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Indirect effect of the COVID-19 pandemic on cardiovascular diseases incidence, mortality, and healthcare use among patients with hypertension but without SARS-CoV-2 infection in Hong Kong: an interrupted time series analysis

Hypertension Research volume 48, pages 2197–2208 (2025)Cite this article

Abstract

This study investigated the effects of the COVID-19 pandemic on cardiovascular disease (CVD) incidence among hypertensive patients without SARS-CoV-2 infection by changes in CVD incidence, all-cause mortality, blood pressure (BP) control, and healthcare utilization rates among this population from Hong Kong. Individuals diagnosed with hypertension from January 2010 to January 2020 were followed up until death, SARS-CoV infection, or April 2022. Interrupted time series analyses on 1,318,907 patients with hypertension, comparing outcomes across four periods: pre-pandemic (January 2012–January 2020), early pandemic (February 2020–February 2021), interwave (March–December 2021), and Omicron outbreak (January–April 2022). A significant increase in out-of-hospital mortality was found when the early pandemic started. Overall all-cause mortality increased progressively during the interwave period. CVD incidence decreased immediately in the early pandemic period, followed by a progressive increase, and surpassed the pre-pandemic level at the beginning of the interwave period. The proportion of patients with office-measured BP ≤ 140/90 mmHg remained below pre-pandemic levels across the pandemic periods. Healthcare utilization declined immediately in February 2020, while most utilization rebounded to the pre-pandemic level after March 2021 and declined again during the Omicron outbreak. Healthcare disruptions during the early pandemic likely delayed CVD diagnosis and treatment, driving an immediate rise in out-of-hospital mortality. When healthcare services gradually recovered in the interwave period, CVD incidence rebounded and both in and out-of-hospital all-cause mortality increased with a lag, possibly related to delayed treatment.

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Funding

This work was supported by the Health Bureau, the Government of HKSAR (grant no: COVID19F08).

Author information

Author notes

  1. These authors contributed equally: Zhuoran Hu, Yuk Kam Yau

Authors and Affiliations

  1. Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Zhuoran Hu, Yuk Kam Yau, Ivy Lynn Mak, Cindy Lo Kuen Lam & Eric Yuk Fai Wan

  2. Division of Health Economics, Policy and Management, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Jianchao Quan & Karen Ann Grépin

  3. Business School, The University of Hong Kong, Hong Kong, China

    Jianchao Quan

  4. Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Gary Kui Kai Lau & Chak Sing Lau

  5. Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Ian Chi Kei Wong & Eric Yuk Fai Wan

  6. Advanced Data Analytics for Medical Science Limited, Hong Kong, China

    Ian Chi Kei Wong & Eric Yuk Fai Wan

  7. Aston Pharmacy School, Aston University, Birmingham, United Kingdom

    Ian Chi Kei Wong

  8. Department of Family Medicine and Primary Health Care, United Christian Hospital, Kowloon East Cluster, Hospital Authority, Hong Kong, China

    David Vai Kiong Chao

  9. Department of Family Medicine and Primary Healthcare, Hong Kong West Cluster, Hospital Authority, Hong Kong, China

    Welchie Wai Kit Ko

  10. Department of Family Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

    Cindy Lo Kuen Lam

  11. The Institute of Cardiovascular Science and Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong, China

    Eric Yuk Fai Wan

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Contributions

ZH and YKY had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. ZH and YKY collected and prepared the data, ZH and YKY performed the data analysis, and ZH performed the visualization. ZH and YKY wrote the manuscript with feedback from CLKL, EYFW, JQ, KAG, ILM, GKKL, ICKW, DVKC, WWKK, CSL, CLKL, and EYFW. EYFW, CLKL, JQ obtained funding from Hong Kong. All authors interpreted the findings, provided a critical review of important intellectual content, and approved the final version.

Corresponding author

Correspondence to Eric Yuk Fai Wan.

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Conflict of interest

EYFW has received research grants from the Health Bureau, the Hong Kong Research Grants Council, Narcotics Division, Security Bureau, Social Welfare Department, Labour and Welfare Bureau of the Government of the Hong Kong SAR and National Natural Science Foundation of China; serves on member of Core Team for Expert Group on Drug Registration of Pharmacy and Poisons Board, and is the director of Advance Data Analytics for Medical Science (ADAMS) Limited (HK). These are outside the submitted work. I.C.K.W. received research grants from Amgen, Janssen, GSK, Novartis, Pfizer, Bayer and Bristol-Myers Squibb and Takeda, Institute for Health Research in England, European Commission, National Health and Medical Research Council in Australia, The European Union’s Seventh Framework Programme for research, technological development, Research Grants Council Hong Kong and Health and Medical Research Fund Hong Kong; consulting fees from IQVIA and World Health Organization; payment for expert testimony for Appeal Court in Hong Kong; serves on advisory committees for Member of Pharmacy and Poisons Board; is a member of the Expert Committee on Clinical Events Assessment Following COVID-19 Immunization; is a member of the Advisory Panel on COVID-19 Vaccines of the Hong Kong Government; is the non-executive director of Jacobson Pharma Corp. Ltd. in Hong Kong; and was the founder and director of Therakind Limited (UK), currently a director of Advance Data Analytics for Medical Science (ADAMS) Limited (HK) and OCUS Innovation Limited (HK, Ireland and UK).

Ethical approval

This study was approved by the Severance Hospital Institutional Review Board (IRB No. 4-2022-0248) and the Institutional Review Board of the University of Hong Kong Hospital Authority Hong Kong West Cluster (ref.: UW 21-297).

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Hu, Z., Yau, Y.K., Quan, J. et al. Indirect effect of the COVID-19 pandemic on cardiovascular diseases incidence, mortality, and healthcare use among patients with hypertension but without SARS-CoV-2 infection in Hong Kong: an interrupted time series analysis. Hypertens Res 48, 2197–2208 (2025). https://doi.org/10.1038/s41440-025-02230-y

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