Role of Self-Measured Home Blood Pressure Monitoring (HBPM) and Effectiveness of Telemedicine During the Era of COVID-19 Pandemic

Changes in Self-Measured Blood Pressure Monitoring Use in 14 States From 2019 to 2021: Impact of the COVID-19 Pandemic

BACKGROUND

Self-measured blood pressure monitoring (SMBP) is an important out-of-office resource that is effective in improving hypertension control. Changes in SMBP use during the Coronavirus Disease 2019 (COVID-19) pandemic have not been described previously.

METHODS

Behavioral Risk Factor Surveillance System (BRFSS) data were used to quantify changes in SMBP use between 2019 (prior COVID-19 pandemic) and 2021 (during the COVID-19 pandemic). Fourteen states administered the SMBP module in both years. All data were self-reported from adults who participated in the BRFSS survey. We assessed the receipt of SMBP recommendations from healthcare professionals and actual use of SMBP among those with hypertension (n = 68,820). Among those who used SMBP, we assessed SMBP use at home and sharing BP readings electronically with healthcare professionals.

RESULTS

Among adults with hypertension, there was no significant changes between 2019 and 2021 in those reporting SMBP use (57.0% vs. 55.7%) or receiving recommendations from healthcare professionals to use SMBP (66.4% vs. 66.8%). However, among those who used SMBP, there were significant increases in use at home (87.7% vs. 93.5%) and sharing BP readings electronically (8.6% vs. 13.1%) from 2019 to 2021. Differences were noted by demographic characteristics and residence state.

CONCLUSIONS

Receiving a recommendation from the healthcare provider to use SMBP and actual use did not differ before and during the COVID-19 pandemic. However, among those who used SMBP, home use and sharing BP readings electronically with healthcare professional increased significantly, although overall sharing remained low (13.1%). Maximizing advances in virtual connections between clinical and community settings should be leveraged for improved hypertension management.

Diagnosing hypertension in primary care: a retrospective cohort study to investigate the importance of night-time blood pressure assessment

BACKGROUND

Ambulatory blood-pressure monitoring (ABPM) has become less frequent in primary care since the COVID-19 pandemic, with home blood-pressure monitoring (HBPM) often the preferred alternative; however, HBPM cannot measure night-time blood pressure (BP), and patients whose night-time BP does not dip, or rises (reverse dipping), have poorer cardiovascular outcomes.

AIM

To investigate the importance of measuring night-time BP when assessing individuals for hypertension.

DESIGN AND SETTING

Retrospective cohort study of two patient populations - namely, hospital patients admitted to four UK acute hospitals located in Oxfordshire, and participants of the BP in different ethnic groups (BP-Eth) study, who were recruited from 28 UK general practices in the West Midlands.

METHOD

Using BP data collected for the two cohorts, three systolic BP phenotypes (dipper, non-dipper, and reverse dipper) were studied.

RESULTS

Among the hospital cohort, 48.9% (n = 10 610/21 716) patients were 'reverse dippers', with an average day-night systolic BP difference of +8.0 mmHg. Among the community (BP-Eth) cohort, 10.8% (n = 63/585) of patients were reverse dippers, with an average day-night systolic BP difference of +8.5 mmHg. Non-dipper and reverse-dipper phenotypes both had lower daytime systolic BP and higher night-time systolic BP than the dipper phenotype. Average daytime systolic BP was lowest in the reverse-dipping phenotype (this was 6.5 mmHg and 6.8 mmHg lower than for the dipper phenotype in the hospital and community cohorts, respectively), thereby placing them at risk of undiagnosed, or masked, hypertension.

CONCLUSION

Not measuring night-time BP puts all groups, other than dippers, at risk of failure to identify hypertension. As a result of this study, it is recommended that GPs should offer ABPM to all patients aged ≥60 years as a minimum when assessing for hypertension.

Patient-initiated cardiovascular monitoring with commercially available devices: How useful is it in a cardiology outpatient setting? Mixed methods, observational study

BACKGROUND

The availability, affordability and utilisation of commercially available self-monitoring devices is increasing, but their impact on routine clinical decision-making remains little explored. We sought to examine how patient-generated cardiovascular data influenced clinical evaluation in UK cardiology outpatient clinics and to understand clinical attitudes and experiences with using data from commercially available self-monitoring devices.

METHODS

Mixed methods study combining: a) quantitative and qualitative content analysis of 1373 community cardiology clinic letters, recording consultations between January-September 2020 including periods with different Covid-19 related restrictions, and b) semi-structured qualitative interviews and group discussions with 20 cardiology-affiliated clinicians at the same NHS Trust.

RESULTS

Patient-generated cardiovascular data were described in 185/1373 (13.5%) clinic letters overall, with the proportion doubling following onset of the first Covid-19 lockdown in England, from 8.3% to 16.6% (p < 0.001). In 127/185 (69%) cases self-monitored data were found to: provide or facilitate cardiac diagnoses (34/127); assist management of previously diagnosed cardiac conditions (55/127); be deployed for cardiovascular prevention (16/127); or be recommended for heart rhythm evaluation (10/127). In 58/185 (31%) cases clinicians did not put the self-monitored data to any evident use and in 12/185 (6.5%) cases patient-generated data prompted an unnecessary referral. In interviews and discussions, clinicians expressed mixed views on patient-generated data but foresaw a need to embrace and plan for this information flow, and proactively address challenges with integration into traditional care pathways.

CONCLUSIONS

This study suggests patient-generated data are being used for clinical decision-making in ad hoc and opportunistic ways. Given shifts towards remote monitoring in clinical care, accelerated by the pandemic, there is a need to consider how best to incorporate patient-generated data in clinical processes, introduce relevant training, pathways and governance frameworks, and manage associated risks.

Prospects for developing and implementing remote blood pressure monitoring in patients under dispensary follow-up

Recently, the use of telemedicine technologies (TMT) in the healthcare has gained great importance. TMT is one of the ways to increase the healthcare availability, including in patients with high blood pressure (BP). Office BP measurement and 24-hour BP monitoring are not accurate enough to study natural or induced BP changes over long periods of time. For the selection of antihypertensive drugs and the diagnosis of hypertension (HTN) in patients with an emotionally unstable personality type, as well as in the differential diagnosis of normotension, preHTN, BP selfmonitoring comes first. The use of BP self-monitoring for the diagnosis, selection of therapy, assessment of adherence and effectiveness of treatment of HTN is more effective with remote, socalled telemetric, dynamic BP monitoring. The article presents world experience in the effective use of dynamic remote BP monitoring using TMT.

 

A Rare Case of Herpes Zoster in an Adult Patient Recovered From Symptomatic Reinfection of COVID-19

In coronavirus disease 2019 (COVID-19) patients, various dermatological conditions have been observed. Varicella zoster virus (VZV) and herpes simplex virus must be ruled out before considering vesicular exanthems linked to COVID-19. The immunological status of the host has an impact on the natural history of herpes zoster (HZ). Age is a major risk factor for most of the cases of HZ. Reactivation of VZV can be triggered by iatrogenic immunosuppression or disease-related immunocompromised state or age-related immunosenescence. Rarely, dermatological symptoms have been reported in recovered COVID-19 patients. We hereby present a rare case of HZ in a recovered patient from symptomatic reinfection of COVID-19. 

Favipiravir-Induced Drug Fever in a Young Adult COVID-19 Patient

Severe acute respiratory syndrome coronavirus 2 has had an indelible effect, with 153,738,171 cases recorded globally as per the World Health Organization’s dashboard. The medical establishment is racing to find repurposed medications that can be successful against this novel coronavirus due to a shortage of new drugs to treat the disease. Favipiravir, an antiviral drug originally developed for influenza, is one of the drugs that has recently received a lot of attention, particularly in India. Here, we present a case of favipiravir-induced drug fever in a young adult coronavirus disease 2019 patient.

Symptomatic Reinfection in Previously Recovered Coronavirus Disease 2019 (COVID-19) Geriatric Patient

Can a patient diagnosed with coronavirus disease 2019 (COVID-19) be infected again? This issue appears to be unsolved. Protective immunity following infection with COVID-19 is still not fully known. In the coming months, an awareness of COVID-19 reinfection will be crucial in directing government and public health policy managements. Here, we present a case of symptomatic reinfection following recovery from COVID-19 in a geriatric patient.