Study Suggests Half a Million Missed Out on Blood Pressure Drugs During COVID-19 Pandemic

A ambulance drives from St Thomas' Hospital in London on Jan. 07, 2022. (Dan Kitwood/Getty Images)

Thousands more heart attacks and strokes may occur in Britain as almost half a million missed the opportunity to start taking blood pressure drugs during the COVID-19 pandemic, a study suggested.

The article, which was published on Jan. 19 in Nature Medicine, also said thousands could have missed out on cholesterol-reducing drugs every month.

The analysis was carried out by researchers at the BHF Data Science Centre—a unit within the Health Data Research UK (HDRUK) that was set up in partnership with the British Heart Foundation (BHF).

Using prescription data as a proxy to estimate the impact of the COVID-19 pandemic on the management of cardiovascular disease (CVD), researchers analyzed 1.32 billion records of community-dispensed CVD medications to 15.8 million people from England, Scotland, and Wales between April 2018 and July 2021.

The study showed that 491,306 fewer individuals started blood pressure-lowering treatment between March 2020 and July 2021 than “would have been expected had 2019 incident treatment levels sustained,” the article said.

If these people remain untreated during their lifetime, there will be an estimated  13,662 additional CVD events, including 2,281 heart attacks and 3,474 strokes, the researchers calculated, using the National Institute of Health and Care Excellence (NICE) hypertension treatment model.

The study went on the say that if these people can be diagnosed and treated within five years, the number of additional CVD events would be reduced to 2,716, “suggesting that at least 1,554 MIs and 3,014 strokes can be avoided.”

Researchers said the estimates were “conservative” as they did not take into account other risk factors such as missing cholesterol-lowering and diabetes drugs.

Lockdowns

At the start of the COVID-19 pandemic, Britons were told to “flatten the curve” and “protect the NHS” by staying at home in a bid to avoid getting infected with the novel coronavirus.

Elective treatments were delayed, and check-ups and diagnostics were also delayed or missed either due to capacity issues or patients’ fear of contracting COVID-19.

COVID-19 restrictions were broadly similar in England, Scotland, and Wales during the first three months of the pandemic with the rules becoming varied later on.

The first national lockdown in March appeared to have had a significant impact on the number of medicines prescribed.

Examining the dispensing of CVD medications in four subgroups—insulin and drugs for high blood pressure, high cholesterol, and Type 2 diabetes (T2DM), researchers found a downward trend over the course of 2020 and into 2021, “suggesting a decline in the active management of CVD in the population.”

Immediately before the first lockdown, there was “a sharp increase” in the prescription of CVD medications, similar to the spikes usually seen before Christmas, but the numbers didn’t drop quickly as they usually would following Christmas.

Looking at the number of incident CVD medications, meaning drugs first dispensed to new patients, the figure showed a steep drop in three of the four subgroups when the first lockdown occurred.

After the easing of restrictions in May 2020, there was a “slow recovery in incident medications,” but the recovery plateaued with the second and third national lockdowns in England on Nov. 5, 2020, and Jan. 6, 2021, respectively, the study said.

In the first half of 2021, incident medications “continued to recover” with a spike March coinciding with the end of the “stay at home” message, the study said, noting that the levels remained “markedly lower than in the pre-pandemic period.”

Between January and June 2021, an average of 27,070 fewer patients were starting to use blood pressure-lowering drugs each month than in the same months in 2019, while the average monthly decline in incident cholesterol-lowering drugs was 16,744, figures show.

During the same period, there were increases in the average monthly incident dispensing of T2DM and insulin, by 623 and 17, respectively.

Lead author Professor Reecha Sofat, associate director at the BHF Data Science Centre ad Breckenridge chair of Clinical Pharmacology at the University of Liverpool, defended the government’s COVID-19 restrictions, saying they were “necessary and undoubtedly saved lives.”

She praised the NHS for the “incredible work” it is already doing towards “identifying people with high blood pressure as early as possible,” but stressed the focus needs to “be sustained in the long-term.”

“Detecting these risk factors early and beginning medication where appropriate is crucial to manage them, helping more people to avoid a preventable heart attack or stroke so they can live in good health for longer,” she said.

BHF Associate Medical Director and Consultant Cardiologist Dr. Sonya Babu-Narayan called for the enabling of patients to “know their numbers—particularly their blood pressure and cholesterol,” so they can “access the help they need when they need it.”

Speaking recently to The BBC on cholesterol-lowering drug Statin, Consultant Cardiologist Dr. Aseem Malhotra said it works the best for “people who have had a heart attack or high risk,” adding that his research found that a healthy lifestyle is the best way to prevent and manage heart disease.