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As many Americans dealt with increasing levels of anxiety and stress during the COVID-19 pandemic, studies suggest their blood pressure was also climbing. In 2021, researchers at the Cleveland Clinic looked at close to half a million middle-aged participants in an employee wellness program and found almost 27% moved into a higher blood pressure category during the pandemic. Women had even higher blood pressure readings than men in the study. The authors said the more dramatic blood pressure increase in women "provides more evidence of the outsized burden the pandemic placed on women."
It is a dangerous trend that concerns heart doctors like Jason P. Glotzbach, MD, a cardiothoracic surgeon at University of Utah Health. "We did see an increase in heart attacks at the U of U during COVID. Most concerning, we saw an increase in people presenting with more severe disease like heart failure and other complications during COVID. I think this drives home the importance of prevention and management of hypertension (HTN) and all components of cardiovascular disease," said Glotzbach.
Blood pressure numbers of less than 120/80 mm Hg are considered within a normal range. Consistently elevated readings from 120 to 129 systolic and 80 to 89 mm Hg diastolic can signal problems that can lead to a diagnosis of high blood pressure. Systolic blood pressure is the top number on a reading that measures the force of blood against the artery walls while the lower chambers or ventricles of the heart are squeezing and pushing blood out to the rest of the body. The diastolic blood pressure is the bottom number of the reading and measures the force of blood against the artery walls when the heart relaxes and the ventricles refill with blood.
Researchers identified a combination of causes for the elevations in blood pressure during the pandemic, including increased alcohol consumption, less physical activity, emotional stress, and a reduction in ongoing medical care and medication management. Even before COVID, Glotzbach had noticed a lack of awareness of the risks posed by hypertension. "I think that HTN is under-recognized and underappreciated as the enormous contributor to cardiovascular morbidity and mortality that it is. Given the rising levels of obesity, Type 2 diabetes, and our aging population, this is a major public health issue that doesn't get as much media coverage as other conditions," said Glotzbach.
There is particular concern for higher rates of hypertension among young people and women in their 40s and 50s. "HTN is insidious (stealthy) in that it doesn't cause symptoms in the early phases, so younger people who are not getting regular check-ups may not realize they have high blood pressure. Weight gain and changes in cardiovascular risk factors can occur in women in their 50s especially, so it is crucial for women to establish primary care surveillance of blood pressure and other parameters, such as body composition and lipid (cholesterol) levels as they age," said Glotzbach.
Life expectancy in the United States keeps dropping at an alarming rate. It fell from 78.9 years in 2019 to 76.6 years in 2021, according to a study by the University of Colorado Boulder. Although COVID-19 deaths overtook heart disease as the number one killer for a few months over the past two years, Americans are still more likely to die of heart disease than any other cause. Prevention is key to reducing the risk from the most common forms of the disease like coronary artery disease (CAD), stroke, heart attack, and heart failure.
Glotzbach has what could be some life-saving advice for people who are dealing with high blood pressure or other conditions that can threaten heart health. "The best protective tool is daily exercise, including some form of resistance training to maintain lean body mass as you age. Yoga, mindfulness, and other relaxation techniques are helpful for people with anxiety," said Glotzbach.
The American Heart Association also recommends regular monitoring of blood pressure using home monitors. Glotzbach suggested that "Blood pressure levels vary over time, so daily testing is often more useful for medication management than one-time readings in the doctor's office due to what is called 'white coat syndrome.'" Whitecoat syndrome is when a patient develops high blood pressure or hypertension only when they are around doctors. These same people usually have normal blood pressure readings in other settings.
Doctors know the effects of the COVID-19 pandemic will be long and far-reaching. They cannot predict whether the increased number of hypertension cases will result in future waves of heart attacks and strokes. Glotzbach hopes such a trend can be avoided. Most healthcare professionals agree that the prescription for stopping the dangerous ripple effects of COVID on the heart is to restart regular medical care and reestablish routines that include eating nutritious food, exercising, and getting proper sleep. They are habits that should make every heart a little healthier.