Effect of the COVID-19 Epidemic on the Association Between Antihypertensive Drug Interruption and the Risk of Major Cardiovascular Event in France

BACKGROUND: The COVID-19 pandemic disrupted healthcare access, potentially impacting cardiovascular prevention by increasing and worsening interruptions in antihypertensive treatment. In this context, we aimed to assess whether the epidemic had modified the effect of antihypertensive interruptions on the risk of major cardiovascular events (MACE). METHODS: From the nationwide SNDS French health insurance databases (2018/01/01-2021/12/31), we identified patients with ≥1 year of continuous antihypertensive drug use. We then constituted a group of patients who interrupted an antihypertensive during the period (interrupters) i.e., who presented with a treatment gap for at least one antihypertensive (entry date: interruption date). Interruption length defined was defined as time to treatment restart. After 1:1 matching, we constituted a second group of patients with continuous antihypertensive treatment at interrupters entry date (persisters; entry date: interrupter entry date). Associations between MACE risk, antihypertensive drug interruption (all durations, ≥15 days, ≥30 days), COVID epidemic period, and the interaction between these were assessed using GEE multivariable models. RESULTS: A total of 2,072,672 interrupter/persister pairs were included (4,145,344 patients; 43.6% in COVID period). Risk of MACE was not found increased after interruptions overall (OR = 0.99; 95%CI [0.97-1.02]); it was when interruptions lasted at least fifteen days (OR = 1.03 [1.01-1.06]) and during the COVID period independently of the existence of interruptions (OR = 1.44 [1.39-1.50]; P-value for interaction: all interruptions 0.69, exceeding 15 days 0.65). CONCLUSIONS: The COVID epidemic period was associated with an increased risk of MACE or all-cause death in antihypertensive drug users without worsening the effect of antihypertensive drug interruptions.