This definition attempts to "multi-solve" counting HTN cases for CDC and CMS use.
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CDC chronic disease management
"Hypertension is generally defined as systolic blood pressure ≥140 mmHg, or diastolic blood pressure ≥90 mmHg. A person who currently uses blood pressure-lowering medication is also defined as having hypertension." Source: CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension
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CMS Quality Measures
COUNT TABLES
Count number of patients per month matching criteria
- htn__count_bp_month : BP (blood pressure) measures
- htn__count_dx_month : HTN diagnosis codes
- htn__count_rx_month : HTN blood pressure control meds
| htn__count_bp_month | Blood Pressure Panel |
|---|---|
| cnt | count number of patients |
| obs_month | Month of BP observation |
| hypertension | BP is 140/90 or higher (true or false) |
| hypotension | BP is 90/60 or lower (true or false) |
| enc_class_code | Encounter class ambulatory, emergency, impatient, observation |
| gender | female or male sex |
| age_at_visit | patient age at time of visit |
| race_display | CDC R5 race |
| ethnicity_display | Hispanic or Latino |
| htn__count_dx_month | Hypertension diagnosis (ICD10-CM or SNOMED-CT) |
|---|---|
| cnt | count number of patients |
| cond_month | Month of HTN diagnosis |
| cond_display | Display the label of HTN diagnosis |
| cond_system_display | SNOMED-CT or ICD-10-CM |
| enc_class_code | Encounter class ambulatory, emergency, impatient, observation |
| gender | female or male sex |
| age_at_visit | patient age at time of visit |
| race_display | CDC R5 code |
| ethnicity_display | Hispanic or Latino |
| htn__count_rx_month | Blood Pressure Medications |
|---|---|
| cnt | count number of patients |
| authoredon_month | Month of medication request |
| rx_display | Display RXNORM drug label |
| rx_category_code | inpatient, outpatient, or community |
DIAGNOSIS
DX of primary essential HTN preferred.
Initial HTN diagnosis may not be available/recorded at the health system, therefore, progression of HTN including pathologies to other organ systems is considered. HTN with heart disease, chronic kidney disease, or secondary HTN also meet inclusion criteria.
Include
- I10 essential hypertension
- I11 Hypertensive heart disease with heart failure
- I12 Hypertensive chronic kidney disease
- I13 Hypertensive heart and chronic kidney disease
- I15 Secondary hypertension
Insufficient
- R03 Elevated blood-pressure reading, without diagnosis of hypertension
- I27 Pulmonary Hypertension
- G93 Benign intracranial hypertension
- H40.05 Ocular Hypertension
Exclude (CMS)
- ESRD End Stage Renal Disease (CKD stage-5)
BLOOD PRESSURE
BP readings should be from outpatient settings NOT an ED or inpatient visit.
One (1) high blood pressure reading is enough for inclusion critiera.
Include
- Systolic >= 140
- Diastolic >= 90
Exclude
- Inpatient encounter
- ED encounter
MEDICATION
Blood pressure control drugs are included for CDC but insufficient for CMS criteria.
CMS excludes blood pressure measures on encounters where certain substances are present that may affect BP readings.
Include (CDC)
- ACE Inhibitors
- ARB Blockers
- Beta Blockers
- Calcium Channel Blockers
- Diuretics
Insufficient
- Statins
Exclude (CMS)
- Cholinesterase Inhibitors
- CNS agents
- Dementia drugs
ENCOUNTER
BP measures from inpatient stays and ED visits should are insufficient.
Include
- Hypertension Screening
- Office Visit
- Home Visit
- Wellness Visit
- Preventive Care
Exclude (CMS)
- Inpatient
- Palliative care
- Hospice services
Patients with excessive morbidity burden.
- Frailty
- Renal transplant/service