Impact of COVID-19 on Australians with hypertension

Ten months into the  COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is unclear how people with hypertension are coping, given their increased risk. A retrospective case-control study compared people with hypertension to matched healthy controls during COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and prevention intentions. The study is published on the preprint server medRxiv* in October 2020.

Image Credit: Angellodeco / Shutterstock
Image Credit: Angellodeco / Shutterstock

CVD and Increased Risk

Many papers have concluded that people with cardiovascular disease (CVD) are at high risk for severe and critical COVID-19 and higher mortality risk from the disease. One reason is that CVD is likely to be associated with a greater chance of comorbidities, which raises the odds of COVID-19-related complications. Secondly, COVID-19 itself causes cardiovascular damage.

These risks have been given ample attention in the coverage of the pandemic. Some clinicians and public health authorities have raised the concern that the fear of being infected with SARS-CoV-2 may deter people with CVD from visiting their doctors or getting the right treatment for their health condition.

Exploring Anxiety Among Hypertensives

The current study explores heightened feelings of being at high risk, anxiety, and the intention to take preventive action during the lockdown and other restrictions due to COVID-19, with the aim of providing data that could shape public health messages in this group of people.

The researchers used data from an Australian national survey to construct two groups, cases, and controls. The cases were patients with hypertension. The baseline data came from April 2020 when the lockdown was in force. The second round of data came from June 2020 and covered only a subset after relaxed restrictions.

The study group included 466 hypertensive patients matched to healthy individuals as controls with similar age, sex, education, and health awareness. In the second round, 147 of these hypertensives were followed up and matched again.

The researchers measured anxiety, risk perceptions, and intention to prevent risk using appropriate scales. At baseline, the participants were asked whether and how much they took the COVID-19 situation seriously. In the follow-up round, the question was framed more specifically to cover the pandemic's health risk globally and in Australia. This narrowing was to account for the different patterns of responses to the outbreak in different countries.

The baseline group participants had an average age of 53 years, with the male: female ratio being almost equal. A little below two-thirds had a university degree, and 92% were aware of the health situation. Their average patient activation score resembles that of other groups of patients.

Over 75% of patients with hypertension in this group were on antihypertensive medication. Almost half had refilled their prescriptions during the lockdown, while 5% had shifted to a longer prescription.

Risk perceptions Increased Among Hypertensives

The baseline data shows a high-risk perception among the hypertensive group, with the risk perception score being 7.7/10. This group thought that the mortality among COVID-19 patients was 7%, with mild symptoms being experienced by 63%. At this point, the controls also shared similar perceptions.

In the second survey, hypertensives had a slightly lower risk perception score at 6.1/10. Still, the controls now had a risk perception of only 5.5/10 when asked about Australia's health risk by the pandemic. This did not apply to the situation in the world at large.

Anxiety Higher Among Hypertensives At the Beginning of Lockdown

Over 75% of this group felt nervous or anxious about the pandemic at least once, with a score of 40.75, which was 1.9 units higher on average than the score among the control group, at 38.85.

During the second round, the difference between the two groups was no longer significant, with the score among hypertensives and controls being 37 and 38, respectively.

Prevention Behaviors Show Mixed Tendency

The hypertensives had a strong tendency to socially distance for their own and others' health. About 40% and 33% said they went out of their homes a few times a week and once a day, respectively.

About 83% of the group was willing to take the flu vaccine, but when a vaccine for COVID-19 became available, 87% said they would get it. The hypertensive subset was 52% more likely to have got the flu shot or be willing to get it, compared to the controls.

This difference was not seen with the COVID-19 vaccine. Neither were hypertensives different from the controls in their willingness to keep on with social distancing or leaving the house.

However, by the time of the second survey, both hypertension and control groups had almost the same chance of getting the flu vaccine, and over 80% said they would get the vaccine, whether the flu shot or the COVID-19 vaccine.

Implications

This Australian study shows that unusually high anxiety levels were common during the lockdown, with hypertensives having a higher risk. The Australian Bureau of Statistics found a doubled prevalence of anxiety in the general population in April 2020 compared to that in 2017-18.

While anxiety may be an appropriate response during this kind of situation, it may give rise to mental ill-health among certain high-risk groups and therefore warrant giving such groups higher priority in mental screening. The greater willingness among the hypertensives to accept flu vaccine during the lockdown, compared to controls, was not reflected in the attitude to a COVID-19 vaccine.

Nonetheless, both groups were found to have a high level of acceptance of both vaccines, even at the beginning of the lockdown, and this did not decline after the lifting of restrictions when a reduced level of risk perception and anxiety was observed been expected.

This large nation-wide study used data from before and after the lockdown, enabling direct comparisons to be made between participants with self-reported hypertension and controls without this condition. However, this may have a reduced generalizability level since the sample did not contain many participants from different cultural and linguistic backgrounds.

The researchers point out, "In Australia, where lockdown effectively reduced the spread of COVID-19 and restrictions eased relatively quickly, these differences dissipated after two months, but locations with prolonged restrictions may require targeted psychological screening for vulnerable groups."

However, the high level of willingness to accept vaccinations is a sign that the population at large is favorably disposed to take measures to prevent COVID-19.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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