Undiagnosed Hypertension

Are there patients in your practice with undiagnosed hypertension who may be “hiding in plain sight”?

Of the 75 million Americans who have hypertension, almost half do not have the condition under control. About 11 million of them don’t know their blood pressure is too high and are not receiving treatment to control it, even though most of these individuals have health insurance and visit a health care provider each year.

That means potentially millions of people with uncontrolled hypertension are seen by clinicians but remain undiagnosed. While following best practices and providing the highest levels of care, providers can still have patients “hiding in plain sight” who are at risk for or have undiagnosed hypertension. Finding these patients and spreading the word about how other health care professionals can find them may help save lives.

References, Resources, and Case Studies

The Maine Center for Disease Control and Prevention — Hypertension: Hiding in Plain Sight
This video provides an overview of potentially undiagnosed hypertension and shares information about patients who may be “hiding in plain sight.”

Patients with Undiagnosed Hypertension: Hiding in Plain Sight
Article explaining the “hiding in plain sight” phenomenon and summarizing what large health systems have done to find patients with undiagnosed hypertension. (JAMA, November 2014)

Improving Identification and Diagnosis of Hypertensive Patients Hiding in Plain Sight (HIPS) in Health Centers
Study illustrating how 10 health centers with a high prevalence of hypertension used algorithmic logic and clinical decision support to identify and engage patients at risk for undiagnosed hypertension. (The Joint Commission Journal on Quality and Patient Safety, March 2018)

Public Health Live: Hiding in Plain Sight: Finding Patients with Undiagnosed Hypertension
Hour-long interview with experts from the Centers for Disease Control and Prevention and the Health Center Network of New York exploring the science and implementation of finding patients with potentially undiagnosed hypertension. (Public Health Live, February 2016)

Hypertension Prevalence — AMGA Results Using Dx Code, Problem List, and Elevated Blood Pressure Readings [PDF – 954K]
This data snapshot shows the differences between hypertension prevalence estimates of AMGA data calculated using three distinctive criteria and the CDC Hypertension Prevalence Estimator Tool for the period of July 2013–June 2014.

A Technology-Based Quality Innovation to Identify Undiagnosed Hypertension Among Active Primary Care Patients
Study demonstrating the move from patient identification to diagnosis using a technology-based strategy and illustrating how finding undiagnosed hypertensive patients is not a documentation issue. (Annals of Family Medicine, July 2014)

Undiagnosed Hypertension Among Young Adults with Regular Primary Care Use
Study comparing the rates of new hypertension diagnosis for different age groups and identifying delay predictors in the initial diagnosis among young adults who regularly use primary care. (Journal of Hypertension, January 2014)

Identifying Patients with Hypertension: A Case for Auditing Electronic Health Record Data
Study examining electronic health record data application to find potentially undiagnosed hypertensive patients and the variability in the magnitude of the “hiding in plain sight” problem across 11 community health centers. (Perspectives in Health Information Management, April 2012)

Underdiagnosis of Hypertension Using Electronic Health Records
Study showing how diagnosis leads to treatment by examining and identifying the diagnosis rates of prevalent and incident hypertension cases in a large outpatient health care system. (American Journal of Hypertension, January 2012)

Video: Finding Undiagnosed Hypertensive Patients

Watch this video to learn more about the four steps to finding patients “hiding in plain sight” with undiagnosed hypertension:

1. Establish clinical criteria for potentially undiagnosed hypertension.
2. Search electronic health record data for patients who meet the established clinical criteria.
3. Implement a plan to diagnose these patients and to treat those with hypertension.
4. Calculate your health practice’s or system’s hypertension prevalence and compare your data against local, state, or national data.

Start with the steps that make the most sense for your practice or system. The most important action to take is beginning the search for these patients. Treating uncontrolled hypertension dramatically reduces patients’ risk for heart attack and stroke. Bringing individuals “hiding in plain sight” into clear view will help protect millions from unnecessary and preventable events.