The Target BP Initiative: Aiming to Improve Hypertension Care for All

The Target Blood Pressure (BP) initiative is a nationwide movement to improve blood pressure control for almost half of American adults living with hypertension. Over a thousand health care organizations have signed on to the program, which was developed by the American Heart Association (AHA) and American Medical Association. Participating organizations have access to various resources, including continuing medical education and assessments to optimize their clinical practices. Achievement awards are granted to those who successfully move the needle and demonstrate better patient outcomes.¹

We spoke to Howard Haft, MD, MMM, for a deeper dive into the initiative. Dr Haft is the chair of the American Heart Association Outpatient Quality Improvement Advisory Group, former executive director of the Maryland Primary Care Program, and adjunct professor of medicine at the University of Maryland School of Medicine.

What Are the Target BP Initiative’s Main Priorities?

The Target BP initiative has 3 primary focus areas: measure, act, and partner (MAP). It calls on health care providers to accurately measure blood pressure using the latest positioning guidelines, initiate a clear and proactive treatment plan for hypertensive patients, and empower patients to self-monitor.¹

One of the key aspects of self-measurement is digital blood pressure monitors. “I’m excited about digital blood pressure monitoring,” said Dr Haft. “I remember older blood pressure devices with mercury, which have largely gone by the wayside. Handheld blood pressure cuffs are notoriously difficult to calibrate. Now, digital blood pressure machines are calibrated right out of the box and don’t need to be recalibrated as frequently.”

He also feels digital monitors are more reliable and less prone to errors. “Digital blood pressure machines also take a lot of the guesswork out of the Korotkoff sounds, which can be subjective and lead to significant differences in accuracy. We’re really encouraging people to self-measure their blood pressure because what you get in the office visit tells you their blood pressure in a white coat situation a few times per year,” he explained.

Another major priority of the initiative is equity. Dr Haft said, “We know that [hypertension] is a big problem, particularly for marginalized communities, because they have a higher incidence of hypertension and greater consequences, like amputations and kidney disease.”

“I think we’ll find enormous value when we look at data through a lens of equity,” shared Dr Haft. “Equity measures avoid the pitfall of relying only on the average performance of a population. Within a population, the more privileged patients may have access to gyms, nutrition, medications, and other factors than the less privileged, giving them an easier path to good blood pressure control. Looking at equity-focused quality measures can reveal demographic groups within the overall population with poorer control, allowing more focused blood pressure control interventions.”

Target Blood Pressure Initiative Participation and Award Criteria

Dr Haft has seen the evolution of all the target recognition programs but feels the current intiative is particularly important. “We know there are 120 million people in the US with hypertension, and based on NHANES data, 70% are uncontrolled,” he explained. “Hypertension is a leading cause of renal failure and other complications. Quality improvement and recognition programs are essential.”

As of 2024, participating health care facilities can be found in 47 states or US territories.² “There’s so much work to be done to improve health and avoid morbidity and mortality. It’s great that the AHA has been doing this and that there’s been continued growth in the program,” emphasized Dr Haft.

“I just looked at recognition data from the springtime, and 1869 organizations submitted data, representing 30 million patients,” shared Dr Haft. “Of these organizations, 1035 received Gold or Gold Plus, which means their organizations are achieving the level of blood pressure control for their patients that’s not achieved in the majority of other adults in the US.”

“Gold or Gold Plus means the organization achieved the requirements for measuring blood pressure accurately and acting rapidly to achieve control. The Gold Plus organizations also achieved the goals in 3 new pillars, which include partnering with patients, self-measured blood pressure, and equitable health care outcomes.”

The Silver Award was granted to 41% of organizations recognized by the program in 2024.² To achieve this designation, participating facilities had to submit blood pressure control data and complete at least 4 of 6 evidence-based BP activities in the 5 pillars of the program, which include:

• Measure accurately
• Act rapidly
• Partner with patients
• Self-measured blood pressure
• Equitable health outcomes³

The AHA will introduce a new Silver Plus award level for 2025. They also plan to reconfigure the criteria required to reach Gold Plus status.²

Ensuring Accuracy in Blood Pressure Measurement

The first pillar of the Target BP initiative is accurate blood pressure measurement. A 2024 paper published in JAMA notes that health care providers commonly use improper positioning when checking blood pressure, leading to inaccurate results. Guidelines recommend measuring blood pressure with the arm supported on a desk and the midcuff positioned at the level of the heart. However, it’s not unusual for blood pressures to be taken on arms that are resting on the patient’s lap or not supported at all.⁴

The crossover randomized clinical trial included 133 adults. Researchers observed that systolic BP was overestimated by 3.9 mm Hg and diastolic BP by 4.0 mm Hg in patients whose arm was supported on their laps. Taking blood pressure on an unsupported arm consistently led to overestimating systolic BP by 6.5 mm Hg and diastolic BP by 4.4 mm Hg.⁴

The Target BP initiative has created an infographic that displays the correct positioning for measuring blood pressure. Along with posting this infographic in rooms where blood pressures are taken, additional goals that fall under this pillar include:

• Calibrate devices per the manufacturer’s guidelines
• Check device validation against a reliable source such as the US Blood Pressure Validated Device Listing (VDL™)
• Train staff how to measure blood pressure (free webinars are available through the initiative)
• Test staff’s ability to measure blood pressure accurately every 6 to 12 months
• Adopt protocol outlining when to repeat blood pressure measurement¹

By focusing on accurate blood pressure measurement first, health care providers can take on the next pillars of the Target BP initiative, including treating blood pressure and teaching patients how to measure it at home correctly.

Looking Forward to a Healthier Future

According to Dr Haft, “If we’re going to improve our nation’s hypertension control and improve our overall health performance compared to other countries, we need to eliminate the barriers to high-value care and address the social and nonmedical challenges faced by vulnerable populations. The Target BP initiative speaks specifically to equitable health outcomes.”  

He said he would like to see the current work on the Target BP initiative continue to scale up with a greater focus on strengthing local community networks. “The Strive for Silver was done last year in addition to the nationwide program. We’re looking at smaller cohorts to help local organizations connect and support each other. We’re looking forward to expanding that regional work,” he explained.

Dr Haft also feels that the information collected through the Target BP program will help advance treatment and research. “The most exciting thing I see now is the registry work. AHA has developed an ambulatory AHA registry with over 300,000 patients from organizations nationwide, providing real-time data at the EMR [electronic medical record] level. This is a world of difference from what we do in the standard approach of recognition programs: data extraction by attestations. Real-time data sharing allows organizations to look at their own demographics to benchmark data points against others for reflection. Researchers can also access that.”

This article originally appeared on The Cardiology Advisor