American Heart Association Report Raises Alarm on Blood Pressure Increases During Pandemic

Luke Laffin, MD

A new report is raising the alarm on the rise in blood pressure among US adults during the COVID-19 pandemic.

A longitudinal study led by investigators at the Cleveland Clinic’s Heart Vascular and Thoracic Institute, results suggest mean blood pressure increased each month with a range of 1.10-2.50 mmHg for systolic and 0.14-0.53 mmHg for diastolic blood pressure from April-December 2020 compared to the same period in 2019. Results also provide insight into the increase according to various age groups based on sex and age as well as detailing the pandemic’s effects on body weight.

“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,” said lead investigator Luke Laffin, MD, co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic, in a statement from the American Heart Association.

Citing major knowledge gaps related to the impact of lifestyle changes from the pandemic, Laffin and a team of colleagues designed the current study with the intent of examining changes in blood pressure during the pandemic using data from an employer-sponsored wellness program operated by Quest Diagnostics. With the goal of assessing changes during pre-pandemic and pandemic periods, the outcomes of interest for the study were changes for 2019 vs 2018, January-March 2020 vs 2019, and April-December 2020 vs 2019.

For inclusion in the study, participants were rewired to have blood pressure measured by trained personnel in all 3 study years. From a cohort of 533,645 potential participants, 464,585 were considered eligible for inclusion. This cohort had a mean age of 45.7 (SD, 11.1) years in 2018 and 53.5% were women.

Initial analysis indicated there were no differences in systolic and diastolic blood pressure from the preceding year between 2019 and January-March 2020 (P=.08 for systolic; P=.3 for diastolic). However, results indicated annual blood pressure increases from April-December 2020 were significantly higher than in 2019 (P <.0001 for both systolic and diastolic).

Compared with the previous year, mean blood pressure changes during the pandemic period ranged from 1.10-2.50 mmHg for systolic blood pressure and 0.14-0.53 mmHg for diastolic blood pressure. Further analysis indicated systolic and diastolic blood pressure increases were present among men and women and across age groups. Investigators pointed out greater increases were observed in women for both systolic and diastolic, in older participants for systolic, and in younger participants for diastolic (P <.0001 for all).

When assessing changes in categorization according to AHA 2017 guidelines, investigators observed a greater proportion of patients being upcategorized (26.8%) during the pandemic period than down categorized (22.0%; chi-square test, P <.0001). Investigators also noted weight gain did not appear to be a primary driver of blood pressure increases, with the changes in weight observed during the pandemic period being similar to those observed among all 3 years examined in the study.

“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,” said Eduardo Sanchez, MD, MPH, the American Heart Association’s chief medical officer for prevention, in a statement. “These results validate why the American Heart Association’s National Hypertension Control Initiative 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 centers 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.”

This study, “Rise in Blood Pressure Observed Among US Adults During the COVID-19 Pandemic,” was published in Circulation.