An Update on High Blood Pressure Performance and Measurement Guidelines

Translation of Scientific Evidence into Clinical Practice

Failure to correctly diagnose and treat patients with high blood pressure can put them at risk for stroke, heart disease, and renal failure. Conversely, treating high blood pressure can reduce atherosclerotic cardiovascular disease.1

Two PCNA prevention experts, Nancy Houston-Miller and Cheryl Dennison-Himmelfarb, were involved in formulating the American Heart Association(AHA)/American College of Cardiology (ACC) Clinical Performance and Quality Measures for Adults With High Blood Pressure guideline recently published in November 2019.1 Its goal is to provide clinicians with tools to measure quality of care and to suggest areas of improvement. The idea is to enhance early detection and effective treatment for high blood pressure.

Prevention nurses are aware that various high blood pressure practice guidelines exist in the literature. The authors of the AHA/ACC Clinical Performance and Quality Measures acknowledge that differences among the guidelines exist that have not yet been resolved. They state that the JNC7 guidelines are outdated. Therefore, the authors of this AHA/ACC Clinical Performance and Quality Measures guideline suggest that the 2017 Hypertension Practice Guidelines2 be used to avoid confusion in the field.

The 2017 Hypertension Practice Guidelines divided the JNC7 prehypertension label (systolic—SBP– 120-139 mmHg and/or diastolic—DBP– 80-89 mmHg) into two categories: elevated blood pressure and Stage 1 hypertension. This change means that, compared to the JNC 7 cut-offs, Stage 1 is diagnosed earlier at SBP 130-139 mmHg and/or 80-89 mmHg, and Stage 2 hypertension is diagnosed earlier at SBP 140mmHg and/or DBP 90 mmHg. According to the guideline, the use of one standard set of evidence-based high blood pressure categories would benefit all the Centers for Medicare and Medicaid plan types, for example, in that health care providers would all be diagnosing high blood pressure at the same blood pressure cut-off levels.

The guideline evaluates recommended strategies from the 2017 Hypertension Clinical Practice Guidelines such as standardized blood pressure measurement, electronic health records, telehealth, team-based care, performance measurement, and a single plan of care. The guideline1 points out that all recommendations have a strong evidence base in reference to elevated, Stage 1, and Stage 2 hypertension. Two examples of the recommendations in the guideline1 especially important to prevention nurses are the performance measurement of risk and the single plan of care. Quality improvement for patients with high blood pressure means that atherosclerotic cardiovascular disease risk assessment should be completed in each patient, regardless of stage. In addition, nurses who help set policies for systems that care for those with high blood pressure must use a single, standardized plan of care for all patients with high blood pressure. Changes like these by prevention nurses are likely to reduce cardiovascular complications from high blood pressure.

Related Resources


  1. Casey DE Jr, Thomas RJ, Bhalla V, Commodore-Mensah Y, Heidenreich PA, Kolte D, Muntner P, Smith SC Jr, Spertus JA, Windle JR, Wozniak GD, Ziaeian B. 2019 AHA/ACC Clinical Performance and Quality Measures for Adults With High Blood Pressure: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes. 2019 Nov;12(11):e000057. doi: 10.1161/HCQ.0000000000000057.
  2. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13-115.

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