Blood Pressure Control Evidence and Resources
High blood pressure is a major risk factor for heart attack, heart failure, stroke and chronic kidney disease. High blood pressure is very common, affecting about 30 percent of adults in the United States. In 2013, high blood pressure was the main or a contributing cause of death for more than 360,000 people in the United States. Substantial clinical evidence shows that controlling high blood pressure results in a significant reduction in heart attacks and strokes.
What PCOR evidence did EvidenceNOW use?
Here are the PCOR findings used by EvidenceNOW for blood pressure control:
In 2015, the U.S. Preventive Services Task Force (USPSTF) reviewed all of the research on screening for high blood pressure .
Recommendation: The USPSTF recommended that primary care clinicians screen all adults for high blood pressure.
In 2004, the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) conducted a comprehensive review of the literature and previous guidelines to develop an evidence-based approach to the management of high blood pressure.
Recommendation: The committee recommended that nearly all people with high blood pressure manage their blood pressure and keep it less than 140/90 mmHg.
EvidenceNOW supported using the JNC7 blood pressure goals but recognized that PCOR findings to guide blood pressure management were evolving. A 2013 panel issued similar guidelines but recommended that the goal for individuals aged 60 and older be a systolic blood pressure of 150 mmHg or less, unless patients already tolerated treatment to less than 140 mmHg. A subgroup of this panel issued a dissenting opinion , and results from a more recent PCOR study called SPRINT supported lower systolic blood pressures. An American Heart Association/American College of Cardiology panel released new guidelines in 2017, which were consistent with those used for EvidenceNOW. As new PCOR evidence emerged, it was incorporated into implementation efforts with primary care practices.
How did EvidenceNOW evaluate whether practices followed this PCOR evidence?
The measure used by EvidenceNOW to evaluate blood pressure control reflects the percentage of patients ages 18–85 who have been diagnosed with hypertension and whose blood pressure is controlled at 140/90 mmHg or less.
This measure was endorsed by the National Quality Forum (NQF 0018) and is used by the Centers for Medicare & Medicaid Services. (Measure ID: CMS165)
The EvidenceNOW goal for primary care practices in the study is to have at least 70 percent of patients diagnosed with hypertension to have their blood pressure adequately controlled to 140/90 mmHg or less.
Blood Pressure Control Resources
Recommendations and Guidelines
This recommendation from the U.S. Preventive Services Task Force reaffirms previous recommendations for high blood pressure screening in adults 18 years of age and older.
This report reviews the role of blood pressure in cardiovascular disease, as well as clinical guidelines for detecting, evaluating, and treating high blood pressure. This guideline was a key PCOR finding disseminated to clinicians participating in EvidenceNOW.
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
This guideline from Eighth Joint National Committee recommends treatment thresholds, goals, and medications for the management of hypertension in adults and was a key PCOR finding disseminated to clinicians participating in EvidenceNOW.
This comprehensive systematic review of evidence on managing high blood pressure was conducted by an expert panel convened by the National Heart, Lung, and Blood Institute.
This comprehensive evidence report from the Cholesterol Expert Panel convened by the National Heart, Lung, and Blood Institute is comprised of systematic evidence reviews and development of clinical practice guidelines for the management of blood cholesterol in adults.
Resources for Practices
EvidenceNOW PCOR Blood Pressure Fact Sheet
This EvidenceNOW fact sheet provides an overview of PCOR findings and guidelines for controlling high blood pressure and includes links to related tools and resources and PCOR evidence sources.
Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension
This research summary of a systematic review compares the effectiveness of various methods and approaches to blood pressure measurement by patients or companions.
Heart Health NOW! Hypertension Treatment Algorithm
This decision tree summarizes treatment recommendations for hypertension.
Blood Pressure Control in Primary Care
This facts-at-a-glance handout for clinicians summarizes recommendations for screening and treating patients with hypertension.
Cardiovascular Disease Prevention: Team-based Care to Improve Blood Pressure Control
This document explains evidence for the team-based approach to hypertension treatment recommended by the Community Preventive Services Task Force. The topics discussed include cost effectiveness, implementation considerations, and evidence gaps.
This article outlines evidence for maintaining a target systolic blood pressure at 140 mmHg for patients older than 60 without diabetes or chronic kidney disease. The guideline from the Eighth Joint National Committee recommended raising the target to 150 mmHg.
Hypertension Control: Action Steps for Clinicians
This brochure summarizes evidence-based strategies to improve blood pressure control. The strategies are divided into three categories: delivery system design, medication adherence, and patient reminders and supports.
Hypertension Control: Change Package for Clinicians
Measuring and improving care processes means changing workflow and delivery systems. This brochure presents clinical process improvements for achieving optimal hypertension control for patients, as well as tools and resources for implementing change.
Partner with Patients, Families & Communities Assessment Tool {Awaiting permission from AMA]
This brief tool is designed to help clinicians partner with patients, families, and communities to assess and improve blood pressure.
Supporting Your Patients With High Blood Pressure: Visit Checklist
This checklist for health care professionals helps foster clear and thorough communication with patients about high blood pressure.
The 2015 M.A.P. Checklists for Improving BP Control [Awaiting permission from AMA]
These checklists from the American Medical Association and Johns Hopkins Medicine help clinicians implement techniques and protocols to Measure accurately, Act rapidly, and Partner with patients, families, and others to improve blood pressure control in their practices.
Controlling Hypertension in Adults
This trifold pamphlet aimed at clinicians presents the treatment algorithm and recommendations for patients with Stage 1 and Stage 2 hypertension.
Blood Pressure Measurement: Measure Accurately
Designed for clinicians’ offices, this poster reviews steps for accurate blood pressure measurement, including tips for correct positioning for patients.
Blood Pressure Control: Tasks for the Practice Facilitator
This four-page checklist and associated materials are designed to be used with primary care practices to address blood pressure control.
Office BP Measurement: Current Challenges and Best Practices
The script and slides from an 11-minute presentation by Anthony Viera, MD, MPH, Director of Hypertension Research Program at UNC-Chapel Hill, cover best practices to address the challenges of blood pressure measurement in the clinician’s office.
Treatment of High Blood Pressure
The script and slides from a 15-minute presentation by Crystal Wiley Cené, General Internist at the UNC School of Medicine, cover recommended guidelines for the treatment of high blood pressure.
Target: BP Technique Quick-check
This checklist is designed for practices to help evaluate whether health care team members are using the proper technique for blood pressure measurements.
Presentation: Getting to Blood Pressure Goal
This 5-minute presentation/video explains evidence treatment goals, how to discuss goals with patients, and how to obtain and report accurate blood pressure readings.
Resources for Practices to Use With Patients
Choosing Medicines for High Blood Pressure
This in-depth patient education booklet explains high blood pressure and the potential risks and benefits of various medications used to treat it.
In Brief: Your Guide to Lowering Your Blood Pressure with DASH
This patient education article explains the Dietary Approaches to Stop Hypertension (DASH) eating plan, an evidence-based plan designed to reduce intake of salt, sugar, and fat to help lower blood pressure and encourage heart health.
High Blood Pressure: How to Make Control Your Goal
This handout helps patients understand how to control their blood pressure. It reviews tips for engaging with care teams, taking medication consistently, monitoring blood pressure, and making healthy choices.
High Blood Pressure: How to Make Control Your Goal (Spanish)
This handout in Spanish helps patients understand how to control their blood pressure. It reviews tips for engaging with care teams, taking medication consistently, monitoring blood pressure, and making healthy choices.
High Blood Pressure: Medications and You
This patient education poster explains hypertension and the types of medications used to treat it.
This postcard is designed to encourage patients to take an active role in monitoring and treating hypertension by providing space to fill out their pharmacy and prescription information for medication refills.
Know the Facts About High Blood Pressure
This is a fact sheet for patients with information about high blood pressure, including signs and symptoms, diagnosis, treatment, healthy blood pressure levels, and prevention tips.
Measuring Your Blood Pressure at Home: A Review of the Research for Adults
This patient education brochure provides information about high blood pressure and measuring blood pressure at home, including tips on available monitors and understanding what the measurements mean.
High Blood Pressure: Medicines to Help You
This guide for patients offers information about the different types of medications used to treat high blood pressure and includes generic and brand names for all FDA-approved drugs.
A Journal to Help You Manage High Blood Pressure
This booklet helps patients managing high blood pressure record their blood pressure readings and medications, and provides information to help patients work with their pharmacist and other members of the health care team.
This wallet card has at-a-glance information about blood pressure for patients and space to write in names of medications and contact information for the health care team.
Supporting Your Loved One With High Blood Pressure
This tip sheet for family members or friends of people with high blood pressure contains advice on communication, providing emotional support, and lifestyle changes to support blood pressure control.
Supporting Your Loved One With High Blood Pressure (Spanish)
This tip sheet in Spanish for family members or friends of people with high blood pressure contains advice on communication, providing emotional support, and lifestyle changes to support blood pressure control.
7 Simple Tips to Get an Accurate Blood Pressure Reading at Home
This handout provides patients with tips and background information geared to help improve accuracy of at-home blood pressure readings.
DASH* to the Diet: Prevent and Control High Blood Pressure Following the DASH Eating Plan
This patient handout offers tips for implementing the Dietary Approaches to Stop Hypertension (DASH) eating plan, which emphasizes fruits, vegetables, and low-fat dairy products, and other steps to help lower blood pressure.
