Impact of COVID-19-related care disruptions on blood pressure management and control in community health centers

Abstract

Background Uncontrolled hypertension is a leading risk factor for cardiovascular disease. To ensure continuity of care, community health centers (CHCs) nationwide implemented virtual care (telehealth) during the pandemic. CHCs use the Centers for Medicare & Medicaid Services (CMS) 165v8 Controlling High Blood Pressure measure to report blood pressure (BP) control performance. CMS 165v8 specifications state that if no BP is documented during the measurement period, the patient’s BP is assumed uncontrolled. Methods To examine trends in BP documentation and control rates in CHCs as telehealth use increased during the pandemic compared with pre-pandemic period, we assessed documentation of BP measurement and BP control rates from December 2019 - October 2021 among persons ages 18-85 with a diagnosis of hypertension who had an in-person or telehealth encounter in 11 CHCs. Rates were compared between CHCs that did and did not implement self-measured BP monitoring (SMBP). Results The percent of patients with hypertension with no documented BP measurement was 0.5% in December 2019 and increased to 15.2% (overall), 25.6% (non-SMBP CHCs), and 11.2% (SMBP CHCs) by October 2021. BP control using CMS 165v8 was 63.5% in December 2019 and decreased to 54.9% (overall), 49.1% (non-SMBP), and 57.2% (SMBP) by October 2021. When assessing BP control only in patients with documented BP measurements, CHCs largely maintained BP control rates (63.8% in December 2019; 64.8% (overall), 66.0% (non-SMBP), and 64.4% (SMBP) by October 2021). Conclusions The transition away from in-person to telehealth visits during the pandemic likely increased the number of patients with hypertension lacking a documented BP measurement, subsequently negatively impacting BP control using CMS 165v8. There is an urgent need to enhance the flexibility of virtual care, improve EHR data capture capabilities for patient-generated data, and implement expanded policy and systems-level changes for SMBP, an evidence-based strategy that can build patient trust, increase healthcare engagement, and improve hypertension outcomes.

Editors’ Commentary on the 2023 ESH Management of Arterial Hypertension Guidelines

“…12 The explanation is uncertain but may have resulted, in part, from confusion related to different US guideline BP target recommendations 6,13,14 and more recently from effects of the COVID-19 pandemic. 15,16 A similar worsening of hypertension awareness (85.6%-77.4%), antihypertensive drug treatment (82.3%-72%), and control to an SBP/BBP <140/90 mm Hg (69%-58.3%) between 2007 and 2017, pre-COVID, has been noted in Canada, especially for women. 17 Tracking the achievement of guidelines BP targets in Europe and many other countries is challenging due to fragmented and irregular conduct of relevant general population surveys.…”

Effects of the COVID-19 Pandemic on Colectomy Outcomes for Inflammatory Bowel Disease

“…11 Especially in the case of colectomies, which are now often performed laparoscopically, inducing pneumoperitoneum already poses an existing risk to patients with compromised cardiovascular function. 12 In addition, there are several other explanations for this decrease in the percentage of patients presenting with medicated hypertension. One factor is the transition of care from inperson to virtual visits caused by the COVID-19 pandemic.…”

“…Studies found that the use of virtual visits increased the number of patients lacking accurate blood pressure measurements to detect hypertension, and in turn led to lower proportions of patients receiving antihypertensive treatment. 12 Furthermore, in the initial months of the novel COVID-19 pandemic in 2020, there was a misunderstanding among patients and providers regarding the use of angiotensin-converting enzyme inhibitors (ACEIs) for hypertension treatment. The misguided concern originated from the idea that ACEI drugs would upregulate ACE2, the binding site of severe acute respiratory syndrome coronavirus 2.…”

“…There was, of course, an elevated risk of COVID-19 morbidity and mortality posed to patients with existing cardiovascular comorbidities, which may have caused some patients to opt for a delayed procedure or alternative treatment 11 . Especially in the case of colectomies, which are now often performed laparoscopically, inducing pneumoperitoneum already poses an existing risk to patients with compromised cardiovascular function 12 …”

“…One factor is the transition of care from in-person to virtual visits caused by the COVID-19 pandemic. Studies found that the use of virtual visits increased the number of patients lacking accurate blood pressure measurements to detect hypertension, and in turn led to lower proportions of patients receiving antihypertensive treatment 12 . Furthermore, in the initial months of the novel COVID-19 pandemic in 2020, there was a misunderstanding among patients and providers regarding the use of angiotensin-converting enzyme inhibitors (ACEIs) for hypertension treatment.…”