The American Heart Association/American College of Cardiology (AHA/ACC) Task Force on Performance Measures released a guideline on clinical performance and quality measures for the care of adult patients with hypertension. The full guideline was published in the Journal of the American College of Cardiology.
For this guideline, the AHA/ACC Task Force reviewed evidence-based guidelines and statements on performance and quality measures of high blood pressure. Harmonizing measures aligned with recommendations from other organizations were formulated, and enhancing measures based on emerging evidence were also developed for the document. According to the Task Force, the enhancing guidelines were specifically formulated in an effort to improve the application of recommendations from the 2017 Hypertension Clinical Practice Guidelines into clinical practice.
Quality and Performance Measures
Several of the quality and performance measures are in line with recommendations from the 2017 Hypertension Clinical Practice guidelines. A new enhancing performance measure in the AHA/ACC guideline promotes a lower blood pressure target in patients with blood pressure ≥140 mm Hg than what is recommended by other organizations. The lower blood pressure target is a systolic blood pressure (SBP) <130 mm Hg, which is suggested to further reduce the risk for cardiovascular-related complications. The Task Force also recommends bringing SBP to a level <130 mm Hg in patients with stage 1 or stage 2 high blood pressure (130-139 mm Hg and 140-159 mm Hg, respectively).
The new guideline provides a harmonized recommendation on the use of nonpharmacologic interventions for stage 2 high blood pressure. The AHA/ACC provides new evidence that indicates the importance of lifestyle modification in this patient population. A harmonizing performance measure included in the guideline is the recommendation for home blood pressure monitoring for the management of stage 2 high blood pressure. The Task Force provides details on adequate ways for patients to measure their blood pressure at home or anywhere outside the clinic.
For patients with elevated blood pressure (ie, 129-120 mm Hg), the Task Force also emphasizes the importance of lifestyle modification to control blood pressure and reduce cardiovascular risk. The Task Force also recommends monitoring medication adherence in patients with stage 1 high blood pressure and an atherosclerotic cardiovascular disease (ASCVD) risk ≥10% and in patients with stage 2 high blood pressure.
Several structural measures, a category of quality measures, were also included in the new guideline. These measures were designed to assess care at the aggregate care delivery unit level, rather than to assess care of prespecified populations with hypertension at the individual, group clinician, or health plan levels.
The Task Force recommends using a standard protocol for uniformly measuring blood pressure in the ambulatory setting. This structural measure may assist in accurately evaluating cardiovascular disease risk and in guiding the management of hypertension. The Task Force also recommends screening for traditional ASCVD risk factors, using the race- and sex-specific ASCVD Risk Estimator, to determine the estimated 10-year ASCVD risk in adults aged 40 to 79 years.
Standardizing the way in which patients are engaged to participate in shared decision-making is also recommended, as this may help with tailoring evidence-based treatment to a patient’s personal goals and values. A standardized shared-decision making process may improve treatment adherence if patients feel they are taking an active role in their care. Telehealth approaches are also recommended for some patients, based on data from meta-analyses of randomized controlled trials that indicate greater reductions in SBP and diastolic blood pressure with this method compared with usual care alone.
“[T]hese new measures are currently not designed or intended to be used for accountability ‘standards’ but rather to be used as a roadmap for solo/small physician offices, group practices, health systems, public health sites, accountable care organizations, and clinically integrated networks, etc., in their collective journeys to establish better and more standardized guideline-based systems of care for the many millions of patients with [high blood pressure] across the United States,” concluded the guideline authors.
2019 AHA/ACC clinical performance and quality measures for adults with high blood pressure. J Am Coll Cardiol. doi:10.1016/j.jacc.2019.10.001.