Hypertension in the time of Corona -- Whose hypertension did the pandemic most affect in North East London?

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

7B.5

Presenter:

Stuart Rison

Twitter:

@DrRison

Co-authors:

Oliver Redfern, Isabel Dostal, Chris Carvalho, Zahra Raisi-Estabragh, John Robson

Author institutions:

Clinical Effectiveness Group (CEG), Centre for Primary Care, Wolfson Institute of Population Health, QMUL, London; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford; William Harvey Research Institute, NIHR Barts Biomedical Research Centre, QMUL, London; Barts Heart Centre, Barts Health NHS Trust, London

Problem

The COVID-19 pandemic necessitated major changes in the primary care management of chronic conditions such as hypertension. Some reports highlighted widening of health inequalities during this period. We set out to investigate health inequities in the management of hypertension in a large cohort of individuals with hypertension from North East London, one of the most diverse and deprived area of England.

Approach

We analysed an open cohort of adults with hypertension in North East London over 43 months. We used NHS England Quality and Outcomes Framework metrics to define controlled hypertension. We also considered differences in blood pressure (BP) recording. We assessed variations in our management of hypertension indicators by ethnicity, sex, age, deprivation and treatment intensity using multiple variable logistic regression analyses performed in April 2019, April 2020, April 2021 and April 2022 (representing the pre-pandemic, pre-lockdown, lockdown and post-lockdown phases of the pandemic).

Findings

The cohort comprised of 219,180 unique patients over the entire study period. BP control assessed using QOF indicators fell from a pre-pandemic peak of 73% to a nadir of 50% by the end of the first UK lockdown, accompanied by similar fall in recently recorded BPs. However, during the same period, BP control in patients with a recent BP recording remained stable (81% to 80%). Across the entire study period, Black/Black British ethnicity group members were less likely to have controlled BP than White ethnicity group members, who themselves were less likely to have controlled BP than Asian/Asian British ethnicity group members. These differences could not be attributed to unequal recording of blood pressures in patient records nor to treatment intensity differences.

Consequences

In this large primary care cohort, BP control in patients with hypertension was broadly maintained during the pandemic despite initial concerns that management of hypertension had significantly deteriorated. The typical QOF indicator of management of hypertension (which suggested the deterioration) should be used with care.Ethnic disparities were observed in hypertension control and the same inequities were present before, during and after the pandemic lockdown. Within the parameters of this study, the pandemic did not disproportionately affect a specific ethnic group. Our study identified Black/Black British ethnicity individuals and younger individuals as potentially warranting targeted interventions.

Submitted by:

Stuart Rison

Funding acknowledgement:

This work was supported by Barts Charity and Health Data Research UK, an initiative funded by UK Research and Innovation, Department of Health and Social Care (England) and the devolved administrations, and leading medical research charities. RM is supported by Barts Charity (MGU0504). CC, ZR-E and OR are grateful for funding from the National Institute for Health Research (NIHR). ZR-E was also supported by British Heart Foundation Clinical Research Training Fellowship No. FS/17/81/33318. OR is also supported by a Drayson Research Fellowship. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.