Influence of stress induced by the first announced state of emergency due to coronavirus disease 2019 on outpatient blood pressure management in Japan

Abstract

To prevent further spread of coronavirus disease 2019 (COVID-19), the Japanese government announced a state of emergency, resulting in major stress for the population. The aim of this study was to investigate a possible association between changes in daily stress and blood pressure (BP) in Japanese patients. We retrospectively investigated 748 patients with chronic disease who were treated by the Sagamihara Physicians Association to determine changes in stress during the COVID-19 state of emergency from 7 April to 31 May 2020. During the state of emergency, office BP significantly increased from 136.5 ± 17.5/78.2 ± 12.0 to 138.6 ± 18.6/79.0 ± 12.2 (p < 0.001 and p = 0.03, respectively). In contrast, home BP significantly decreased from 128.2 ± 10.3/75.8 ± 8.8 to 126.9 ± 10.2/75.2 ± 9.0 (p < 0.001 and p = 0.01, respectively), and the ratio of white coat hypertension was significantly increased (p < 0.001). Fifty-eight percent of patients worried about adverse effects of hypertension as a condition contributing to the severity and poor prognosis of COVID-19; decreased amounts of exercise and worsened diet compositions were observed in 39% and 17% of patients, respectively. In conclusion, a significant increase in office BP with the white coat phenomenon was observed during the state of emergency, as well as an increase in related stress. To prevent cardiovascular events, general practitioners should pay more attention to BP management during stressful global events, including the COVID-19 pandemic.

Impact of the first announced state of emergency owing to coronavirus disease 2019 on stress and blood pressure levels among patients with type 2 diabetes mellitus in Japan

“…The present study was a subanalysis of our previous study 4 and involved the same patients. Retrospectively, we scrutinized 748 patients with chronic diseases who were treated by the Sagamihara Physicians Association to determine changes in stress during the state of emergency due to COVID‐19 from 7 April to 31 May 2020.…”

“…Although the COVID‐19 pandemic differed from conventional natural disasters, it is thought that the state of emergency caused increased stress among the people in Japan. We previously reported an increase in blood pressure (BP) after the state of emergency announcement among outpatients who visited clinics in Japan 4 . We also reported that the increase in BP was related to worsening dietary intake.…”

Delicate but significant changes in blood pressure—the importance of clinical research by frontline clinicians

“…Although there were several potential limitations, the study by Kobayashi et al [7] drove research activities in Japan, which may be why the reviewers thought highly of the results of this study. Unlike other countries, the number of noncommercial clinical studies conducted in Japan began to decrease in 2018 [12].…”

“…Kobayashi et al reported changes in conventional office and self-measured home blood pressures among patients before and during the COVID-19 pandemic based on a clinical observational study conducted by practitioners in Sagamihara, Kanagawa prefecture, which was the suburb of the Tokyo metropolitan area [7]. Of the 919 assessed patients, 748 were set as the study population to be analyzed.…”

“…The study group further collected a questionnaire regarding the change in stress by the declaration of emergency among the same 748 patients (the month and date were not given) [7]. Unfortunately, very few clinically meaningful results were reported.…”