Blood Pressure Control

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.

Related Webpages

Tools and Resources

For Clinicians

• Million Hearts Hypertension Control Change Package (HCCP), 2^nd Edition [PDF – 2 MB]
  The HCCP is a quality improvement tool that lists process improvements that outpatient clinical settings can use to seek optimal hypertension control.
• Fixed-Dose Combination Antihypertensive Medication Coverage By State Medicaid and Medicaid Managed Care Organizations (June 2022) [PDF – 11 MB]
  This policy analysis provides coverage information for fixed-dosed combination (FDC) antihypertensive medications for Medicaid and Medicaid Managed Care Organizations for 50 states and Washington, DC. The FDC state summaries can be used to update health center and other Medicaid provider formularies, educate clinicians about the effectiveness and availability of covered FDCs for managing patients with hypertension, and embed covered FDCs into clinical workflows.
• American Medical Association MAP^BP
  This quality improvement program uses the MAP framework: Measure accurately, Act rapidly, and Partner with patients to improve blood pressure control.
• Target:BP
  This quality improvement and recognition program from the American Medical Association and the American Heart Association helps health care organizations and care teams improve blood pressure control rates.
• NACHC Million Hearts Improving Blood Pressure Control for African Americans Roadmap [PDF – 2 MB]
  This tool helps organizations achieve ≥80% blood pressure control for their African American – and all – patients with hypertension.

For Public Health Practitioners

• The Surgeon General’s Call to Action to Control Hypertension
  A 2020 document that seeks to avert the negative health effects of hypertension by identifying evidence-based interventions that can be implemented, adapted, and expanded in diverse settings across the U.S.

For Patients

• What’s the Big Deal About Controlling My Blood Pressure? [PDF – 326 KB]
  This guide from the Washington State Department of Health outlines the small changes in blood pressure that can make a big difference in health. Available in Spanish [PDF – 333 KB]. Chinese, Russian, Korean, and Vietnamese translations are also available.
• Mind Your Risks^® Campaign
  Mind Your Risks^® is a public health campaign from the National Institute of Neurological Disorders and Stroke (NINDS) created to educate Black men with, or at risk of, high blood pressure about the importance of taking charge of their health.