Pandemic Makes Remote BP Monitoring Essential

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Naomi Deirdre Fisher, MD
Director, Hypertension Service and Hypertension Specialty Clinic, Brigham and Women’s Hospital
Associate Professor of Medicine, Harvard Medical School
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The following transcript has been edited for length and clarity.

Patient Care: I can't leave out a question about the impact of COVID-19 on management of hypertension, because so many people, especially people with chronic conditions, are so concerned that they are not going in for maintenance for regular routine follow-up. Has hypertension suffered a similar fate to diabetes and COPD?

Dr Fisher: The COVID-19 pandemic has changed the way we practice medicine and probably permanently. In most cases, it's been a disaster. Patients aren’t coming in for cancer screenings, for stress tests, for vaccinations. But I think for this particular diagnosis of hypertension there may actually be a benefit.

We are transitioning more to home blood pressure monitoring because we have to, right? It's not reasonable for a patient to come into the office to have a blood pressure measured, not only because of the pandemic, but because as we've already explained, I care a lot more about what their blood pressure is at home anyway. So, it's the right thing to do. Home blood pressure monitoring is more appropriate. It's more cost effective. It's safer, and it's giving us better data. So, for us in hypertension, this is providing us a tremendous opportunity to have our remote monitoring programs grow.

Patient Care: That answered the next question which was whether this [the pandemic] is going to lead us into a lot more telemedicine in general. It certainly is a really huge bump in education for the patient with hypertension at home.

I was interested that the other day you said you were very busy in clinic and that sounded hopeful. Are you seeing patients on a regular basis?

Dr Fisher: I'm seeing patients in clinic but it's remote clinic. I direct hypertension clinic at the Brigham and Women's Hospital, so my patients all have high blood pressure. But unless there's a specific need for me to examine them, we're conducting business over the computer and spend a lot of time evaluating their blood pressures, their symptoms, their history, titrating the medications that way. But yes, I'm very gratified that business is busy. Patients are understanding that they can really get this part of their care without any pause during the pandemic.

Patient Care: Is there anything else you might want to say to primary care physicians about hypertension management and preventive cardiology?

Dr Fisher: Hypertension has now become the number one global risk factor for disease. I think it's finally capturing the interest that it deserves. It's a global problem, a global problem of really immense significance that's affecting 1 in 2 adults in America. So if you don't have hypertension, surely your friend does.

Treating hypertension is doable, but it's tough. It really takes a focus. It takes an understanding that this is an engagement of the patient and the doctor together. It's teamwork. We have to take into consideration very innovative ways to treat hypertension. We have to encourage lifestyle modifications because obesity needs to be named as a single outstanding, growing epidemic on its own that's really responsible for a large part of it. There are a lot of issues that make it challenging, but I would say the hope is that if we align our resources, we really can make a huge, huge dent in cardiovascular risk and help our patients significantly.

Patient Care: Great. Thank you so much, Dr. Fisher.

Dr Fisher: Thank you. It's been a pleasure.