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Comment on “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”

Hypertension Research volume 48, pages 3303–3304 (2025)Cite this article

Dear Editor, the publication on “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 [1].” Although this study has many advantages, such as a large sample size of over 1.3 million people and long-term follow-up data covering more than 10 years, which improves its reliability and policy relevance, it also has significant shortcomings, particularly its observational design. Even with an interrupted time series analysis adequate for policy contexts, causal linkages cannot be readily identified, and it fails to account for critical confounders such as changes in health behaviors or population stress levels at the time.

In terms of statistics, while the four-phase approach allows for an understanding of the dynamics of impacts during different stages of the pandemic, there is a lack of additional information on confidence intervals and sensitivity analysis to assess the robustness of the results, such as how the results would change if the BP measurement criteria or CVD definition were changed. Furthermore, relying simply on data from healthcare service recipients may bias the results by excluding the private sector access population.

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Data availability

The data that support the findings of this study are available from the corresponding author, Daungsupawong H, upon reasonable request.

Reference

  1. Hu Z, Yau YK, Quan J, Grépin KA, Mak IL, Lau GKK, 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. 2025. https://doi.org/10.1038/s41440-025-02230-y.

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Authors and Affiliations

  1. Private Academic Consultant, Phonhong, Lao People’s Democratic Republic

    Hinpetch Daungsupawong

  2. Department of Community Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth (Deemed to be University), Pune, India

    Viroj Wiwanitkit

Authors
  1. Hinpetch Daungsupawong
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  2. Viroj Wiwanitkit
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Contributions

HP 50% ideas, writing, analyzing, approval. VW 50% ideas, supervision, approval.

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Correspondence to Hinpetch Daungsupawong.

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Daungsupawong, H., Wiwanitkit, V. Comment on “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”. Hypertens Res 48, 3303–3304 (2025). https://doi.org/10.1038/s41440-025-02279-9

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  • DOI: https://doi.org/10.1038/s41440-025-02279-9

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