analyzed.
- Maintaining controlled hypertension was less likely during the pandemic (RR: 0.93).
- Longer follow-up intervals decreased the likelihood of maintaining control in both periods.
- Gaining control of uncontrolled hypertension was slightly more likely during the pandemic (RR: 1.01).
Conclusions:
- Extended follow-up intervals during the pandemic negatively impacted the maintenance of hypertension control.
- Individuals with uncontrolled hypertension showed a modest increase in achieving control during the pandemic.
- The findings highlight the importance of consistent follow-up for managing hypertension, even amidst public health crises.
Design:
Retrospective cohort study.
Objective:
We sought to examine whether disruptions in follow-up intervals contributed to hypertension control.
Background:
Disruptions in health care were widespread during the coronavirus disease 2019 pandemic.
Patients And Methods:
We identified a cohort of individuals with hypertension in both prepandemic (March 2019-February 2020) and pandemic periods (March 2020-February 2022) in the Veterans Health Administration. First, we calculated follow-up intervals between the last prepandemic and first pandemic blood pressure measurement during a primary care clinic visit, and between measurements in the prepandemic period. Next, we estimated the association between the maintenance of (or achieving) hypertension control and the period using generalized estimating equations. We assessed associations between follow-up interval and control separately for periods. Finally, we evaluated the interaction between period and follow-up length.
Results:
A total of 1,648,424 individuals met the study inclusion criteria. Among individuals with controlled hypertension, the likelihood of maintaining control was lower during the pandemic versus the prepandemic (relative risk: 0.93; 95% CI: 0.93, 0.93). Longer follow-up intervals were associated with a decreasing likelihood of maintaining controlled hypertension in both periods. Accounting for follow-up intervals, the likelihood of maintaining control was 2% lower during the pandemic versus the prepandemic. For uncontrolled hypertension, the likelihood of gaining control was modestly higher during the pandemic versus the prepandemic (relative risk: 1.01; 95% CI: 1.01, 1.01). The likelihood of gaining control decreased with follow-up length during the prepandemic but not pandemic.
Conclusions:
During the pandemic, longer follow-up between measurements contributed to the lower likelihood of maintaining control. Those with uncontrolled hypertension were modestly more likely to gain control in the pandemic.
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