Changes in the monitoring and management of hypertension during the COVID-19 pandemic.

BACKGROUND

The COVID-19 pandemic caused major healthcare disruptions including the diagnosis and management of hypertension. We evaluated the impact of the COVID-19 pandemic on the monitoring and management of hypertension within the US. Military Health System (MHS) and assessed differences in screening across racial groups and socioeconomic strata.

METHODS

Retrospective evaluation of MHS beneficiaries aged 18-64 years. We compared the hypertension incidence, frequency of blood pressure (BP) monitoring and proportion of hypertension cases with adequately controlled BP during the last healthcare encounter from September 1, 2017-February 28, 2020 (pre-COVID-19 period) to the time frame of the COVID-19 period (March 1, 2020-September 30, 2022).

FINDINGS: We identified 440,107 new hypertension cases among 4,825,679 TRICARE beneficiaries (7.63%, n = 317,976 in the pre-COVID-19 period to 3.25%, n = 122,131, during the COVID-19 period (p < 0.001). Following adjusted analysis, beneficiaries who identified as Black (OR 1.53, 95% CI 1.51-1.55), American Indian/Alaskan Native (OR 1.12, 95% CI 1.05-1.19), or Asian/Pacific Islander (OR 1.15, 95% CI 1.12-1.18), and Senior Enlisted personnel (OR 1.34, 95% CI 1.31-1.37) were more likely to receive a diagnosis of hypertension over the five-year study period. The median number of BP measurements (8 vs. 4) and the percentage of hypertension cases on anti-hypertensive medications (5.7% vs. 3.7%) significantly decreased during the COVID-19 period (p < 0.001).

INTERPRETATION: We found a significant reduction in the diagnosis of hypertension among beneficiaries during the COVID-19 period. BP control decreased in parallel during the period of COVID-19, with a corresponding reduction in follow-up health care visits among individuals with uncontrolled hypertension.