Blood pressure levels in US adults rose during COVID-19 pandemic
Click Here to Manage Email Alerts
BP levels in U.S. adults increased during the COVID-19 pandemic compared with prior years, a finding that is not attributable to weight gain during lockdown, researchers reported in Circulation.
Average monthly increases in BP ranged from 1.1 mm Hg to 2.5 mm Hg during the pandemic, according to the research letter.
According to Luke J. Laffin, MD, co-director of the Center for Blood Pressure Disorders at Cleveland Clinic, and colleagues, “the increase in systolic BP among U.S. adults during the COVID-19 pandemic could signal a forthcoming increase in incident cardiovascular disease mortality. Reasons for pandemic-associated BP elevations are likely multifactorial, and although weight gain was not the reason, other possible reasons could include increased alcohol consumption, less physical activity, emotional stress and less ongoing medical care (including reduced medication adherence).”
Changes in BP
To assess changes in BP before and during the COVID-19 pandemic, the researchers conducted a longitudinal analysis utilizing data from an annual employer-sponsored wellness program operated by Quest Diagnostics. For the program, employees had annual BP measurements taken by trained personnel from 2018 to 2020.
The present analysis included 464,585 participants (53.5% women; mean age, 45 years).
Researchers observed no significant changes in BP measurements during the pre-pandemic period (2019 and January-March 2020). Changes from the preceding year in both systolic and diastolic BP showed no differences between 2019 and January to March 2020 (P for systolic = .8; P for diastolic BP = .3); however, annual BP increase was higher during the pandemic (April to December 2020) compared with pre-pandemic (P < .0001).
During the pandemic period, monthly increases in BP averaged 1.1 mm Hg to 2.5 mm Hg for systolic BP and 0.14 mm Hg to 0.53 mm Hg for diastolic BP, compared with the previous year (P < .0001).
According to the researchers, these increases were consistent for both men and women, across age groups; larger increases in BP were observed among women for both systolic and diastolic BP; and researchers observed larger increases in systolic BP among older participants and larger increases in diastolic BP in younger participants (P < .0001 for all).
Changes in hypertension classification
Researchers then characterized changes in BP based on the 2017 U.S. BP guidelines: normal, elevated, stage 1 hypertension and stage 2 hypertension.
Recategorization to a higher or lower BP classification was equivalent in the pre-pandemic period compared with 2018 (P = .1).
According to the study, a greater proportion of participants were up-categorized (26.8%) than down-categorized (22%) during the pandemic era than during the pre-pandemic era (P < .0001).
Laffin and colleagues noted that weight gain was not the reason for the observed increases in BP during the pandemic. A small average weight reduction in men was seen in the pandemic period (–0.2 lb) and the weight increase among women (0.6 lb) was the same as during the pre-pandemic period.
“From a public health perspective, during a pandemic, getting vaccinated and wearing a mask are important. However, the results of our research reinforce the need to also be mindful of chronic health conditions such as the worsening of blood pressure,” Laffin said in the release. “Even in the midst of the pandemic, it’s important to pay attention to your blood pressure and your chronic medical conditions. Get regular exercise, eat a healthy diet, and monitor your blood pressure and cholesterol. See your doctor regularly to learn how to manage your cardiovascular risk factors.”
Reference:
- U.S. adults’ blood pressure levels increased during the COVID-19 pandemic. https://newsroom.heart.org/news/u-s-adults-blood-pressure-levels-increased-during-the-covid-19-pandemic. Published Dec. 6, 2021. Accessed Dec. 6, 2021.
Perspective
Back to Top
Matthew I. Tomey, MD, FACC, FSCAI
In an analysis of nearly one-half million individuals included in an employer-sponsored wellness program, Laffin and colleagues identified an increase in BP during the COVID-19 pandemic in comparison with the preceding year. The absolute change in BP was small but statistically significant. During the pandemic, more individuals developed new hypertension or a more severe classification of it. Notably, findings were conserved across sexes and age groups, with the largest increases observed in women. Older individuals tended to have larger increases in systolic BP and younger individuals had larger increases in diastolic BP.
Caution is required in interpretation of this study given its cross-sectional nature; potential for inter-observer and temporal variation in measurement of BP; large sample size providing significant power to detect small differences of uncertain validity or clinical significance; and the small absolute differences in BP reported. With this stated, findings do tend to corroborate our anecdotal experience of encountering patients with new and newly uncontrolled hypertension.
If true, the observed increase in burden of high BP is likely multifactorial in origin and ominous. The COVID-19 pandemic has brought significant changes in our way of life, attitudes toward and access to health care and self-care. For better and for worse, individuals eat differently, consume alcohol differently, engage in exercise differently and experience and cope with stress differently. Some individuals have experienced changes in body weight; of interest, weight gain did not appear to account for BP elevation in this study. Including but not limited to BP, a subset of our patients has clearly experienced a deterioration in cardiometabolic health in the context of the COVID-19 pandemic.
Herein lies cause for concern. As we increasingly appreciate the importance of lifetime cardiometabolic health to the genesis, progression and clinical manifestation of ASCVD, we need to anticipate the deleterious effect of an "increased dose" of poor cardiometabolic health during the COVID-19 pandemic on our population's future incidence of clinical ASCVD, including heart disease and stroke. Even values of BP and cholesterol at the "upper limit of normal" are associated with increased risk. I believe that our single greatest opportunity to reduce the burden of CVD and mortality in the decades to follow this pandemic is to help our patients to pay attention to BP and cardiometabolic health now.
Collapse
Read more about
Click Here to Manage Email Alerts