Focus on HEDIS^®: Managing patients with high blood pressure

This is first in a series of articles focusing on key Healthcare Effectiveness Data and Information Set measures.

Hypertension is among the most common conditions seen in the primary care setting. If left untreated, it can lead to myocardial infarction, stroke, renal failure and even death.

Controlling your patient’s blood pressure is more than just a simple blood pressure reading. Encouraging and coaching your patient to adopt healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure.

The 2014 Eighth Joint National Committee released new evidence-based guidelines for the management of high blood pressure in adults.

Adequate blood pressure control is defined as:

• Patients age 18 to 59 whose blood pressure was under 140/90
• Patients age 60 to 85 years of age with a diagnosis of diabetes whose blood pressure was less than 140/90
• Patients age  60 to 85 without a diagnosis of diabetes whose BP was less than 150/90

Here are several important things to keep in mind when caring for your hypertensive patients:

• To confirm diagnosis of hypertension, notation of hypertension must appear in the medical record during an outpatient visit on or before June 30 of each year.
• Examples of notation include: Hypertension, HTN, High BP, Elevated BP, Borderline HTN, Intermittent HTN, History of HTN, Hypertensive vascular disease, Hyperpiesia and Hyperpiesis.
• A representative blood pressure is the most recent blood pressure reading taken during the measurement year (by Dec 31) and it occurs after the date of service in which the diagnosis of hypertension occurred. If multiple readings occur in a single visit, the lowest systolic and lowest diastolic is the representative blood pressure and determines blood pressure control.
• A blood pressure reading must have been taken and documented in the chart during the same visit in which you assessed the patient for hypertension and again at subsequent visits.
• Self-reported blood pressure readings taken by your patient are not considered accurate in diagnosing hypertension.

If lifestyle changes alone are not effective in keeping your diabetic patient’s blood pressure controlled, it may be necessary to add anti-hypertensive medications to your patient’s regimen.

• Initiate pharmacologic anti-hypertensive treatment that includes an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.

Take the opportunity to educate your patient about the importance of taking their recommended medications regularly. You should also discuss medication side effects.

HEDIS is a registered trademark of the National Committee for Quality Assurance.