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Nearly 500,000 Missed Out on Antihypertensive Drugs During Pandemic

Nearly half a million people missed out on starting medication to lower their blood pressure during the COVID-19 pandemic, said UK researchers.

For the new study, published in Nature Medicine, the researchers set out to investigate the impact of the Covid-19 pandemic on the management of risk factors for heart and circulatory diseases.

The authors explained that, for their research, they used medication data as a proxy for cardiovascular disease (CVD) management using routinely collected, de-identified, individual-level data comprising 1.32 billion records of CVD medications dispensed to 15.8 million people aged 18 years and over, from England, Scotland, and Wales, between 1 April 2018 and 31 July 2021.

Decline in CVD Medication Dispensing

They identified monthly counts of prevalent and incident medications dispensed, as well as changes compared with the previous year, for several CVD-related indications, "focusing on hypertension, hypercholesterolemia, and diabetes", they said.

"Overall, we observed a downward trend in CVD medications dispensed over the course of 2020 and into 2021," the authors said, which intimated a "decline in the active management of CVD in the population".

They found that during the first half of 2021, compared with 2019, on average:

  • 27,070 fewer people commenced antihypertensive medication each month
  • 16,744 fewer people commenced lipid-lowering medication each month
  • 623 more people commenced type 2 diabetes medication each month

They stressed that these numbers could be an "underestimate" of the indirect effect of the COVID-19 pandemic, as they focussed on hypertension.

"A fuller analysis of the impact would need to include all CVD categories," they pointed out.

Professor Reecha Sofat, associate director at the BHF Data Science Centre, Breckenridge chair of clinical pharmacology at the University of Liverpool, and lead author, warned: "Measures to prevent infection spread were necessary and undoubtedly saved lives. The NHS has already taken important and positive steps towards identifying people with high blood pressure as early as possible. However, we need this focus to be sustained in the long-term to prevent any increase in heart attacks and strokes, which will add to a healthcare system already under extreme pressure."

'Surprisingly Reassuring'

The authors explained that the decline in the dispensing of antihypertensive medications between March 2020 and July 2021 represented 491,306 fewer individuals initiating treatment than expected. They predicted this could result in 13,662 additional CVD events, including 2281 cases of myocardial infarction and 3474 cases of stroke, "should individuals remain untreated over their life course".

However, identifying individuals for treatment within 5 years could reduce the total number of CVD events associated with the pandemic to 2716 CVD events, suggesting that at least 1554 myocardial infarctions and 3014 strokes could be avoided.

In light of these results, methods to identify and treat individuals who have missed treatment for CVD risk factors and remain undiagnosed are "urgently" required to avoid large numbers of excess future CVD events, they voiced.

Sir David Spiegelhalter, emeritus professor of statistics at the University of Cambridge, said that the "excellent" study was "surprisingly reassuring". 

He commented that the predicted figures of 2000 extra heart attacks and 3000 extra strokes "may sound bad", but assumed that the individuals remained untreated for their whole lives. 

"This comes out at perhaps 100 extra heart attacks a year, or two a week, which is not a big number, especially when compared with the 100,000 annual hospital admissions for heart attacks reported by the British Heart Foundation.

"This study, therefore, implies that disrupted cardiovascular prevention is playing a negligible role in current excess deaths," he alluded.

Opportunity to Step in Earlier

Professor Sofat stressed that people with cardiovascular risk factors were not being identified at the same rate as before the pandemic.

"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.

The authors explained that this is the first time that medicines data has been used to follow changes in day-to-day management of chronic conditions, and that being able to routinely track this in future, particularly during healthcare crises, would allow the NHS and policymakers to step in earlier to avoid a repeat of the impact of the COVID-19 pandemic.

Dr Sonya Babu-Narayan, consultant cardiologist, and BHF associate medical director decreed that "it's not too late to limit the damage".

"We need to make it easier and more accessible for everyone to know their numbers - particularly their blood pressure and cholesterol. This means empowering people to access the help they need when they need it so they can be supported to manage their own health."

Funding for the study was supported by the British Heart Foundation Data Science Centre at Health Data Research UK. The authors declared no competing interests.