Hypertension is a major cause of health problems in the U.S. It affects 47% of adults (116 million people),¹ was a primary or contributing factor in 670,000 deaths in 2020,² and accounts for more than $1.3 billion in medical costs annually.³

Ideal hypertension management includes checking a patient's blood pressure (BP) in the office or ensuring the patient is correctly using a validated BP monitor at home, consistently recognizing when BP is above goal, discussing an adjusted treatment plan with the patient, following up to monitor the effect of any intervention, and continuing with frequent follow-up care until the patient achieves BP control consistent with national guidelines.⁴

Despite this clear treatment path, improving rates of hypertension control has proven challenging. Barriers include suboptimal clinic workflows, limited staffing, multiple competing patient concerns, and limited appointment availability.

Focusing only on the individual dynamics of the physician-patient encounter has limited potential for improving outcomes in this area. Instead, improved hypertension control requires taking a team-based and patient-centered approach and developing workflows outside of typical clinic visits. There is not a one-size-fits-all solution, as it depends on staffing challenges and clinic resources, but we present two different models that have improved hypertension control at two of our primary care sites.

TWO MODELS

We piloted the two models of hypertension management in primary care within an academic medical center in an urban, historically underserved environment. Site 1 offered a BP clinic led by a nurse practitioner (NP), and Site 2 offered protocol-driven registered nurse (RN) visits focused on hypertension within the general clinic workflow.

At both sites, patients have not always been able to get timely follow-up appointments with their primary care clinician due to lack of appointment availability, cost of copays, and lack of transportation. The COVID-19 pandemic also kept patients out of the office, further reducing hypertension control rates. Control rates at Site 1 fell from 50% pre-pandemic to 40% one year post-pandemic. Control rates at Site 2 fell from 55% to 48%, respectively. Against this backdrop, we launched our pilots.