Impact of COVID-19 first wave on blood pressure in India using National Family Health Survey data

Impact of COVID-19 first wave on blood pressure in India using National Family Health Survey data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Impact of COVID-19 first wave on blood pressure in India using National Family Health Survey data Preben Bentdal, Anagha Joshi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9342168/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Background : Understanding temporal trends and determinants of blood pressure (BP) in India is essential for designing national health strategies. Using two consecutive nationally representative surveys, NFHS-4 (2015–2016) and NFHS-5 (2019–2021), we have recently systematically examined sex/gender stratified physiological and socio-economic correlates of BP and hypertension in India. NFHS-5 survey data coincided with the COVID-19 pandemic, providing a unique opportunity to study the association between COVID-19 and BP. Methods : We first analyzed temporal trends in BP in adult men and women in India using NFHS-4 and NFHS-5. To assess comparability across cohorts, we first compared mean systolic (SBP) and diastolic BP (DBP) across matched BMI–age groups for each survey year. NFHS-5 data were further divided into pre-COVID (2019–March 2020) and post-COVID (November 2020–April 2021) subsets. Because pre- and post-COVID NFHS-5 data were collected in different states, we created state-matched NFHS-4 datasets to adjust for regional variation. We then compared SBP and DBP across four harmonized datasets to isolate the association between COVID-19 and BP changes. Results : Across all BMI–age groups, NFHS-5 showed an approximate 3 mmHg increase in SBP relative to NFHS-4, in both men and women. Year-stratified analyses revealed that BP levels in 2019 were comparable to those in 2015-16, but BP rose progressively in 2020 and 2021 in both men and women. Within NFHS-5, post-COVID BP values were consistently higher than pre-COVID values, with the largest SBP increases observed in women with low BMI (15–20). Interestingly, pre-COVID data, when compared with NFHS-4, showed the highest SBP rise in women with higher BMI (20–25). After adjusting for state-level differences using NFHS-4 datasets, SBP remained higher in NFHS-5 post-COVID across nearly all BMI–age groups in both sex/genders. The magnitude of SBP increase varied by demography, where older low-BMI women and younger low-BMI men exhibited the greatest post-COVID rise. Conclusion : BP levels in India increased between NFHS-4 and NFHS-5, with a marked rise in SBP during the COVID-19 pandemic period. These findings suggest a population-level association between the first wave of COVID-19 and elevated SBP in both men and women, across age, BMI, and regional differences. The heterogeneous impact across demographic groups needs further exploration. Blood pressure COVID-19 Socio-economic factors Healthcare policies Sex/Gender Non-communicable diseases Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFigures.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 21 Apr, 2026 Editor assigned by journal 08 Apr, 2026 Submission checks completed at journal 08 Apr, 2026 First submitted to journal 07 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9342168","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":629289359,"identity":"4592e74f-9671-4193-bab5-7ac0bac59c36","order_by":0,"name":"Preben Bentdal","email":"","orcid":"","institution":"University of Bergen","correspondingAuthor":false,"prefix":"","firstName":"Preben","middleName":"","lastName":"Bentdal","suffix":""},{"id":629289360,"identity":"a63a0f16-f2c5-469c-9aad-496a709d3cb8","order_by":1,"name":"Anagha Joshi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIie3PMQuCQBTA8RcHThe3PsmtL/BAkKKir2IEtZgEQVNEIDhFs9+jL6AITlarUFtjixBEU3RBg5M6Bt0f3nDwfjwOQKX6wTQ5TI4A4BDmgHYlEV/CPiQK6hB9UyCMA1QTOnvX23wFTIhDFA/8jgstLywnl8TqBQkwPXDteObjAoyk/BJltmVyDRhlnD5ktEGHSskwmz5M/pLklFLcrUMoc8xr04c2hQ7FjZpkyZo7tPTAoWh7xIWGk6q/TPd3/ugbQqRm/lyuXYHjsJTINATAwrNqX8byGksqlUr1z70BvDFBqnqU9ywAAAAASUVORK5CYII=","orcid":"","institution":"University of Bergen","correspondingAuthor":true,"prefix":"","firstName":"Anagha","middleName":"","lastName":"Joshi","suffix":""}],"badges":[],"createdAt":"2026-04-07 08:54:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9342168/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9342168/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108182025,"identity":"a6e55cd1-c841-4782-a203-176412f27e48","added_by":"auto","created_at":"2026-04-30 08:59:05","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1058864,"visible":true,"origin":"","legend":"","description":"","filename":"ImpactofCOVID19firstwaveonbloodpressureinIndiausingNationalFamilyHealthSurveydata.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9342168/v1_covered_d914eb2e-0163-4d98-ba48-d4b073afef2d.pdf"},{"id":108128315,"identity":"924a13d9-7509-4faa-a723-660bf65ddd95","added_by":"auto","created_at":"2026-04-29 15:41:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":2823487,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFigures.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9342168/v1/f201c40d1656060014906ffa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of COVID-19 first wave on blood pressure in India using National Family Health Survey data","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Blood pressure, COVID-19, Socio-economic factors, Healthcare policies, Sex/Gender, Non-communicable diseases","lastPublishedDoi":"10.21203/rs.3.rs-9342168/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9342168/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Understanding temporal trends and determinants of blood pressure (BP) in India is essential for designing national health strategies. Using two consecutive nationally representative surveys, NFHS-4 (2015–2016) and NFHS-5\u003c/p\u003e\n\u003cp\u003e(2019–2021), we have recently systematically examined sex/gender stratified physiological and socio-economic correlates of BP and hypertension in India. NFHS-5 survey data coincided with the COVID-19 pandemic, providing a unique\u003c/p\u003e\n\u003cp\u003eopportunity to study the association between COVID-19 and BP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: We first analyzed temporal trends in BP in adult men and women in India using NFHS-4 and NFHS-5. To assess comparability across cohorts, we first compared mean systolic (SBP) and diastolic BP (DBP) across matched BMI–age groups for each survey year. NFHS-5 data were further divided into pre-COVID (2019–March 2020) and post-COVID (November 2020–April 2021) subsets. Because pre- and post-COVID NFHS-5 data were collected in different states, we created state-matched NFHS-4 datasets to adjust for regional variation. We then compared SBP and DBP across four harmonized datasets to isolate the association between COVID-19 and BP changes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Across all BMI–age groups, NFHS-5 showed an approximate 3 mmHg increase in SBP relative to NFHS-4, in both men and women. Year-stratified analyses revealed that BP levels in 2019 were comparable to those in 2015-16, but\u003c/p\u003e\n\u003cp\u003eBP rose progressively in 2020 and 2021 in both men and women. Within NFHS-5, post-COVID BP values were consistently higher than pre-COVID values, with the largest SBP increases observed in women with low BMI (15–20). Interestingly,\u003c/p\u003e\n\u003cp\u003epre-COVID data, when compared with NFHS-4, showed the highest SBP rise in women with higher BMI (20–25). After adjusting for state-level differences using NFHS-4 datasets, SBP remained higher in NFHS-5 post-COVID across nearly all\u003c/p\u003e\n\u003cp\u003eBMI–age groups in both sex/genders. The magnitude of SBP increase varied by demography, where older low-BMI women and younger low-BMI men exhibited the greatest post-COVID rise.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: BP levels in India increased between NFHS-4 and NFHS-5, with a marked rise in SBP during the COVID-19 pandemic period. These findings suggest a population-level association between the first wave of COVID-19 and\u003c/p\u003e\n\u003cp\u003eelevated SBP in both men and women, across age, BMI, and regional differences. 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