Top Things to Know: Implementation Strategies to Improve BP Control in the United States
Published: August 31, 2023
Prepared by Anne Leonard MPH, BSN, RN National Senior Director Science and Medicine
- Hypertension or high blood pressure (BP) is one of the most important risk factors that contribute to incident cardiovascular events including coronary heart disease, stroke, and heart failure as well as kidney disease.
- BP control in 2015-2018 defined by the National Health and Nutrition Examination Survey as <140mmHg systolic/<90mmHg diastolic, was less likely among non-Hispanic Black adults (age- and sex-adjusted prevalence ratio [PR], 0.85, 95% confidence interval [CI] 0.77-0.94), non-Hispanic Asian adults (PR 0.86, 95% CI 0.75-0.99), and Hispanic adults (PR 0.83, 95% CI 0.72-0.96) compared to non-Hispanic whites.
- The determination of BP control is based on the average of multiple office BP measurements with or without out-of-office BP measurements including ambulatory BP monitoring or Self-Measured Blood Pressure (SMBP) monitoring.
- Clinical practice guidelines make recommendations on lifestyle modification for control of BP, discuss first line antihypertensive medications and also discuss different classes of antihypertensive medications for BP control.
- This statement discusses several barriers to successful implementation of BP control interventions. Social determinants of health (SDOH), patient level, organizational-level, community level, and policy level barriers are discussed and are consolidated in a table for quick access and review.
- Several strategies to improve BP control are included in this statement. These include anti-racism efforts (and is defined in this paper) , accurate BP measurement and increased SMBP monitoring, team-based care modalities, lifestyle modification strategies, developing anti-hypertensive medication treatment protocols, aiding in improving acceptance and adherence to antihypertensive medications, continuous quality improvement financial strategies, and large-scale implementation and dissemination.
- Strategic priorities at the individual, organizational, community, and policy levels could help to close the gap between scientific recommendations and BP control. This scientific statement has identified top strategic priorities, organized by an implementation approach.
- The statement lays out implementation strategies within the socio-ecological framework to help guide health care professionals in the quest for optimal BP control.
- With the key areas for implementation outlined in this statement, the strategies discussed could be coupled with successful large-scale implementation and dissemination strategies and shared accountability at multiple levels of the socio-ecological framework to achieve successful BP control in the US.
- The American Medical Association and the Centers for Disease Control and Prevention have been key stakeholders and collaborators on this scientific statement with the goal of working toward better control of BP in the US.
Citation
Abdalla M, Bolen SD, Brettler J, Egan BM, Ferdinand KC, Ford CD, Lackland DT, Wall HK, Shimbo D; on behalf of the American Heart Association and American Medical Association. Implementation strategies to improveblood pressure control in the United States: a scientific statement from the American Heart Associationand American Medical Association [published online ahead of print August 31, 2023]. Hypertension. doi: 10.1161/HYP.0000000000000232