Impact of clinic-provided home blood pressure monitors during COVID-19 pandemic on blood pressure in underserved adults over 50 years old

ABSTRACT

Introduction: While virtual primary care appointments were essential during COVID-19 pandemic, routine vitals were not available, prohibiting the assessment of hypertension control. As a potential solution, a federally qualified health center in Omaha, Nebraska, provided validated home blood pressure monitors (HBPM) to patients at no-cost. Research Question or Hypothesis: Did providing a validated HBPM to underserved patients over the age of 50 during COVID-19 result in lower blood pressure (BP) compared to those without a HBPM? Study Design: Retrospective, cohort study using data from electronic health records. Methods: This study included patients over 50 years old with hypertension or elevated BP. Intervention patients were provided a HBPM between 3/16/2020 and 9/15/2021 (index date). Primary outcome was change in systolic BP (SBP) and diastolic BP (DBP) from baseline to 6-month follow-up. Baseline characteristics and outcomes were compared between groups using inferential statistics as appropriate for the data. Multivariable linear regression analyses were used to assess the association of receiving a HBPM and BP change controlling for baseline BP and other confounders. Results: A total of 60 HBPM and 121 comparison patients were included. Mean (sd) baseline SBP did not differ between HBPM and comparison patients at 146 mmHg (26.0) and 147 mmHg (23.8) respectively, p = 0.858. Mean (sd) baseline DBP was lower in the HBPM group at 79 mmHg (13.5) vs 84 mmHg (12.5), p=0.013. SBP change from baseline was -13.7 mmHg (28.7) and -12.8 mmHg (26.2) (p = 0.832) while DBP change was -3.6 mmHg (12.7) versus -5.7 (14.2) (p = 0.346) in HBPM and comparison groups respectively. In multivariable analysis, the HBPM group had a significantly greater reduction in SBP at follow-up versus comparison patients (coefficient -7.20 [95% CI -13.79, -0.62]). Conclusion: HBPM was a useful tool for maintaining or improving BP in underserved patients during COVID-19.