Hypertension care during the COVID-19 pandemic in an integrated health care system

Association between equivalized annual household income and regular medical visits for hypertensive patients since the COVID-19 outbreak

Previous studies have shown an increase in blood pressure during the coronavirus disease 2019 (COVID-19) pandemic even among patients receiving antihypertensive treatment. This study aims to evaluate the association between equivalized annual household income and refraining from regular medical visits for hypertensive patients since the COVID-19 outbreak. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), including 2832 hypertensive patients aged 20-79 years from the 2020 survey and at least one survey between 2021 and 2023. They were categorized into lower-income ( Collapse

Key Words

• COVID-19
• Epidemiology
• Health inequities
• Hypertension
• Socioeconomic factors

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MESH Headings

• Humans
• COVID-19/epidemiology
• Middle Aged
• Hypertension/epidemiology
• Male
• Female
• Aged
• Income
• Adult
• Japan/epidemiology
• Young Adult
• SARS-CoV-2

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Affiliation(s)

Maya Toyama Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan Department of Nephrology, Self-Defense Forces Sendai Hospital, Sendai, Japan
Michihiro Satoh Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan. Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan. Department of Pharmacy, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan.
Hideaki Hashimoto Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
Yutaro Iwabe Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan Center for Clinical Research Promotion and Development, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
Takahito Yagihashi Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan Department of Cerebrovascular Medicine, Konan Hospital, Sendai, Japan
Shingo Nakayama Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
Takahisa Murakami Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan Division of Aging and Geriatric Dentistry, Department of Rehabilitation Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
Naoki Nakaya Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
Hirohito Metoki Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan Tohoku Institute for Management of Blood Pressure, Sendai, Japan
Atsushi Hozawa Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan
Takahiro Tabuchi Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine, Sendai, Japan

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Applications and outcomes of implementing telemedicine for hypertension management in COVID-19 pandemic: A systematic review

INTRODUCTION

COVID-19 presented a significant challenge for patients with hypertension in terms of access to care. However, telemedicine offered the healthcare system opportunities that had previously been underutilized. Therefore, this study aims to systematically review the applications and outcomes of telemedicine for hypertension management during the COVID-19 pandemic.

METHOD

A structured search was conducted in accordance with PRISMA guidelines across multiple databases, including PubMed, Cochrane, Web of Science, and Scopus. The search was limited to studies published from December 2019 until May 2023, resulting in a total of 3727 studies. After quality appraisal using the CASP checklists version 2018, 29 articles were included in the final review. Data analysis was performed using thematic analysis.

RESULTS

Most of the studies reviewed had used the proprietary platforms (N = 14) and 11 studies had used public platforms such as social messengers or email. Also 9 studies relied on phone calls (N = 9) to record and transmit the clinical data. Some studies had applied two different approaches (proprietary/public platforms and phone). six articles (20.7%) focused only on hypertension control, while 23 articles (79.3%) examined hypertension as a comorbidity with other diseases. Also, the study identified 88 unique concepts, 15 initial themes, and six final themes for outcomes of using telemedicine for hypertension management during the COVID-19 pandemic. These themes include BP control, BP measurement and recording, medication management, mental health, care continuity and use and acceptance.

CONCLUSION

Telemedicine provides patients with hypertension with the opportunity to engage in medical consultations in a more convenient and comfortable manner, with the same validity as in-person visits. Telemedicine facilitates the creation of a connected network to support patients with high BP at any time and in any location. Limitations and issues may arise due to patients and healthcare staff's unfamiliarity with telemedicine. These issues can be resolved through the ongoing use and continuous feedback.

Telehealth Trends and Hypertension Management Among Rural and Medicaid Patients After COVID-19

Objective: Examine the associations between rurality and low income with primary care telehealth utilization and hypertension outcomes across multiple years pre- and post-COVID-19 pandemic onset. Methods: We compiled electronic health record data from the mixed rural/urban Dartmouth Health system in New Hampshire, United States, on patients with pre-existing hypertension or diabetes receiving primary care in the period before (January 2018-February 2020) and after the transition period to telehealth during the COVID-19 Pandemic (October 2020-December 2022). Stratifying by rurality and Medicaid enrollment, we examined changes in synchronous (office and telehealth visits, including audio/video use) and asynchronous (patient portal or telephone message) utilization, and control of mean systolic blood pressure (SBP) <140. Results: Analysis included 46,520 patients, of whom 8.2% were Medicaid enrollees, 42.7% urban residents. Telehealth use rates were 12% for rural versus 6.4% for urban, and 15% for Medicaid versus 8.4% non-Medicaid. The overall postpandemic telehealth visit rate was 0.29 per patient per year. Rural patients had a larger increase in telehealth use (additional 0.21 per year, 95% CI, 0.19-0.23) compared with urban, as did Medicaid (0.32, 95% CI 0.29-0.36) compared with non-Medicaid. Among the 38,437 patients with hypertension, SBP control worsened from 83% to 79% of patients across periods. In multivariable analysis, rurality corresponded to worsened control rates compared with urban (additional 2.4% decrease, 95% CI 2.1-2.8%); Medicaid and telehealth use were not associated with worsened control. Conclusions: Telehealth expansion enabled a higher shift to telehealth for rural and low-income patients without impairing hypertension management.

Evaluation of blood pressure variation in recovered COVID-19 patients at one-year follow-up: a retrospective cohort study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has various sequelae, one of which might be hypertension. We aimed to evaluate COVID-19's impact on blood pressure (BP) in non-hospitalized patients at one-year follow-up.

METHOD

A total of 7,950 consecutive COVID-19 patients regularly visiting our cardiology clinic were retrospectively screened. Patients' electronic medical records including demographics, comorbidities, vital signs, treatments, and outcomes, were reviewed by two physicians. Individuals with at least one BP measurement in the three months preceding COVID-19 and one measurement in 12 months or more following recovery were included. BP levels before and after COVID-19 were compared using the paired t-test.

RESULTS

5,355 confirmed COVID-19 patients (mean age 55.51 ± 15.38 years) were included. Hypertension (56.9%) and diabetes mellitus (34%) were the predominant comorbidities, and 44.3% had prior major adverse cardiovascular events. Both systolic (126.90 ± 20.91 vs. 139.99 ± 23.94 mmHg, P < 0.001) and diastolic BP (80.54 ± 13.94 vs. 86.49 ± 14.40 mmHg, P < 0.001) were significantly higher post-COVID-19 vs. pre-COVID-19. Notably, 456 (14%) hypertensive patients experienced exacerbated hypertension, while 408 (17%) patients developed new-onset hypertension, overall 864 (16%) of patients had exacerbation or new hypertension. Linear regression analysis revealed that advanced age, smoking, previous cardiovascular events, hypertension, and diabetes mellitus predict increased BP following COVID-19 (P < 0.001).

CONCLUSION

COVID-19 raised systolic and diastolic BP in the long term in non-hospitalized patients, with over one-sixth developing new-onset or exacerbated hypertension. All patients should be evaluated regarding BP, following COVID-19 recovery, particularly those with the mentioned predictive factors. (clinicaltrial.gov: NCT05798208).

Hypertension Control During the Coronavirus Disease 2019 Pandemic: A Cohort Study Among US Veterans

DESIGN

Retrospective cohort study.

OBJECTIVE

We sought to examine whether disruptions in follow-up intervals contributed to hypertension control.

BACKGROUND

Disruptions in health care were widespread during the coronavirus disease 2019 pandemic.

PATIENTS AND METHODS

We identified a cohort of individuals with hypertension in both prepandemic (March 2019-February 2020) and pandemic periods (March 2020-February 2022) in the Veterans Health Administration. First, we calculated follow-up intervals between the last prepandemic and first pandemic blood pressure measurement during a primary care clinic visit, and between measurements in the prepandemic period. Next, we estimated the association between the maintenance of (or achieving) hypertension control and the period using generalized estimating equations. We assessed associations between follow-up interval and control separately for periods. Finally, we evaluated the interaction between period and follow-up length.

RESULTS

A total of 1,648,424 individuals met the study inclusion criteria. Among individuals with controlled hypertension, the likelihood of maintaining control was lower during the pandemic versus the prepandemic (relative risk: 0.93; 95% CI: 0.93, 0.93). Longer follow-up intervals were associated with a decreasing likelihood of maintaining controlled hypertension in both periods. Accounting for follow-up intervals, the likelihood of maintaining control was 2% lower during the pandemic versus the prepandemic. For uncontrolled hypertension, the likelihood of gaining control was modestly higher during the pandemic versus the prepandemic (relative risk: 1.01; 95% CI: 1.01, 1.01). The likelihood of gaining control decreased with follow-up length during the prepandemic but not pandemic.

CONCLUSIONS

During the pandemic, longer follow-up between measurements contributed to the lower likelihood of maintaining control. Those with uncontrolled hypertension were modestly more likely to gain control in the pandemic.

The Burden of Cardiovascular Disease in the Post-COVID Era

In 2019, before the COVID-19 pandemic, cardiovascular disease (CVD) was the leading cause of death. Since 2020, the pandemic has had far-reaching effects on the landscape of health care including CVD prevention and management. Recent decreases in life expectancy in the United States could potentially be explained by issues related to disruptions in CVD prevention and control of CVD risk factors from the COVID-19 pandemic. This article reviews the effects of the SARS-CoV-2 virus and the accompanying pandemic on CVD risk factor prevention and management in the United States. Potential solutions are also proposed for these patients.

Assessing Primary Care Blood Pressure Documentation for Hypertension Management During the COVID-19 Pandemic by Patient and Provider Groups

Background

Primary care electronic medical record (EMR) data can be used to identify, manage, and screen hypertension cases. However, this approach relies on completeness and accessibility of documented blood pressure (BP) values. With the large switch to virtual care due to the COVID-19 pandemic, we assessed BP documentation in primary care EMRs during the pandemic, across patient and physician groups.

Methods

Hypertension-related visits were identified during the pre-pandemic (January 2017 to February 2020) and pandemic (March 2020 to December 2021) periods from a primary care EMR database in Ontario, Canada. Clustered logistic regression models were used to analyze the relationship of physician and patient characteristics with an outcome variable of documented BP. A chart review of 3200 hypertension visits without a BP recorded in structured data fields was conducted to determine if BP was recorded in progress notes.

Results

Pre-pandemic, 75.7% of hypertension-related visits (113,966 of 150,511) had a BP recorded in structured documentation, but this significantly decreased to 36.4% (26,660 of 73,239) during the pandemic (odds ratio [OR] = 0.18, 95% confidence interval [CI]: 0.18-0.19). For virtual visits, 14.3% (6357 of 44,572) had a documented BP, vs 74.0% (20,056 of 27,089) for in-person visits. Chart review found that 55.9% of hypertension visits had no associated BP in structured documentation, but did have a BP recorded in the progress note. Male providers, compared to female providers, were less likely to record BPs pre-pandemic (OR = 0.45, 95% CI: 0.32-0.63) and during the pandemic, for both virtual visits (OR = 0.48, 95% CI: 0.32-0.71) and in-person visits (OR = 0.46, 95% CI: 0.33-0.64).

Conclusions

BP documented in primary care EMRs declined during the pandemic, most likely due to high rates of virtual visits impacting hypertension detection and management.

Ups and downs of conducting a national representative survey on hypertension during pandemic time: main results of SEPHAR IV

OBJECTIVES

This national representative survey sought to assess hypertension's prevalence, awareness, treatment and control in Romania.

METHODS

A representative sample (by age, sex and residence) of 1477 Romanian adults (51.19 ± 16.61 years, range 18-80 years, 59.9% women) was multimodally evaluated during two study visits. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg or previously diagnosed hypertension, regardless of BP. Awareness was defined by knowledge of previous hypertension diagnosis or of current use of antihypertensive treatment. Treatment was defined by antihypertensive medication taken at least 2 weeks prior to enrolment. Control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg at both visits in treated hypertensive patients.

RESULTS

Hypertension prevalence was 46% ( n  = 680) consisting of 81.02% ( n  = 551) known hypertensive patients and 18.98% ( n  = 129) newly diagnosed hypertensive patients. Awareness, treatment and control of hypertension were: 81% ( n  = 551), 83.8% ( n  = 462) and 39.2% ( n  = 181).

CONCLUSION

Despite numerous pandemic-related obstacles in conducting a national survey, SEPHAR IV updates hypertension epidemiological data of a high-cardiovascular-risk Eastern-European population. This study confirms previous predictions of hypertension prevalence, treatment and control, which remain unfavourable because of unsatisfactory control of promoting factors.