Tracking Blood Pressure Control Performance and Process Metrics in 25 US Health Systems: The PCORnet Blood Pressure Control Laboratory

Abstract

Background The National Patient‐Centered Clinical Research Network Blood Pressure Control Laboratory Surveillance System was established to identify opportunities for blood pressure (BP) control improvement and to provide a mechanism for tracking improvement longitudinally. Methods and Results We conducted a serial cross‐sectional study with queries against standardized electronic health record data in the National Patient‐Centered Clinical Research Network (PCORnet) common data model returned by 25 participating US health systems. Queries produced BP control metrics for adults with well‐documented hypertension and a recent encounter at the health system for a series of 1‐year measurement periods for each quarter of available data from January 2017 to March 2020. Aggregate weighted results are presented overall and by race and ethnicity. The most recent measurement period includes data from 1 737 995 patients, and 11 956 509 patient‐years were included in the trend analysis. Overall, 15% were Black, 52% women, and 28% had diabetes. BP control (<140/90 mm Hg) was observed in 62% (range, 44%–74%) but varied by race and ethnicity, with the lowest BP control among Black patients at 57% (odds ratio, 0.79; 95% CI, 0.66–0.94). A new class of antihypertensive medication (medication intensification) was prescribed in just 12% (range, 0.6%–25%) of patient visits where BP was uncontrolled. However, when medication intensification occurred, there was a large decrease in systolic BP (≈15 mm Hg; range, 5–18 mm Hg). Conclusions Major opportunities exist for improving BP control and reducing disparities, especially through consistent medication intensification when BP is uncontrolled. These data demonstrate substantial room for improvement and opportunities to close health equity gaps.

Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and COVID-19-related outcomes: A patient-level analysis of the PCORnet blood pressure control lab

“…The BP Control Lab is an established research collaboration, including 27 health systems, that leverages PCORnet infrastructure, including the PCORnet common data model (CDM), to support large-scale observational studies and national surveillance, large pragmatic RCTs, and local quality improvement efforts centered on hypertension and related cardiovascular disease [13] , [14] . The PCORnet CDM facilitates standardization of EHR data, including patient demographics, encounters, diagnoses, procedures, medications (prescribed and dispensed), vitals, laboratory measures, and related domains.…”

Impact of the COVID-19 pandemic on the management of risk factors in patients with stable atherosclerotic vascular disease

“…In an analysis of real-world data from 1.7 million patients with hypertension a blood pressure goal of < 130/80 mmHg and < 140/90 mmHg was achieved in 30% and 62% of patients, respectively. Control of BP varied across race and ethnicity with Black patients having the lowest blood pressure control [5] . Our study showed that during the pandemic patients were less likely to have their blood pressure monitored and less likely to achieve their guideline-directed blood pressure control.…”

Seasonal variation in blood pressure control across US health systems

“…To date, no studies have explored BP seasonal variation in adults with hypertension across the US nor investigated seasonal fluctuation in BP control metrics, such as BP control or antihypertension medication intensification. Therefore, we aimed to estimate the magnitude of the seasonal variation in population-based BP control measures in the US, and the extent to which outdoor temperature and precipitation explains this variation using data from the PCORnet BP Control Laboratory Surveillance System (BP Track) [18,19].…”