Social isolation during COVID-19 pandemic linked with high blood pressure

SAC 2020 is a virtual meeting during 19 to 21 November. Faculty from the European Society of Cardiology (ESC) will participate in joint scientific sessions with the Argentine Society of Cardiology as part of the ESC Global Activities programme.

"Admission to the emergency department during the mandatory social isolation period was linked with a 37% increase in the odds of having high blood pressure -- even after taking into account age, gender, month, day and time of consultation, and whether or not the patient arrived by ambulance," said study author Dr. Matías Fosco of Favaloro Foundation University Hospital, Buenos Aires.

Mandatory social isolation due to COVID-19 was implemented on 20 March in Argentina as a part of a general lockdown. People were told to stay at home, except for essential workers (e.g. doctors and nurses). The general public were permitted to leave home only to buy food, medicine and cleaning supplies. Schools and universities were closed, and public events were suspended.

"After social isolation began, we observed that more patients coming to emergency had high blood pressure," said Dr. Fosco. "We conducted this study to confirm or reject this impression."

The study was conducted in the emergency department of Favaloro Foundation University Hospital. The frequency of high blood pressure1 among patients aged 21 and above during the three-month social isolation (20 March to 25 June 2020) was compared to two previous time periods: the same three months in 2019 (21 March to 27 June 2019) and the three months immediately before social isolation (13 December 2019 to 19 March 2020).

Blood pressure is a standard measurement on admission to the emergency department and almost every patient (98.2%) admitted between 21 March 2019 and 25 June 2020 was included in the study. The most common reasons for admission were chest pain, shortness of breath, dizziness, abdominal pain, fever, cough, and hypertension.

The study included 12,241 patients. The average age was 57 years and 45.6% were women. During the three-month isolation period 1,643 patients were admitted to the emergency department. This was 56.9% less than during the same three months in 2019 (3,810 patients) and 53.9% lower than during the three months immediately before social isolation (3,563 patients).

During the social isolation period, 391 (23.8%) patients admitted to emergency had high blood pressure. This proportion was significantly higher compared to the same period in 2019, when it was 17.5%, and compared to the three months before social isolation, when it was 15.4% (p<0.01).

Dr. Fosco said: "There are several possible reasons for the connection between social isolation and high blood pressure. For example, increased stress because of the pandemic, with limited personal contact and the onset or exacerbation of financial or family difficulties. Changed behaviours may have played a role, with higher intake of food and alcohol, sedentary lifestyles and weight gain."

Dr. Fosco noted that the reasons for admission were similar between the periods studied, so were not responsible for the increase in high blood pressure. But he said: "Patients may have felt more psychological tension during transportation to the hospital because of travel restrictions and police controls and a fear of becoming infected with coronavirus after leaving home. In addition, patients being treated for high blood pressure may have stopped taking their medicine due to preliminary warnings about possible adverse effects on COVID-19 outcomes (which were later dismissed)."

He concluded: "Blood pressure control helps prevent heart attacks and strokes and serious illness from COVID-19, so it's essential to maintain healthy lifestyle habits, even under social isolation and lockdown conditions. Many regulations related to the pandemic have now relaxed and we are investigating if this is reflected in the blood pressure of patients admitted to emergency."

Dr. Héctor Deschle, Scientific Programme Chair of SAC 2020, said: "This study illustrates the collateral damage generated by isolation. There has been a significant decrease in heart disease consultations, which inevitably leads to avoidable complications. But I would like to emphasise the psychological damage pointed out by the authors, which we perceive daily in consultations and which is expressed as fear, hopelessness, irritability, and difficulty concentrating. This affects interpersonal relationships and physical health. This study puts the spotlight on the concomitant consequences of the outbreak and the restrictions used to struggle against it."

Professor Jose Luis Zamorano, ESC regional Ambassador for Argentina at SAC 2020, said: "This very interesting study simply highlights that we as cardiologists must keep a watchful eye on our cardiology patients beyond the pandemic. If we do not treat and carefully follow our cardiac patients during the pandemic, we will see an increase of adverse outcomes in the future."