Hypertension Control Change Package, Second Edition

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The Hypertension Control Change Package (HCCP) was originally published in 2015 and has been used in the field to improve hypertension (HTN) control by a variety of health centers and clinics.1  New clinical guidelines, development of new resources, and general advances in quality improvement for HTN management prompted the need for this updated version.

For the second edition of the HCCP, published in 2020, we

• Reached out to the Million Hearts® Hypertension Control Champions to gather their tested tools and resources that enabled them to reach high levels of HTN control with their patients.
• Included more self-measured blood pressure (SMBP)-focused content with tools and resources.
• Showcased more tools to find patients with potentially undiagnosed HTN.
• Added new strategies that focus on chronic kidney disease testing and identification.

Download the Guide [PDF – 1.7 MB]

What Is the HCCP?

The HCCP presents a listing of process improvements that outpatient clinical settings can implement as they seek optimal HTN control.

The HCCP is composed of change concepts, change ideas, and evidence- or practice based-tools and resources.

• Change concepts are general notions that are useful in the development of more specific ideas for changes that lead to improvement.
• Change ideas are actionable, specific ideas for changing a process. Change ideas can be rapidly tested on a small scale to determine whether they result in improvements in the local environment.
• With each change idea the HCCP lists evidence- or practice-based tools and resources that can be adapted or adopted in a health care setting to improve HTN control.

The HCCP is broken down into four main focus areas:

How Should We Use the HCCP?

Start by bringing together a team of physicians, nurse practitioners, physician assistants, nurses, medical assistants, pharmacists, quality improvement staff, and administration to discuss the aspects of HTN control that are most in need of improvement.

The team can then select corresponding interventions from the HCCP that best address those issues.

Each strategy you choose should first be tested on a small scale (i.e., conduct “small tests of change”) to assess feasibility and allow the team to evaluate and adjust before instituting the change on a broader, more permanent scale.

We do not recommend that any practice attempt to implement all of the interventions at once, nor is it likely that all interventions will be applicable to your clinical setting.

Spread the Word

Use the following sample social media messages and graphic to promote the HCCP through your personal or professional channels.

Facebook/LinkedIn

• Only about 1 in 4 adults with #hypertension have their condition under control. The Million Hearts tag] Hypertension Control Change Package can help health care professionals improve patient #BloodPressure control with evidence-based resources. [https://bit.ly/2Net7xY #MillionHeartsQI
• Health care professionals: Make hypertension control your goal! Check out the latest updates to the Million Hearts tag] Hypertension Control Change Package for process improvements, tools, and resources to optimize control in clinical settings. [https://bit.ly/2Net7xY #MillionHeartsQI
• Nearly half of adults with uncontrolled #hypertension have a blood pressure of 140/90 mm Hg or higher. Improve patient #BloodPressure control with the updated Million Hearts tag] Hypertension Control Change Package. [https://bit.ly/2Net7xY #MillionHeartsQI

Twitter

• Only about 1 in 4 adults with #hypertension have their condition under control. The @MillionHeartsUS Hypertension Control Change Package can help improve patient #BloodPressure control with evidence-based resources. https://bit.ly/2Net7xY #MillionHeartsQI
• Check out the updated @MillionHeartsUS Hypertension Control Change Package! Explore process improvement tips and tools to optimize #hypertension control in health care settings. https://bit.ly/2Net7xY #MillionHeartsQI
• Nearly half of adults with uncontrolled #hypertension have a blood pressure of 140/90 mm Hg or higher. Improve patient #BloodPressure control with the updated @MillionHeartsUS Hypertension Control Change Package. https://bit.ly/2Net7xY #MillionHeartsQI

Shareable Graphic

[](https://millionhearts.hhs.gov/images/HTNCCP-shareable.jpg)

Learn More

Reference

• Million Hearts®. National Association of Community Health Centers Partnership Shows Quick Hypertension Control Returns. https://millionhearts.hhs.gov/files/Champions-SS-NACHC.pdf [PDF – 240 KB]. Accessed April 12, 2019 .

Acknowledgments and ContributorsAuthors

The Million Hearts® Hypertension Control Change Package was originally conceptualized and authored by Hilary K. Wall, MPH*; Rikita Merai, MPH*; Jerome A. Osheroff, MD, FACP, FACMI (TMIT Consulting, LLC); and Brita Roy, MD, MPH, MS (Robert Wood Johnson Foundation Clinical Scholars Program at Yale University) in 2015. The second edition was authored by Hilary K. Wall, MPH*; Lauren Owens, MPH (IHRC, Inc.); and Kaitlin Graff, MSW, MPH.

Contributors

The following individuals contributed subject matter expertise, identified tools and resources, and reviewed the document: Jerome A. Osheroff, MD, FACP, FACMI (TMIT Consulting, LLC); Meg Meador, MPH, C-PHI, CPHQ (National Association of Community Health Centers); Michael Rakotz, MD, FAHA, FAAFP (American Medical Association); and Elizabeth Montgomery (National Kidney Foundation).

Reviewers

The following individuals provided review and feedback on the document: Joseph Vassalotti, MD (National Kidney Foundation); Laurence Sperling, MD, FACC, FACP, FAHA, FASPC*; Betsy Thompson, MD, MSPH, DrPH, RADM, U.S. Public Health Service*; Judy Hannan, RN, MPH*; Salvatore J. Lucido, JD, MPA*; and Mary G. George, MD, MSPH, FACS, FAHA.*

**Graphic Design and Editorial Assistance **

Graphic and HTML design support was provided by Booker Daniels, MPH*; Susan Davis (Northrop Grumman Corporation); Jessica Spraggins, MPH; and Palladian Partners, Inc.

*Centers for Disease Control and Prevention

Website Hosting Assistance

Website hosting support of tools and resources was provided by the National Association of Chronic Disease Directors.

We would like to extend special thanks to the following organizations for developing the tools and resources that are showcased in the change package. Million Hearts® Hypertension Control Champions are bolded.

• Agency for Healthcare Research and Quality (AHRQ)
• Alexander Valley Healthcare, Cloverdale, CA
• Altura Centers for Health (previously Tulare Community Health Clinic), Tulare, CA
• American College of Cardiology (ACC)
• American College of Preventive Medicine (ACPM)
• American Heart Association (AHA)
• American Medical Association (AMA)
• American Medical Group Association (AMGA)
• American Medical Group Foundation (AMGF)
• American Society of Health-System Pharmacists ARcare/KentuckyCare, Augusta, AR
• Association of State and Territorial Health Officials (ASTHO)
• Beth Israel Deaconess Medical Center, Boston, MA
• Broadway Internal Medicine, Queens, NY
• California Health Care Foundation Cardi-OH: Ohio Cardiovascular Health Collaborative
• Cheshire Medical Center/Dartmouth-Hitchcock, Keene, NH
• Cigna
• Cleveland Clinic
• Community Health Centers, West Valley City, UT
• Consumer Reports
• Cornerstone Health Care (now Wake Forest Baptist Health), Winston-Salem, NC
• Ellsworth Medical Clinic, Ellsworth, WI
• Esperanza Health Centers, Chicago, IL
• Exercise is Medicine®
• Family Practice Notebook
• Food and Drug Administration (FDA)
• Golden Valley Health Centers, Merced, CA
• Grace Community Health Center, Gray, KY
• Green Spring Internal Medicine, Lutherville, MD
• Health Resources & Services Administration (HRSA)
• HealthPartners (previously Park Nicollet), Bloomington, MN
• Healthy Hearts Northwest
• HealthyHearts NYC
• Heart Health Now! North Carolina Cooperative
• Henry Ford Health System, Detroit, MI
• HIPxCHANGE
• Hypertension Canada
• Institute for Healthcare Improvement (IHI)
• Intermountain Healthcare, Salt Lake City, UT
• Jennifer Brull, MD, Post Rock Family Medicine, Plainville, KS
• Johns Hopkins University
• Kaiser Permanente
• Kaiser Permanente Mid Atlantic States
• Kaiser Permanente Northern California
• Kaiser Permanente Southern California
• Kansas Healthcare Collaborative
• La Maestra Community Health Centers, City Heights, CA
• Marshfield Clinic Health System, Marshfield, WI
• Mercy Clinics, Inc., Des Moines, IA
• **Michael Rakotz, MD, FAHA, FAAFP, Northwestern Medical Group, Chicago, IL **(now with AMA)
• Minnesota Board of Nursing
• Minnesota Department of Health
• Move Your Way
• National Association of Community Health Centers (NACHC)
• National Heart, Lung, and Blood Institute (NHLBI)
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• National Kidney Disease Education Program
• National Kidney Foundation (NKF)
• Neighborhood Healthcare, San Diego/Riverside Counties, CA
• New England QIN-QIO
• New West Physicians, Golden, CO
• New York City Department of Health and Mental Hygiene (NYC DOHMH)
• New York City Health & Hospitals (NYC Health & Hospitals)
• NorthShore Health Centers, Northwest IN
• Open Door Family Medical Centers, Ossining, NY
• Penn Medicine Department of OBGYN’s Heart Safe Motherhood Program
• Plymouth Family Physicians, Plymouth, WI
• Premier Medical Associates, Monroeville, PA
• Quality Insights (previously West Virginia Medical Institute)
• Redwood Community Health Coalition, Petaluma, CA
• Reliant Medical Group, Worcester, MA
• Rush University Medical Center, Chicago, IL
• Sanford Health, Sioux Falls, SD
• Script Your Future
• Sharp Rees-Stealy Medical Group, San Diego, CA
• Sinai Urban Health Institute
• Target: BP
• The Office of the National Coordinator for
• Health Information and Technology (ONC)
• ThedaCare, Northeastern WI
• Trinity Clinic-Whitehouse, TX
• University of Texas Medical Branch
• UVM Medical Center (previously Fletcher Allen Health Care/University of Vermont), Burlington, VT
• Vermont Department of Health
• Washington State Department of Health
• Whitney M. Young, Jr. Health Center, Albany, NY
• Zufall Health, Dover, NJ

For More InformationHilary K. Wall, MPH
Division for Heart Disease and Stroke Prevention
Centers for Disease Control and Prevention
hwall@cdc.gov

Suggested CitationCenters for Disease Control and Prevention. Hypertension Control Change Package (2nd ed.). Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2020.

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