Hypertension: Management of Uncontrolled Hypertension*
The prevalence of hypertension is high, with the risk rising as people age.1 The risk from elevated blood pressure is significant and is a leading cause of preventable death due to cardiovascular disease. Many people are unaware that they have hypertension and even among those who do, less than half are treated to the recommended target levels.1 The prevalence of resistant hypertension is difficult to assess due to medication non-adherence and pseudo-resistance but may lie between 7% to 28% of the population.2,3 A systematic, team-based approach to managing patients with uncontrolled hypertension in your practice will improve patient outcomes and clinician satisfaction.4
Why is the Module Important?
- The risk of cardiovascular disease (CVD) increases in a log-linear fashion beginning from SBP levels of 115 mm Hg and DBP levels of 75 mm Hg. Every 20 mm Hg rise in SBP or 10 mm Hg rise in DBP is associated with a doubling in the risk of death from stroke, heart disease or other vascular disease.
- Effective blood pressure management has been shown to decrease the incidence of stroke, heart attack, and heart failure.5
- Hypertension was the leading cause of death and disability worldwide in 2010. In the US it is 2nd only to tobacco use as a preventable cause of death for any reason.
- Careful attention must be made to identify pseudo-resistance and non-adherence to prescribed medication regimens.
- Interfering substances and secondary hypertension are rare causes of resistant hypertension but their influence must be considered and appropriately evaluated.
- Strategies for the management of resistant hypertension are well defined.
At the conclusion of this activity, the participant will be able to:
- List common reasons for patients to have uncontrolled hypertension after initial therapy is applied
- Identify options for escalating therapy in patients with uncontrolled hypertension on one or two drugs
- Connect clinicians, patients and families to resources to improve blood pressure control
- Define resistant hypertension and the optimal methods for treatment
Practice Advisor Content Manager
Jillian Schneider, MHA, Manager Practice Support, American College of Physicians
Lawrence Ward, MD, MPH, FACP, Executive Vice Chairman of Medicine, Thomas Jefferson University Hospital
Beverly Johnson, BSN, President and Chief Executive Officer, Institute for Patient and Family Centered Care
Mary Minniti, CPHQ, Senior Policy and Programs Specialist, Institute for Patient and Family Centered Care
Cynthia (Daisy) Smith, MD, FACP, Vice President, Clinical Programs, American College of Physicians
Monica Lizarraga, MPH, Grants Administrator
Disha Patel, Practice Support Coordinator
Cheryl Rusten, MPA, Programs and Grants Manager
Margo Williams, MHA, Senior Associate, Medical Practice
The following have disclosed relationships with commercial companies or organizations:
Cynthia (Daisy) Smith, MD
Stock holdings/stock options with Merck.
Spouse works for Merck.
All other listed individuals (manager, contributors, editors) have nothing to disclose.
Continuing Medical Education
The American College of Physicians (ACP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education (CME) for physicians.
The ACP designates this CME activity for a maximum of 20 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 20 practice assessment MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credit claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
This module offers CME and practice assessment MOC points, as well as verification of attendance. Credit is divided into two stages. After taking the ACP Practice Biopsy, reading the background material and case study, and reviewing the resources, users may submit for up to 10 credits and points. To receive the remaining 10 credits and points you must create an Action Plan, implement measurable changes in one or more targeted areas, and come back after 30 days and take a Follow-up Biopsy before CME/MOC can be claimed.
Once you have completed each stage, you will be provided instructions on how to claim CME and MOC credit or download a certificate of attendance.
To earn CME credits, you must attest after completion of the second module biopsy that you have:
- Participated in the completion of the ACP Practice Biopsy
- Participated in the review of the ACP Practice Biopsy result
- Participated in identifying an action plan to improve our practice
- Participated in the implementation of the plan
- Participated in the follow up ACP Practice Biopsy to measure improvement
When you have done so, follow the on-screen instructions to complete and submit the submission form.
- 20.00 ABIM MOC
- 20.00 AMA PRA Category 1 Credit™
- 1.00 Attendance