During the 4th Annual University of Utah Translational Hypertension Symposium, there was a discussion about the inequities in health care for the diagnosis and management of hypertension in the United States and how these inequities have been exacerbated by the COVID-19 pandemic. A synopsis of this discussion was published in the Journal of the American Heart Association.
As of March of 2021, more than half a million Americans have died from COVID-19. Due to the increased burden on the healthcare system the management of chronic conditions has been interrupted for many patients and this disruption will likely have long-term consequences. This is particularly concerning for hypertension, as it is one of the leading causes of cardiovascular disease.
During the conference, clinicians described that they had substantially reduced or completely discontinued in-person outpatient hypertension consultations. During telemedicine visits, it was apparent that most patients did not have access to validated at-home blood pressure monitors, as only 15% on the market are validated.
There was also a trend during this time for myocardial infarction (16.3 vs 4.0 per week), stroke (14.7 vs 7.0 per week), and heart failure (25.6 vs 9.0 per week) acute visits to decrease coupled with a 20% increase of out-of-hospital deaths. The discussion participants speculated that individuals did not want to risk COVID-19 exposure and avoidance of care may have been responsible for the rebound of non-COVID-19 hospitalizations due to unmanaged chronic conditions at the beginning of the pandemic.
During the few years before the pandemic, there has been a trend for blood pressure control rates to be on the decline. This pattern has been more pronounced among minority populations in the United States, likely due to disparities in healthcare access. Inadequate control of blood pressure has been associated with healthcare disparities, lack of physical activity, poor access to healthy foods, low health literacy, and distrust of the healthcare system.
Addressing inequalities in hypertension health care must include national and state health policies, local community outreach, the healthcare organization and practice, the clinical team, and the individual patient and support network.
Policy changes will be needed to ensure that telehealth may be accessible for all individuals. This may be challenging as minority populations have less access to high-speed internet. The discussion participants urged for expansion of the Affordable Care Act.
For healthcare practice and the clinical team, the panel stated that clinicians could use antihypertensive medications more effectively, such as 2 or 3 drug combinations therapies. Greater emphasis should also be placed on encouraging patients to adhere to life-style changes.
The discussion highlighted how effective community-based outreach programs have been for empowering individuals to take an active role in monitoring their own blood pressure. By accessing individuals through trusted members of their community, better trust with the healthcare system may be fostered with time.
Bress A P, Cohen J B, Anstey D E, et al. 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 andemic. J Am Heart Assoc. Published online May 19, 2021. doi: 10.1161/JAHA.121.020997