Lockdowns, Stay-At-Home Orders May Have Hampered Hypertension Control in US Adults

Hirsohi GotanaHirsohi Gotandda, MD, PhD

Adding to the bevy of long-term health concerns that have arisen as a result of the COVID-19 pandemic, data from a study of patients from Cedars-Sinai, Columbia, and Ochsner health systems are providing an overview of blood pressure outcomes among people with hypertension before and during the COVID-19 pandemic.

An uninterrupted time series analysis comparing trends in blood pressure outcomes before and after stay-at-home orders during the COVID-19 pandemic, results of the study indicate systolic and diastolic blood pressure increased by 1.79 mmHg and 1.30 mmHg, respectively, compared to prepandemic levels, which investigates note should serve as a warning related to potential cardiovascular health on a population level.

“We had a unique opportunity to examine the pandemic’s impact on hypertension management among a large, diverse group of people from three major cities,” said study investigator Hiroshi Gotanda, MD, PhD, an assistant professor of Medicine at Cedars-Sinai, in a statement. “Our analysis revealed similar patterns among participants from three different regions and a variety of racial, ethnic and socioeconomic backgrounds.”

Although the COVID-19 pandemic has directly impacted care, prognosis, and outcomes of millions throughout the world, the indirect effects of the pandemic have become a focal point of research efforts for many. Among those is Gotanda and a team of colleagues from Cedars-Sinai, Columbia University Irving Medical Center, and Ochsner Health, who launched the current study with the intent of leveraging electronic health record data from each institution to develop a more comprehensive understanding of the impact of early lockdown and stay-at-home measures on hypertension management.

Using EHR data obtained from the aforementioned medical centers, investigators identified 137,593 individuals for inclusion in their analyses. Using data form these individuals, investigators performed an interrupted time series analysis designed to compare the level and slope of blood pressure outcomes from August 2018-January 2020 against a period after stay-at-home orders were implemented from April 2020-November 2020. The primary outcomes of interest for the study were change in systolic and diastolic blood pressure as well as the proportion of individuals below the target blood pressure target goal of less than 140/90 mmHg.

Results of the investigators’ analyses suggested the number of blood pressure measurements performed dropped significantly early in the pandemic and gradually increased. When examining changes in blood pressure, investigators pointed out both systolic and diastolic blood pressure increased during the pandemic period compared with the prepandemic period, with increases of 1.79 mmHg (95% CI, 1.57 to 2.01; P <.001) and 1.30 mmHg (95% CI, 1.18 to 1.42; P <.001) for systolic and diastolic blood pressure, respectively.

Further analysis demonstrated the proportion of patients achieving optimal blood pressure control decreased by 3.43 percentage points during the pandemic (95% CI, -3.97 to -2.90; P <.001). Additionally, investigators noted a trend toward increasing control in the prepandemic period (3.19 percentage points per year [955 CI, 2.96 to 3.42]; P <.001) that was subsequently flattened during the pandemic period (0.27 percentage points per year [95% CI, -0.81 to -1.37]; P=.62).

“It is critical to increase access to healthcare, potentially through telemedicine and home blood pressure monitoring, to mitigate disruptions in care during future large-scale emergencies,” said study investigator Teryl Nuckols, MD, MSHS, director of the Division of General Internal Medicine in the Cedars-Sinai Department of Medicine, in the aforementioned statement. “We want to avoid compounding the effects of widespread disasters by creating additional public health crises.”

This study, “Changes in Blood Pressure Outcomes Among Hypertensive Individuals During the COVID-19 Pandemic: A Time Series Analysis in Three US Healthcare Organizations,” was published in Hypertension.