Abstract P352: High Rates Of Hypertension Control Require Mean Systolic Blood Pressure 10 Mm Hg Or More Below Target.

Abstract

Background: Given BP variability, we hypothesized that hypertension (HTN) control rates &gt80% to &lt140/90, required by some national recognition programs, occur when mean systolic (S)BP is 10 mmHg or more below target. Methods: Two cohort databases were analyzed: (i) SBP Intervention Trial (SPRINT-POP) Year 02 and (ii) American Medical Association’s Measure accurately, Act Rapidly, Partner with patients BP (AMA MAP TM BP) quality improvement program. MAP BP included adults with HTN at diverse health systems who had 2+ healthcare visits and received care from clinicians (N=544) with 24+ patients. The main outcome was the relationship of mean SBP to BP control (&lt140/90) in SPRINT standard (SPRINT-S) and intensive (SPRINT-I) treatment arms and by 5 mmHg increments in mean patient-panel SBP of clinicians in MAP BP. Results: In SPRINT-S (n=4,303) and SPRINT-I (n=4,323), mean SBP was 136.7 and 121.7 at the last visit with BP &lt140/90 in 60.7% and 88.4% of participants, respectively (Figure). In AMA MAP BP (n=168,978), mean SBP at the last visit was 132.1 with BP &lt140/&lt90 in 69.8% of patients. For MAP BP clinicians with mean patient-panel SBP 120-<125 (similar to SPRINT-I), 87.6% of patients were controlled to &lt140/90 (Figure) with control falling to 78.8%, 70.8% and 56.9% with mean clinician SBP 125-&lt130, 130-&lt135, 135-&lt140 (similar to SPRINT-S), respectively. In MAP BP, mean SBP accounted for 80% of variance (R 2 =0.80) in control to &lt140/90. Conclusions: Attaining HTN control rates &gt80% to &lt140/90 in a clinical trial and diverse practice settings occurs with group mean SBP &lt130. The findings are relevant to clinicians, BP targets, and incentives for HTN control.