After many years of good management of their high blood pressure, Americans are letting that control slip: the number of Americans with uncontrolled blood pressure rates has been rising. And while this trend has been creeping up since 2015, Covid-19, as with most things today, seems to have left its mark.

These increasing numbers aren’t confined to adults. Children, as young as first grade, are being diagnosed with high blood pressure. And yes, the ranks of children with high blood pressure are growing.

These hypertension numbers are in lock-step with the rising rates of obesity.

Going up

After surveying more than 18,000 adults over two decades, researchers reported in JAMA this fall that the proportion of people with controlled high blood pressure rose from 31.8% in 1999 to 48.5% by 2008. That figure dipped by 2018 to 43.7%.

Anecdotally, the pandemic has apparently had an impact. According to Livongo, a chronic care management company in California, the majority of its 410,000-plus members have high blood pressure, and their numbers also are growing.

Livongo surveyed its members from September 2019 through August 2020.

Until the end of January 2020, the average percentage of members with high blood pressure was 62%. The percentage peaked at 67% when the first case of Covid-19 was announced in the US, climbed to 68% in early April, when the CDC recommended wearing face masks. By August, the percentage had settled to 65% of members.

And then there are the children. Hypertension is a growing problem in children, especially with the growing rate of obesity, said Griffin P. Rodgers, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases, and Gary H. Gibbons, MD, of the National Heart, Lung and Blood Institute, both in Bethesda, MD, in a podcast.

Hypertension in children aged six to 11 has increased to 19% and in adolescents, 21%. The physicians acknowledged that obesity is a complex problem, with no consistent treatment other than bariatric surgery, which is not an option for the vast majority of people, including children.

Hypertension makes you vulnerable

Stress and anxiety over health concerns and the economy are not causes of sustained high blood pressure, but they can trigger unhealthy habits such as smoking, drinking alcohol and overeating, that can raise blood pressure, according to the Mayo Clinic

And having hypertension can make you more vulnerable if you have Covid-19.

According to a report published in May in the Journal of Human Hypertension, hypertension is the most common comorbidity related to early cases of Covid-19 in China and the US. Covid-19 patients with high blood pressure were more likely to be hospitalized and have poor outcomes, said the report.

Access to a physician

People with regular access to a physician have better control of blood pressure; getting cuffed is usually the first event that occurs in a doctor’s office.

But some American’s access to that doctor’s office is shutting. In a recent JAMA podcast, Howard Bauchner, MD, professor of pediatrics at the Boston University School of Medicine, said the loss of employment during the pandemic could mean many Americans are losing access to health care, and control of their hypertension levels.

Other reasons for increased hypertension

Poor diet and lack of exercise are two major causes of high blood pressure. Walking is normally a cheap and easy way to get some exercise, it can also reduce stress. But many Americans do not have access to safe places to exercise. And lock downs only make taking a stress-free walk more stressful.

As for food, opting for French fries as opposed to lean chicken and roasted vegetables can increase a person’s intake of salt or lead to obesity, both of which can raise blood pressure.

The pandemic and food insecurity

The pandemic has planted many working Americans, and schoolchildren, in front of the computer for hours. Prepared food and groceries can be delivered to the door, which eliminates walking from the car to the restaurant and roaming the aisles of the grocery store.

Now, some Covid-19 restrictions make these even less accessible.

Children who eat their only nutritious meal of the day at school are at greater risk when schools are closed. They are also missing out on recess.

Many people refer to weight gain during the pandemic as their “Covid 15,” said Eric Adler, MD , director of cardiac transplant and mechanical circulatory support at UC San Diego Health.

“The lifespan for Americans decreased for the first time last year and so many children already have diabetes,” he told Medical Daily. “… Physicians are like firefighters now. We are attempting to put out fires that should never have even started.”

Prevent high blood pressure now

High blood pressure has few symptoms. Sometimes people get headaches, but often they have no idea that their pressure is high. Uncontrolled high blood pressure can cause hemorrhagic strokes, when the force of the high blood pressure causes blood vessels in the brain to burst.

There are programs to help with feeding your family. Alexandra Schweitzer, senior fellow at the Harvard Kennedy School, told Medical Daily that “doctors’ offices are screening patients for food insecurity and can refer patients to local resources.” The Feeding America website has information on finding food banks. Ms. Schweitzer said food banks have reported an increase in users, even in higher income neighborhoods.

Many health plans recognize that prevention is much cheaper than treating hypertension, obesity and diabetes. Some health plans have programs to help their members who have difficulty meeting healthy eating objectives. These resources can include nutrition counseling, home food delivery for high-risk members, and food tailored to medical needs.

If your access to fresh, healthy food is limited, there are federal programs such as SNAP and WIC. Do whatever you can to avoid obesity and hypertension, because, as Dr. Adler said, “There is no do-over with a stroke.”

Yvonne Stolworthy, MSN, RN graduated from nursing school in 1984 and has spent many years in critical care and as an educator in a variety of settings, including clinical trials.