Abstract Body: Introduction: The prevalence of blood pressure (BP) control of <140/90 mmHg in the Veterans Health Administration (VHA) in the early 2000s was high (>75%). However, the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP guideline and COVID-19 pandemic may have affected pre-and-post treatment BP.
Research Question: Were there changes in pre-and-post treatment systolic BP (SBP, mmHg) and control prevalence relative to the 2017 BP guidelines and COVID-19 pandemic?
Methods: Our retrospective study included Veterans initiating antihypertensive medication in VHA outpatient settings from 11/13/2014-11/12/2020. Using the first antihypertensive prescription fill date, Veterans were placed into one of 4 cohorts (Panel A): 1) pre-ACC/AHA 2017 guideline; 2) first year post-guideline; 3) second year post-guideline (included first confirmed US COVID case); and 4) during-COVID. Linear and logisitc regression estimated age- and dropout-adjusted mean SBP levels and likelihood of BP control at 1 year.
Results: Among 94,551 Veterans included (mean age 65 years, 94% male, 69% non-Hispanic White), 68.5% had pre-treatment SBP ≥130. In this group, over time, the mean pre-treatment SBP decreased and post-treatment SBP increased (Panel B). Overall, the respective proportion in each cohort with 1-year BP control of <130/80 was 31.3%, 33.1%, 32.5%, and 31.5% (p-trend=0.16) (Panel C). Assessment of 1-year BP control of <140/90 was 72.7%, 74,4%, 74.0%, and 71.8% (p-trend=0.91). The prevalence of 1-year BP control pre- and during-COVID was 31.8% vs 31.5% (p=0.44).
Conclusions: Mean post-treatment SBP levels and 1-year BP control prevalence were stable after the release of the 2017 guideline and during the COVID-19 pandemic.