Abstract
The global coronavirus disease 2019 (COVID-19) pandemic has led to a health crisis. It remains unclear how anxiety affects blood pressure (BP) and cardiovascular risk among older patients with hypertension. In this study, we extracted longitudinal data on home BP monitored via a smartphone-based application in 3724 elderly patients with hypertension from a clinical trial (60–80 years; 240 in Wuhan and 3484 in non-Wuhan areas) to examine changes in morning BP during the COVID-19 outbreak in China. Anxiety was evaluated using Generalized Anxiety Disorder-7 item scores. Changes in morning systolic BP (SBP) were analyzed for five 30-day periods during the pandemic (October 21, 2019 to March 21, 2020), including the pre-epidemic, incubation, developing, outbreak, and plateau periods. Data on cardiovascular events were prospectively collected for one year. A total of 262 individuals (7.0%) reported an increased level of anxiety, and 3462 individuals (93.0%) did not. Patients with anxiety showed higher morning SBP than patients without anxiety, and the between-group differences in SBP change were +1.2 mmHg and +1.7 mmHg during the outbreak and plateau periods (P < 0.05), respectively. The seasonal BP variation in winter among patients with anxiety was suppressed during the pandemic. Anxious patients had higher rates of uncontrolled BP. During the 1-year follow-up period, patients with anxiety had an increased risk of cardiovascular events with a hazard ratio of 2.47 (95% confidence interval, 1.10–5.58; P = 0.03). In summary, COVID-19-related anxiety was associated with a short-term increase in morning SBP among older patients and led to a greater risk of cardiovascular events. (ClinicalTrials. gov number, NCT03015311).
Highlights
These authors contributed : Shuyuan Zhang, Yixuan Zhong, Lixin Wang, Xinhua Yin.A list of members and their affiliations appears in the Supplementary Information
The pandemic timeline was categorized into five 30-day periods on the basis of the dynamics of COVID-19 and the actions taken by the Chinese government [10, 11], including the pre-epidemic period (October 21 to November 2019, as the reference), incubation period (November to December 20, 2019), developing period (December 21, 2019 to January 20, 2020), outbreak period (January 21 to February 20, 2020), and plateau period (February 21 to March 21, 2020) (Supplementary Fig. 1)
Linear mixed models were used to compare morning systolic BP (SBP) at the individual level at each period of the pandemic between patients who reported an increased level of anxiety and those who did not, with random intercepts to account for repeated measurements within the same patient
Summary
These authors contributed : Shuyuan Zhang, Yixuan Zhong, Lixin Wang, Xinhua Yin. Effective blood pressure (BP) control in older patients can reduce the risk of cardiovascular disease (CVD) and mortality. Older hypertensive patients are more vulnerable to severe COVID-19 outcomes [7, 8] and may experience large fluctuations in BP along with psychological stress such as anxiety, depression, or other negative emotions [9]. Effective management of BP during the COVID-19 pandemic is very important; there is a lack of evidence from large-scale, prospective studies about whether COVID-19related anxiety affects BP control and cardiovascular risk. We used data from a randomized clinical trial of BP management leveraging a smartphone-based application (app) to examine whether anxiety was associated with large fluctuations in home BP among older patients with hypertension before and during the COVID-19 outbreak.
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