The Hypertension Control Change Package: A Menu of Fixes for Blood Pressure Care

Only about 1 in 4 adults with hypertension have it under control, and nearly half of adults with uncontrolled hypertension have a blood pressure of 140/90 mm Hg or higher. The Million Hearts® Hypertension Control Change Package (HCCP) is a guide for outpatient clinics that want to do better: a menu of process improvements, each backed by tools that other practices have used.

Image from the Centers for Disease Control and Prevention

First and second editions

The first edition came out in 2015 and was used by many health centers and clinics. New clinical guidelines, new resources and progress in quality improvement led to a second edition in 2020, which:

• gathers tested tools from Million Hearts® Hypertension Control Champions — practices that reached high control rates;
• adds more on self-measured blood pressure (SMBP);
• shows more tools for finding patients who may have undiagnosed hypertension;
• adds strategies for testing for and identifying chronic kidney disease.

How it is built

The ideas fall into four focus areas, each leading to the next: key foundations, equipping care teams, population health management and individual patient supports.

Image from the Centers for Disease Control and Prevention

Using it

1. Assemble a team — physicians, nurse practitioners, physician assistants, nurses, medical assistants, pharmacists, quality improvement staff and administrators — and agree on which parts of hypertension control most need work.
2. Pick the interventions from the package that address those gaps.
3. Test each one small — a "small test of change" — to check it is feasible, then adjust before rolling it out more widely and permanently.

Don't try everything at once. Not every intervention will suit every clinic, and the authors advise against implementing them all together.

Sources

Based on "Hypertension Control Change Package, Second Edition," Million Hearts®, U.S. Department of Health and Human Services, by Hilary K. Wall, Lauren Owens and Kaitlin Graff of the Centers for Disease Control and Prevention (first edition 2015 by Hilary K. Wall, Rikita Merai, Jerome A. Osheroff and Brita Roy); a work of the United States government in the public domain. The full guide is a PDF.