Hypertension, health inequities, and implications for COVID-19 – Harvard Health Blog
The COVID-19 pandemic has led many people to forgo the monitoring and treatment of chronic conditions such as hypertension (high blood pressure). It is now quite evident that people with hypertension are also more likely to develop serious complications from the coronavirus. In the United States, African Americans and other racial and ethnic minorities, including Hispanics and Native Americans, are more likely to have hypertension and have therefore been disproportionately affected by the COVID-19 pandemic.
What is the connection between high blood pressure and heart disease?
Hypertension is the most common modifiable risk factor for major cardiovascular events, including death, heart attack, and stroke, and it plays a major role in the development of heart failure, kidney disease and dementia. Over the past decades, significant efforts have been made to increase awareness and treatment of hypertension.
High blood pressure increases stress on the heart and arteries as well as other organs, including the brain and kidneys. Over time, this stress causes changes that negatively impact the body’s ability to function. To reduce these negative effects on the heart, drugs are usually prescribed when blood pressure exceeds 140/90 for people without significant cardiovascular risk, or above 130/80 in people with known coronary artery disease or other coexisting diseases such as diabetes.
Some groups are disproportionately affected by hypertension and severe COVID-19
According to a recent study published in JAMA, the proportion of study participants with controlled blood pressure (defined as <140/90 mm Hg) first increased and then remained stable at 54% from 1999 to 2014. However, the proportion of patients with blood pressure was controlled decreased significantly thereafter, to 44% by 2018. Additionally, some subgroups appeared to have disproportionately higher rates of uncontrolled hypertension: African Americans, uninsured patients and patients with Medicaid, as well as younger patients (aged 18 to 44) and older patients (75 years and older). An accompanying editorial noted that the prevalence of uncontrolled blood pressure was disproportionately higher in non-Hispanic black adults from 1999 to 2018.
With a higher prevalence of hypertension, African American, Native American and Hispanic communities had higher rates of hospitalization and death during the pandemic, according to the CDC. While vulnerability to serious complications from COVID is highest in elderly patients, regardless of race or ethnicity and socio-economic circumstances, according to the National Bureau of Economic Research, “vulnerability based on conditions pre-existing populations face long-standing disparities in health and mortality by race. -ethnicity and socio-economic status. “
How does hypertension lead to serious complications from COVID-19?
The link between hypertension and severe coronavirus disease remains complex. Some experts believe that uncontrolled blood pressure leads to chronic inflammation throughout the body, which damages blood vessels and leads to disruption of the immune system. This leads to difficulty fighting the virus or a dangerous overreaction of the immune system to COVID-19. Certain classes of antihypertensive drugs (ACE inhibitors and angiotensin receptor antagonists, or ARBs) were initially thought to worsen the infection, but this has since been refuted. Several research groups have shown that with close monitoring, these drugs can be used safely during COVID infection.
What do people with high blood pressure need to know to reduce their risk?
Good blood pressure control has long-term health benefits and may help prevent severe symptoms of COVID-19. Therefore, we strongly encourage you to take your medications as directed and follow healthy living practices such as regular exercise, achieving and maintaining a healthy weight, a low sodium diet and healthy for the heart such as the Mediterranean diet, as well as stress reduction and the practice of mindfulness.
Plus, it’s more important than ever to follow up with your doctor to control your blood pressure. While the thought of going to a hospital or a doctor’s office in the midst of a pandemic can put people on edge, many hospitals and clinics are quite safe due to proper safety measures such as that universal mask wearing and social distancing. Many have also expanded telemedicine or virtual visits for patients.
What can we do to address inequalities in the delivery of health care?
COVID-19 has forced us to address inequalities in healthcare delivery that contribute to worse clinical outcomes in vulnerable patient groups.
With the growing number of people with uncontrolled blood pressure and the pandemic disrupting the management of chronic health conditions, this may provide us with a great opportunity to deliberately change the current trends in hypertension and narrow the gap by health inequity. Potential areas of interest include:
- promote research on how the COVID-19 pandemic has affected the management of chronic diseases like high blood pressure
- identify barriers to care, especially in vulnerable subgroups
- increase awareness of the importance of chronic disease management, especially in communities where there are inequalities in health care
- innovate to make virtual health technology more widely accessible
- provide additional resources for chronic disease management to vulnerable subgroups
- implement long-term political solutions to tackle health inequalities.
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