How did the COVID-19 pandemic affect blood pressure?

A US study found higher blood pressure levels were associated with the COVID-19 pandemic, due to stay-at-home orders impacting healthy lifestyle behaviours

Published in Circulation, it was found that the stay-at-home orders implemented across the U.S. between March and April 2020 – in response to the COVID-19 pandemic – had an evidently negative impact on healthy lifestyle behaviours for many people.

Shifting many people to remote health care for numerous chronic health conditions including high blood pressure, it was found that many Americans did not take care of themselves efficiently during the pandemic.

Nearly half of American adults have high blood pressure

High blood pressure is a leading cause of heart disease, and nearly 75% of all the cases recorded remain above the recommended blood pressure levels.

Researchers retrieved de-identified health data from an employee wellness program, including employees and spouses/partners, to evaluate changes in blood pressure levels before and during the COVID-19 pandemic.

The data comprised of nearly a half million adults across the U.S., with the average age of 46 years. Of which, 54% were women, who had their blood pressure measured during an employee health screening every year from 2018 through 2020.

Participants were categorised into four groups: normal, elevated, stage 1 hypertension and stage 2 hypertension based on the current American Heart Association blood pressure guidelines.

The researchers compared monthly average blood pressures between 2018 and 2019 and blood pressure measures in January through March 2019 to January through March 2020, which was pre-pandemic. They then studied blood pressure changes when comparing April to December 2020, during the pandemic, to April to December 2019, before the pandemic.

What were the changes in average blood pressure?

During the pandemic from April to December 2020, average upsurges in blood pressure each month ranged from 1.10 to 2.50 mm Hg higher for systolic blood pressure – the top number in a blood pressure reading that indicates how much pressure the blood is exerting against the artery walls with each contraction – and 0.14 to 0.53 mm Hg for diastolic blood pressure – the bottom number in a blood pressure reading indicates how much pressure the blood is exerting against the artery walls while the heart is resting, between contractions – compared with the same time period in 2019.

Before the pandemic, blood pressure measures were predominantly unchanged when comparing previous years of the study.

Higher increases in blood pressure measures were seen among women for both systolic and diastolic blood pressure, among older participants for systolic blood pressure, and in younger participants for diastolic blood pressure.

From April to December 2020, compared to the pre-pandemic period, more participants at 26.8% were re-categorised to a higher blood pressure category, while only 22% of participants moved to a lower blood pressure category.

Lead study author Luke J. Laffin, M.D., co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic in Cleveland, Ohio said: “At the start of the pandemic, most people were not taking good care of themselves. Increases in blood pressure were likely related to changes in eating habits, increased alcohol consumption, less physical activity, decreased medication adherence, more emotional stress and poor sleep.

 “And we know that even small rises in blood pressure increase one’s risk of stroke and other adverse cardiovascular disease events.”

However, the study did have the limitation of the key cause for higher blood pressure being unclear. As well as this, the study’s findings may not be representative of adults who do not participate in the study’s used employee wellness program.

Laffin added: “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.

“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.”

A new wave of strokes and heart attacks?

The study authors are continuing the study from these results, aiming to discover whether this trend continued in 2021. This increase in blood pressure nationally may imply a forthcoming wave of strokes and heart attacks across the affected population.

Dr Eduardo Sanchez, the American Heart Association’s chief medical officer for prevention, said: “Unfortunately, this research confirms what is being seen across the country – the COVID-19 pandemic has had and will continue to have long-reaching health impacts across the country and particularly related to uncontrolled hypertension.

“These results validate why the American Heart Association’s National Hypertension Control Initiative (NHCI) is critically important. With a particular emphasis on historically under-resourced communities in the United States, the comprehensive program supports health care teams at community health centres through regular blood pressure management training, technical assistance and resources that include the proper blood pressure measurement technique, self-measured blood pressure monitoring and management, medication adherence and healthy lifestyle services.”

Read the full study here.