Summary
A scientific statement from the American Heart Association (AHA) and American Medical Association (AMA) details the disconnect between guidelines for hypertension management and data on actual blood pressure (BP) control in patient care.1 Despite robust evidence-based guidelines from national organizations, recent data confirm that BP control has declined in the United States in the last decade.2
An exploration of potential barriers to BP control, including individual- and community-level barriers, is key to understanding the gap between guidelines and BP control at the patient level (Table 1).
Table 2 includes strategies to improve BP control: continuing (or starting) antiracism efforts, ensuring accurate BP measurement in ambulatory and home settings, establishing treatment protocols, using designated lifestyle counseling services, and maximizing team-based care. It also provides links to implementation tools and resources from national organizations, and highlights priority strategies for implementation, which address barriers at the individual, organization, community, and policy levels.
Large-scale implementation projects, including the integration of treatment protocols and practice facilitation, have been successful in closing the gap between scientific evidence and BP control.3,4
Sources
1Abdalla M, Bolen SD, Brettler J, et al. Implementation strategies to improve blood pressure control in the United States: a scientific statement from the American Heart Association and American Medical Association. Hypertension. 2023;80(10):e143-e157. doi:10.1161/HYP.0000000000000232.
2Muntner P, Miles MA, Jaeger BC, et al. Blood pressure control among US adults, 2009 to 2012 Through 2017 to 2020. Hypertension. 2022;79(9):1971-1980. doi:10.1161/HYPERTENSIONAHA.122.19222.
3Wang A, Pollack T, Kadziel LA, et al. Impact of practice facilitation in primary care on chronic disease care processes and outcomes: a systematic review. J Gen Intern Med. 2018;33(11):1968-1977. doi:10.1007/s11606-018-4581-9.
4Fontil V, Gupta R, Moise N, et al. Adapting and evaluating a health system intervention from Kaiser Permanente to improve hypertension management and control in a large network of safety-net clinics. Circ Cardiovasc Qual Outcomes. 2018;11(7):e004386. doi:10.1161/CIRCOUTCOMES.117.004386.