Controlling High Blood Pressure

Measure Specification

High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal. The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High blood pressure is common; according to the American Heart Association, between 2013-2016, approximately 121.

5 million US adults ≥20 years of age had HBP and the prevalence of hypertension among US adults 65 and older was 77.0 percent. In an analysis of adults with hypertension in NHANES, the estimated age-adjusted proportion with controlled BP increased from 31.8 percent in 1999 to 53.8 percent in 2014. However, that proportion declined to 43.7 percent in 2017 to 2018.

HBP increases risks of heart disease and stroke which are two of the leading causes of death in the U.S. A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease. The National Center for Health Statistics reported that in 2020 there were over 670,000 deaths with HBP as a primary or contributing cause.

Between 2009 and 2019 the number of deaths due to HBP rose by 65 percent. Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively. Age-adjusted death rates attributable to HBP in 2019 were more than twice as high in non-Hispanic Black males (56.7 percent) when compared to rates for non-Hispanic White males (25.

7 percent). HBP costs the U.S. approximately 131 billion dollars each year, averaged over 12 years from 2003 to 2014. A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures of ≥ 160 mm Hg could be effective and cost-saving. Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality.

The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mm Hg compared to a SBP goal of <140 mm Hg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality. Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease.

Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.

U.S. Preventive Services Task Force (USPSTF) (2021): -The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. This is a grade A recommendation American Academy of Family Physicians (2017): - Treat adults who have hypertension to a standard blood pressure target (less than 140/90 mm Hg) to reduce the risk of all-cause and cardiovascular mortality (strong recommendation; high-quality evidence).

Treating to a lower blood pressure target (less than 135/85 mm Hg) does not provide additional benefit at preventing mortality; however, a lower blood pressure target could be considered based on patient preferences and values. (Grade: strong recommendation, Quality of evidence: high) - Consider treating adults who have hypertension to a lower blood pressure target (less than 135/85 mm Hg) to reduce risk of myocardial infarction (weak recommendation; moderate-quality evidence).

Although treatment to a standard blood pressure target (less than 140/90 mm Hg) reduced the risk of myocardial infarction, there was a small additional benefit observed with a lower blood pressure target. There was no observed additional benefit in preventing stroke with the lower blood pressure target. (Grade: weak recommendation, Quality of evidence: low) American Diabetes Association (2022): - For individuals with diabetes and hypertension at higher cardiovascular risk (existing atherosclerotic cardiovascular disease or 10-year atherosclerotic cardiovascular disease risk >=15%), blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained (Level of evidence: B).

This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. For the purposes of MIPS implementation, this patient-intermediate measure is submitted a minimum of once per patient during the performance period. The most recent quality data code (QDC) will be used if the measure is submitted more than once.

In reference to the numerator element, only blood pressure readings performed by a clinician or an automated blood pressure monitor or device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician.

Blood pressure readings taken by an automated blood pressure monitor or device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm automated blood pressure monitor or device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record.

Do not include BP readings: 1) Taken during an acute inpatient stay or an ED visit 2) Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests. BP readings taken on the same day that the member receives a common low-intensity or preventive procedure are eligible for use.

For example, the following procedures are considered common low intensity or preventive (this list is just for reference, and is not exhaustive): • Vaccinations. • Injections (e.g., allergy, vitamin B-12, insulin, steroid, toradol, Depo-Provera, testosterone, lidocaine). • TB test. • IUD insertion. • Eye exam with dilating agents. • Wart or mole removal.

3) Taken by the patient using a non-digital device such as with a manual blood pressure cuff and a stethoscope. • If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled." • If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.

Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance.