CMS165 / #236 — Controlling high blood pressure

Performance is met when the most recent blood pressure in the measurement period is adequately controlled: systolic < 140 mmHg and diastolic < 90 mmHg.

Denominator

• Age 18–85.
• Essential hypertension diagnosed before and continuing into the first six months of the measurement period.
• A qualifying encounter in the measurement period.

Finding the readings

Blood pressure arrives in two shapes; handle both:

• a panel Observation (LOINC 85354-9) with systolic (8480-6) and diastolic (8462-4) in component[];
• standalone systolic and diastolic observations.

Rules:

• Scan every coding of each component. On some EHRs the first coding is proprietary and the LOINC is further down (see Oracle Health).
• The unit must be mmHg.
• Search by the panel code rather than category=vital-signs — some servers return nothing for the category search (see eClinicalWorks).

Selecting the reading

1. Find the days that have both a systolic and a diastolic reading.
2. Disqualify readings taken during an inpatient stay or an emergency department visit. You need encounter start and end times to apply this.
3. Take the most recent qualifying day.
4. On that day, take the lowest systolic and the lowest diastolic independently — they do not have to come from the same reading.

Record three states explicitly — controlled, not controlled, and not documented — rather than leaving the result blank.

Exclusions

• Hospice, palliative care, and age 66+ in long-term care.
• Frailty with advanced illness: age 66–80 needs both; age 81+ needs frailty alone.
• Pregnancy during the period (look back nine months from evidence of pregnancy).
• End-stage renal disease, chronic kidney disease stage 5, kidney transplant or dialysis.