The COVID-19 pandemic has caused many people to forego follow-up care and treatment for chronic conditions such as high blood pressure. It’s now pretty obvious that people with high blood pressure are also more likely to develop severe complications from the coronavirus. In the United States, African American and other racial and ethnic minorities, including Hispanics and Native Americans, are more likely to have high blood pressure and are therefore disproportionately affected by the COVID-19 pandemic.
What is the link between high blood pressure and heart disease?
Hypertension is the most common changeable risk factor for major cardiovascular events such as death, heart attack and stroke and plays an important role in the development of heart failure, kidney disease and dementia. In the past few decades, great efforts have been made to raise awareness and treatment of high blood pressure.
Hypertension increases the stress on the heart and arteries, as well as other organs, including the brain and kidneys. Over time, this stress leads to changes that adversely affect the functioning of the body. To reduce these adverse effects on the heart, drugs are usually prescribed when blood pressure is above 140/90 in people with no significant cardiovascular risk or above 130/80 in people with known coronary artery disease or other co-existing diseases such as diabetes .
Certain groups are disproportionately affected by high blood pressure and severe COVID-19
According to a recently published study in JAMAThe proportion of study participants with controlled blood pressure (defined as <140/90 mm Hg) initially increased and remained constant at 54% from 1999 to 2014. However, the proportion of patients with controlled blood pressure decreased significantly later to 44% by 2018. In addition, certain subgroups appeared to have a disproportionately high rate of uncontrolled hypertension: African-Americans, uninsured patients and patients on Medicaid, as well as younger patients (18 to 44 years of age ) and elderly patients (75 years and older). An accompanying editorial found that the prevalence of uncontrolled blood pressure in non-Hispanic black adults was disproportionately high from 1999 to 2018.
With higher prevalence of high blood pressure, African Americans, Native Americans, and Hispanics had higher rates of hospitalizations and deaths during the pandemic, according to the CDC. According to the National Bureau of Economic Research, elderly patients are most susceptible to serious complications from COVID, regardless of race or ethnicity or socio-economic circumstances. “Vulnerability due to pre-existing conditions collides with long-standing differences in health and mortality by race, ethnicity and socio-economic status. “
How does high blood pressure lead to serious COVID-19 complications?
The relationship between high blood pressure and severe coronavirus illness remains complex. Some experts believe that uncontrolled blood pressure leads to chronic inflammation throughout the body that damages blood vessels and leads to dysregulation of the immune system. This leads to difficulties in fighting the virus or a dangerous overreaction of the immune system to COVID-19. Certain classes of blood pressure medications (ACE inhibitors and angiotensin receptor blockers, or ARBs) were originally thought to make the infection worse, but this has since been refuted. Several research groups have shown that if closely monitored, these drugs can be used safely during COVID infection.
What do people with high blood pressure need to know to reduce their risk?
Proper blood pressure control has long-term health benefits and can help prevent severe COVID-19 symptoms. Because of this, we strongly recommend taking your medications as directed and following healthy lifestyle habits like exercising regularly, achieving and maintaining a healthy weight, following a low-sodium, heart-healthy diet like the Mediterranean Diet, reducing stress, and exercising mindfulness.
In addition, it is now more important than ever to contact your doctor to help keep blood pressure under control. While the idea of going to the hospital or doctor’s office in the middle of a pandemic can put people at risk, many hospitals and clinics are fairly safe due to proper safety measures like wearing a universal mask and social distancing. Many have also expanded telemedicine or virtual visits for patients.
What can we do to address health inequalities?
COVID-19 has forced us to address health care inequalities that contribute to poorer clinical outcomes in vulnerable patient populations.
With the rising number of people with uncontrolled blood pressure and the pandemic disrupting chronic disease management, this can be an excellent opportunity for us to purposefully change current trends in high blood pressure and narrow the gap in health inequalities. Possible focuses are:
- Promote research on how the COVID-19 pandemic has impacted the treatment of chronic diseases such as high blood pressure
- Identify barriers to care, especially in vulnerable subgroups
- Raising awareness of the importance of managing chronic diseases, especially in communities where health inequalities exist
- Innovations to make virtual health technology more widely accessible
- Provide additional resources for chronic disease management for vulnerable subgroups
- Implementing long-term policy solutions to address health inequalities.
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