Anxiety, home blood pressure monitoring, and cardiovascular events among older hypertension patients during the COVID-19 pandemic

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).

Keywords: Anxiety; Cardiovascular disease; Coronavirus disease 2019 (COVID-19); Home blood pressure; Smartphone-based application.

Fig. 1

Flowchart of the present study. Abbreviations: STEP the strategy of blood pressure intervention in older hypertensive patients, COVID-19 coronavirus disease 2019, BP blood pressure

Fig. 2

Trajectory pattern of morning SBP and antihypertensive medication in older patients with anxiety compared with those without anxiety during the pandemic. Abbreviations: SBP systolic blood pressure. The timeline of COVID-19 in China was classified as the pre-epidemic period as the reference (October 21 to November 20, 2019), incubation period (November 21 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). The values in the graphs indicate the adjusted mean monthly average morning SBP within each period of the pandemic among patients with anxiety (blue line) and without anxiety (orange line) after adjustment for age, sex, and body mass index. The gray line indicates the average temperature of the areas where the participants lived during the pandemic

Fig. 3

Kaplan–Meier curves of total cardiovascular events in patients with anxiety compared with patients without anxiety during the COVID-19 period. CI confidence interval, COVID-19 coronavirus disease 2019. Patients with anxiety showed a higher risk for the incidence of total cardiovascular events than patients without anxiety during the 1-year follow-up, including acute coronary syndrome (acute myocardial infarction and hospitalization for unstable angina), stroke (ischemic or hemorrhagic), acute decompensated heart failure, coronary revascularization, atrial fibrillation, or death from cardiovascular causes