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

Abstract

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 (P<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 (P<0.0001). Maintenance during the pandemic was achieved earlier (median 11.8 versus 19.6 weeks, P<0.0001), with more frequent monthly calls (8.2 versus 3.1, P<0.0001) and more monthly home BP recordings per patient (32.4 versus 18.9, P<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.

Keywords: COVID‐19; blood pressure; hypertension; remote patient monitoring; telehealth; telemedicine.

Figure 1. Blood pressure changes in participants with sustained hypertension in the remote hypertension management program before and during the COVID‐19 pandemic.

A, Changes in all participants who were found to have sustained hypertension. B, Changes only in those participants with sustained hypertension who reached maintenance. *P<0.0001. SBP indicates systolic blood pressure; and DBP, diastolic blood pressure.

Figure 2. Time to maintenance analysis by enrollment period.

Each data point indicates the cumulative probability that a patient enters maintenance based on the duration of their participation in the program (days from enrollment). Patients who dropped out of the program are censored. Colored shading indicates 95% CIs.

Figure 3. Enrollment and follow‐up (through March 2021) of patients in the remote hypertension management program.

A, Enrollment during the prepandemic period (September 2019–March 2020). B, Enrollment during the pandemic period (March–September 2020).