Remote Hypertension Program Supported Blood Pressure Control During COVID-19

Naomi Fisher, MD

Credit: Coller School of Management, Tel Aviv University

A remote hypertension program successfully supported patients in achieving blood pressure control during the COVID-19 pandemic, despite systemic disruptions to medical care, according to new research.¹

The investigative team, led by Naomi Fisher, MD, Mass General Brigham, suggests integrated remote hypertension management programs have the potential to dramatically improve both blood pressure control and home blood pressure data quality, ultimately helping to transform hypertension care delivery.

“During the pandemic, there was a dramatic decline in the number of patients who had their blood pressure measured, and we even saw a small nationwide increase in blood pressure,” Fisher said.² “Our remote management program at Mass General Brigham was already established pre-pandemic, so it was primed to help take care of our patients with high blood pressure. This program was able to provide care when patients needed it most, and demonstrated the efficacy of a team-based, entirely remote management system.”

Rates of blood pressure control have been reported as poor and worsening over time. The onset of the COVID-19 pandemic threatened to exacerbate the trend by disrupting care delivery for chronic diseases, such as hypertension.¹ Per the investigators, blood pressure assessments occurred less frequently during the pandemic era, with the overall number falling drastically in early 2020.

The current retrospective analysis evaluated blood pressure control in an entirely remote hypertension management program at Mass General Brigham during a 6-month pre-pandemic period (September – March 2020) and a 6-month pandemic period (March – September 2020). A total of 1,256 program participants were included in the analysis, with 605 enrolled during the pre-pandemic period and 651 enrolled during the pandemic period.

Each participant in the remote hypertension program was provided with a digitally connected home blood pressure monitor and educated by program navigators on proper measurement techniques. An evidence-based algorithm for hypertension management analyzed home blood pressure records and guided pharmacological decision-making.

For each patient, a team of trained navigators, pharmacists, and supervising physicians worked together to implement a treatment strategy. Outcome data were collected through program reporting and review of EHR-patient charts through March 2021 to allow 6-months of program participation.

The patient population was a median age of 63 years old and was 57% female. Compared with the pre-pandemic group, the investigative team noted that more patients enrolled during the pandemic were from traditionally underserved populations. The proportion of non-White patients (46.5% versus 28.3%; P <.001) and non-English speaking patients (18.6% versus 3.5%; P <.001) increased significantly, according to the data.

Upon analysis, investigators found 51.1% of enrolled patients with sustained hypertension reached blood pressure goals. In this population, the rates of achieving goal blood pressure improved to 94.6% during the pandemic period from 75.8% pre-pandemic (P <.0001).

Data showed the mean baseline home blood pressure was 141.7/81.9 mmHg during the pandemic and 139.8/82.2 pre-pandemic. Blood pressure fell by approximately 16/9 mmHg in both periods (P <.0001). Investigators noted this was a magnitude of reduction in systolic blood pressure associated with an approximately 40% relative risk reduction in major cardiovascular events and all-cause mortality.

The team additionally indicated the need to adapt the clinical algorithm to accommodate patient needs during the pandemic. Calcium channel blockers were prescribed more frequently than angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs), as these therapies require lab testing for patients adjusting to new dosages.

In the pandemic period, maintenance was achieved earlier (median, 11.8 versus 19.6 weeks; P <.0001), and engagement in the program increased, with a greater frequency of monthly phone calls between navigators and patients (8.2 versus 3.1; P <.0001). Moreover, on average, patients during the pandemic were found to measure their blood pressure at home more frequently (32.4 versus 18.9; P <.0001) than in the pre-pandemic period.

The team at Mass General Brigham is developing a hypertension program for patients with resistant hypertension with uncontrolled blood pressure, despite medications, and is aiming to scale the remote management program beyond their metropolitan location. Fisher and colleagues noted the growing landscape of digital health care could transform the delivery of care for hypertension, as well as other chronic diseases including heart failure and diabetes.

“Successful programs that engage providers and patients in a meaningful, structured way have the potential to provide dramatic benefits in global cardiovascular health,” Fisher said.²

References

1. Lee SG, Blood AJ, Cannon CP, et al. Remote Cardiovascular Hypertension Program Enhanced Blood Pressure Control During the COVID-19 Pandemic [published online ahead of print, 2023 Mar 13]. J Am Heart Assoc. 2023;e027296. doi:10.1161/JAHA.122.027296
2. Remote Blood Pressure Management Program enhanced care during pandemic. EurekAlert! https://www.eurekalert.org/news-releases/982300. Published March 13, 2023. Accessed March 16, 2023.