Tracking Blood Pressure Control Performance and Process Metrics in 25 US Health Systems: The PCORnet Blood Pressure Control Laboratory

Abstract

Background The National Patient-Centered Clinical Research Network Blood Pressure Control Laboratory Surveillance System was established to identify opportunities for blood pressure (BP) control improvement and to provide a mechanism for tracking improvement longitudinally. Methods and Results We conducted a serial cross-sectional study with queries against standardized electronic health record data in the National Patient-Centered Clinical Research Network (PCORnet) common data model returned by 25 participating US health systems. Queries produced BP control metrics for adults with well-documented hypertension and a recent encounter at the health system for a series of 1-year measurement periods for each quarter of available data from January 2017 to March 2020. Aggregate weighted results are presented overall and by race and ethnicity. The most recent measurement period includes data from 1 737 995 patients, and 11 956 509 patient-years were included in the trend analysis. Overall, 15% were Black, 52% women, and 28% had diabetes. BP control (<140/90 mm Hg) was observed in 62% (range, 44%-74%) but varied by race and ethnicity, with the lowest BP control among Black patients at 57% (odds ratio, 0.79; 95% CI, 0.66-0.94). A new class of antihypertensive medication (medication intensification) was prescribed in just 12% (range, 0.6%-25%) of patient visits where BP was uncontrolled. However, when medication intensification occurred, there was a large decrease in systolic BP (≈15 mm Hg; range, 5-18 mm Hg). Conclusions Major opportunities exist for improving BP control and reducing disparities, especially through consistent medication intensification when BP is uncontrolled. These data demonstrate substantial room for improvement and opportunities to close health equity gaps.

Keywords: health equity; high blood pressure; hypertension; quality and outcomes; race and ethnicity.

Figure 1. Time trends in blood pressure (BP) control outcomes, 2017 to 2019.

Outcomes were BP control to <140/90 mm Hg (A), BP control to <130/80 mm Hg (B), and improvement in BP (defined as either a reduction of 10 mm Hg in systolic BP or achievement of systolic BP <140 mm Hg in months 10 to 12 of the measurement period among hypertensive patients with a systolic BP not previously controlled) (C). Each data point represents metric results from a 1‐year measurement period. Dates on the x axis represent the ends of those measurement periods (ie, the first measurement period starts on January 1, 2017 and ends December 31, 2017 (Figure S2). Results are weighted averages across participating health systems and are given overall and by race and ethnicity. Light gray lines represent the BP control outcomes for each of the individual health systems included in the time trend analyses, and demonstrate a wide degree of variability based on health system.

Figure 2. Time trends in medication intensification and systolic blood pressure (SBP) change, 2017 to 2019.

Medication intensification (prescription of a new drug class) (A) occurred in only 12% of patients overall, and occurred less commonly among White participants than other racial and ethnic groups. SBP change (B) among those patients in whom a medication intensification did occur, a drop in SBP of −15 mm Hg was observed on average, and this drop in SBP was consistent across all racial/ethnic groups. Each data point represents metric results from a 1‐year measurement period. Dates on the x axis represent the ends of those measurement periods (ie, the first measurement period starts on January 1, 2017 and ends on December 31, 2017 (Figure S2). Results are weighted averages across participating health systems and are given overall and by race and ethnicity. Light gray lines represent the blood pressure control outcomes for each of the individual health systems included in the time trend analyses, and demonstrate a wide degree of variability based on health system.