Controlling Hypertension in Region X

By Anthony Harvey

It is estimated that nearly half of all adults in the United States have hypertension[1] (AKA high blood pressure). The impact? An estimated 691,000 deaths in the United States in 2021[2] where hypertension acted as either a primary or contributing cause.
 
With the prevalence of hypertension and its associated health risks as high as it is, all FQHCs throughout the nation are required to report on both their number of patients with high blood pressure as well as the number of patients whose hypertension is controlled (<140 mmHg & associated with significantly less health risks). The below figures demonstrate the varying treatment outcomes achieved by FQHCs across Region X and within each individual state throughout 2022.

When interpreting the below figures, the number of patients with hypertension provides context as to how large of a patient base is being treated. This metric by itself cannot reasonably be deemed a positive or negative element. There are many factors outside of a FQHC's control that can contribute to the number of patients with high blood pressure (e.g. total number of patients being served, demographics of the area, etc.). Hence, our primary metric for gauging an FQHC's performance, as it relates to treating hypertensive patients, is the percent of hypertensive patients whose hypertension is controlled. Each dot represents a separate FQHC within Region X.

Interestingly, across all states, there is a positive correlation between the number of hypertensive patients and the percent of these patients whose hypertension was controlled. While there are too many variables in play to deduce a precise conclusion as to why this is, it would broadly suggest that larger pools of hypertensive patients do not inhibit FQHCs in achieving positive treatment outcomes. On the contrary, provided an FQHC is otherwise proportionally scaled to meet the needs of their patient base, larger pools of hypertensive patients are associated with improved treatment outcomes.
 
Also worth noting is the variance in performance between FQHCs throughout Region X as well as within each individual states. In Region X, this performance ranges from 41% to 76.4% controlled hypertension. At first glance, one might conclude that we are lacking a common standard of care to be adhered to by all FQHCs when it comes to hypertension treatment. However, it is important to consider that we do not have the full picture of the varying challenges each FQHC might face that is inhibiting their ability to better treat their patients (e.g. staffing retention, provider burnout). With that said, these varying levels of performance, and in particular the top performers, highlight what kinds of treatment outcomes are achievable and worth striving for.
 
For the purposes of comparison, the national average across all patients for all FQHCs in the United States was 63.4% in 2022[3]. Note that this is not the same as the average by health center, which is likely a bit lower. This is because larger FQHCs with more hypertensive patients are given proportionally higher representation in the 63.4% figure compared to smaller FQHCs with fewer hypertensive patients. Considering more hypertensive patients appears to be positively correlated with the percent controlled, it is likely the average percent controlled by health center is slightly lower than the average percent controlled across all FQHC patients (63.4%).

[1] Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults

[2] Multiple Cause of Death 2018–2021 on CDC WONDER Database

​[3] UDS Report (2022), Table 7: Health Outcomes and Disparities, Section B: Controlling High Blood Pressure