COVID pandemic impact on hypertension management in North-East London: an observational cohort study using electronic health records (preprint)

Background: The COVID19 pandemic had a major impact on primary care management of long-term conditions such as hypertension. This observational cohort study of adults with hypertension registered in 193 primary care practices in North-East London between January 2019 and October 2022 investigated the impact of the COVID19 pandemic on the treatment and control of blood pressure including demographic and social inequities. Method and findings: In 224,329 adults with hypertension, the proportion with a blood pressure (BP) recorded within the preceding 1 year fell from a 91% pre-pandemic peak to 62% at the end of the pandemic lock-down phase and improved to 77% by the end of the study. The proportion with controlled hypertension (<80 years old, BP <=140/90mmHg; 80 or more years old: <=150/90mmHg) for the same time points was 81%, 50% and 60% respectively. Using 'blood pressure control' (which considered only patients with a valid blood pressure recording) as the indicator attenuated the reduction to 83%, 80% and 78% respectively. The study used multivariable logistic analysis at four representative time points (Pre-pandemic: April 2019; Pre lockdown: April 2020; Lockdown: April 2021; Post-lockdown: April 2022) to identify temporal, clinical and demographic influences on blood pressure monitoring and control. Pre-pandemic inequities in the management of hypertension were not significantly altered by the pandemic. Throughout the pandemic phases, in comparison to the White ethnic group, the Black ethnic group was less likely to achieve blood pressure control (ORs 0.81 [95% CI = 0.78 to 0.85, p-value<0.001] to 0.87 [95% CI = 0.84 to 0.91, p-value<0.001]). Conversely, the Asian ethnic group was more likely to have controlled blood pressure (ORs 1.09 [95% CI = 1.05 to 1.14, p-value<0.001] to 1.28 [95% CI = 1.23 to 1.32, p-value<0.001]). Younger, male, more affluent individuals, individuals with unknown or unrecorded ethnicity or those untreated were less likely to have blood pressure controlled to target throughout the study. Conclusion: The COVID pandemic had a greater impact on blood pressure recording than on blood pressure control. Although recording and control have improved, these had not returned to pre-pandemic levels by the end of the study period. Ethnic inequalities in blood pressure control persisted during the pandemic and remain outstanding.

Suspected COVID-19 in primary care: how GP records contribute to understanding differences in prevalence by ethnicity. (preprint)

Abstract Background The first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focussed on severe presentations, intensive care capacity, and the timely supply of equipment. General practice has seen a rapid take up of technology to allow virtual consultations, enabling the management of mild and moderate community cases. Aim To quantify the prevalence and time-course of suspected COVID-19 presenting to general practices during the London epidemic. To report disease prevalence by ethnic group, and explore how far differences by ethnicity can be explained by data in the electronic health record (EHR). Design and Setting Cross-sectional study using anonymised data from the primary care records of 1.3 million people registered with 157 practices in four adjacent east London clinical commissioning groups (CCGs). The study area includes 48% of people from ethnic minorities and is in the top decile of social deprivation in England. Method Suspected COVID-19 cases were identified using SNOMED codes. Explanatory variables included age, gender, self-reported ethnicity and measures of social deprivation. Clinical factors included 16 long-term conditions, latest body mass index and smoking status. Results There were 8,985 suspected COVID-19 cases. Ethnicity recording was 78% complete. Univariate analysis showed a two-fold increase in odds of infection for South Asian and Black adults compared to White. In a fully adjusted analysis, including clinical factors, the odds were: South Asian OR 1.93 (95% CI = 1.83 to 2.04) Black OR 1.47 (95% CI 1.38 to 1.57) Conclusions Using data in GP records Black and south Asian ethnicity remain as predictors of community cases of COVID-19, with levels of risk similar to hospital admission cases. Further understanding of these differences requires social and occupational data.