Notes from the Field: Characteristics of Million Hearts Hypertension Control Champions, 2012–2019

Matthew D. Ritchey, DPT1; Judy Hannan, MPH1; Hilary K. Wall, MPH1; Mary G. George, MD1; Laurence S. Sperling, MD1,2 (View author affiliations)

View suggested citation
Article Metrics

Views equals page views plus PDF downloads

Related Materials

Million Hearts is a national initiative co-led by CDC and the Centers for Medicare & Medicaid Services that aims to prevent 1 million heart attacks, strokes, and other related acute cardiovascular events by 2022 (1,2). On November 19, 2019, the initiative recognized 17 Million Hearts Hypertension Control Champions for achieving ≥80% blood pressure control rates among their patients with hypertension. These Champions include clinicians, practices, health centers, and health systems from 15 states that provide care for 201,045 adult patients, approximately one third (68,019) of whom have hypertension. The Hypertension Control Challenge is held annually to identify new Champions, with a call for applications in the spring, review and vetting in the summer, and announcement of Champions in the late fall. Since 2012, Million Hearts has recognized 118 Champions from 36 states and the District of Columbia who care for more than 15 million adult patients, including 5 million with hypertension (Table).*

Hypertension is a leading modifiable risk factor for heart disease and stroke (13). In light of this risk and the potential impact on preventing cardiovascular events by controlling hypertension, Million Hearts focuses on improving control of blood pressure among persons with hypertension. The Hypertension Control Challenge is an opportunity to call attention to the importance of controlling blood pressure in preventing cardiovascular disease and to create a sense of urgency around hypertension control, encouraging clinicians and health systems to share their achievements and promote their successful strategies.

To be eligible for recognition as a 2019 Champion, applicants were required to have an adult patient population of at least 500 persons and a hypertension control rate of 80% or higher among patients aged 18–85 years with diagnosed hypertension during a 12-month reporting period starting on or after January 1, 2018. Hypertension control was defined as a last blood pressure reading of <140/90 mm Hg, which aligns with current clinical performance measure specifications used by the health care sector to track progress in hypertension control. Using definitions consistent with these specifications nationally, approximately 75 million adults have hypertension, and only one half of these persons have their hypertension controlled (4). Applicants submitted information on their patient population size, demographic characteristics, and hypertension prevalence and control rates. Applicants’ eligibility status was assessed, and a subset of their submitted hypertension control data was validated through a formal external review.§

All 17 Champions identified in 2019 were from the private sector, including nine (53%) who had a rural-only service area and five health centers funded by the Health Resources and Services Administration. Among the 17 Champions, the median adult patient population size was 2,639 (range = 574–137,415) (Table). The median hypertension prevalence was 34% (range = 21%–52%), and the median hypertension control rate was 84% (range = 80%–98%).

This national recognition program demonstrates that achieving high hypertension control rates is possible across a range of health care settings and among patient populations at high risk for uncontrolled hypertension (15). Various strategies have been reported by past Champions that supported their achievement of high control rates (5). Specific strategies highlighted by this year’s Champions included identifying a clinician within their organization who was dedicated to leading their hypertension management quality improvement efforts, arranging frequent office visits until blood pressure control was achieved, using hypertension treatment protocols and electronic health record–supported patient registries to guide patient treatment and follow-up, and providing clinician feedback through performance reports. In addition, Champions reported engaging patients in self-measured blood pressure monitoring to assess progress, inform decision-making, and encourage treatment adherence. A broader application of the strategies used by the Champions identified through the Hypertension Control Challenge could help to improve hypertension control rates nationally and decrease the incidence of heart disease and stroke.

Corresponding author: Matthew D. Ritchey,, 770-488-7232.

1Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, CDC; 2Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.

All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.


  1. Wall HK, Ritchey MD, Gillespie C, Omura JD, Jamal A, George MG. Vital signs: prevalence of key cardiovascular disease risk factors for Million Hearts 2022—United States, 2011–2016. MMWR Morb Mortal Wkly Rep 2018;67:983–91. CrossRefexternal icon PubMedexternal icon
  2. Ritchey MD, Wall HK, George MG, Wright JS. US trends in premature heart disease mortality over the past 50 years: where do we go from here? Trends Cardiovasc Med 2019;. CrossRefexternal icon
  3. Go AS, Bauman MA, Coleman King SM, et al. An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J Am Coll Cardiol 2014;63:1230–8. CrossRefexternal icon PubMedexternal icon
  4. Ritchey MD, Gillespie C, Wozniak G, et al. Potential need for expanded pharmacologic treatment and lifestyle modification services under the 2017 ACC/AHA Hypertension Guideline. J Clin Hypertens (Greenwich) 2018;20:1377–91. CrossRefexternal icon PubMedexternal icon
  5. Young A, Ritchey MD, George MG, Hannan J, Wright J. Characteristics of health care practices and systems that excel in hypertension control. Prev Chronic Dis 2018;15:170497. CrossRefexternal icon PubMedexternal icon
TABLE. Characteristics of patient populations treated by Million Hearts Hypertension Control Champions, 2012–2019Return to your place in the text
Characteristic 2019 2012–2018* Total
Champions (total no.) 17 101 118
States represented, no. 15 35 37§
Sector, no.
Private 17 98 115
Federal 0 3 3
Service area type, no. (%)
Urban 7 (41) 50 (50) 57 (48)
Rural 9 (53) 19 (19) 28 (24)
Both urban and rural 1 (6) 32 (32) 33 (28)
HRSA-funded health centers, no. (%) 5 (29) 31 (31) 36 (31)
No. of adult patients treated annually
Median (range) 2,639 (574–137,415) 6,682 (550–6,100,000) 5,706 (550–6,100,000)
Total 201,045 15,049,386 15,250,431
Self-reported patient population characteristics, median percentage (no. of Champions with response; percentage range)
Minority** 20 (17; 0–92) 27 (98; 0–100) 25 (115; 0–100)
English as a second language 3 (17; 0–85) 3 (96; 0–95) 3 (113; 0–95)
Medicaid beneficiary 15 (17; 0–75) 18 (98; 0–85) 17 (115; 0–85)
Uninsured 5 (17; 0–21) 5 (18; 0–33) 5 (35; 0–33)
No. of adult patients with hypertension treated annually
Median among Champions (range) 838 (189–45,704) 1,676 (96–2,900,000) 1,474 (96–2,900,000)
Total 68,019 5,023,114 5,091,133
Median hypertension prevalence, % (range) 34 (21–52) 30 (7–86) 31 (7–86)
Median blood pressure control rate,†† % (range) 84 (80–98) 80 (70–99) 81 (70–99)

Abbreviation: HRSA = Health Resources and Services Administration.
* Excludes 2016.
California, Connecticut, Florida, Illinois, Iowa, Kentucky, New Jersey, New York, Pennsylvania, Rhode Island, Texas, Utah, Virginia, Washington, and Wisconsin.
§ In addition to the states in which 2019 Champions were recognized, also includes the District of Columbia, Colorado, Georgia, Hawaii, Kansas, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, New Hampshire, New Mexico, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, Tennessee, West Virginia, and Wyoming; the U.S. Department of Veterans Affairs was also recognized as a Champion in 2013 and has coverage throughout the United States.
Information on HRSA-funded health center status was not consistently collected during 2012–2017; therefore, it might be underreported.
** Minority status of the patient population was determined by the applicant. No formal definition was recommended for use.
†† During 2012–2017, Champions were recognized for having blood pressure control rates of 70% or higher.

Suggested citation for this article: Ritchey MD, Hannan J, Wall HK, George MG, Sperling LS. Notes from the Field: Characteristics of Million Hearts Hypertension Control Champions, 2012–2019. MMWR Morb Mortal Wkly Rep 2020;69:196–197. DOI: icon.

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services.
Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

Questions or messages regarding errors in formatting should be addressed to

View Page In:pdf icon PDF [143K]
Page last reviewed: February 20, 2020