“Real world” data from health systems reveal opportunities for blood pressure improvement

UCSF platform will support blood pressure surveillance and randomized trials


As many as 40% of the roughly 80 million Americans with high blood pressure may not have the condition under control, according to a study published today in the journal Circulation: Cardiovascular Quality and Outcomes. The lead author of the study is Mark Pletcher, MD, PhD, professor of epidemiology and biostatistics at UCSF. Pletcher’s co-PIs are Valy Fontil, assistant professor of medicine at UCSF, and Rhonda Cooper-DeHoff, PharmD, associate professor at the University of Florida.


Uncontrolled blood pressure is the leading cause of preventable death in the United States even though existing medications, when prescribed and taken according to guidelines, work well.


The Circulation study, drawing on electronic health records (EHRs) from 1.5 million patients, found that just 60% had their hypertension under control, with blood pressure below 140/90 mmHg. When blood pressure was high at a clinic visit, less than a quarter of visits included a second reading to confirm the blood pressure elevation, and only 12% received a prescription for a new class of blood pressure-lowering medication, as guidelines recommend.


“Our analysis of real-world data shows marked room for improving blood pressure and medication management for many patients,” said Pletcher. “One of the main challenges is the low frequency with which clinicians prescribe new medication when blood pressure is high. We need to understand that phenomenon better, and find ways to reduce clinicians’ and patients’ reluctance to start new medication. Because we know that when new medications are started, they work!”  


Mark Pletcher, MD, MPH

The data published today come from BP Track, one of three new studies using the Blood Pressure Control Laboratory, a platform Pletcher and colleagues developed to support multi-site research into blood pressure control. BP Track will continue to conduct national surveillance of clinical management of blood pressure with a focus on tracking disparities over time. 


The other two studies are randomized controlled clinical trials that also use “real world” data from electronic health records.  Those studies – BP Home and BP MAP – have launched and are ongoing.  BP Home is a randomized trial comparing the effectiveness of Smartphone-linked versus standard home blood pressure monitoring. BP MAP compares the effectiveness of two versions of a quality improvement program developed by the American Medical Association (AMA).


“The BP Control Lab sets up a one-of-a-kind infrastructure that makes it possible to understand how a quality improvement program like the AMA’s can be implemented in various health systems across the country and how to tailor different components of the intervention to different types of clinical environments,” said Fontil.


“The AMA is committed to  improving blood pressure control in the US, and the results of BP MAP are going to help guide how we scale up programs to have the biggest impact most efficiently,” Michael Rakotz, MD, Vice President of Health Outcomes at the AMA, said.


The BP Control Lab platform uses PCORnet, the National Patient-Centered Clinical Research Network developed by the Patient-Centered Outcomes Research Institute, and the Eureka Research Platform, a platform developed by Pletcher with UCSF colleagues Jeffrey Olgin and Gregory Marcus, to support reliable and HIPAA-compliant collection of patient-generated health data from mobile devices. The BP Track research was done in partnership with the American Heart Association and the AMA.


Additional authors include Thomas Carton, Ph.D.; Kathryn M. Shaw, M.P.H.; Myra Smith, M.P.H.; Sujung Choi, Ph.D.; Jonathan Todd, Ph.D.; Alanna M. Chamberlain, Ph.D.; Emily C. O’Brien, Ph.D.; Madelaine Faulkner, M.P.H.; Carlos Maeztu, M.A.; Gregory Wozniak, Ph.D.; Michael Rakotz, M.D.; Christina M. Shay, Ph.D.


The paper title is “The PCORnet Blood Pressure Control Laboratory: A Platform for Surveillance and Efficient Trials.”