Blood Pressure Control

Woman using a home blood pressure monitor.

High blood pressure, also known as hypertension, affects men and women of all races, ethnicities, and age groups throughout the U.S.. An estimated 47% of U.S. adults (116 million) have high blood pressure, using criteria from the 2017 clinical guideline from the American College of Cardiology (ACC), the American Heart Association (AHA), and other organizations, which defines high blood pressure as systolic blood pressure >130 mmHg and/or diastolic blood pressure >80 mmHg.1,2

Of people with high blood pressure who are recommended to be on antihypertensive medications and make lifestyle modifications, 74% (68 million) do not have their blood pressure under control. Uncontrolled blood pressure is a leading cause of heart attack, stroke, heart failure, dementia, and kidney disease. Moreover, hypertensive disorders of pregnancy are increasing in prevalence.3,4 These conditions raise a woman’s lifetime risk of cardiovascular disease (CVD) and are associated with poor birth outcomes.5

The prevalence of hypertension is higher in non-Hispanic Black persons than non-Hispanic White persons or persons of Hispanic origin. Moreover, non-Hispanic Black persons develop hypertension at younger ages than non-Hispanic White persons.6 Death rates from CVD linked to high blood pressure are increasing for people aged 35-64 in the majority of U.S. counties, and are highest among non-Hispanic Black persons.7 Additionally, people living in communities with a low socioeconomic status or without health insurance are less likely to have controlled high blood pressure than their counterparts.8.9

National surveillance data suggest that millions of people are unaware of their high blood pressure and data from clinical settings reinforce this; there are non-trivial numbers of patients seen in clinical settings who have multiple abnormal blood pressure readings but have not been diagnosed with hypertension. These patients with potentially undiagnosed hypertension are “hiding in plain sight” and strategies exist for finding them so they can be appropriately diagnosed, treated, and brought to control.10

The 2017 ACC/AHA blood pressure guideline recommends initial combination therapy with two or more antihypertensive medications for most people with hypertension. Despite this recommendation, surveillance data show that 40% of people with hypertension are on monotherapy.11 Moreover, Blood pressure control related to the medication class and number of medications taken vary by race. Black persons have lower rates of control than White persons across all medication classes and among those on two, three, or four different classes.12 Standardized hypertension treatment protocols can be used to support timely medication intensification, improve blood pressure control, and may help achieve equitable care.13

Another evidence-based strategy that has been shown to lower blood pressure and improve control in persons with hypertension is self-measured blood pressure monitoring (SMBP). When combined with additional clinical support, SMBP may also reduce therapeutic inertia and improve medication adherence. SMBP is also recommended to confirm new hypertension diagnoses, and many resources exist to support its use.

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