Increased Resting and Peak Exercise Systolic Blood Pressure in Children Throughout the COVID-19 Pandemic

Abstract

The COVID-19 pandemic created significant disruptions to daily life. Lockdown effects resulted in decreased exercise capacity and increased blood pressure in adults and adolescents in the first year of the pandemic. We examined changes in exercise capacity (peak workload, ventilatory anaerobic threshold-VAT, and VO₂ peak), resting BP, and peak exercise BP in children before the COVID-19 pandemic and throughout five 6-month intervals of the pandemic. 951 maximal cardiopulmonary exercise tests completed by healthy children aged ≤ 18 years were analyzed retrospectively. BP was auscultated. Tests were divided into pre-pandemic and six-month intervals starting from the declaration of the pandemic (Interval 1: March 11 2020-August 2020, Interval 2: September 2020-February 2021, Interval 3: March-August 2021, Interval 4: September 2021-February 2022, Interval 5: March-August 2022). Peak workload, VAT, and VO₂ peak were unchanged from pre-pandemic baseline until Interval 3, when they were significantly decreased. Exercise capacity then returned to values unchanged from baseline. Peak exercise systolic BP was significantly higher than baseline in Intervals 2, 4, and 5. Resting systolic BP was significantly higher than baseline in Interval 5. There was no significant difference in age, sex, BMI, or peak exercise heart rate between intervals. Peak exercise BP was elevated above pre-pandemic baseline when exercise capacity was unchanged. The decrease in exercise capacity subsequently resolved, but the increase in post-exercise BP remained in Intervals 4 and 5. An increase in peak exercise BP preceded a small but significant increase in resting systolic BP.

Keywords: Blood pressure; COVID-19; Children; Exercise capacity; Hypertension.