American Heart Association, Inc.

Under Pressure: Transforming Hypertension Care to Extend Human Life Expectency Highly Ranked

Heart and circulatory system diseases

We will scale proven, low-cost, sustainable practices that reduce high blood pressure, the leading risk factor and contributor to human death and disability worldwide.

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Lead Organization

American Heart Association, Inc.

Dallas, Texas, United States

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Non-communicable diseases cause the most deaths worldwide. Despite having complex contributing factors, the most common and significant risk factor is also the least complex to reduce: high blood pressure.Admittedly, hypertension is rarely a headline-grabber. But it affects nearly half of U.S. adults and over 1.4 billion people worldwide, with significant racial and economic disparities. Meanwhile, hypertension is relatively easy to diagnose and inexpensive to treat. Even small reductions in blood pressure can translate to significant health gains, offering remarkable cost-to-impact value. This is an urgent and “winnable” challenge. We have proven ways to close gaps in how blood pressure is measured and managed through three simple, evidence-based healthcare provider practices that are adoptable and sustainable in diverse settings. We will scale these effective practices across the U.S. and key global markets, benefiting more than 100 million patients. Improving hypertension control will directly result in millions of longer, healthier lives.

Problem Statement

Over 1.4 billion people have high blood pressure; many won’t know until suffering a heart attack, stroke or kidney disease, because there are often no symptoms. Hypertension is mistaken as a “first world problem” –it affects nearly half of U.S. adults– but rates are escalating in low- and middle-income countries. Since 2010, hypertension is the top contributing risk factor to years of life lost globally, responsible for about half of all deaths from heart disease and stroke, the world’s top two killers.Meanwhile, hypertension is relatively easy to detect, requiring no blood draws or labs. It is most often treated with low-cost generic medications. And it can dramatically change health trajectories with a small change: even a five point decrease in blood pressure can reduce mortality risk from heart disease and stroke by 9% and 14% respectively.So why is hypertension still claiming so many lives? To start, there is large gap in public awareness, given its “silent” nature.Also, studies show that healthcare provider actions have more impact on hypertension outcomes than patient behaviors, and there are clear gaps between recommended clinical practices and actual care provided. With limited bandwidth, providers face pressures to address acute rather than preventive or chronic needs, have limited data infrastructure focused on these needs, and they can struggle to incorporate updated guidelines into their daily reality and routines. With simplified steps and quality improvement methods, we can change provider practices in hypertension care and close these gaps to save and extend lives.

Solution Overview

We will sustainably transform how healthcare providers measure and manage blood pressure by scaling up highly effective elements from the validated Target: BP program. Namely, three high-impact priority practices comprise the backbone of the program’s “M.A.P.” framework: ensuring Measurement accuracy, Acting rapidly to initiate or escalate treatment, and Partnering with patients to encourage home-based actions critical for successful blood pressure control. The AHA and AMA will use effective on-site and remote training and technical assistance approaches along with data-driven quality tracking and recognition incentives to help U.S. healthcare providers adopt and sustain these M.A.P. practices. The AHA and WHL will likewise support providers nationally in India, China, and Brazil with training and technical assistance, prioritizing “M” measurement accuracy to start. These activities will be complemented by awareness-raising for public and provider audiences, as well as supportive community partner engagement and related policy advocacy.Building from our current reach, we can feasibly help up to 3,000 clinics institutionalize M.A.P. practices and improve their hypertension control rates to a target of 70%, benefiting over 100 million patients across the four countries, with a saturation focus in selected regions and populations with greatest need. Given the prevalence of the hypertension threat, our target impact must be broad: sustainably changing provider practices at thousands of facilities that reach millions of patients now and over time. But the impact will also be deep: targeting high-risk, underserved populations like African Americans in the southeastern U.S., and substantially reducing individual patients’ risk of disease, lengthening their lives.

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Project Funders

  • Local/regional foundations with single-site impact 2015 - 2018
  • Corporate Sponsorships with hypertension impact 2015 - 2019
  • Kaiser Permanente 2015 - 2018

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