Blood pressure control ‘decreased substantially’ during COVID-19 pandemic
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BP control declined among U.S. adults in 2020 compared with 2019, due to the COVID-19 pandemic, according to a study of 24 health systems presented at the American Heart Association Scientific Sessions.
“We observed large variability across health systems in blood pressure control metrics,” Alanna M. Chamberlain, PhD, MPH, FAHA, associate professor of epidemiology in the departments of cardiovascular medicine and quantitative health sciences at Mayo Clinic in Rochester, Minnesota, said during a presentation. “Our results showed suboptimal blood pressure control even before the COVID-19 pandemic, and show substantial opportunity for improvement. Blood pressure control decreased substantially during the COVID-19 pandemic, accompanied by a reduction in follow-up health care visits among persons with hypertension. Blood pressure control has not rebounded to pre-pandemic levels.”
The BP Track study analyzed trends in BP control in the year before the COVID-19 pandemic and during the pandemic in patients with hypertension from 24 health systems participating in the National Patient-Centered Clinical Research Network (PCORnet). According to Chamberlain, this study “is the first use of PCORnet for national surveillance of blood pressure control and related process metrics.” She noted that “each health system transforms their data to a common data model, which is updated on a quarterly basis.”
Variability in BP control metrics
The 2019 data included 8,295,484 encounters with 1,770,547 patients. The 2020 data included 6,592,142 encounters with 1,726,794 patients. In both years, the cohorts were 48% male, 68% white and 51% were aged 65 to 85 years.
BP control, defined as < 140 mm Hg systolic/90 mm Hg diastolic, was lower in 2020 than in 2019 (60.5% vs. 53.3%; difference, –7.2; 95% CI, –9 to –5.4), Chamberlain said during the presentation.
When BP control was defined as < 130 mm Hg systolic/80 mm Hg diastolic in accordance with the 2017 AHA/American College of Cardiology hypertension guideline, the difference in control between 2019 and 2020 remained (difference, –4.6; 95% CI, –5.4 to –3.7), Chamberlain said.
The weighted averages of improvement in BP control, defined as the percentage of patients with previously uncontrolled systolic BP who achieved a systolic BP of less than 140 mm Hg or an improvement of at least 10 mm Hg, were 29.7% in 2019 and 23.8% in 2020 (difference, –5.9; 95% CI, –7.9 to –3.8), according to the researchers.
The weighted averages of repeat visits, defined as percentage of visits by people with uncontrolled BP that were followed by another visit within 4 weeks, were 36.7% in 2019 and 31.7% in 2020 (difference, –5; 95% CI, –5.9 to –4.1), Chamberlain said, noting repeat visits declined precipitously in the early months of the pandemic.
The rate of medication intensification, defined as percentage of visits where a patient with uncontrolled hypertension received a prescription for a different class of medication, was 10.8% in 2019 and 11.7% in 2020, according to the researchers.
The declines in BP control and repeat visits occurred in all races and ethnicities, and BP control remained lowest in Black patients, Chamberlain said.
BP control at the end of 2020 had not rebounded to 2019 levels, Chamberlain said.
‘Continued surveillance is needed’
The BP Track study did not include data from 2021, according to Chamberlain.
“Continued surveillance is needed to determine whether this decline in blood pressure control during the pandemic will result in future cardiovascular events,” Chamberlain said.
The current data do not include to what extent telehealth visits accounted for follow-up visits in 2020, she said.
During a discussant presentation following presentation of the results, Cardiology Today Editorial Board Member Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA, professor of medicine, John W. Deming department of medicine, Tulane University School of Medicine, said “the data are not completely clear because we are not really sure whether telehealth gives us any benefit in terms of reducing the disruption of care.
“If you look across the population that was studied, there remains the disparity of the Black adults having poorer control of blood pressure, and this predates the pandemic. The pandemic did not cause these inequities, but allows these disparities to be maintained. If we don’t correct these unacceptable findings, we are not going to see a decrease in cardiovascular morbidity and mortality, especially in non-Hispanic Black populations,” Ferdinand said.
Perspective
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Florian Rader, MD
Clearly, BP control worsened during the COVID-19 pandemic, and has not returned to pre-pandemic levels, despite there being some improvement by late 2020, according to the investigators. Previous studies showed that since 2014, BP control rates are on the decline. The pandemic played a role in the worsening of BP control rates, but we saw this trend of worsening before the pandemic, which is especially worrisome.
The worsening BP control seen in the current study focusing on the time frame around the pandemic can be explained by the following: Many patients did not want to leave their home, thus had less interactions with their medical provider to adjust medications if needed. They may also have had a harder time getting their medications from their pharmacy, affecting medication compliance, especially for those who did not use mail-order pharmacies. In addition, many individuals gained weight. When that happens, there is the potential for BP to increase. So, we have worsening BP due to less medical supervision, worse adherence and worse overall lifestyle.
To avoid these pitfalls during the pandemic and improve BP control again, we have to become comfortable to go outside, go back to exercising, go back to maintaining a healthy weight and go back to the doctor’s office, especially when one sees their BP is not controlled and medication adjustment is needed. One obvious step to getting all this accomplished is getting vaccinated against COVID-19 and getting a booster vaccination if indicated to be adequately protected. It is so important to not lose focus on BP control, otherwise the pandemic will bring an aftermath of CV complications related to elevated BP.
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Chamberlain AM, et al. LBS.02. Hypertension: Local, Global and Pandemic Impacts. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).
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