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Navigating new challenges to help patients control hypertension

Many new barriers to care emerged when the COVID-19 pandemic struck. Our practices were faced with helping patients keep up with care for chronic diseases such as hypertension while also overcoming new challenges that had not been encountered before. Hypertension management is an area of priority that took a hard hit over the past year due to the complexity that the pandemic introduced.

For example, telehealth does not lend itself well to collecting blood pressure data from patients. Added social and financial stressors experienced by patients have been shown to interfere with medication and follow-up compliance. Also, since patients don’t necessarily feel poorly when their blood pressure is high, we do not always hear from our patients proactively.

Many Legacy Health Partners (LHP) practices noted fewer screenings and higher blood pressure readings on average in 2020. Here are some ideas to help improve documentation and blood pressure control as we continue through 2021: 

In office visits: 

  • Train and evaluate medical assistants and nursing staff for taking blood pressure readings properly upon hire and annually thereafter. There are many competency checklists available for use within your own program, including this one from the American Medical Association.
  • Institute a policy to have the patient lie or sit quietly for 5-10 minutes and to re-assess blood pressure readings over a chosen threshold (for instance, above 140/90 mmHg or above 150/90 mmHg if the patient is over age 60 and has no diabetes or CKD).
  • Note in the patient’s chart if they have a history of white coat hypertension.
  • Verify that the patient is taking their medications as prescribed.  


Telehealth visits: 

  • Encourage patients with hypertension to acquire a home blood pressure cuff (Note: many pharmacies have closed access to their automated cuffs due to COVID-19).
  • Make sure that the patient understands how to take an accurate reading.
  • Ask for the patient’s most recent reading and assess their medication compliance at each telehealth visit. 


LHP is currently piloting a program with Regence to send home blood pressure cuffs to Legacy Medical Group (LMG) Medicare Advantage patients with hypertension and is in discussion with Legacy-PacificSource to do the same with LHP Medicare Advantage patients. We’ll share more details in the future. Clinicians may also consider reacquainting themselves with the JNC 8 Hypertension Treatment Guideline Algorithm.