Photo Credit: Amenic181

Patients had lower blood pressure readings at home, suggesting telemedicine may be a promising resource for improving hypertension management.

During the COVID-19 pandemic, telemedicine proved to be a reliable and widely used tool that ensured clinicians could meet patients’ healthcare needs, especially patients with chronic illnesses. Since hypertension is one of the most common chronic illnesses, investigators of a recent study evaluated how blood pressure (BP) readings compared when conducted via telemedicine versus a conventional in-office setting.

“Various randomized controlled studies and meta-analysis have shown that greater BP reductions and a larger proportion of patients achieved BP control when a telemedicine approach was utilized compared with usual care,” wrote lead author Ajay Kerai, MD, and colleagues.

In-Office Versus Telehealth BP Readings

Researchers enrolled 154 patients in a retrospective chart review study to identify whether patients had improved hypertension with at-home readings compared with in-office readings. Secondary outcomes included predictors for lower and higher BP and predictors of missing telehealth appointments.

To prepare for the telehealth visits, physicians trained patients to accurately measure BP at home per the American Heart Association (AHA) guidelines. In addition, clinicians provided patients with a prescription for an automated home BP machine. Patients picked up the machine at any local pharmacy, along with a log to record their readings.

Results showed a significant decrease in BP when participants took readings at home versus in the office. About 72% of patients had BP greater than 140/90, and 13% had BP greater than 180/120 during their in-office visits. These percentages decreased to 45% and 2% at the first televisit, respectively. In patients with BP greater than 140/90, there was no major difference in BP when comparing the first telehealth visit to the last in-office visit.

Dr. Kerai and colleagues also found that patients with type 2 diabetes had lower odds of missing appointments (aOR: 0.34 [0.12-0.91], P=0.03), and patients with partners were more likely to have lower BP at a telehealth visit (aOR 3.2 [95% CI 1.15-9.86]; P=0.03).

Telemedicine Useful for Hypertension Management 

This study suggests telemedicine can be a useful resource to manage hypertension, as patients had significantly lower BP readings at home compared with in-office readings.

According to the investigators, “this finding may be explained by several factors such as antihypertensive medication initiation/changes during an in-office visit, white coat hypertension, and inaccurate measurement of in-office BP (eg, not in accordance with the AHA guidelines where patients should not have exercised for 30 min, completely relaxed for 5 min before measurement, using correct cuff size, and incorrect arm placement).”

Patients with partners had lower BP readings, which emphasized the importance of social support in the management of hypertension and other chronic illnesses, investigators wrote. Furthermore, patients with diabetes had lower odds of missing appointments, which may be due to their increased health literacy and adherence to more health requirements.

“From the data, we can conclude that through telemedicine, we can certainly prevent unnecessary overtreatment of hypertension, thus reducing patients’ risk of hypotension and any associated complications,” Dr. Kerai and colleagues concluded.

The 2017 ACC/AHA guidelines for the management of hypertension state that telehealth is a class IIa recommendation and a useful adjunct to interventions shown to reduce BP for patients with hypertension. Given these guidelines and the results of Dr. Kerai’s study, telemedicine may be an invaluable resource to ensure continuous, accessible, and precise care for patients with hypertension.