Act Rapidly

Uncontrolled High Blood Pressure Needs to be Met With Immediate Action

High blood pressure:

Accounts for more deaths from CVD than any other modifiable risk factor
Is second only to cigarette smoking as a preventable cause of death in the US
Was present in more than half of people who die from coronary heart disease and stroke

Reduce Therapeutic Inertia

Therapeutic inertia—failing to start or intensify treatment when BP is high—is a common problem. It is also a leading factor contributing to suboptimal BP control rates, along with the failure of patients to schedule or return for follow up appointments. Both can leave your patient with serious unmanaged risk and can be addressed with an evidence-based treatment protocol.

“For women, high blood pressure has a bigger impact on death from heart disease and stroke than any other risk factor. For men, only cigarette smoking has a higher impact.”
—AHA Statistical Update

Extend Lives: Act Rapidly to Manage Elevated Blood Pressures

When average office BP 120-129 and <80mm Hg at 2 or more office visits:

Start nonpharmacologic therapy
Follow up in 3-6 months
Consider out-of-office BP measurement using 24-hour ambulatory blood pressure monitoring (ABPM) or self-measured blood pressure (SMBP)

When average office BP ≥130-139 or 80-89 mm Hg and patient does not have clinical ASCVD, diabetes, or CKD:

Use the AHA/ACC ASCVD Risk Estimator to calculate 10-year risk. If 10-year risk is ≥10%, start pharmacotherapy. Follow up every 4 weeks, using the treatment algorithm to guide therapy until BP is <130/80 mm Hg
If 10-year risk is <10% in low-risk patient, start or continue nonpharmacologic therapy and follow up in 3-6 months
Consider out-of-office BP measurement using 24-hour ABPM or SMBP

When average office BP ≥130-139 or 80-89 mm Hg and patient has clinical ASCVD, diabetes, or CKD:

Start or continue nonpharmacologic therapy. Treat as if 10-year risk is ≥10%

*When starting a diuretic, ACE or ARB, follow up in 2 weeks to check electrolytes and renal function.

When average office BP ≥140 or >90 mm Hg:

Start or continue nonpharmacologic therapy
Start pharmacotherapy, prescribing 2 different classes of antihypertensive agents in most patients (with caution if patient is elderly)*
Follow up every 4 weeks until BP is controlled
Consider out-of-office BP measurement using 24-hour ABPM or SMBP

Reassess on an ongoing basis using SMBP to identify white coat hypertension and determine a patient’s adherence and response to therapy.

*When starting a diuretic, ACE or ARB, follow up in 2 weeks to check electrolytes and renal function.

Practice Assessment: How Rapidly Do You Act?

Notify the provider if a patient has high BP? Flag high BPs in the electronic health record (EHR)? Use a hypertension treatment protocol? Identify patients with uncontrolled BP using an EHR report? Identify contributing factors of clinical inertia?

Taking Action is Not Enough—We Must Partner With Patients to Achieve Control

If measurements are valid, action is quick and effective, and your practice follows up with patients to monitor their progress, you can help patients achieve and maintain control. This reduces serious risk of CVD and associated comorbidities.

Up Next: Partner With Patients

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Act Rapidly

Act Rapidly

Uncontrolled High Blood Pressure Needs to be Met With Immediate Action

Reduce Therapeutic Inertia

Extend Lives: Act Rapidly to Manage Elevated Blood Pressures

Practice Assessment: How Rapidly Do You Act?

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Taking Action is Not Enough—We Must Partner With Patients to Achieve Control

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Questions to Ask Your Doctor