Federal Hypertension Control Leadership Council (the Council)

Guiding Vision

Controlling hypertension for all Americans will save lives, improve health and resilience, and reduce costs.

The Council

The Council convened in late 2020 to make equitable hypertension control a national priority, in response to the Surgeon General’s Call to Action to Control Hypertension. It aims to inspire, coordinate, and accelerate action to improve equitable hypertension prevention, detection, and control.

Founding members of the Council include 12 federal agencies and offices under the Department of Health and Human Services (HHS):

• Agency for Healthcare Research and Quality (AHRQ)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare & Medicaid Services (CMS)
• U.S. Food and Drug Administration (FDA)
• Health Resources and Services Administration (HRSA)
• Indian Health Services (IHS)
• National Heart, Lung, and Blood Institute (NHLBI)
• National Institute of Neurological Disorders and Stroke (NINDS)
• Office of Disease Prevention and Health Promotion (ODPHP)
• Office of Minority Health (OMH)
• Office of the National Coordinator for Health Information Technology (ONC)
• Office on Women’s Health (OWH)

In addition to fueling collaborations among member agencies and offices, the Council is a valuable source of expertise on hypertension for relevant HHS priorities, such as rural health, maternal health, and health equity. The Council is supported by CDC’s Division for Heart Disease and Stroke Prevention.

Action Framework With Three Objectives

Initial priorities are in bold.

• Improve Prevention
  • Increase access to affordable, lower-sodium food options.
  • Increase access to safe places to be active, participation in lifestyle programs, and implementation of physical activity guidelines.
  • Build communities with equitable access to affordable, healthy food and safe places to be active.
• Improve Detection
  • Find undiagnosed patients “hiding in plain sight,” e.g., by using electronic health record diagnostic algorithms.
  • Advance clinicians’ use of validated blood pressure monitors for diagnosis.
  • Build and expand community-based settings to detect hypertension and refer people with hypertension to medical care.
• Improve Control
  • Increase use of team-delivered treatment protocols that support changing or increasing medicine when hypertension remains uncontrolled, helping people with hypertension have a healthier lifestyle, and reducing differences in treatment among patient groups.
  • Improve patients’ ability to take medicine as it’s prescribed by lowering the cost, making it simpler to remember how to take it, and using best practices.
  • Increase the use of self-measured (or out-of-office) blood pressure monitoring.
  • Recognize and reward high performance and improvement by individuals, clinical and community teams, and health care systems.
  • Connect people to care using community-based screenings.

Each strategy was drafted based on its impact, feasibility, opportune timing, and potential HHS agency ownership. Each action will be examined for impact on health equity, disparities reduction, and COVID-related issues.

Hypertension 101

Hypertension is common; control is not. Nearly 116 million (1 in 2) US adults have hypertension. Among adults with hypertension, only about 1 in 4 has it under control.^[1]

Hypertension harms. Uncontrolled hypertension puts millions of people at risk for largely preventable events and conditions, such as heart attacks, strokes, kidney disease, heart failure, dementia, and severe pregnancy complications, which raise a woman’s lifetime risk of heart disease.^[2]

We are losing ground. After decades of improvement, the national control rate is decreasing.^[3] Early data show a further loss of hypertension control because of disruptions in health and care during the COVID-19 pandemic.

Hypertension is inequitable. Striking disparities exist in hypertension prevalence and control.^[4] For example, hypertension is the main cause of differences in life expectancy between Black and White adults.

Hypertension is costly: Annual costs for health care services, medicines, and loss of productivity from premature death amount to $131 billion to $198 billion. This cost is an underestimate because it does not include the substantial productivity losses from hypertension-induced illness, such as stroke.^[5]

Hypertension is controllable. We know what works to prevent, detect, and control hypertension. It’s time to ensure that best and promising practices, including those that address the inequities that result in disparities, are adopted, expanded, and spread across the country.

The Council welcomes new members from across and beyond HHS. For more information or to discuss joining the Council contact FedHTNCouncil@cdc.gov.

Select Hypertension Resources from Council Members

• The Surgeon General’s Call to Action to Control Hypertension (CDC)
• High Blood Pressure (CDC)
• Million Hearts^® (HHS)
• Hypertension Control (HRSA)
• FY 2021 Supplemental Funding for Hypertension (NHCI-HC) | Bureau of Primary Health Care (HRSA)
• Keeping High Blood Pressure Under Control (NHLBI)
• Mind Your Risks (NIH)
• Preventing and Treating High Blood Pressure Is About More Than Just the Numbers – News & Events (Health.gov)

References

^[1]  Centers for Disease Control and Prevention. Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. US Department of Health and Human Services. March 22, 2021. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html. Accessed March 6, 2023.

^[2] Ford ND, Cox S, Ko JY, et al. Hypertensive disorders in pregnancy and mortality at delivery hospitalization—United States, 2017–2019. MMWR Morb Mortal Wkly Rep 2022;71:585–591. DOI: http://dx.doi.org/10.15585/mmwr.mm7117a1.

^[3] Muntner P, Hardy ST, Fine LJ, et al. Trends in blood pressure control among US adults with hypertension, 1999-2000 to 2017-2018. JAMA. 2020;324(12):1190-1200. doi:10.1001/jama.2020.14545.

^[4] CDC. Hypertension cascade: HTN prevalence, treatment and control estimates among US adults aged 18 years and older applying the criteria from the ACC/AHA 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019.

^[5] Kirkland EB, Heincelman M, Bishu KG, Schumann SO, Schreiner A, Axon RN, Mauldin PD, Moran WP. Trends in healthcare expenditures among US adults with hypertension: national estimates, 2003-2014. J Am Heart Assoc. 2018 May 30;7(11):e008731. doi: 10.1161/JAHA.118.008731. PMID: 29848493; PMCID: PMC6015342.