Hypertension at Home: How Telehealth Can Impact Hypertension Screening

Purpose: Telemedicine is a virtual or hybrid platform of delivering healthcare that has grown tremendously over the last decade thanks to technological advancements. Since the start of the COVID-19 pandemic in 2020, preventive care screenings of hypertension, diabetes, hyperlipidemia, and obesity have significantly declined due to hesitations with in-person visits and staffing limitations in clinics and hospitals. That combined with a significant reduction in physical activity might probe one to think about the adverse impacts the pandemic might have in the cardiac health of the average American. Hypertension, defined here as ≥140mmHg systolic or ≥ 90mmHg diastolic, is a very prevalent pathology in our population and can lead to devastating sequelae such as heart attack, stroke, kidney disease, and dementia. Looking specifically at hypertension management, some limitations to screening include lack of an available blood pressure cuff at home and missed follow-up visits with providers leading to non-renewal of anti-hypertensive medications. This investigation aims to retrospectively study how the pandemic impacted the incidence of hypertension in 2020 and understand what role telemedicine played in providing healthcare screenings to patients. We postulate that there is an increased incidence of hypertension in 2020, during the pandemic, compared to 2019, before the pandemic. Methods: Retrospective data was gathered via chart review of an urgent care telemedicine company on patients aged 18-65. 1,000 charts were de-identified, randomized, and stratified by pre-pandemic (July-December 2019) or pandemic (July-December 2020) periods. The incidence of hypertension was calculated per year. The criteria for hypertension included systolic pressure ≥140mmHg or diastolic blood pressure ≥90mmHg. A two-sample t-test with unequal variance was used to confirm significance. Results: Preliminary analysis, comparing 2019 pre-pandemic visits (n=500) with 2020 pandemic visits (n=232) showed a statistically significant increase in incidence of systolic (20% during the pandemic compared with 16% before the pandemic, p< 0.05) and diastolic (36% during the pandemic compared with 26% before the pandemic, p< 0.05) blood pressure readings. Conclusion: Based on the increased number of hypertensive readings during 2020 compared to 2019, we conclude that there is a higher incidence of hypertension during the COVID-19 pandemic. This finding can be explained by multiple factors and requires further investigation. First, the pandemic severely restricted physical activity with jobs being lost or switched to virtual formats, forcing many to stay home. Second, unhealthy diets and increased caloric intake may have led to increased obesity. Lastly, lack of follow-up with physicians may have led to reduced hypertension screenings allowing more patients to have undiagnosed and untreated hypertension. Telemedicine is one avenue that may address these problems. This platform offers convenience in scheduling and attending appointments, therefore including younger populations that are often abandoned in early screenings. It has a wider reach that is not geographically bound and has the potential to reduce healthcare costs. We hope that this study raises further questions regarding the rise in hypertension during the pandemic and ways to increase early detection of preventable conditions.