eCQM Title

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

eCQM Identifier (Measure Authoring Tool) 22 eCQM Version number 7.1.000
NQF Number Not Applicable GUID 9a033a94-3d9b-11e1-8634-00237d5bf174
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Developer Quality Insights
Endorsed By None
Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated
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CPT(R) contained in the Measure specifications is copyright 2007-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2017 International Health Terminology Standards Development Organisation. All Rights Reserved.
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Measure Scoring Proportion
Measure Type Process
Risk Adjustment
Rate Aggregation
Hypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40% of the adult population has hypertension; the majority of people over age 65 have a hypertension diagnosis (Appleton SL, et. al., 2012 and Luehr D, et. al., 2012). Winter (2013) noted that 1 in 3 American adults have hypertension and the lifetime risk of developing hypertension is 90% (Winter KH, et. al., 2013). The African American population or non-Hispanic Blacks, the elderly, diabetics and those with chronic kidney disease are at increased risk of stroke, myocardial infarction and renal disease. Non-Hispanic Blacks have the highest prevalence at 38.6% (Winter KH, et. al., 2013). Hypertension is a major risk factor for ischemic heart disease, left ventricular hypertrophy, renal failure, stroke and dementia (Luehr D, et. al., 2012). 

Hypertension is the most common reason for adult office visits other than pregnancy. Garrison (2013) stated that in 2007, 42 million ambulatory visits were attributed to hypertension (Garrison GM and Oberhelman S, 2013). It also has the highest utilization of prescription drugs. Numerous resources and treatment options are available, yet only about 40-50% of the hypertensive patients have their blood pressure under control (<140/90) (Appleton SL, et. al., 2012, Luehr D, et. al., 2012). In addition to medication non-compliance, poor outcomes are also attributed to poor adherence to lifestyle changes such as a low-sodium diet, weight loss, increased exercise and limiting alcohol intake. Many adults find it difficult to continue medications and lifestyle changes when they are asymptomatic. Symptoms of elevated blood pressure usually do not occur until secondary problems arise such as with vascular diseases (myocardial infarction, stroke, heart failure and renal insufficiency) (Luehr D, et. al., 2012).

Appropriate follow-up after blood pressure measurement is a pivotal component in preventing the progression of hypertension and the development of heart disease. Detection of marginally or fully elevated blood pressure by a specialty clinician warrants referral to a provider familiar with the management of hypertension and prehypertension.  The 2010 ACCF/AHA Guideline for the Assessment of Cardiovascular Risk in Asymptomatic Adults continues to support using a global risk score such as the Framingham Risk Score, to assess risk of coronary heart disease (CHD) in all asymptomatic adults (Greenland P, et. al., 2010).  Lifestyle modifications have demonstrated effectiveness in lowering blood pressure (JNC 7, 2003).  The synergistic effect of several lifestyle modifications results in greater benefits than a single modification alone. Baseline diagnostic/laboratory testing establishes if a co-existing underlying condition is the etiology of hypertension and evaluates if end organ damage from hypertension has already occurred. Landmark trials such as ALLHAT have repeatedly proven the efficacy of pharmacologic therapy to control blood pressure and reduce the complications of hypertension.  Follow-up intervals based on blood pressure control have been established by the JNC 7 and the USPSTF.
Clinical Recommendation Statement
The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation.
Improvement Notation
Higher score indicates better quality
Appleton SL, Neo C, Hill C L, Douglas K A & Adams R J (2012). Untreated hypertension: prevalence and patient factors and beliefs associated with under-treatment in a population sample. Journal of Human Hypertension, advance online publication December 13, 2012.
Garrison GM & Oberhelman S (2013). Screening for hypertension annually compared with current practice. Annals of Family Medicine, 11 (2), 116-121.
Luehr D, Woolley T, Burke R, Dohmen F, Hayes R, Johnson M, Kerandi H, Margolis K, Marshall M, O'Connor P, Pereira C, Reddy G, Schlichte A & Schoenleber M (2012). Hypertension diagnosis and treatment; Institute for Clinical Systems Improvement health care guideline. Updated November, 2012.
U.S. Preventive Services Task Force (USPSTF) (2007). Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine; 147(11):783-6
U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute & National High Blood Pressure Education Program (2003). The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). NIH Publication No. 03-5233
Winter K H, Tuttle L A & Viera A J (2013). Hypertension. Prim Care Clin Office Pract, 40, 179-194.
Blood Pressure (BP) Classification: 
BP is defined by four (4) BP reading classifications: Normal, Pre-Hypertensive, First Hypertensive, and Second Hypertensive Readings

Recommended BP Follow-Up: 
The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the "Recommended Blood Pressure Follow-Up Interventions" listed below

Recommended Lifestyle Modifications: 
The JNC 7 report outlines lifestyle modifications which must include one or more of the following as indicated:
*  Weight Reduction
*  Dietary Approaches to Stop Hypertension (DASH) Eating Plan 
*  Dietary Sodium Restriction
*  Increased Physical Activity
*  Moderation in alcohol (ETOH) Consumption

Second Hypertensive Reading: 
Requires a BP reading of Systolic BP >= 140 mmHg OR Diastolic BP >= 90 mmHg during the current encounter AND a most recent BP reading within the last 12 months Systolic BP >= 140 mmHg OR Diastolic BP >= 90 mmHg

Second Hypertensive Reading BP Interventions:  
The JNC 7 report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated:
*  Anti-Hypertensive Pharmacologic Therapy 
*  Laboratory Tests 
*  Electrocardiogram (ECG)

Recommended Blood Pressure Follow-Up Interventions:
*  Normal BP: No follow-up required for Systolic BP < 120 mmHg AND Diastolic BP <80 mmHg
*  Pre-Hypertensive BP: Follow-up with rescreen every year with systolic BP of 120-139 mmHg OR diastolic BP of 80-89 mmHg AND recommend lifestyle modifications OR referral to Alternative/Primary Care Provider
*  First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg: 
      *  Follow-up with rescreen > 1 day and < 4 weeks AND  recommend lifestyle modifications OR referral to Alternative/Primary Care Provider  
*  Second Hypertensive BP Reading: Patients with second elevated reading of  systolic BP >=140 mmHg OR diastolic BP >= 90 mmHg:  
      *  Follow-up with Recommended lifestyle recommendations  AND one or more of the Second Hypertensive Reading Interventions OR referral to Alternative/Primary Care Provider
Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, use the most recent as the representative blood pressure.

Eligible professionals or eligible clinicians who report the measure must perform the blood pressure screening at the time of a qualifying visit by an eligible professional or eligible clinician and may not obtain measurements from external sources. 

The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current BP reading as indicated, example: "Patient referred to primary care provider for BP management."
Transmission Format
Initial Population
All patients aged 18 years and older at the beginning of the measurement period with at least one eligible encounter during the measurement period
Equals Initial Population
Denominator Exclusions
Patient has an active diagnosis of hypertension
Patients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated if the blood pressure is pre-hypertensive or hypertensive
Numerator Exclusions
Not Applicable
Denominator Exceptions
Patient Reason(s): 
Patient refuses to participate (either BP measurement or follow-up)


Medical Reason(s):
Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status.  This may include but is not limited to severely elevated BP when immediate medical treatment is indicated.
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents

Population Criteria




Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables

Measure Set
Preventive Care and Screening