Woman prepares to receive blood-pressure measurement with an arm-cuff monitor fitted by a health care provider.

Blood pressure up? COVID-19 pandemic could be to blame

It’s a fact few can dispute: The COVID-19 pandemic has been devastating on Americans. It has caused high rates of death and illness, disrupted nearly every aspect of daily life, and been linked to increased heart disease, lung disease, obesity, and sleep problems.

Now, NHLBI-funded researchers say the virus and related stress can also be blamed for an increase in blood pressure among Americans.

A large observational study, recently published in the journal Circulation, reviewed health data from more than half a million Americans from 50 states and the District of Columbia. It found a small, but consequential, rise in average blood pressure during the early peak of the pandemic.

All the study’s participants were enrolled in an employer-sponsored wellness program that required them to have their blood pressure measured by trained personnel every year during the three-year period analyzed, 2018-2020.

The study found that the average systolic blood pressure – the top number in the blood pressure reading – increased by about 2 millimeters of mercury (mm Hg) 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 mm Hg.

By contrast, no changes were reported in average blood pressure readings in the 15-month pre-pandemic period between January 2019 and the start of the peak pandemic period (from April 2020 to December 2020). The later period saw widespread stay-at-home orders and lockdowns.

“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 mm Hg 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. High blood pressure, or hypertension, can also raise the risk of more severe complications from COVID-19 disease.

Already in the United States, about half of adults have hypertension, but only about one in four (24%) have it under control.

Blood Pressure management graphic
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, Laffin 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 a 2020 report from the Centers for Disease Control and Prevention.

In people without hypertension, Laffin said, the increase was “perhaps related to changes in dietary patterns.”  Specifically, the researcher points to excess sodium or salt intake. “We know that the biggest driver with respect to dietary patterns of blood pressure is excess sodium, so people were likely eating saltier foods during the pandemic.”

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 findings are supported by at least two other nationwide blood pressure tracking studies that show jumps in pressure readings during this period. Laffin ruled out other explanations for the increase, including obesity, virus-induced hypertension, and vaccines themselves. The evidence in this study did not support those factors, he said.

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.”

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 Internal Medicine, one in five people with hypertension may be taking such medications. The most common includes antidepressants, prescription strength nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and estrogens, that study found. Patients should check with their doctor or pharmacist about this possibility, the researchers said, to see if they can replace these drugs with safer alternatives.

And everybody, Laffin said, should focus on good self-care, as it is critical to keeping hypertension under control, or preventing it in the first place. Eating heart-healthy foods, moving more, getting enough sleep, and better stress management all can make a huge difference, he said. 

Also, “It’s important to know your blood pressure numbers,” he said, whether you have hypertension or not.  People can easily find out what those are by visiting a blood pressure check station at their local supermarket or drugstore or using arm-cuff style monitors to check their pressure at home, he said.

Regular activities like these, Laffin noted, save lives. “Don’t just get so focused on COVID that you neglect other preventive measures or self-care issues,” he said. “We have to prevent COVID infection and spread, but we also have to prevent strokes and heart attacks.”

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.

“While this study contributes to knowledge about the impact of the pandemic on blood pressure and the value of self-care, it’s important to see your health care provider and follow lifestyle and medication recommendations if you already have hypertension,” Fine added.