Clinic-Based Strategies to Reach United States Million Hearts 2022 Blood Pressure Control Goals

Abstract

Background-The Centers for Disease Control and Prevention's Million Hearts initiative includes an ambitious ≥80% blood pressure control goal in U.S. adults with hypertension by 2022. We used the validated Blood Pressure Control Model (BPCM) to quantify changes in clinic-based hypertension management processes needed to attain ≥80% blood pressure control.Methods and Results-The BPCM simulates patient blood pressures weekly using three key modifiable hypertension management processes: office visit frequency, clinician treatment intensification given an uncontrolled blood pressure, and continued antihypertensive medication use (medication adherence rate). We compared blood pressure control rates (using the Seventh Joint National Committee on hypertension targets) achieved over four years between usual care and the best observed values for management processes identified from the literature (1-week return visit interval, 20%−44% intensification rate, and 76% adherence rate). We determined the management process values needed to achieve ≥80% blood pressure control in U.S. adults. In adults with uncontrolled blood pressure, usual care achieved 45.6% control (95% uncertainty interval [UI] 39.6%−52.5%) and literature-based best observed values achieved 79.7% control (95% UI 79.3%−80.1%) over four years. Increasing treatment intensification rates to 62% of office visits with an uncontrolled blood pressure resulted in ≥80% blood pressure control, even when the return visit interval and adherence remained at usual care values. Improving to best observed values for all three management processes would achieve 78.1% blood pressure control in the overall U.S. population with hypertension, approaching the ≥80% Million Hearts 2022 goal.Conclusions-Achieving the Million Hearts blood pressure control goal by 2022 will require simultaneously increasing visit frequency, overcoming therapeutic inertia, and improving patient

Analysis of Therapeutic Inertia and Race and Ethnicity in the Systolic Blood Pressure Intervention Trial: A Secondary Analysis of a Randomized Clinical Trial

“…Therapeutic inertia has been identified as a key clinician-level barrier to BP control. 13 , 27 , 28 , 29 A simulation by Bellows et al 30 found that medication intensification was the most influential of the multiple interventions to achieve BP control. In community practice, therapeutic inertia is estimated to be present in more than 80% of clinic visits.…”

Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID‐19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID‐19 Pandemic

“… 31 An analysis by Bellows et al found that, out of the multiple interventions to achieve BP control, medication intensification was the most impactful. 32 …”

“… 42 , 43 To do so, we must invest in increasing the implementation of and providing greater access to proven highly effective team‐based care models for hypertension. 32 , 33 We have a steep climb ahead. A recent report found that 40% of patients with uncontrolled hypertension are only taking one antihypertensive medication.…”

Cost-Effectiveness and Challenges of Implementing Intensive Blood Pressure Goals and Team-Based Care

“…Beyond logistics, integrating more-intensive BP goals into clinical practice will be challenging at the prescriber level. Clinical inertia, the phenomenon of not initiating or intensifying therapy at the point of care despite a BP reading that is above goal, is highly prevalent in hypertension management [43,44] and may be a key factor preventing BP control [45]. Several factors associated with the patient, provider, and system elicit clinical inertia [46], such as low health literacy, insufficient provider-patient time, or lack of protocols.…”