Commitment to Hypertension Control During the COVID-19 Pandemic

Million Hearts Initiative Exemplars

Amena Abbas, MPH; Judy Hannan, RN, MPH; Haley Stolp, MPH; Fátima Coronado, MD, MPH; Laurence S. Sperling, MD


Prev Chronic Dis. 2022;19(8):e47 

In This Article


A total of 8 Hypertension Control Exemplars were identified (Box). Four Exemplars were clinical practices (California Right Meds Collaborative, Community Health & Wellness Partners, Jessie Trice Community Health Center, and Philadelphia FIGHT), including 3 federally qualified health centers that provided direct patient care. Four were health system support organizations (Aledade, Inc, Missouri Hospital Association, Quality Insights, Inc, and YMCA of Central New York). Exemplars providing clinical services served a median population of 7,315 patients, mostly in geographically urban settings (urban service areas). Overall patient characteristics include a 58% racial and ethnic minority mean, 6% with English as second language, 32% with Medicaid coverage, and 26% uninsured. Among Exemplar clinical practices, the mean percentage of patients with a diagnosis of hypertension in 2020 was 31%. The mean blood pressure control rate reported was 65% in 2019, 60% in 2020, and 61% in July 2021. Clinical practices reported a decrease in blood pressure control rates between 2019 and 2020, but an increase or no change between reported rates in 2020 and 2021.

We detailed strategies and reported outcomes for each Exemplar (Table). The average percentage of patients with hypertension that Exemplars reported reaching through their various strategies and interventions was 45%. Exemplars also reported implementing hypertension control strategies that focused on specific characteristics or demographics of patients with hypertension. Exemplars providing clinical services reported using telehealth services, adapting self-measured blood pressure monitoring, establishing drive-thru or parking lot clinics to measure blood pressure, developing medication management strategies, partnering with community organizations, and creating strategies for patient outreach including using population health software to develop high-risk registries for outreach. Several Exemplars reported direct outreach to patients through methods such as delivery of prescription medications to those with comorbidities including hypertension, or phone calls to follow up and assess patient health.

Health system support organizations reported several approaches to respond to critical needs of clinical practices. Approaches included distributing home blood pressure measurement devices, adapting existing program activities to be delivered by using virtual platforms, and leveraging existing partnerships and innovative payment models to bolster and sustain hypertension activities. The organizations also worked to bolster remote blood pressure monitoring by providing resources to remove barriers or ease bureaucratic challenges for clinical practices to immediately access blood pressure monitoring devices for their patients. Others led efforts to focus on vulnerable patient populations, such as 1 Exemplar that leveraged statewide partnerships to focus on hypertension control among pregnant and postpartum women at highest risk for hypertension-related complications. Health system support organizations also provided resources to identify patients who were at increased risk for adverse cardiovascular events by encouraging participating clinical practices to use dashboards and other analytical software to target patients and monitor trends in blood pressure control.

Several Exemplars reported improved hypertension control rates resulting from supportive practice networks. Examples include a quality improvement network achieving blood pressure control rates of 83%, a medication therapy management pilot achieving a blood pressure control rate of over 85% in previously uncontrolled hypertensive patients, and a pilot delivered in a virtual format that improved control rates from 73% to 82% in its clinical sites in 6 months. Other highlighted outcomes include patient engagement resulting in positive feedback, results from expanded outreach efforts such as medication delivery to more than 600 patients, and blood pressure measurement device distribution. Collectively, Exemplars were successful in distributing over 4,000 devices for self-monitored blood pressure monitoring.

Exemplars reported several challenges and barriers to hypertension control, including limited available funds to meet the demand for blood pressure measurement devices for self-monitored blood pressure monitoring and in bringing public insurance programs to provide blood pressure cuffs to patients. Furthermore, although telehealth services were expanded considerably during the pandemic, many patients were unfamiliar with the technology or had limited access to high-speed internet for stable virtual visits. An ongoing need also exists for flexibility to better streamline processes and workflows to ensure smooth transitions in adapting services throughout the pandemic.