Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID‐19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID‐19 Pandemic

Abstract

The COVID‐19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID‐19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID‐19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID‐19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID‐19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence‐based pharmacotherapy are essential. There is a need to improve the implementation of community‐based interventions and blood pressure self‐monitoring, which can help build patient trust and increase healthcare engagement.

Preventing the Next Pandemic: The Case for Investing in Circulatory Health – A Global Coalition for Circulatory Health Position Paper

“…Inequalities in health care were brought to the fore by the COVID-19 pandemic. The decline in non-COVID related hospital admissions was greater in areas of resource constraints as was the decline in blood pressure control in people of colour [35]. Furthermore, there is less information available from LMICs with only a third of the publications in a recent review stemming from LMICs [25].…”

The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study

“…BP measurement is a fundamental component of hypertension management [12,13], and there has been increasing concern that the increased use of telemedicine visits in primary care and cardiology outpatient settings may impact the accurate assessment of BP and, in turn, how well BP is controlled for patients with hypertension [14]. To address this potentially unintended consequence of telemedicine expansion, we performed an electronic health record (EHR)-based retrospective analysis of a diverse population of patients with hypertension receiving care at a large, urban, academic medical center across an 11-month period during the COVID-19 pandemic.…”

Impact of Telehealth on Blood Pressure Control in Community Health Centers

“…3 Health disparities in hypertension prevalence and management are well documented and have been further exposed and exacerbated by COVID-19. 4,5 Furthermore, delayed medical care has been widely reported during the pandemic 6 and care avoidance was found to be more prevalent among some of the primary populations served by community health centers (CHCs) including low-resourced communities, communities of color, and persons with underlying medical conditions such as hypertension. 7 In response to the COVID-19 pandemic, CHCs adapted by offering virtual care (telehealth) to provide continuity of care to their patient population while ensuring the health and safety of their staff and patients.…”