Hypertension management and outcomes during the covid-19 pandemic: diagnosis, blood pressure telemonitoring use and mortality

Introduction The effects of COVID-19 on people with hypertension are poorly understood, but potentially severe both due to increased risk of cardiovascular events post covid (1) and by altering the way people accessed healthcare (2). This study aimed to explore the immediate impact of COVID-19 on the hypertensive population in Scotland. Methods The study used linked routine clinical data. Hypertensive patients from five NHS Scotland Health Boards were identified through the Prescribing Information System (PIS) between March 2019 and February 2021. Linked data included Blood Pressure (BP) telemonitoring data from the Connect Me BP service, outcome data (cardiovascular events and mortality) from Scottish Morbidity Records, and National Records of Scotland COVID-19 testing and vaccination records from Public Health Scotland (PHS). Follow up was until February 2022. EDRIS, the research arm of PHS, linked and pseudonymised the data and transferred it to the secure national safe haven analysis platform for access by the research team. The study was approved by the Public Benefit and Privacy Panel for Health and Social Care. Results Almost 450,000 people with hypertension were identified across the whole adult age range, 52% male. Of those, 89% had been diagnosed prior to the study. New diagnoses dropped by over 50% during the first year of the COVID-19 pandemic. The use of long term BP telemonitoring increased rapidly during the pandemic from 5000 to over 10,000. Overall mortality was over 8%. Mortality rates showed a similar pattern to the general population during the pandemic and remained above pre-pandemic levels until the end of the follow up period in February 2022. Discussion BP telemonitoring supported healthcare delivery at a time when normal services were severely disrupted due to COVID-19. However the data suggests that there may be an increase in the number of people with undiagnosed hypertension with associated raised cardiovascular risk. Mortality in this population was increased by the COVID-19 pandemic and remained above pre-pandemic levels.