Hypertension: Improvement in Blood Pressure

Percentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period

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Hypertension, or high blood pressure, is a very common and dangerous condition that increases risk for heart disease and stroke, two of the leading causes of death for Americans (Farley et al., 2010). Compared with other dietary, lifestyle, and metabolic risk factors, high blood pressure is the leading cause of death in women and the second-leading cause of death in men, behind smoking (Danaei et al., 2011). Approximately 1 in 3 U.S. adults, or about 70 million people, have high blood pressure but only about half (52%) of these people have their high blood pressure under control. Additionally, data from NHANES 2011 to 2012 found that 17.2% of U.S. adults are not aware they have hypertension (Nwankwo et al., 2013). Projections show that by 2030, approximately 41.4% of US adults will have hypertension, an increase of 8.4% from 2012 estimates (Heidenreich et al., 2011).

The estimated direct and indirect cost of high blood pressure for 2011 is $46.4 billion. This total includes direct costs such as the cost of physicians and other health professionals, hospital services, prescribed medications and home health care, as well as indirect costs due to loss of productivity from premature mortality (Mozaffarian et al., 2015). Projections show that by 2030, the total cost of high blood pressure could increase to an estimated $274 billion (Heidenreich et al., 2011).

Better control of blood pressure has been shown to significantly reduce the probability that undesirable and costly outcomes will occur. In clinical trials, antihypertensive therapy has been associated with reductions in stroke incidence (35-40%), myocardial infarction (20-25%) and heart failure (>50%) (Chobanian et al., 2003). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): Treating systolic blood pressure and diastolic blood pressure to targets that are <140/90 mmHg is associated with a decrease in cardiovascular disease complications

A higher score indicates better quality

Centers for Disease Control and Prevention (CDC). Prevalence of self-reported cardiovascular disease among persons aged >=35 years with diabetes: United States, 1997-2005. MMWR Morb Mortal Wkly Rep. 2007;56:1129-1132.

Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2572.

Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, Ezzati M. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors [published correction appears in PLoS Med. 2011;8. doi: 10.1371/annotation/0ef47acd-9dcc-4296-a897-872d182cde57]. PLoS Med. 2009;6:e1000058.

Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38:600-9.

Heidenreich, P.A., J.G. Trogdon, O.A. Khavjou, et al. 2011. "Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association." Circulation.123:933-944.

Mozaffarian, D., E.J. Benjamin, A.S. Go, et al. 2015. "Heart disease and stroke statistics-2015 update: a report from the American Heart Association." Circulation. 131:e29-e322. doi: 10.1161/CIR.0000000000000152

Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the US: National Health and Nutrition Examination Survey, 2011-2012. NCHS Data Brief, No. 133. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2013.

Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No.03 - 5233 December 2003

Adequate control: a systolic blood pressure < 140 mmHg. 

Uncontrolled blood pressure: a systolic blood pressure >= 140 mmHg.

Uncontrolled baseline blood pressure: systolic blood pressure >= 140 mmHg that is taken during the first outpatient encounter of the measurement year in which the patient has an active diagnosis of hypertension. This must occur during the first six months of the year. If the patient with hypertension has uncontrolled blood pressure during the first outpatient encounter of the measurement year, then include the patient in the initial patient population of the measure.

Follow-up blood pressure: systolic blood pressure taken during the first outpatient encounter during the measurement year that occurs at least six months after the baseline blood pressure.

Improvement in blood pressure: the follow-up blood pressure is at least 10 mmHg less than the baseline systolic blood pressure.

Blood pressure readings must be taken while the patient is sitting. If multiple measurements occur on the same date, the last systolic and diastolic readings should be used.

"Occurrence A of Physical Exam, Performed: Systolic Blood Pressure (result)" represents the baseline blood pressure, which must occur prior to "Occurrence B of Physical Exam, Performed: Systolic Blood Pressure (result)", which represents the follow-up blood pressure.

To calculate the "Physical Exam, Performed: Delta systolic blood pressure (result)" data element, subtract the value of "Occurrence B of Physical Exam, Performed: Systolic Blood Pressure (result)" from the value of "Occurrence A of Physical Exam, Performed: Systolic Blood Pressure (result)". 

The data element "Physical Exam, Performed: Delta systolic blood pressure (result)" is intended to represent the result of the mathematic comparison between systolic blood pressures taken during two separate visits. This is a calculation artifact, and there's no requirement to document the delta data element in the medical record.

TBD

All patients aged 18-85 years of age, who had at least one outpatient visit in the first six months of the measurement year, who have a diagnosis of essential hypertension documented during that outpatient visit, and who have uncontrolled baseline blood pressure at the time of that visit

Equals Initial Population

Exclude from the denominator all patients with evidence of end-stage renal disease (ESRD) on or prior to December 31 of the measurement year. Documentation of dialysis or kidney transplant also meets the criteria for evidence of ESRD.

Exclude from the denominator all patients with a diagnosis of pregnancy during the measurement year.

Exclude patients who were in hospice care during the measurement year.

Patients whose follow-up blood pressure is at least 10 mmHg less than their baseline blood pressure or is adequately controlled.

If a follow-up blood pressure reading is not recorded during the measurement year, the patient's blood pressure is assumed "not improved."

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Not Applicable