Some patients with high blood pressure are "hiding in plain sight": they come to the clinic, have their pressure taken, and still leave without a diagnosis. Million Hearts, the national initiative against heart attack and stroke, asks every practice to look for them.
The size of the gap
| Americans with hypertension | 75 million |
| …whose blood pressure is not under control | almost half |
| …who do not know their pressure is too high and get no treatment for it | about 11 million |
Most of those 11 million have health insurance and see a health care provider every year. So potentially millions of people with uncontrolled hypertension are being seen by clinicians and not diagnosed — even in practices that follow best practice and give excellent care. Treating uncontrolled hypertension dramatically lowers the risk of heart attack and stroke, which is why finding these patients, and showing other clinicians how to do it, may save lives.
Four steps
- Set clinical criteria for what counts as potentially undiagnosed hypertension.
- Search the electronic health record for patients who meet them.
- Put a plan in place to diagnose those patients and treat the ones who have hypertension.
- Work out the practice's or system's hypertension prevalence, and compare it with local, state or national figures.
Begin with whichever steps suit the practice best. The most important thing is to start looking. A short Million Hearts video walks through the four steps, and a partner toolkit helps spread the word.
Further reading
| Resource | What it offers |
|---|---|
| Undiagnosed Hypertension Change Package — National Association of Community Health Centers, January 2016 (PDF) | materials for mapping a clinic's workflow and finding the changes that improve detection and diagnosis |
| Hypertension: Hiding in Plain Sight — Maine Center for Disease Control and Prevention (video) | an overview of potentially undiagnosed hypertension and the patients who may be missed |
| Patients with Undiagnosed Hypertension: Hiding in Plain Sight — JAMA, November 2014 | explains the phenomenon and what large health systems have done about it |
| Improving Identification and Diagnosis of Hypertensive Patients Hiding in Plain Sight (HIPS) in Health Centers — The Joint Commission Journal on Quality and Patient Safety, March 2018 | how 10 health centers with high hypertension prevalence used algorithms and clinical decision support to find and engage patients at risk |
| Hiding in Plain Sight: Finding Patients with Undiagnosed Hypertension — Public Health Live, February 2016 | an hour-long interview with experts from CDC and the Health Center Network of New York on the science and the practice |
| Hypertension Prevalence — AMGA Results (PDF) | how prevalence estimates from AMGA data differ under three criteria — diagnosis code, problem list, elevated readings — and against CDC's Hypertension Prevalence Estimator Tool, July 2013–June 2014 |
| A Technology-Based Quality Innovation to Identify Undiagnosed Hypertension Among Active Primary Care Patients — Annals of Family Medicine, July 2014 | moving from identifying patients to diagnosing them, and why the gap is not a documentation problem |
| Undiagnosed Hypertension Among Young Adults with Regular Primary Care Use — Journal of Hypertension, January 2014 | rates of new diagnosis by age group, and what delays diagnosis in young adults who see primary care regularly |
| Identifying Patients with Hypertension: A Case for Auditing Electronic Health Record Data — Perspectives in Health Information Management, April 2012 | using record data to find potentially undiagnosed patients, and how much the problem varied across 11 community health centers |
| Underdiagnosis of Hypertension Using Electronic Health Records — American Journal of Hypertension, January 2012 | diagnosis rates for existing and new cases in a large outpatient system, showing how diagnosis leads to treatment |
Sources
Based on "Undiagnosed Hypertension," Million Hearts, U.S. Department of Health and Human Services, content provided by the Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from millionhearts.hhs.gov
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