Changes in Blood Pressure Outcomes Among Hypertensive Individuals During the COVID-19 Pandemic: A Time Series Analysis in Three US Healthcare Organizations.

BACKGROUND: The COVID-19 pandemic may have negatively affected medical care for and self-management of chronic hypertension. We sought to examine the impact of the pandemic on blood pressure (BP) among individuals with hypertension. METHODS: Using an interrupted time series analysis, we compared the level and trend (slope) of BP outcomes before the public health emergency declaration (prepandemic period: August 2018 through January 2020) versus after the stay-at-home orders (pandemic period: April 2020 through November 2020) among adults with hypertension followed at 3 large health systems (n=137 593). Outcomes include systolic and diastolic BP recorded in electronic health records and the proportion of individuals with BP <140/90 mm Hg. RESULTS: The number of BP measurements substantially dropped early in the pandemic and then gradually increased. During the pandemic period, systolic and diastolic BP increased by 1.79 mm Hg (95% CI, 1.57-2.01; P<0.001) and 1.30 mm Hg (95% CI, 1.18-1.42; P<0.001), respectively, compared with the prepandemic period. Similarly, the proportion of patients with controlled BP decreased by 3.43 percentage points (95% CI, -3.97 to -2.90; P<0.001). A trend showing increasing control in the prepandemic period (+3.19 percentage points per year [95% CI, +2.96 to +3.42]; P<0.001) flattened during the pandemic period (+0.27 percentage points per year [95% CI, -0.81 to -1.37]; P=0.62). CONCLUSIONS: The first 8 months of the pandemic were associated with worsening BP outcomes among individuals with hypertension. Opportunities to ensure ongoing access to health care with telemedicine and home BP monitoring may mitigate adverse impacts on BP control for future disasters/emergencies.

The Retail Outlet Health Kiosk Hypertension Trial (ROKHYT): Pilot Results.

BACKGROUND: Blood pressure (BP) control was only 43.7% in the National Health and Nutrition Survey (NHANES) survey in 2017-2018. Scalable, nonclinic-based strategies to control BP are needed. We therefore conducted a pilot trial of a text-messaging intervention in a national network of retail outlet health kiosks with BP devices. All study procedures were conducted remotely. METHODS: Eligible individuals (N = 140), based on average BP greater than or equal to 140/90 mm Hg at kiosks during the prior year, were randomized to intervention vs. usual care. Intervention consisted of tailored text messages providing educational information with embedded links to educational videos on topics related to BP control. BP measurements were obtained at kiosks at 3, 6, and 12 months following randomization; control was defined as BP < 140/90 mm Hg. Follow-up at 12 months was curtailed due to SARS-CoV-2. We therefore combined 12-month (N = 62) or carried forward 6-month (N = 61) data as the primary end point. RESULTS: Participants were 51.4% male, 70.7% white/Caucasian, had mean age of 52.1 years, and mean baseline BP 145.5/91.8 mm Hg. At the end point, 37.7% intervention vs. 27.4% usual care subjects achieved BP control (difference, 10.3%, 95% confidence interval -6.2%, 26.8%). In an intention-to-treat analysis with multiple imputation of missing data, 12-month BP control was 29.0% vs. 19.8% favoring intervention (difference, 9.2%. 95% confidence interval -7.3%, 25.7%); intervention vs. control differences in adjusted mean BP levels were systolic BP: -5.4 mm Hg (95% confidence interval: -13.5, 2.7) and diastolic BP: +0.6 mm Hg (95% confidence interval: -4.2, 5.4). CONCLUSIONS: These pilot results support the potential for a highly scalable text-messaging intervention to improve BP. CLINICAL TRIALS REGISTRATION: Trial Number NCT03515681.

Innovations to Sustain Non-Communicable Disease Services in the Context of COVID-19: Report from Pakkred District, Nonthaburi Province, Thailand.

During the COVI9-19 pandemic, Pakkred hospital in Thailand implemented innovative practices to ensure the continuation of essential medical services for non-communicable disease patients. These practices included decentralized care, telemedicine, home blood pressure monitoring, community delivery of medicines, and facility infrastructure changes. Despite the decrease in hospital visits by hypertension patients during the pandemic, our results suggest that this package of interventions may have contributed to sustained hypertension and diabetes control rates in Pakkred district.

Leveraging Telemedicine for Chronic Disease Management in Low- and Middle-Income Countries During Covid-19.

In response to the Covid-19 pandemic, many low- and middle-income countries (LMICs) expanded access to telemedicine to maintain essential health services. Although there has been attention to the accelerated growth of telemedicine in the United States and other high-income countries, the telemedicine revolution may have an even greater benefit in LMICs, where it could improve health care access for vulnerable and geographically remote patients. In this article, we survey the expansion of telemedicine for chronic disease management in LMICs and describe seven key steps needed to implement telemedicine in LMIC settings. Telemedicine can not only maintain essential medical care for chronic disease patients in LMICs throughout the Covid-19 pandemic, but also strengthen primary health care delivery and reduce socio-economic disparities in health care access over the long-term.