Rapid Evaluations of Telehealth Strategies to Address Hypertension

A Mixed-Methods Exploration at Two US Health Systems During the COVID-19 Pandemic

Meera Sreedhara, PhD, MPH; Kara Suvada, MPH; Myles Bostic, MPH; Amber Scott, MPH; Ethan Blum, MS; Julia Jordan, MPH; Kincaid Lowe Beasley, MPH


Prev Chronic Dis. 2022;19(12):E81 

In This Article

Abstract and Introduction


Telehealth is a promising intervention for hypertension management and control and was rapidly adopted by health systems to ensure continuity of care during the COVID-19 pandemic. Rapid evaluations of telehealth strategies at 2 US health systems explored how telehealth affected health care access and blood pressure outcomes among populations disproportionately affected by hypertension. Both health systems implemented telehealth strategies to maintain continuity of health care services during the COVID-19 pandemic. The evaluations used a mixed-method approach; qualitative interviews were conducted with key staff, and quantitative analyses were performed on patient electronic health record data. Both health systems exhibited similar trends in telehealth use, which allowed for continued access to health care for some patients but hindered other patients who had limited access to the internet or the equipment needed. Telehealth provides opportunities for blood pressure control and management. Further evaluation is needed to understand the role of broadband internet access as a social determinant of health and its impact on equitable patient access to health care.


More than half of US adults who have hypertension have uncontrolled high blood pressure, which increases the risk of cardiovascular disease and stroke.[1] Disparities in hypertension and blood pressure control persist, in part, because of structural and systemic inequities.[2] The effect of the COVID-19 pandemic on hypertension control is unclear because only a small amount of evidence exists, which is conflicting and did not evaluate the impact among populations at highest risk for hypertension.[3–5]

Telehealth, the use of electronic and telecommunication technologies for health care delivery and education, is recommended for blood pressure control.[6] Although the COVID-19 pandemic limited the delivery of office-based primary care visits and blood pressure assessments,[7] less stringent federal and state regulations led to the broad expansion of telehealth, including primary care.[7,8]

Studies conducted during the COVID-19 pandemic reported changes in telehealth use and subsequent inequities in the general population.[8–10] Limited research described the use of telehealth for hypertension control in a primary care setting.[3,5] As of March 2022, 20.5% of US adults reported having had a recent telehealth appointment,[9] with use during the pandemic varying by such factors as race, ethnicity, age, insurance status, income, language, and urbanicity.[8,10] Despite the potential to improve access to health care for people lacking transportation or living in rural areas,[11] it is unclear how telehealth has affected access to chronic disease management services during the pandemic.[3,5] As national organizations call for the equitable expansion of telehealth,[11] practice-based evidence describing the role of telehealth in supporting patients with a diagnosis of hypertension is needed for health care systems to successfully adapt to the shifting landscape of health care delivery.