Commitment to Hypertension Control During the COVID-19 Pandemic

Million Hearts Initiative Exemplars

Amena Abbas, MPH; Judy Hannan, RN, MPH; Haley Stolp, MPH; Fátima Coronado, MD, MPH; Laurence S. Sperling, MD


Prev Chronic Dis. 2022;19(8):e47 

In This Article

Implications for Public Health

Our report summarizes hypertension control strategies that MH Exemplars implemented in response to the disruptions to routine medical care during the COVID-19 pandemic. Data support the fact that frequent interactions with clinical staff are essential to chronic disease management and during temporary disruptions in access to health care for hypertensive patients when a natural disaster results in increased rates of uncontrolled hypertension.[12] Identifying innovative strategies and sharing lessons learned from Exemplars might help inform future efforts to improve health care delivery related to hypertension control during and after a public health or environmental emergency.

Patients with existing medical conditions have experienced poor outcomes in the setting of an emergency, including difficulty accessing emergency services and routine care.[13] People living with chronic diseases, including hypertension, are at an increased risk of adverse health outcomes in the face of public health emergencies, and this risk increases exponentially with a prolonged crisis.[12] Many communities are not adequately prepared to meet the needs of people living with chronic diseases during a public health emergency. MH Exemplars have demonstrated resilience and tenacity in their mission to control hypertension by accelerating innovation and adaptation of their services, despite many challenges through strategies that may have otherwise taken years to integrate into the services and workflow of these clinics and organizations.

Disruptions in access to care as a result of the pandemic have exposed the need to have a more integrated health system with potentially expanded roles for care team members such as community pharmacists. For example, an Exemplar implemented an accelerated pilot program focused on comprehensive medication management using a network of community pharmacists, physicians, and health plans. Studies have demonstrated that pharmacy-delivered medication therapy management can improve health outcomes for hypertensive patients and those with other chronic conditions or comorbidities.[14] The medication therapy management program drove collaboration between community pharmacists and primary care physicians, resulting in hypertension control rates of more than 85%.

Many health care organizations and primary care practices used new and adapted existing resources to rapidly move to virtual care. Emergency funds provided by the passage of the CARES (Coronavirus Aid, Relief, and Economic Security) Act were allocated for "provider relief … related to expenses or lost revenues that are attributable to coronavirus".[15] Several Exemplars leveraged these emergency funds to immediately respond to the need of their patients and support expenses related to telehealth services, and to provide blood pressure measurement devices, other educational materials, and software for patient care. Moreover, Exemplars demonstrated that existing partnerships facilitated rapid implementation of their interventions and supported ongoing efforts. This activation of a ready network of partners contributed to a rapid response to gaps in care related to COVID-19 for health services and access.

The study is subject to limitations. First, data and outcomes were self-reported. Collecting data on patient outcomes or evaluating changes in blood pressure control rates as a result of the strategies implemented might have been useful. Second, a small number of Exemplars reported strategies focused on specific patient demographics; therefore, we were not able to examine or explicitly address the impact on health disparities. As there are disparities in hypertension control as well as COVID-19 infection and outcomes, it is crucial to document successful strategies for populations at higher risk. Lastly, as the data were obtained from a sample of a small number of clinics and organizations, the results and outcomes are not generalizable to the broader population of hypertension control program partners.

The COVID-19 pandemic has presented many challenges to hypertension control, including unprecedented disruptions to routine care and chronic disease management. The small-scale implementation of comprehensive interventions during a public health crisis allowed Exemplars to demonstrate promising results and sustainable impacts, captured the interest of relevant community members or organizations, and encouraged decision makers and partners to adopt and scale intervention models to their respective health systems. The examples presented demonstrate that even during a time of crisis, focusing on and achieving hypertension control is possible. Many of the adaptations made by these Exemplars can and will continue during noncrises and add important insights into creative solutions to long-standing problems, such as improving hypertension control.