Uncontrolled hypertension is a leading cause of heart disease and stroke. Controlling hypertension can
prevent cardiovascular disease as it is critical for good cardiovascular health. It’s a top priority for the
federal Million Hearts initiative, which aims to prevent one million heart attacks and strokes within five
years. Controlling hypertension is challenging. Since high blood pressure rarely has symptoms, it’s
often not a topic patients discuss with their providers. Effectively managing hypertension
includes both lifestyle changes and long-term medication use, both of which are challenging
when there are no symptoms to be relieved. These issues conspire to keep almost 50
percent of people with hypertension in the danger zone—uncontrolled and at risk for preventable
heart attacks and strokes, as well as kidney and heart failure.
The data are sobering—one third of the U.S. population has high blood pressure—
and almost half of those don’t have it under control. Let’s unpack the numbers a little more.
About one-third of people with uncontrolled high blood pressure aren’t even aware they
have it, so they aren’t taking medication to control it. That’s about 13 million people
who are at increased risk for a heart attack or stroke and damage to other organs.
Many assume that people with uncontrolled hypertension are uninsured and don’t have
regular access to health care, and therefore don’t get high blood pressure detected and
diagnosed. In fact, the opposite is true—most people with hypertension who are unaware,
untreated, and uncontrolled have health insurance and a usual source of health care, and have
been to see their health care provider in the last year. What does this
mean for you, as a health care provider? Potentially millions of people with uncontrolled hypertension are seen each year—but remain
undiagnosed. It is likely that hypertensive patients are hiding in plain sight
within your system or practice. While following best practices and providing
the highest levels of care, you can have patients who are at risk for or have
undiagnosed high blood pressure. There are four critical steps that can help
identify people with potentially undiagnosed hypertension. One.
Establish clinical criteria for potential undiagnosed hypertension, based on current
evidence-based guidance. Work with your team to determine the number of elevated readings
and the degree of elevation that should trigger inclusion of a patient in this group of
potentially hypertensive people. There’s no one right answer, so pick what works best for your practice,
based upon your available resources and capacity. Two. Search your electronic health record
data for patients that meet the clinical criteria you’ve established; then
Three. Implement a plan to diagnose these patients, and to treat those with hypertension.
The diagnostic regimen could include 24-hour ambulatory blood pressure monitoring; home
blood pressure monitoring; automated office blood pressure readings; or repeated
high-quality, in-office measurement. For those patients with confirmed high blood pressure, institute
standardized treatment protocols and provide feedback to the team to support patients in
achieving and maintaining blood pressure control. Four. As a quality check, calculate your practice’s
hypertension prevalence and compare your data against local, state, or national prevalence
data. If your calculated value is much lower than national or local estimates, search for
patients with patterns of high blood pressure who haven’t been diagnosed. Since this is
a continuous process, make a plan to reassess and reevaluate. Following these
four steps can help you identify and protect those patients with undiagnosed
hypertension. Start with the steps that make the most sense for your practice. What’s
important is that you start looking and take steps with your patients to prioritize
control. Bringing those hiding in plain sight into clear view will help protect millions from
unnecessary and preventable events. Million Hearts has made blood pressure control
a critical national priority and has developed clinician and patient resources to help you.
Visit millionhearts.hhs.gov for case studies, resources, and other tools that can help you
find patients who are hiding in plain sight.