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\n High blood pressure, or hypertension, affects millions of Americans, and some have hypertension that is undiagnosed and untreated\u2014they are \u201chiding in plain sight.\u201d Because hypertension rarely has symptoms, it\u2019s not often a topic patients discuss with their health care providers. Even while following best practices and providing the highest level of care, providers can have patients who are at risk for hypertension or who remain undiagnosed.
\nMillion Hearts\u00ae, a national effort to prevent 1 million heart attacks and strokes by 2017, has made blood pressure control a priority. Million Hearts\u00ae encourages health care providers to take steps to identify patients with potentially undiagnosed hypertension.
\nThe Facts about Hypertension
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- Uncontrolled hypertension is a leading cause of heart disease and stroke.1 It also raises the risk for kidney and heart failure. \n
- One in three U.S. adults\u2014about 70 million people\u2014has hypertension.2 Almost half of these people don\u2019t have their blood pressure under control.3 \n
- About 13 million U.S. adults with hypertension aren\u2019t even aware they have it and are not being treated.2 \n
- Most people with uncontrolled blood pressure have health insurance and see their providers at least twice a year,3 but remain undiagnosed. \n
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\n Video: Finding Undiagnosed Hypertensive Patients
\nWatch this video to learn how to find patients in your practice who may be \u201chiding in plain sight\u201d with undiagnosed hypertension.
\nMake hypertension control a priority for your practice. Follow these four critical steps to help you identify patients with potentially undiagnosed hypertension who are hiding in plain sight:
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- Establish clinical criteria for potential undiagnosed hypertension using current evidence-based guidance. Work with your health care team to determine the number of elevated blood pressure readings and the degree of elevation that should trigger a red flag for a patient. \n
- Search electronic health record (EHR) data for patients who meet your established clinical criteria. For example, some providers have searched EHR registries using algorithms to extract relevant information.4 Pick the approach that works best for your practice based on your available resources. \n
- Implement a plan to communicate with these patients and to treat those with hypertension.
The plan could include 24-hour ambulatory or home blood pressure monitoring, automated office blood pressure readings, or repeated in-office measurement. For patients with confirmed hypertension, follow standardized treatment protocols and provide feedback to your care team about how best to support patients in achieving and maintaining blood pressure control. \n - Calculate the hypertension prevalence in your practice and compare your data against local, state, or national prevalence data. Comparing the prevalence of hypertension among your patients to national or local values could add much-needed context to blood pressure control rates and may help identify more patients who might benefit from additional clinical action. \n
Start with the steps that make the most sense for your practice. What\u2019s important is that you begin the process. Bringing those patients who are hiding in plain sight into clear view and spreading the word about how other health care professionals can find them will help protect millions from unnecessary and preventable events.
\nThe interactive Million Hearts\u00ae Hypertension Prevalence Estimator Tool generates an expected percentage of patients with hypertension based on the specific characteristics of your health system\u2019s or practice\u2019s patient population. Compare the expected prevalence to the calculated prevalence\u2014if the values are significantly different, you may have patients \u201chiding in plain sight\u201d with undiagnosed hypertension. Use the tool.
\nResources to Help Find Patients with Undiagnosed Hypertension
\nThe following resources can help you diagnose, treat, and manage hypertension in your practice.
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- Undiagnosed Hypertension Change Package external icon\u2014 This guide can help clinicians map and identify enhancements to clinical workflows that improve detection and diagnosis of hypertension. \n
- Hypertension Control: Change Package for Clinicians pdf icon[679 KB]external icon\u2014This guide is a quality improvement tool for ambulatory clinical settings to improve hypertension control. It provides health care providers with an evidence base of process improvements to more efficiently and effectively care for hypertensive patients. \n
- Hypertension Control: Action Steps for Clinicians pdf icon[312 KB]external icon\u2014This guide offers proven strategies to help clinicians work with their patients to control hypertension, including creative ways to deliver care, improve medication adherence, and optimize patient reminders and supports. \n
- High Blood Pressure \u2014This site provides fact sheets, data and statistics, and other helpful resources for patients and practitioners. \n
References
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- Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the US: National Health and Nutrition Examination Survey, 2011-2012 pdf icon[777 KB] NCHS Data Brief, No. 133. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2013. \n
- D Mozaffarian et al (2016). Heart Disease and Stroke Statistics \u2014 2016 Updateexternal icon. Circulation; 133: e38-e360. doi: 10.1161/CIR.0000000000000350. \n
- Yoon S, Fryar C, Carroll M. Hypertension Prevalence and Control Among Adults: United States, 2011\u20132014. NCHS Data Brief, No. 220. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2015. \n
- D Banerjee et al (2012). Underdiagnosis of hypertension using electronic health records external icon. Am J Hypertens ; 25(1):97-102. \n