Blood pressure trends and disparities across the COVID-19 pandemic in a large diverse urban population

The COVID-19 pandemic disrupted healthcare systems, daily routines, and socioeconomic conditions, potentially increasing systolic blood pressure (SBP) at the population level. Understanding long-term SBP trends is critical to inform hypertension management and address pandemic-exacerbated disparities. We performed a retrospective study using interrupted time series analyses of electronic medical records from the Montefiore Health System (January 2017-August 2024). Adults with in-person outpatient visits were included in the primary analysis of comparing SBP trends post-onset of pandemic to pre-pandemic. Secondary analyses stratified by age, sex, race/ethnicity, and neighborhood-level socioeconomic indicators. Among 789,897 patients with 8,207,177 outpatient SBP measurements (55.0 ± 18.4 years old; 66.5% female), SBP increased by 1.69 mmHg (95% CI, 1.59-1.78; P < 0.001), and did not return to pre-pandemic levels until 16 months later. Racial/ethnic minorities experienced larger pandemic-related SBP increases (P < 0.05). Patients from lower socioeconomic neighborhoods had greater SBP increases than residents of higher socioeconomic neighborhoods (P < 0.05). The COVID-19 pandemic was associated with sustained population-level increases in SBP, disproportionately affecting racial/ethnic minorities and lower socioeconomic groups. These findings highlight the need for targeted interventions to mitigate long-term cardiovascular risks and reduce exacerbated health disparities.