Resources
Evidence-based Treatment Protocols for Improving Blood Pressure Control*
Million Hearts® encourages widespread adoption and use of standardized treatment protocols for improving blood pressure control. Simple, evidence-based treatment protocols can have a powerful impact in improving control by clarifying titration intervals and treatment options, by expanding the types of staff that can assist in timely follow-up with patients, and when embedded in electronic health records, by serving as clinical decision support at the point of care so no opportunities are missed to achieve control. A variety of evidence-based hypertension treatment protocols are available for practices and health care systems to select from, including the following protocols, or a custom protocol can be developed using the template.
*The hypertension protocols featured are examples of a wide variety of available evidence-based hypertension treatment protocols that practices and health care systems may consider for adoption and use. Linking to non-federal sites does not constitute an endorsement by the Department of Health and Human Services, the Centers for Disease Control and Prevention, or any of their employees of the sponsors or the information or products presented on the sites. Links to non-federal sites containing hypertension protocols serve only as a source of guidance. Health care professionals should always consider the individual clinical circumstances of each person seeking hypertension control. Links to the hypertension protocols are not intended to be a substitute for professional medical advice; individuals should seek advice from their health care professionals.
Creating a Hypertension Treatment Protocol
- Use this template if you would like to create your own protocol [PDF-1.5M].*
- Elements Associated with Effective Adoption and Use of a Protocol: Insights from Key Stakeholders [PDF-111K]
* Template will continue to be updated as evidence, guidelines evolve.
Million Hearts® Interactive Protocol for Controlling Hypertension
Recommended Elements of Effective Hypertension Protocols
- Clarity and simplicity
- Lifestyle modification
- Treatment by stage of hypertension
- Time interval to titration and reassessment
- Use of low-cost 1st-line treatment
- Exclusions and suggestions for medications based on concurrent medical conditions
- Recommended lab tests
- Reminder of the underlying causes of non-essential or secondary hypertension
- Adherence-enhancing approaches such as fixed dose and/or combination drugs
- Indications for referral to hypertensive specialist
- Number needed to treat to avoid a clinical event
- Supporting references
- Congruent with current guidelines, including JNC-7
Recommendations for Successful Adoption and Use of Hypertension Protocols
- Make hypertension control a priority in the practice or health system and identify the protocol as a key tool in achieving safe and swift control of blood pressure for hypertensive patients
- Use an electronic or paper registry that identifies patients with high blood pressure and permits tracking over time
- Conduct pre-visit planning to ensure blood pressure is a focus of patient visits
- Fully use the expertise and scope of practice of every member of the health care team: physician, nurse, community pharmacist, medical assistant, care coordinator, and others
- Include patient as an essential member of team
- Provide adequate equipment and training to ensure attainment of correct blood pressure measurement
- Incorporate coaching and self-management into patient education and follow-up visits
A Sample of Evidence-based Hypertension Control Protocols
Veterans Affairs (VA)/Department of Defense (DOD)
The VA/DOD protocol focuses on the critical decision points in the management of hypertension in primary care and provides comprehensive evidence-based recommendations incorporating current information and approaches. Distinguishing characteristics include:
Protocol
- Use of thiazide diuretics as first-line therapy
- Recommendations for prehypertension and treatment by stage of hypertension
- Target goals vary depending on patient's co-morbidities (e.g., diabetes, chronic kidney disease)
- The evidence base for each step
- Recommended lab tests
- Last reviewed July 2005
Supplemental Guidance
- Recommendations for specific segments of patient populations
- Impact of lifestyle therapies on blood pressure in hypertensive adults
- Causes of inadequate response to therapy
- Strategies to improve patient adherence
The protocol was developed for use by integrated health care delivery systems that care for adults. Distinguishing characteristics include:
Protocol
- Use of thiazide diuretic/ACE inhibitor combinations as first-line therapy; when feasible, Single Pill Combination (SPC) tablets are preferred.
- Guidelines for women of child-bearing potential
- Recommended drugs and dosages
- Documentation of the number needed to treat (NNT) to prevent one additional negative health outcome
- Last reviewed May 2013
Supplemental Guidance
- Systems-based approach that establishes a comprehensive hypertension control program with these elements:
- Treatment protocol elements listed previously
- Team-based care
- Convenient blood pressure checks
- Population registry
- Quality performance goals
- Quality performance tracking metrics
- Self-monitoring blood pressure
Institute for Clinical Systems Improvement (ICSI)
The Institute for Clinical Systems Improvement (ICSI) protocol was developed for use by networks of medical groups. It includes an evaluation of individual research reports and an assessment of the overall strength of the evidence supporting a particular conclusion or recommendation. Distinguishing characteristics include:
Protocol
- Hyperlinks to more information on various topics
- Classification of blood pressure includes ambulatory home/24hr monitor
- Reviewed November 2012
Supplemental Guidance
- Treatment of subpopulations (e.g., racial/ethnical minorities, patients with resistant hypertension)
- Quality improvement
- Extensive supporting references
New York City Health and Hospitals Corporation (HHC) [PDF-1.7M]
The New York City Health and Hospital Corporation (HHC) protocol was developed for use by large municipal healthcare delivery systems that also have clinics in communities. Distinguishing characteristics include:
Protocol
- Use of thiazide diuretics as first-line therapy
- Recommended lab tests
- Recommended drugs and dosages
- Tailored protocol for patients with hypertension and diabetes
- Healthy lifestyle advice
Supplemental Guidance
- Treatment of resistant hypertension and hypertension in people with diabetes
- List of drugs, supplements that may contribute to hypertension
- Description of the impact of lifestyle therapies on blood pressure in hypertensive adults
- Self-care tools/messages for patients
Patient Resources
- http://www.ahrq.gov/patients-consumers/treatmentoptions/index.html (see Heart Conditions)
- http://millionhearts.hhs.gov/resources/teamuppressuredown.html#Patients
- http://millionhearts.hhs.gov/resources/tools.html#ahaTools
- http://hearthealthmobile.com
Learn More
- Protocol-Based Treatment of Hypertension: A Critical Step on the Pathway to Progress, The Journal of the American Medical Association
- An Effective Approach to High Blood Pressure Control. Hypertension, Journal of the American Heart Association
- An Effective Approach to High Blood Pressure Control A Science Advisory From the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention
- Better Blood Pressure Control: A National Priority—CDC Director Tom Frieden interview with Medscape
Suggested Citation
Centers for Disease Control and Prevention. Protocol for Controlling Hypertension in Adults. Atlanta, Georgia. 2013.
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