Impact of telemedicine use on blood pressure control during the covid-19 pandemic

ABSTRACT

Background: Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care. quality. Objectives: To examine the association between telemedicine use and blood pressure (BP) control. Methods: This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<0.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<0.001 for 2+ telemedicine visits;reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=0.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=0.03 for 2+ telemedicine visits). Conclusions: BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded.