Hypertension, or high blood pressure (BP), is when the force of blood against the artery walls is persistently too high. If uncontrolled, the condition can cause heart disease or stroke.
Classification of BP
BP guidelines from the American Heart Association/American College of Cardiology provide four BP categories based on the average of two or more in-office readings on two or more occasions:
- Normal: < 120 mm Hg systolic BP (SBP) and < 80 mm Hg diastolic BP (DBP)
- Elevated: 120-129 mm Hg SBP and < 80 mm Hg DBP
- Stage 1 hypertension: 130-139 mm Hg SBP or 80-89 mm Hg DBP and
- Stage 2 hypertension: ≥ 140 mm Hg SBP or ≥ 90 mm Hg DBP
High BP is typically symptomless, can quietly damage blood vessels and can lead to serious health problems.
In a 2022 “AMA Moving Medicine” video update on hypertension, Rachel Villanueva, MD, president of the National Medical Association (NMA), and a clinical assistant professor of obstetrics/gynecology at the New York University Grossman School of Medicine, notes that "hypertension does not necessarily make you feel bad to be causing damage, to be causing issues with your vision, kidneys, heart and leading to heart disease and other chronic diseases."
Heart-health statistics reinforce the need for all physicians and their patients to prioritize hypertension control. From statistics shared by AMA’s Release the Pressure toolkit:
- Nearly half of U.S. adults have hypertension
- Approximately 860,000 people die from heart disease annually in the U.S.
- The prevalence of high BP in Black women is nearly 42% higher than among white women in the U.S., and 14% higher for Black men compared with white men
Patient-focused approaches help reduce high BP
While there is no cure for high BP, it is important for patients to take steps to improve health outcomes, such as making effective lifestyle changes and taking BP-lowering medications (PDF) as prescribed by their physicians.
Perform self-measured blood pressure (SMBP)
Self-measured blood pressure (SMBP) refers to BP measurements obtained outside of a physician’s practice or clinical setting, typically at home. When combined with clinical support (for example, one-on-one or telehealth and education), SMBP can help enhance the quality and accessibility of care for people with high BP and improve BP control.
The AMA’s “7-step SMBP Quick Guide” (PDF) is a reference for physicians and care teams to help train patients to perform SMBP monitoring. Also of note is that the Current Procedural Terminology (CPT®) code set now includes SMBP.
Measure BP accurately
BP measurement is a routine practice in most practices but it can be easy to get inaccurate measurements. The AMA’s infographic for in-office BP measurement (PDF) offers a simple way to get the most accurate BP readings, and is also available in Spanish (PDF).
For care teams, using a blood pressure measurement competency (PDF) can help team members understand the importance of accurate BP measurement.
Address high BP readings
Establish best practices to address a patient’s uncontrolled or high BP, with action plans for treatment and internal protocols. In addition, define workflow processes for managing patients who have high BP—with a hypertension diagnosis or without.
Partner with patients and monitor success
Partner with patients, families and communities to promote self-management that addresses high BP. Use collaborative, patient-centered communication strategies (PDF) with patients to increase engagement and promote adherence to their care plan.
A care plan may include making appropriate lifestyle changes such as eating healthful food, avoiding unhealthy alcohol use and monitoring sodium consumption.
Team with peers
Network with peers and collaborate on patient-focused approaches to improve high BP:
- Learn about best practices to get patients to commit to a treatment plan
- Measure, Act and Partner (MAP) to help patients control BP
- Discuss and follow evidence-based treatment protocols
- Guide your care team through implementation of a quality improvement BP program
- Participate in recognition programs for efforts focused on BP control within the populations you serve
The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help diagnose and manage their patients’ high BP. These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association (AHA).
Other key AMA high BP resources include:
- Improving health outcomes
- The 7-step self-measured blood pressure (SMBP) quick guide
- Peer-reviewed publications on hypertension from the AMA’s Improving Health Outcomes
- AMA Journal of Ethics:
- AMA Ed Hub™ hypertension collection, including:
- “Hypertension: High Blood Pressure Management, Impact and Inequities”
- 3 Tools to Help Health Care Students Accurately Measure Blood Pressure
- “Does This Adult Patient Have Hypertension? Interview With Dr. Anthony Joseph Viera"
- “Association of Health Care Processes With Racial or Ethnic Disparities in Blood Pressure Control"
- JAMA Network™ collection of hypertension articles
- For information on how to find validated blood pressure devices, visit ValidateBP.org
Reviewed by: Kate Kirley, MD, MS, Director, Chronic Disease Prevention and Programs
Reviewed on: June 3, 2022