The prevalence of hypertension in the United States is staggering, with almost half of adults (119.9 million) meeting the American Heart Association's criteria for the condition — blood pressure (BP) ≥ 130/80 mm Hg or current use of medication to lower BP.¹ Only about one-fourth of those (27 million) have their hypertension under control.¹ Lowering BP significantly reduces cardiovascular (CV) events, stroke, and death with an absolute risk reduction of 28 CV events, 17 strokes, and nine deaths per 1,000 persons treated for five years.²

Due to its profound impact on outcomes, hypertension control is often a target for quality improvement (QI) and pay-for-performance programs. In 2021, our health care system was linking patient panel outcomes on certain quality measures, including hypertension control, to clinician performance pay. Unfortunately, many clinicians were skeptical of data accuracy and patient attribution, and they did not want to be held accountable for factors they could not control, such as medication adherence or measurements obtained in a different setting (e.g., the emergency department). In part because of these barriers, physician engagement in QI efforts was low across our 10 family medicine offices. Our rates of hypertension control were under target, and our approach to improvement was not yielding the desired results.