[NARRATOR] 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.