Remote Cardiovascular Hypertension Program Enhanced Blood Pressure Control During the COVID-19 Pandemic

• Published in: Journal of the American Heart Association Vol. 12; no. 6; p. e027296
• Main Authors: Lee, Simin Gharib, Blood, Alexander J, Cannon, Christopher P, Gordon, William J, Nichols, Hunter, Zelle, David, Scirica, Benjamin M, Fisher, Naomi D L
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 21-03-2023; Wiley
• Subjects: blood pressure; Blood Pressure - physiology; Blood Pressure Monitoring, Ambulatory - methods; COVID-19 - epidemiology; COVID‐19; Female; Humans; hypertension; Hypertension - drug therapy; Hypertension - therapy; Male; Middle Aged; Original Research; Pandemics - prevention & control; remote patient monitoring; Retrospective Studies; telehealth; telemedicine; remote patient monitoring; blood pressure; telemedicine; COVID‐19; hypertension; telehealth
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.122.027296

Background The COVID-19 pandemic disrupted traditional health care; one fallout was a drastic decrease in blood pressure (BP) assessment. We analyzed the pandemic's impact on our existing remote hypertension management program's effectiveness and adaptability. Methods and Results This retrospective observational analysis evaluated BP control in an entirely remote management program before and during the pandemic. A team of pharmacists, nurse practitioners, physicians, and nonlicensed navigators used an evidence-based clinical algorithm to optimize hypertensive treatment. The algorithm was adapted during the pandemic to simplify BP control. Overall, 1256 patients (605 enrolled in the 6 months before the pandemic shutdown in March 2020 and 651 in the 6 months after) were a median age of 63 years old, 57% female, and 38.2% non-White. Among enrolled patients with sustained hypertension, 51.1% reached BP goals. Within this group, rates of achieving goal BP improved to 94.6% during the pandemic from 75.8% prepandemic (
<0.0001). Mean baseline home BP was 141.7/81.9 mm Hg during the pandemic and 139.8/82.2 prepandemic, and fell ≈16/9 mm Hg in both periods (
<0.0001). Maintenance during the pandemic was achieved earlier (median 11.8 versus 19.6 weeks,
<0.0001), with more frequent monthly calls (8.2 versus 3.1,
<0.0001) and more monthly home BP recordings per patient (32.4 versus 18.9,
<0.0001), compared with the prepandemic period. Conclusions A remote clinical management program was successfully adapted and delivered significant improvements in BP control and increased home BP monitoring despite a nationally observed disruption of traditional hypertension care. Such programs have the potential to transform hypertension management and care delivery.