This serious health issue got worse during the pandemic

Hypertension was already a serious problem in the United States before COVID-19 hit our shores. Unfortunately, a new study published in the American Heart Association journal, Circulation, indicated that U.S. adult blood pressure increased even more during the pandemic.

The study accessed data from a half a million people enrolled in an employee wellness program operated by Quest Diagnostics. The average age of the employees and their spouse/partners was 46 years old and 54 percent of the people in the study were women. Participants had their blood pressure measured at employee health screenings for three years, beginning in 2018. Researchers then compared the blood pressure readings from year to year.

In the pre-pandemic years, there were no significant increases in either systolic or diastolic blood pressure readings from one year to the next, but when researchers compared the pre-pandemic readings to readings taken from April to December 2020, 26 percent of the participants had moved into a higher blood pressure category.

This news didn’t surprise cardiologist John Hostetter, MD, at Cape Cod Healthcare Cardiovascular Centers in Falmouth and Sandwich.

“The pandemic is sort of the perfect storm for all of the things that can make blood pressure worse,” he said. “There’s definitely been previous studies that have shown higher incidences of cardiac events after disasters like earthquakes and Hurricane Katrina and the World Trade Center. They’ve all been associated with higher risks of heart attacks and I think there is no doubt that the chronic stress that comes from the pandemic also contributes.”

Psycho-social factors such as anxiety, depression and chronic stress all have a negative impact on hypertension and data shows that things like a job loss and bereavement also affect blood pressure, Dr. Hostetter said. He pointed to other additional factors that were unique to the pandemic that are also in play. Our lifestyle and habits were probably worse for obvious reasons. People have been trapped in their houses and were less apt to go to the gym or exercise.

“I think there was also a tendency to gain weight between a less healthy diet and more of the carbs and easy food that was accessible when we were lounging around our house,” he said. “There was probably a little more alcohol too and alcohol can also contribute to high blood pressure.”

Americans Missing the Goals

The American Heart Association changed their hypertension guidelines in 2017. Previously, blood pressures of 140 over 90 were considered acceptable. The official definition of hypertension is now anything higher than 130 over 80 but the ideal numbers are 120 over 80.

Americans were not coming close to those goals even before the pandemic, Dr. Hostetter said. In 2019, there were an estimated 116 million adults with hypertension. That is about 50 percent of the population. Of those, only one quarter of those people had blood pressure that was well-controlled.

“The problem with hypertension is that people don’t tend to have symptoms typically at lower levels,” he said. “Extraordinarily high readings can give you headaches and neurologic changes, but the vast majority of the people don’t have any symptoms to warn them that this is brewing.”

Adding to the perfect storm is the fact that few people were seeing their doctors in person for close to two years. Instead, a large number of patients saw their doctors through virtual visits.

“Unless people were actively involved in checking their blood pressure at home, essentially their hypertension has probably been ignored for two years, at a time when maybe it was most necessary to be paying attention to it,” Dr. Hostetter said.

“I probably wouldn’t have been too concerned if people weren’t as aware of their blood pressure for three to six months because this is a lifelong effect. Unfortunately, this is stretching into years and that’s obviously a big impact on future health.”

While it’s not uncommon for people to ignore their blood pressure, Dr. Hostetter compared the pandemic toll to the estimated death toll caused by hypertension and it was a startling comparison. By early February 2022, the CDC reported that just over 888,000 Americans have died from COVID-19. That means roughly 444,000 deaths per year have occurred.

“Some of the studies have suggested that up to 500,000 deaths a year can be attributed to hypertension,” Dr. Hostetter said. “So as much as we’re focused on the pandemic because it’s such an acute issue, hypertension does that every year.”

How to Lower Risk

The good news is there are things people can do to lower their risk of hypertension and even reverse early hypertension. All of them involve making the following lifestyle changes recommended by Dr. Hostetter:

• Follow a low-sodium diet. Different organizations propose different numbers, but a simple number to remember is to keep sodium less than 2,000 milligrams a day. The average U.S. intake is close to 3,500 milligrams a day.
• Eat a diet that is high in fruits, vegetables, whole grains and seafood and low in red meat and saturated fats.
• Get at least 150 minutes of moderate exercise a week (about 30 minutes a day five days a week).
• Limit alcohol intake. If you do drink alcohol, limit it to two servings or less a day for men and one serving or less a day for women.
• Lose weight. Studies suggest that for every two pounds you lose, your blood pressure can drop by a point. So, if you lose 10 to 15 pounds, you could possibly drop your blood pressure by five to seven points, which could be enough to drop from hypertensive to pre-hypertensive or allow you to take fewer medications.
• Schedule an appointment to see your doctor soon, if you haven’t already done so.

Dr. Hostetter has observed that some patients are still putting off visiting their doctors because of fear of exposure to COVID-19. A Cleveland Clinic survey done last year backs up this theory. In the survey, 52 percent of Americans and 65 percent of heart disease patients avoided check-ups because of the pandemic. That can be a big mistake, according to Dr. Hostetter.

“The healthcare system is definitely trying its best to be as safe as possible and vaccinate their staff and so forth so people shouldn’t put off their health at this point because it’s increasingly important for their long-term prevention of heart attacks, strokes and kidney disease to control something as common as high blood pressure,” he said.