Control High Blood Pressure
Fast Facts
- High blood pressure (hypertension) is one of the key risk factors for cardiovascular disease including heart disease and stroke.
- Cardiovascular disease caused 877,503 deaths in 2019 (or 1 in 3 deaths).1
- Of the 877,503 Americans who died of any type of CVD in 2018, 659,401 died from heart disease, that is 1 out of every 4 deaths (23.1% of all deaths).2
- Stroke killed 150,005 of the 877,503Americans who died of CVD in 2019 – that is 1 in every 6 deaths from CVD and 5.2% of all deaths.1
- According to the American College of Cardiology/American Heart Association (ACC/AHA) 2017 hypertension guideline, hypertension is defined as a blood pressure ≥130/≥80 mmHg.4
- An estimated 1116 million American adults (47.3%) have hypertension—nearly 1 in 2 adults. 5
- Most adults with hypertension don’t have it controlled—3 in 4 (92.1 million) US adults with hypertension have a blood pressure of 130/80 mm Hg or higher. 5
- About 1 in every 7 health care dollars is spent on heart disease.3
- Annual heart disease costs to the nation averaged $363.4 billion in 2016-2017.2
Evidence-Based Interventions
- Use strategies that help people get access to and properly use anti-hypertensive and lipid-lowering prescription medications through improved care coordination that include:
- Low cost medication copayments, fixed dose medication combinations, and extended medication fills;
- Innovative pharmacy packaging (e.g, calendar blister packs); and
- Improved care coordination using standardized protocols, primary care teams including use of community health workers, medication therapy management programs, and self-measured blood pressure monitoring (SMBP) with clinical support.
- Provide home blood pressure monitors to patients with high blood pressure and reimburse clinicians for the clinical support services required for self-measured blood pressure monitoring (SMBP).
Healthcare Providers
Coordinated Care Teams
A CDC Community Guide Task Force review 6 found strong evidence of effectiveness for interventions that engage community health workers in a team-based care model to improve blood pressure and cholesterol in patients at increased risk for heart disease. Findings suggest using community health workers alongside physicians and nurses in team-based care was linked to large improvements in blood pressure and cholesterol control.
Pharmacists on Care Teams
A study of a pharmacist–physician collaborative approach to managing high blood pressure demonstrated that within a year and a half, nearly twice as many patients had control of their blood pressure when pharmacists helped the patients manage their medications, compared with those not assisted by pharmacists.7
Self-Measured Blood Pressure Monitoring
Self-measured blood pressure monitoring (SMBP)external icon is the regular measurement of blood pressure by a patient at home or elsewhere outside of a clinical setting often using a personal blood pressure measurement device. The Community Preventive Services Task Force found that there is:
- Strong evidence that SMBP interventions, when combined with additional support like patient counseling, education, or web-based support, are effective in improving blood pressure outcomes in patients with high blood pressure.8
- Sufficient evidence that SMBP interventions, when used alone, are effective in improving blood pressure outcomes in patients with high blood pressure.9
- Additionally, SMBP interventions are cost-effective when used with either additional support or within team-based care. The return on investment is from $7.50 to $19.34 per dollar in the long run (10 years).10
Payers
Medication Management
Using a pharmacy benefit that varies copayments based upon patient risk for cholesterol-lowering therapy can improve patient medication compliance and reduce patients’ need for other services like hospitalization or an emergency department visit.
This study revealed that if you assume 6.3 million people insured by private insurance or Medicaid were on cholesterol-lowering therapy, changing the copayments results in:
- Avoiding almost 80,000 hospitalizations.
- More than 31,000 emergency department admissions.
- Over $1 billion in annual savings.11
Employers
Medication Management
In a 6-month study, pharmacists provided a variety of medication therapy management (MTM) services to patients with heart disease at no cost to the patients as part of their employer’s health plan. The MTM group’s total direct healthcare expenditures were significantly lower ($359/patient) and revealed a return on investment of $1.67 per $1 spent.12
Clinically, those who received MTM were more successful at meeting their blood pressure and body mass index (BMI) goals. In less than 1 year, pharmacists had a positive financial and clinical impact on patients with cardiovascular disease.12
Healthcare Providers
- Provide blood pressure checks without appointment or co-payment.
- Use evidence-based blood pressure treatment protocols.
- Use non-medical staff trained in the proper procedure to take blood pressure to help patients self-manage their blood pressure.
- Participate in medication therapy management programs with community or health system pharmacists.
Payers
- Use administrative claims data to identify possible gaps in blood pressure care among your members.
- Work with participating healthcare professions to implement protocols for blood pressure treatment.
- Incentivize healthcare providers and pharmacies to use e-prescribing.
- Compared to written prescriptions, e-prescribing has been shown to increase the percentage of prescriptions that are picked up by 10%.13, 14
- Consider reducing out-of-pocket costs for blood pressure medications that are combined with team-based care and medication counseling.
- Reimburse for the clinical support services required for SMBP (i.e. time clinicians spend training patients in SMBP techniques, interpreting SMBP readings, and providing treatment based on SMBP readings)15.
Employers
- Use MTM suggestions for health benefit and pharmacy benefit managers found in Million Hearts® Medication Adherence: Action Steps for Health Benefit Managerspdf iconexternal icon such as promoting dispensing of 90 day medications, reimbursing pharmacists for medication counseling, or incentivizing pharmacists and physicians to form team-based care and protocols
Additional Resources
National Association of Community Health Centers Self-Measured Blood Pressure Monitoring: Implementation Guide for Health Care Delivery Organizationpdf iconexternal icon
This implementation guide is designed to help health care delivery organizations implement SMBP into practice or optimize existing SMBP processes.
Million Hearts® Medication Adherenceexternal icon
Calls to action for public health practitioners, employers, and pharmacy benefit managers; also includes an online module from the American Medical Association to help providers find answers to common questions about how to involve staff and patients in identifying nonadherence and changing behaviors.
Million Hearts® Interactive Protocol for Controlling Hypertension
A tool meant to enhance the management of blood pressure in adults aged 18-85 years and to be used by health care practitioners to assist in controlling their patients’ hypertension.
Million Hearts® Hypertension Prevalence Estimator Tool
The Million Hearts® Hypertension Prevalence Estimator Tool provides the user with a health system’s expected hypertension prevalence, which is the estimated percentage of patients receiving care within the health system who have hypertension. Health systems (including practices) can compare their expected hypertension prevalence calculated using the Estimator Tool with their measured prevalence to assess if they potentially have a large percentage of their patient population who have undiagnosed hypertension.
CDC Division for Heart Disease and Stroke Prevention Pharmacy Resources
Resources and information for pharmacists about their role in team-based care for patients. Public health professionals can learn about effective strategies to partner with pharmacists.
CDC’s Advancing Team-Based Care Through Collaborative Practice Agreementspdf icon
A resource and implementation guide for adding pharmacists to the care team.
CDC’s Increasing the Use of Collaborative Practice Agreements (CPAs) Between Prescribers and Pharmacistspdf icon
This brief describes how CPAs can increase patient access to health care by empowering pharmacists to practice as an extension of physicians and other prescribers to help patients manage or prevent chronic diseases. It also provides action steps and resources that health care decision makers, public health practitioners, and prescribers can take to develop CPAs.
References
1 Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999–2019 on CDC WONDER Online Database website.
2 Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, , et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143:e00 –e006. DOI: 10.1161/CIR.0000000000000950
3 Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139:e1–e473. doi: 10.1161/CIR.0000000000000659.
4 Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluatioin, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension. 2018;71:e13–115.
5 Centers for Disease Control and Prevention (CDC). Hypertension Cascade: Hypertension Prevalence, Treatment and Control Estimates Among US Adults Aged 18 Years and Older Applying the Criteria From the American College of Cardiology and American Heart Association’s 2017 Hypertension Guideline—NHANES 2013–2016. Atlanta, GA: US Department of Health and Human Services; 2019external icon. Accessed March 12, 2020.
6 Cardiovascular Disease: Interventions Engaging Community Health Workers. The Guide to Community Preventive Services (The Community Guide)external icon. March 2015. Accessed January 21, 2021.
7 Wentzlaff DM, Carter BL, Ardery G, et al. Sustained blood pressure control following discontinuation of a pharmacist intervention. J Clin Hypertens. 2011;13(6):431–7.
8 Cardiovascular Disease: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control – When Combined with Additional Support.” The Guide to Community Preventive Services (The Community Guide). February 12, 2019. Accessed March 04, 2019. https://www.thecommunityguide.org/findings/cardiovascular-disease-self-measured-blood-pressure-with-additional-support.
9 Cardiovascular Disease: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control – When Used Alone.external icon” The Guide to Community Preventive Services (The Community Guide). February 12, 2019. Accessed March 04, 2019.
10 Arrieta A, Woods J, Qiao N, Jay S. Cost-benefit analysis of home blood pressure monitoring in hypertension diagnosis and treatment: an insurer perspective. Hypertension 2014: 64:891– 6.
11 Goldman DP, Joyce GF, Karaca- Mandic P. Varying Pharmacy Benefits With Clinical Status: The Case of Cholesterol-lowering Therapy. Am J Manag Care. 2006;12:21-28.
12 Wittayanukorn S, Westrick SC, Hansen RA, et al. Evaluation of medication therapy management services for patients with cardiovascular disease in a self-insured employer health plan. J Manag Care Pharm. 2013 Jun;19(5):385–95
13 Health Manag Technol. 2012;33(4):22-3. PMID 22558674
15 Pickering TG, Miller NH, Ogedegbe G, Kra-koff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: executive summary: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. J Am Soc Hypertens. 2008;2:192–202.