“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,” said Luke J. Laffin, MD, the codirector of the center for blood pressure disorders at the Cleveland Clinic in Ohio and the lead author of the study, in an American Heart Association (AHA) press release. “And we know that even small rises in blood pressure increase one’s risk of stroke and other adverse cardiovascular disease events.” These findings are important, and they confirm what doctors are seeing in clinics every day, says Lawrence Phillips, MD, a cardiologist and the medical director of outpatient cardiology at NYU Langone Health in New York City. Dr. Phillips was not involved in the research. “During the COVID pandemic, chronic-condition management, including blood pressure management, has at times been overlooked by patients — and understandably so, as other life stressors have been amplified,” he says.
Nearly Half of U.S. Adults Have High Blood Pressure
According to the Centers for Disease Control and Prevention (CDC), nearly half of adults in the United States (47 percent, or 116 million people) have high blood pressure, which means they have a systolic blood pressure greater than 130 millimeters of mercury (mmHg) or a diastolic blood pressure greater than 80 mmHg, or they are taking medication for hypertension. Blood pressure is a measurement of the pressure of blood pushing against the walls of the arteries, according to the National Institutes of Health (NIH). Systolic blood pressure is the top number in a blood pressure reading that indicates how much pressure the blood is exerting against the artery walls with each contraction. Diastolic blood pressure is the bottom number in a blood pressure reading, and it indicates how much pressure the blood is exerting against the artery walls while the heart is resting, between contractions. If blood pressure stays high for a long time, it can cause damage to organs and increases the risk of heart attack, stroke, heart failure, and kidney failure.
Blood Pressure Levels Increased During the Pandemic
To study changes in blood pressure levels before and during the COVID-19 pandemic, researchers used anonymized health data from 464,585 employees and their spouses or partners who were enrolled in a wellness program. The average age of participants was 46 years old, and 54 percent were women. Subjects had their blood pressure measured during an employee health screening every year from 2018 through 2020. Participants were categorized into four groups: normal, elevated, stage 1 hypertension, and stage 2 hypertension, according to current AHA blood pressure guidelines. Researchers found the following trends in average blood pressures:
When researchers compared study years before the pandemic began, blood pressure measures didn’t change much. During the pandemic from April to December 2020, average increases in blood pressure each month ranged from 1.10 to 2.50 mmHg for systolic blood pressure and 0.14 to 0.53 mmHg for diastolic blood pressure compared with the corresponding period in 2019.Higher increases in blood pressure measures were seen among women for both systolic and diastolic blood pressure, in older participants for systolic blood pressure, and in younger participants for diastolic blood pressure.From April to December 2020, compared with pre-pandemic times, 26.8 percent of participants entered a higher blood pressure category, while only 22 percent moved to a lower blood pressure category.
Small population-level increases in blood pressure are associated with increased long-term incidence of major adverse cardiovascular events, and these findings could mean an increase in cardiovascular disease mortality later, according to the authors. Although this study wasn’t set up to uncover why blood pressure went up during the pandemic, it’s likely because of the way life has changed, says Phillips. “At the start of the pandemic, people were staying home more, exercising less, increasing alcohol intake, eating a poorer diet, gaining weight, and experiencing higher levels of generalized stress. It’s not surprising that these factors have resulted in elevated blood pressure,” he says. Although other studies have shown that Americans have gained weight during the pandemic, extra pounds weren’t the reason for the observed rise in blood pressure in this research, according to the authors. In this population, there was actually an average reduction in weight in men, and the increase in weight of women was the same as the pre-pandemic period. This is somewhat surprising, says Phillips. “Anecdotally, I’ve seen weight gain as a significant factor in the worsening of chronic conditions in many people. Similarly, I’ve seen people who have taken control of their risk factors, including weight, who have seen improvement in their conditions and risk factors, and that includes high blood pressure,” he says.
Expert Advice for Managing Your Blood Pressure — and Your Overall Health
If the pandemic has derailed your normal routine and healthy habits, there’s no better time than the present to get back on track. Here’s what Phillips tells his patients. Know your numbers. This continues to be extremely important, he says. “People are staying home more than ever as a result of the pandemic, which means more home monitoring is needed. Have a blood pressure cuff, check it regularly, and take ownership of your numbers so you know if they are elevated,” he says. Stay in touch with your doctor. “Many of these changes in blood pressure are due to nonadherence to medications and lack of follow-up,” says Phillips. Don’t be afraid to go the doctor when you need care, and take advantage of telehealth to stay in better touch with your provider, he says. Double down on lifestyle modifications. Both patients and healthcare providers have been through a lot in the last few years, says Phillips. “Weight management, diet, and exercise kind of went to the side in the earlier part of the pandemic. Now we need to challenge ourselves to restart those things that we let go so that we can have better management of chronic conditions, including controlling blood pressure,” he says.
