Background: Restrictions imposed by the government of the United Kingdom (UK) to control the spread of COVID-19 had a profound impact on healthcare delivery. The extent to which these restrictions may have impacted screening and treatment for hypertension (HT) in primary care is understudied.
Objectives: To describe the impact of the COVID-19 pandemic on HT diagnosis and treatment in primary care.
Methods: We used the UK’s Clinical Practice Research Datalink to form a cohort of all adult patients registered at a contributing practice between Jan 2011 and Mar 2022. To describe the impact of the pandemic on HT diagnosis, we calculated monthly incidence rates of HT during our study period and compared them to expected rates based on 10-year historical trends. To generate expected rates we fit a negative binomial regression model to monthly event counts from Jan 2011 to Feb 2020, then computed predicted rates between Mar 2020 and Mar 2022. The model used the natural logarithm of person-months at risk as offset and included terms for calendar month and number of months since Jan 2011, with stratification by sex and UK nation (England, Scotland, Wales, North Ireland). Using the same model, we also compared observed vs. expected monthly rates of antihypertensive medication (AHM) initiation and change.
Results: HT incidence rates were stable with minor seasonal variation before the pandemic, averaging 74/100,000 person-months (SD: 9.3) from Jan 2011 to Feb 2020. In Apr 2020, the first full month of lockdown, rates fell to their minimum of 28/100,000 person-months, a 65% (95%CI 64%-67%) reduction compared to historical trends. Rates recovered slowly but did not return to expected levels until Nov 2021. Reductions did not vary by sex but did vary by nation. North Ireland had the greatest reduction (74%; 95%CI 72%-76%) and Scotland the smallest (54%; 95%CI 52%-57%), while England and Wales were similar to the overall (66%; 95%CI 65%-67% and 68%; 95%CI 66%-70%). In Apr 2020, there was a 39% (95%CI 37%-42%) decrease in the rate of AHM initiation. However by Jul 2020 patients initiated AHMT at a rate 42% higher than expected, and rates remained above historical trends thereafter. Reductions were similar in men and women. North Ireland had the largest decrease in initiation rates in Apr 2020 and the slowest recovery. A similar pattern was observed for AHM change with a 45% (95%CI 42%-49%) rate reduction in Apr 2020 and quick rebound above historical values, with no difference by sex. All regions had similar reductions in Apr 2020, but North Ireland rebounded much higher in Jul 2020.
Conclusions: The COVID-19 pandemic had a significant impact on primary care for HT. Rates of new diagnoses were more adversely affected than rates of AHM initiation or change.
