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.

Access the partner toolkit to spread the word

Hypertension Prevalence

Million Hearts® has made blood pressure control a national priority to help save lives and improve Americans’ cardiovascular health. Comparing a health system’s or practice’s calculated hypertension prevalence to the expected hypertension prevalence, generated by the Hypertension Prevalence Estimator Tool, will help health systems and practices identify potential patients with undiagnosed hypertension.

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Hypertension Prevalence Estimator Tool

This interactive Million Hearts® tool is a great starting point for health systems or practices to better understand hypertension prevalence among their patient population. The tool generates an expected percentage of patients with hypertension based on the specific characteristics of a health system’s or practice’s patient population. Providers can then compare the expected prevalence to their calculated prevalence—if the values are quite different, there may be patients “hiding in plain sight” with undiagnosed hypertension.

Use the tool

Frequently Asked Questions: Hypertension Prevalence Estimator Tool

References, Resources, and Case Studies

Featured Resource: National Association of Community Health Centers Undiagnosed Hypertension Change Package  [PDF – 3.6M]external icon
Compilation of materials to help clinicians map and identify enhancements to clinical workflows that improve detection and diagnosis of hypertension. (National Association of Community Health Centers, January 2016)

The Maine Center for Disease Control and Prevention — Hypertension: Hiding in Plain Sightexternal icon
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 Sightexternal icon
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 Centersexternal icon
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 Hypertensionexternal icon
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.

Development and Validation of a Hypertension Prevalence Estimator Tool for Use in Clinical Settingsexternal icon
Study describing the development and validation of a tool that health systems can use to compare their reported hypertension prevalence with expected prevalence. (Journal of Clinical Hypertension, January 2016)

A Technology-Based Quality Innovation to Identify Undiagnosed Hypertension Among Active Primary Care Patientsexternal icon
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 Useexternal icon
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 Dataexternal icon
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 Recordsexternal icon
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.

Page last reviewed: January 28, 2021