High blood pressure, or hypertension, is a common and dangerous condition affecting about 1 of 3 U.S. adults. It is often referred to as the “silent killer” because it often has no symptoms, but increases the risk for heart disease and stroke1. High blood pressure does this by hardening arteries and can burst or block arteries that supply blood and oxygen to the brain. Of the over 75 million adults in the U.S. who have high blood pressure, only about half have it under control.


Controlling high blood pressure is an important step in reducing the negative health outcomes and decreased morbidity from these associated risks. Providers can help members manage their high blood pressure by encouraging healthier lifestyles and prescribing the right medications. All blood pressure readings and the dates they were obtained should be included in the member’s chart. If the member has an elevated blood pressure, but does not have hypertension it is important to note why using proper coding2.


What is the HEDIS measure?

Controlling High Blood Pressure assesses adults ages 18-85 with a diagnosis of hypertension and whose blood pressure was properly controlled base on the following criteria3:

  • - Adults 18-59 years of age whose blood pressure was <140/90 mm Hg
  • - Adults 60-85 years of age, with a diagnosis of diabetes, whose blood pressure was <140/90 mm Hg
  • - Adults 60-85 years of age, without a diagnosis of diabetes, whose blood pressure was <150/90 mm Hg


Patient claims should include one systolic reading and one diastolic reading2:


Most recent systolic blood pressure


<130 mm Hg


130-139 mm Hg


≥ 140 mm Hg


Most recent diastolic blood pressure


<80 mm Hg


80-89 mm Hg


≥ 90 mm Hg


Continued management and diverse pathways to care are essential in controlling hypertension and reducing the risk of complications. While it is extremely beneficial for the patient to have continuous management, it also benefits our providers. As HEDIS rates increase, there is potential for the provider to earn maximum or additional revenue through Pay for Quality, Value Based Services, and other pay-for-performance models.4


Tips for talking to patients5

  • - Educate patients on the risks of hypertension
  • - Encourage patients to lose excess weight through regular exercise
  • - Talk about the importance of a balanced diet and limiting sodium and alcohol consumption
  • - Advise patients who are smoking to quit
  • - Talk about chronic stress and ways to cope with it in a healthy way


1 https://www.cdc.gov/bloodpressure/index.htm

2 https://www.premera.com/documents/033017.pdf

3 https://www.ncqa.org/hedis/measures/controlling-high-blood-pressure/

4 https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/value-based-programs.html

5 https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974

Featured In:
September 2019 Anthem Maine Provider News