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Small Rise in Blood Pressure Averages During the Covid-19 Pandemic

Written By: 
The ADC Medical Education Team

A large observational study found a small, but consequential, rise in average blood pressure during the early peak of the Covid-19 pandemic. The study, published in December in the American Heart Association’s journal Circulation, reviewed health data from more than half a million Americans from 50 states and the District of Columbia.

The study found that the average systolic blood pressure – the top number in the blood pressure reading – increased by about 2 millimeters of mercury (mmHg) from April 2020 to December 2020 – considered the peak of the pandemic. The average diastolic pressure – the bottom number – also rose slightly. Normal blood pressure is less than 120/80 mmHg.

By contrast, no changes were reported in average blood pressure readings in the 15-month pre-pandemic period between January 2019 and April 2020, when widespread stay-at-home orders and lockdowns began.

“That’s concerning,” said Luke Laffin, M.D., the study’s lead author and co-director of the Center for Blood Pressure Disorders at the Cleveland Clinic. “On the individual level, that [2 mmHg increase] doesn’t seem like a lot. But we know that a small increase in blood pressure can cause a significant increase in strokes and heart attacks across the population” — which, in turn, can lead to death,” he added.

Multiple Factors behind the Nationwide Increase

Laffin said multiple factors were behind the nationwide increase, starting with a reduction in ongoing medical care during the pandemic. People with hypertension were not seeing their doctors regularly, he explained, and that meant many were not filling their prescriptions for antihypertensive medications. During the pandemic, an estimated 40 percent of U.S. adults reported avoiding medical care because of concerns related to Covid-19, according to 2020 information from the Centers for Disease Control and Prevention.

The greatest increase was experienced by women, who made up half of the study’s participants. “We know from other literature that pandemics tend to put an undue burden on women,” Laffin said. That includes taking care of children, paying bills, and, in the case of Covid-19, coordinating virtual learning. “That can result in less time to make the lifestyle changes that they need to control cardiovascular risk factors, including blood pressure.”

Stress, which has long been known to increase blood pressure, likely played a significant role in this study population, as well. “We know that if people don’t handle stress well, that impacts their lifestyle choices,” Laffin said. “They don’t eat right, they drink more alcohol, they don’t get sufficient sleep.” The Red Cross considers stress as it relates to Covid-19 a significant enough factor to address it on their website. First, it urges people to understand how stress can affect you and, second, suggests a number of specific and healthy ways to cope with it, not only for yourself but for your entire family.

Another factor may have been at play, too: medications people were taking for other conditions that unintentionally raised blood pressure. According to a study reported recently in JAMA, one in five people with hypertension may be taking such medications. The most common include antidepressants, prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and estrogens. Patients should check with their doctor or pharmacist, the researchers said, to see if they can replace these drugs with safer alternatives.

Lawrence Fine, M.D., Dr.P.H., senior advisor of NHLBI’s Clinical Applications and Prevention Branch, agreed. “Reversing blood pressure increases during the pandemic and beyond is important to the future cardiovascular health of millions of Americans and less than half of Americans with hypertension have achieved adequate control of their hypertension. This study suggests the pandemic possibly made this problem somewhat worse,” he said.


Blood pressure up? COVID-19 pandemic could be to blame | NHLBI, NIH

Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns — United States, June 2020 | MMWR (cdc.gov)

Prevalence of Medications That May Raise Blood Pressure Among Adults With Hypertension in the United States | Cardiology | JAMA Internal Medicine | JAMA Network

COVID-19 and Chronic Disease: The Impact Now and in the Future (cdc.gov)

How Has COVID-19 Impacted Blood Pressure? – Cleveland Clinic

Be Well Together | American Heart Association

People with Certain Medical Conditions | CDC