Trends of blood pressure control in the U.S. during the COVID-19 pandemic - PubMed (original) (raw)

Nishant P Shah et al. Am Heart J. 2022 May.

Abstract

Importance: COVID-19 altered lifestyles and disrupted routine health care. Whether blood pressure (BP) control worsened during COVID-19 is unknown.

Objective: To understand whether home BP control worsened during COVID-19 across the United States (US) .

Design, setting, and participants: A population-based analysis of home BP data from 72,706 participants enrolled in a digital health hypertension control program. Data was compared before (January 2019 to March 2020) and during (April 2020 to August 2020) COVID-19.

Main outcomes and measures: Monthly mean home BP readings, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were quantified before and during the pandemic. Multivariable adjustments were made for age, sex, race, region, and months enrolled. Home BP readings were also classified based on monthly averages and highest home BP readings into risk groups: Stage 2 HTN: BP> = 135 or DBP> = 85; Uncontrolled HTN: SBP> = 145 or DBP> = 95; or Severely uncontrolled HTN: SBP> = 160 or DBP> = 100).

Results: Overall, 72,706 participants were enrolled in a digital health hypertension program between 1/1/2019 and 8/31/2020. Compared with participants pre-COVID-19 (n = 33,440), those during COVID-19 (n = 39,266) were of similar age (mean 53.0 ± 10.7 years vs 53.3 ± 10.8 years); sex (46% vs 50.6% female) and race (29.1% vs 34.2% non-white). Relative to pre-Covid (Apr-Aug 2019) the mean monthly number of home BP readings rose during COVID-19 (Apr-Aug, 2020), from 7.3 to 9.3 per month (P < .001). During COVID-19, participants had higher monthly adjusted mean SBP (131.6 mmHg vs. 127.5 mmHg, P < .001); DBP (80.2 mmHg vs. 79.2 mmHg, P < .001); and MAP (97.4 mmHg vs. 95.3 mmHg; P < .001). Relative to the pre-pandemic period, during COVID-19 the proportion of participants with a mean monthly BP classified as uncontrolled or severely uncontrolled hypertension also rose, 15% vs 19% and 4% vs 5%, respectively CONCLUSIONS AND RELEVANCE: Based on home BP readings, mean monthly BP rose modestly after COVID-19, despite increased utilization of home monitoring. Further studies are needed to examine the longitudinal effects of the pandemic on cardiovascular disease risk factors, the impact of these on long-term population health.

Copyright © 2021. Published by Elsevier Inc.

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Figures

Figure 1

Figure 1

Distribution of mean number of BP readings in 2019 and 2020 by month. The blue circles represent 2019; red plus represented Jan-Mar 2020; and green x represents the pandemic period of Apr-Aug 2020..

Figure 2

Figure 2

Distribution of monthly mean systolic blood pressure (A), diastolic blood pressure (B), and mean arterial blood pressure (C) readings in 2019 and 2020 in adjusted models. The blue circles represent 2019; red plus represented Jan-Mar 2020; and green x represents the pandemic period of Apr-Aug 2020. Adjustments were made for age, sex, race, region, and months in program. BP is measured in mmHg.

Figure 3

Figure 3

Mean differences between 2020 and 2019 by month for SBP and DBP. The average difference between 2019 and 2020 are displayed for systolic blood pressure and diastolic blood pressue.

Figure 4

Figure 4

Distribution of the adjusted proportion of participants with Stage 2 or higher (>=135 or DBP>= 85 o), uncontrolled BP (>=145 or DBP>= 95) and severely uncontrolled (>=160 or DBP>=100) categories in 2019 and 2020 classified by either a) monthly mean BP or b) peak blood pressure. The blue circles represent 2019; red plus represented Jan-Mar 2020; and green x represents the COVID-19 period of Apr-Aug 2020. Adjustments were made for age, sex, race, region, and months in program.

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