The Quality Committee recently released its recommendations for Improving Hypertension Control for our patients. These are evidence-based, relying on the most recent national guidelines. They incorporate the new definition and target for treating hypertension as outlined by the American Heart Association (AHA) and the American College of Cardiology (ACC), who took over updates after the Joint National Commission (JNC8) disbanded in 2013.
This issue is not only important to ensure the health of our patients due to the known effects of long standing hypertension but also to ensure we are meeting our quality metrics performance for CMS and MIPS reporting. In 2015 and 2016 only 67% of our patients had their BP well controlled according to CMS. This increased only slightly to 70% in 2017 which was just shy of the national mean performance.
Some key points of these recommendations include:
- Recognize the new definition/classification: Stage 1 (130/80 to 139/89) and Stage 2 (140/90 and higher) with different implications for follow up and treatment. Share this new definition with staff to ensure we’re providing consistent messaging and care to patients.
- Review proper techniques for taking BP with your staff. BP control starts with accurate measurements.
- Address the issue whenever the BP is noted to be elevated. This may be as simple as rechecking it and documenting another BP (either you or staff) or making diet and medication changes and ensuring a timely follow-up visit.
- If Stage 1 HTN – schedule a 4 week follow up with provider
- If Stage 2 HTN – schedule a 2 week follow up with provider
- Remember lifestyle modifications are important in treating both stages of hypertension, and are first line for stage 1. These include weight loss, the DASH diet, reducing sodium, increasing dietary potassium, physical activity, and moderating alcohol consumption.
While these evidence-based recommendations should meet the needs of most patients, they’re by no means a substitute for good clinical judgement. Decisions about care must always carefully consider clinical circumstances and characteristics of each individual.