Heart Disease and Stroke Prevention: Team-based Care to Improve Blood Pressure Control

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends team-based care to improve patients’ blood pressure. Evidence shows team-based care increases the proportion of patients with controlled blood pressure and reduces systolic (SBP) and diastolic (DBP) blood pressure. Economic evidence indicates team-based care is cost-effective.

Intervention

Team-based care to improve blood pressure control is a health systems-level, organizational intervention that uses a multidisciplinary team to improve the quality of care. Team-based care is established by adding new staff or changing the roles of existing staff who work with a primary care provider.

Each team includes the patient, the patient’s primary care provider, and other professionals such as nurses, pharmacists, dietitians, social workers, and community health workers. Team members provide process support and share responsibilities of blood pressure control to complement the activities of the primary care provider. Responsibilities include medication management, patient follow-up, and adherence and self-management support.

Team-based care interventions typically include activities to do the following:

  • Facilitate communication and coordination of care support among various team members
  • Enhance the use of evidence-based guidelines by team members
  • Establish regular, structured follow-up mechanisms to monitor patients’ progress and schedule additional visits as needed
  • Actively engage patients in their own care by providing them with education about blood pressure (i.e., hypertension) medication, adherence support (for medication and other treatments), and tools and resources for self-management (including self-measured blood pressure monitoring and health behavior change)

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

About The Systematic Review

The CPSTF recommendation is based on evidence from a review of 54 studies (search period January 2012 – June 2020). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cardiovascular disease prevention.

This recommendation updates and replaces the 2012 finding of strong evidence of effectiveness for team-based care to improve blood pressure control. This update focuses on evidence from studies published since 2012.

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 54 studies.

  • The proportion of patients with controlled blood pressure increased by a median of 8.5 percentage points (39 studies).
  • Systolic blood pressure measurements were reduced by a median of 3.5 mmHg (44 studies).
  • Diastolic blood pressure measurements were reduced by a median of 2.1 mmHg (35 studies).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

A systematic review of economic evidence shows team-based care interventions to improve blood pressure control are cost-effective, based on a median cost per quality adjusted life year (QALY) gained of $24,472, which is below a conservative threshold of $50,000.

The systematic economic review included 27 studies (search period January 2011 through January 2021). Monetary values are reported in 2020 U.S. dollars.

  • The median intervention cost per patient per year was $311 (22 studies).
  • The median change in healthcare cost per patient per year was -$167 (13 studies).
  • The median total cost (intervention cost plus change in healthcare cost) per patient per year was $72 (15 studies with 17 estimates). A negative value indicates the averted healthcare cost is greater than the intervention cost.
    • 11 estimates were positive and 6 were negative.
  • The median ROI was -0.7 (12 studies). ROI, from the health system perspective, is the ratio of the difference in averted health care cost and intervention cost to intervention cost. ROI is favorable if the estimate is greater than zero.
    • 7 estimates were negative and 5 were positive.
  • The median cost per quality-adjusted life year (QALY) gained was $24,472 (11 studies).
    • Eleven of 12 estimates were below a conservative $50,000 threshold, indicating cost-effectiveness.

Applicability

Based on the results from the review, findings should be applicable to patients with high blood pressure in the United States. Studies conducted in health care settings serving racial and ethnic minority populations found meaningful improvements in blood pressure control for Black or African American and Hispanic or Latino patients.

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • Which factors affect sustainability and intensity of team-based care interventions?
  • How should these interventions be used by systems of care?
  • Are there differences in the effectiveness and economic efficiency of these interventions when they include all patients with hypertension rather than limiting participation to those with uncontrolled blood pressure?
  • How does intervention effectiveness vary based on patients’ baseline rates of blood pressure control? At what baseline rate does team-based care become an inefficient intervention for improving blood pressure control in a patient population?
  • What are the effects of adding digital interventions and innovative use of technology-enabled resources to team-based care? Specifically, what are the benefits associated with patients’ use of web portals and mobile technology?
  • How do costs and reimbursement mechanisms impact the effectiveness of team-based care?
  • What are the long-term effects of team-based care on morbidity and mortality outcomes? More studies of longer duration are needed to capture effects.
  • Is the intervention cost-effective over 5- to 10-year time horizons?
  • What are the economic outcomes for interventions implemented in rural areas?
  • How do interventions affect productivity of patients at their worksites?
  • What are the development, implementation, and training costs associated with the intervention?

Study Characteristics

  • Study designs included randomized controlled trials (27 studies), non-randomized trials (2 studies), other designs with a concurrent comparison group (1 study), retrospective and other cohorts (9 studies), time series (4 studies), and before-after without control (11 studies).
  • Studies were conducted in the United States (38 studies), Australia (3 studies), Germany (2 studies), Hong Kong, China (2 studies), and the United Kingdom (2 studies); one each was done in Canada, Denmark, Italy, Netherlands, South Korea, Sweden, and Switzerland.
  • Team-based care members who worked with patients and primary care providers were predominately nurses (22 studies), pharmacists (13 studies), or both (7 studies).
  • Team members commonly provided health behavior counseling, coaching, or education to support blood pressure management (18 studies), medication adherence (19 studies), or lifestyle activities (31 studies).
  • Primary care providers most often communicated with one or more team members through electronic medical records (27 studies) or direct team communication (22 studies).

Analytic Framework

Effectiveness Review

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Economic Review

The economic review team develops an analytic framework to align economic outcomes with each stage of the effectiveness review analytic framework. It informs the economic research questions and may be used to summarize the evidence for intervention cost, economic benefit, cost-effectiveness, and cost-benefit.

Summary Evidence Table

Effectiveness Review

Content is in development.

Economic Review

Content is in development.

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Following are studies that evaluated team-based care interventions for blood pressure control included in the updated Community Guide review (search period January 2012-June 2020).

Effectiveness Review

Adair R, Christianson J, Wholey DR, White K, Town R, et al. Care guides-employing nonclinical laypersons to help primary care teams manage chronic disease. J Ambulatory Care Manage 2012;35(1):27-37.

Adair R, Wholey DR, Christianson J, White KM, Britt H, et al. Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial. Annals of Internal Medicine 2013;159:176-84.

Ashburner JM, Horn DM, O’Keefe SM, Zai AH, Chang Y, et al. Chronic disease outcomes from primary care population health program implementation. American Journal of Managed Care 2017; 23:728-35.

Benson GA, Sidebottom A, Sillah A, Boucher JL, Miedema MD, et al. Reach and effectiveness of the HeartBeat Connections telemedicine pilot program. Journal of Telemedicine & Telecar 2018;24:216-23.

Bosworth HB, Olsen MK, McCant F, Stechuchak KM, Danus S, et al. Telemedicine cardiovascular risk reduction in veterans: The CITIES trial. American Heart Journal 2018;199:122-9.

Buhse S, Kuniss N, Liethmann K, M ller UA, Lehmann T, et al. Informed shared decision-making programme for patients with type 2 diabetes in primary care: cluster randomised controlled trial. BMJ Open 2018;8:e024004.

Bui-Duy MK, Wong S, Lam R, Karliner LS. Development of a multistep hypertension quality improvement program in an academic general medicine practice. J Healthc Qual 2019;41(3):172-9.

Carter BL, Coffey CS, Ardery G, Uribe L, Ecklund D, et al. Cluster-randomized trial of a physician/pharmacist collaborative model to improve blood pressure control. Circ Cardiovasc Qual Outcomes 2015; 8:235-43.

Carter BL, Vander Weg MW, Parker CP, Goedken CC, Richardson KK, et al. Sustained blood pressure control following discontinuation of a pharmacist intervention for veterans. Journal of Clinical Hypertension 2015;17:701-8.

Choudhry NK, Isaac T, Lauffenburger JC, Gopalakrishnan C, Lee M, et al. Effect of a remotely delivered tailored multicomponent approach to enhance medication taking for patients with hyperlipidemia, hypertension, and diabetes: the STIC2IT cluster randomized clinical trial. JAMA Intern Med 2018;. 178:1182 9.Chuang E, Ganti V, Alvi A, Yandrapu H, Dalal M. Implementing panel management for hypertension in a low-income, urban, primary care setting. Journal of Primary Care & Community Health 2014;5:61-6.

Crowley MJ, Powers BJ, Olsen MK, Grubber JM, Koropchak C, et al. The Cholesterol, Hypertension, And Glucose Education (CHANGE) study: results from a randomized controlled trial in African Americans with diabetes. American Heart Journal 2013;166:179 86.

Dean SC, Kerry SM, Khong TK, Kerry SR, Oakeshott P. Evaluation of a specialist nurse-led hypertension clinic with consultant backup in two inner city general practices: randomized controlled trial. Family Practice 2014;31:172-9.

Fisher NDL, Fera LE, Dunning JR, Desai S, Matta L, et al. Development of an entirely remote, non-physician led hypertension management program. Clinical Cardiology 2019;42:285-91.

Fontil V, Gupta R, Moise N, Chen E, Guzman D, et al. Adapting and evaluating a health system intervention from Kaiser Permanente to improve hypertension management and control in a large network of safety-net clinics. Circulation. Cardiovascular Quality & Outcomes 2018; 11:e004386.

Fortuna RJ, Nagel AK, Rose E, McCann R, Teeters JC, et al. Effectiveness of a multidisciplinary intervention to improve hypertension control in an urban underserved practice. Journal of the American Society of Hypertension 2015;9:966-74.

Frei A, Senn O, Chmiel C, Reissner J, Held U, et al. Implementation of the chronic care model in small medical practices improves cardiovascular risk but not glycemic control. Diabetes Care 2014;37:1039 47.

Green BB, Anderson ML, Ralston JD, Catz SL, Cook AJ. Blood pressure 1 year after completion of web-based pharmacist care. JAMA Intern Med 2013;173(13):1250-2.

Green, BB, Anderson ML, Cook AJ, Catz S, Fishman PA, et al. e-Care for heart wellness: a feasibility trial to decrease blood pressure and cardiovascular risk. American Journal of Preventive Medicine 2014. 46:368-77.

Hebert PL, Sisk JE, Tuzzio L, Casabianca JM, Pogue VA, et al. Nurse-led disease management for hypertension control in a diverse urban community: a randomized trial. Journal of General Internal Medicine 2011;27(6):630-9.

Heisler M, Hofer TP, Schmittdiel JA, Selby JV, Klamerus ML, et al. Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems: the adherence and intensification of medications cluster randomized, controlled pragmatic trial. Circulation 2012;125:2863-72.

Heisler M, Hofer TP, Schmittdiel JA, Selby JV, Klamerus ML, et al. Improving blood pressure control through a clinical pharmacist outreach program in patients with diabetes mellitus in 2 high-performing health systems. Circulation 2012;125(23):2863-72.

Hirsch JD, Steers N, Adler DS, Kuo GM, Morello CM, et al. Primary care-based, pharmacist-physician collaborative medication-therapy management of hypertension: a randomized, pragmatic trial. Clinical Therapeutics 2014;36:1244-54.

Jacobs M, Sherry PS, Taylor LM, Amato M, Tataronis GR, et al. Pharmacist Assisted Medication Program Enhancing the Regulation of Diabetes (PAMPERED) study. Journal of the American Pharmacists Association 2012;52:613 21.

Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large-scale hypertension program. JAMA 2013;310(7):699-705.

Katon W, Russo J, Lin EH, Schmittdiel J, Ciechanowski P, et al. Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. Archives of General Psychiatry 2012. 69:506 14.

Lee CH, Chang BY. Effect of disease improvement with self-measurement compliance (measurement frequency level) in SmartCare Hypertension Management Service. Telemedicine Journal & E-Health 2016;22:238-45.

Lindin M, Hellenius ML, Rydell-Karlsson M, Ekblom-Bak E. Long-term effects on cardiovascular risk of a structured multidisciplinary lifestyle program in clinical practice. BMC Cardiovascular Disorders 2018;18(59).

Lv N, Xiao L, Simmons ML, Rosas LG, Chan A, et al. Personalized hypertension management using patient-generated health data integrated with electronic health records (EMPOWER-H): six-month pre-post study. Journal of Medical Internet Research 2017;19:e311.

Maciejewski, ML, Bosworth HB, Olsen MK, Smith VA, Edelman D, et al. Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care? Circulation. Cardiovascular Quality & Outcomes 2014;7:269-75.

Magid DJ, Olson KL, Billups SJ, Wagner NM, Lyons EE, et al. A pharmacist-led, American Heart Association Heart360 Web-enabled home blood pressure monitoring program. Circulation. Cardiovascular Quality & Outcomes 2013;6:157-63.

Margolis KL, Asche SE, Bergdall AR, Dehmer SP, Groen SE, et al. Effect of home blood pressure telemonitoring and pharmacist management on blood pressure control: a cluster randomized clinical trial. JAMA 2013;310:46 56.

Margolis KL, Asche SE, Dehmer SP, Bergdall AR, Green BB, et al. Long-term outcomes of the effects of home blood pressure telemonitoring and pharmacist management on blood pressure among adults with uncontrolled hypertension: follow-up of a cluster randomized clinical trial. JAMA Network Open 2018;1:e181617.

Margolius D, Bodenheimer T, Bennett H, Wong J, Ngo V, et al. Health coaching to improve hypertension treatment in a low-income, minority population. Annals of Family Medicine 2012;10:199-205.

Persell SD, Karmali KN, Lazar D, Friesema EM, Lee JY, et al. Effect of electronic health record-based medication support and nurse-led medication therapy management on hypertension and medication self-management: a randomized clinical trial. JAMA Internal Medicine 2018;178:1069-77.

Resnick HE, Ilagan PR, Kaylor MB, Mehling D, Alwan M. TEAhM-Technologies for Enhancing Access to Health Management: a pilot study of community-based telehealth. Telemedicine Journal & E-Health 2012;18:166-74.

Safai N, Carstensen B, Vestergaard H, Ridderstr le M. Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates: a retrospective cohort study from a specialized diabetes treatment centre in Denmark. BMJ Open 2018;8:e019214.

Sahakyan Y, Abrahamyan L, Shahid N, Stanimirovic A, Pechlivanoglou P, et al. Changes in blood pressure among patients in the Ontario Telehomecare programme: an observational longitudinal cohort study. Journal of Telemedicine & Telecare 2018;24:420-7.

Salisbury C, O’Cathain A, Thomas C, Edwards L, Gaunt D, et al. Telehealth for patients at high risk of cardiovascular disease: pragmatic randomised controlled trial. BMJ 2016;353:i2647.

Scherpbier-de Haan ND, Vervoort GM, van Weel C, Braspenning JC, Mulder J, et al. Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial. British Journal of General Practice 2013;63:e798-806.

Schwartz MD, Jensen A, Wang B, Bennett K, Dembitzer A, et al. Panel management to improve smoking and hypertension outcomes by VA primary care teams: a cluster-randomized controlled trial. Journal of General Internal Medicine 2015;30:916-23.

Sisson EM, Dixon DL, Kildow DC, Van Tassell BW, Carl DE, et al. Effectiveness of a pharmacist-physician team-based collaboration to improve long-term blood pressure control at an inner-city safety-net clinic. Pharmacotherapy: The Journal of Human Pharmacology & Drug Therapy 2016;36:342-7.

Svarstad BL, Kotchen JM, Shireman TI, Brown RL, Crawford SY, et al. Improving refill adherence and hypertension control in black patients: Wisconsin TEAM trial. Journal of the American Pharmacists Association 2013;53:520-9.

Thomas KL, Shah BR, Elliot-Bynum S, Thomas KD, Damon K, et al. Check It, Change It: A community-based, multifaceted intervention to improve blood pressure control. Circ Cardiovasc Qual Outcomes 2014;7:828-34.

Tilton JJ, Edakkunnathu MG, Moran KM, Markel Vaysman A, DaPisa JL, et al. Impact of a medication therapy management clinic on glycosylated hemoglobin, blood pressure, and resource utilization. Annals of Pharmacotherapy 2019;53:13-20.

van den Berg N, Meinke-Franze C, Fiss T, Hoffmann W. Changes in blood pressure in patients with hypertension in the context of delegated GP-home visits: a prospective implementation study. Blood Pressure Monitoring 2013;18:63-71.

Victor RG, Lynch K, Li N, Blyler C, Muhammad E, et al. A cluster-randomized trial of blood-pressure reduction in black barbershops. New England Journal of Medicine 2018;378:1291-1301.

Willard-Grace R, Chen EH, Hessler D, DeVore D, Prado C, et al. Health coaching by medical assistants to improve control of diabetes, hypertension, and hyperlipidemia in low-income patients: a randomized controlled trial. Annals of Family Medicine 2015;13:130-8.

Yip BH, Lee EK, Sit RW, Wong C, Li X, et al. Nurse-led repeat prescription for patients with controlled hypertension: a randomised controlled trial. Hong Kong Medical Journal 2018;24 Suppl 4:4-7.

Yu EY, Wan EY, Wong CK, Chan AK, Chan KH, et al. Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study. Journal of Hypertension 2017;35:627-36.

Zillich AJ, Jaynes HA, Bex SD, Boldt AS, Walston CM, et al. Evaluation of pharmacist care for hypertension in the Veterans Affairs patient-centered medical home: a retrospective case-control study. American Journal of Medicine 2015;128:539.e.

Economic Review

Adair R, Wholey DR, Christianson J, White KM, Britt H, et al. Improving chronic disease care by adding laypersons to the primary care team: a parallel randomized trial. Annals of Internal Medicine 2013;159(3):176-84.

Allen JK, Himmelfarb CRD, Szanton SL, Frick KD. Cost-effectiveness of nurse practitioner/community health worker care to reduce cardiovascular health disparities. Journal of Cardiovascular Nursing 2014;29(4):308.

Augustovski F, Chaparro M, Palacios A, Shi L, Beratarrechea A, et al. Cost-effectiveness of a comprehensive approach for hypertension control in low-income settings in Argentina: trial-based analysis of the hypertension control program in Argentina. Value in Health 2018;21(12):1357-64.

Barton GR, Goodall M, Bower P, Woolf S, Capewell S, et al. Increasing heart health lifestyles in deprived communities: economic evaluation of lay health trainers. Journal of Evaluation in Clinical Practice 2012;18(4):835-40.

Chan C-W, Siu S-C, Wong CK, Lee VW. A pharmacist care program: positive impact on cardiac risk in patients with type 2 diabetes. Journal of Cardiovascular Pharmacology and Therapeutics 2012;17(1):57-64.

Chung JS, Lee KK, Tomlinson B, Lee VW. Clinical and economic impact of clinical pharmacy service on hyperlipidemic management in Hong Kong. Journal of Cardiovascular Pharmacology and Therapeutics 2011;16(1):43-52.

Cowper PA, Peterson MJ, Pieper CF, Sloane RJ, Hall KS, et al. Economic analysis of primary care based physical activity counseling in older men: the VA LIFE trial. Journal of the American Geriatrics Society 2017;65(3):533-9.

Dehmer SP, Baker-Goering MM, Maciosek MV, Hong Y, Kottke TE, et al. Modeled health and economic impact of team-based care for hypertension. American Journal of Preventive Medicine 2016;50(5):S34-S44.

Dixon P, Hollinghurst S, Edwards L, Thomas C, Gaunt D, et al. Cost-effectiveness of telehealth for patients with raised cardiovascular disease risk: evidence from the Healthlines randomised controlled trial. BMJ Open 2016;6(8):e012352.

He J, Irazola V, Mills KT, Poggio R, Beratarrechea A, et al. Effect of a community health worker led multicomponent intervention on blood pressure control in low-income patients in Argentina: a randomized clinical trial. JAMA 2017;318(11):1016-25.

Henke RM, Goetzel RZ, McHugh J, Isaac F. Recent experience in health promotion at Johnson & Johnson: lower health spending, strong return on investment. Health Affairs 2011;30(3):490-9.

Hong JC, Padula WV, Hollin IL, Hussain T, Dietz KB, et al. Care management to reduce disparities and control hypertension in primary care. Medical Care 2018;56(2):179-85.

Houle SK, Chuck AW, McAlister FA, Tsuyuki RT. Effect of a pharmacist managed hypertension program on health system costs: an evaluation of the study of cardiovascular risk intervention by pharmacists Hypertension (SCRIP HTN). Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy 2012;32(6):527-37.

Iles RA, Eley DS, Hegney DG, Patterson E, Young J, et al. Revenue effects of practice nurse-led care for chronic diseases. Australian Health Review 2014;38(4):363-9.

Isetts BJ, Brummel AR, De Oliveira DR, Moen DW. Managing drug-related morbidity and mortality in the patient-centered medical home. Medical Care 2012;50(11):997-1001.

Katon W, Russo J, Lin EH, Schmittdiel J, Ciechanowski P, et al. Cost-effectiveness of a multicondition collaborative care intervention: a randomized controlled trial. Archives of General Psychiatry 2012;69(5):506-14.

Kulchaitanaroaj P, Brooks JM, Chaiyakunapruk N, Goedken AM, Chrischilles EA, et al. Cost-utility analysis of physician pharmacist collaborative intervention for treating hypertension compared with usual care. Journal of Hypertension 2017;35(1):178-87.

Kulchaitanaroaj P, Carter BL, Goedken AM, Chrischilles EA, Brooks JM. Instrumental variable methods to assess quality of care the marginal effects of process-of-care on blood pressure change and treatment costs. Research in Social and Administrative Pharmacy 2015;11(2):e69-e83.

Monahan M, Jowett S, Nickless A, Franssen M, Grant S, et al. Cost-effectiveness of telemonitoring and self-monitoring of blood pressure for antihypertensive titration in primary care (TASMINH4). Hypertension 2019;73(6):1231-9.

Overwyk KJ, Dehmer SP, Roy K, Maciosek MV, Hong Y, et al. Modeling the health and budgetary impacts of a team-based hypertension care intervention that includes pharmacists. Medical Care 2019;57(11):882-9.

Prezio EA, Pag n JA, Shuval K, Culica D. The Community Diabetes Education (CoDE) program: cost-effectiveness and health outcomes. American Journal of Preventive Medicine 2014;47(6):771-9.

Shireman TI, Svarstad BL. Cost-effectiveness of Wisconsin TEAM model for improving adherence and hypertension control in black patients. Journal of the American Pharmacists Association 2016;56(4):389-96.

Siaw M, Ko Y, Malone D, Tsou K, Lew YJ, et al. Impact of pharmacist involved collaborative care on the clinical, humanistic and cost outcomes of high risk patients with type 2 diabetes (IMPACT): a randomized controlled trial. Journal of Clinical Pharmacy and Therapeutics 2017;42(4):475-82.

Simpson S, Lier D, Majumdar S, Tsuyuki R, Lewanczuk R, et al. Cost effectiveness analysis of adding pharmacists to primary care teams to reduce cardiovascular risk in patients with type 2 diabetes: results from a randomized controlled trial. Diabetic Medicine 2015;32(7):899-906.

Stoddart A, Hanley J, Wild S, Pagliari C, Paterson M, et al. Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial. BMJ Open 2013;3(5).

Twiner MJ, Marinica AL, Kuper K, Goodman A, Mahn JJ, et al. Screening and treatment for subclinical hypertensive heart disease in emergency department patients with uncontrolled blood pressure: a cost effectiveness analysis. Academic Emergency Medicine 2017;24(2):168-76.

Wagner TH, Willard-Grace R, Chen E, Bodenheimer T, Thom DH. Costs for a health coaching intervention for chronic care management. American Journal of Managed Care 2016;22(4):e141-6.

Additional Materials

Implementation Resources

CDC’s Division for Heart Disease and Stroke Prevention developed an implementation resource to help communities and health systems implement team-based to improve blood pressure control.

Search Strategies

Effectiveness Review

The Community Preventive Services Task Force finding is based on evidence from a systematic review published in 2006 (Walsh et al., search period January 1980-July 2003) and a more recent Community Guide review (search period July 2003-May 2012). In updating the evidence, The Community Guide used the same search strategy that was used for the Walsh 2006 review. The following databases were searched from 1980 up to 2012 to identify studies of team-based care: MEDLINE and the Cochrane Effective Practice and Organization of Care (EPOC) registry.

The same search strategy was used for the period 2012 2019 and again for an update through to August 2020.

Medline (Ovid)

1 Public Health/

2 Emergency Responders/

3 1 and 2

4 Disaster Planning/

5 1 and 4

6 Disease Management/

7 patient care planning/

8 patient-centered care/

9 primary health care/

10 progressive patient care/

11 critical pathways/

12 delivery of health care, integrated/

13 health services accessibility/

14 managed care programs/

15 product line management/

16 patient care team/

17 behavior control/

18 counseling/

19 health promotion/

20 patient compliance/

21 after-hours care/

22 (coordination or coordinated or multifactorial or multicomponent or multidisciplinary or interdisciplinary or integrated or community-based or organized).ti.

23 (care or approach or intervention or strategy or strategies or management or managing or center* or clinic*).ti.

24 22 and 23

25 organization-and-administration/

26 or/6-21

27 24 or 25 or 26

28 total quality management/

29 quality control/

30 (“TQM” or “CQI”).ti.

31 quality.ti.

32 (continous or total).ti.

33 31 and 32 1621

34 (management or improvement).ti.

35 33 and 34

36 28 or 29 or 30 or 35

37 Education, Continuing/

38 education.ti.

39 continuing.ti.

40 38 and 39

41 (medical or professional* or nursing or physician* or nurse*).ti.

42 40 and 41 4561

43 outreach.ti. 2996

44 (visit* or educational).ti.

45 academic.ti.

46 detailing.ti.

47 45 and 46

48 44 or 47

49 37 or 42 or 48

50 diffusion of innovation/

51 diffusion.ti.

52 (innovation or technology).ti.

53 51 and 52

54 50 or 53

55 Medical audit/

56 (audit or feedback or compliance or adherence or training).ti.

57 (improvement* or improving or improves or improve or guideline* or practice* or medical or provider* or physician* or nurse* or clinician* or academic or visit*).ti.

58 practice guidelines/

59 57 or 58

60 56 and 58

61 (financial or economic or physician*).ti.

62 Patient*.mp.

63 61 or 62

64 incentive*.ti.

65 63 and 64

66 reminder systems/

67 reminder.ti.

68 reimbursement mechanisms/

69 55 or 60 or 65 or 66 or 67 or 68

70 medical informatics/ or internet/ or telemedicine/ or telephone/ or (computer* or ” decision support” or telemedicine or telecommunication* or modem or (mobile adj2 phone) or (cell adj2 phone) or telephone*).ti.

71 27 or 36 or 49 or 54 or 69 or 70

72 Hypertension/

73 (hypertension or (blood adj2 pressure)).ti.

74 72 or 73

75 71 and 74

76 meta-analysis.pt. or meta-analysis.tw.

77 (review or guideline).pt. or (consensus or guideline* or literature or overview or review).ti. or decision support techniques/

78 (cochrane or medline or cinahl).tw.

79 “national library”.tw.

80 (handsearch* or search* or searching).tw.

81 (hand or manual or electronic or bibliograph*).tw. or database*.mp.

82 (synthesis or overview or review or survey).ti.

83 (systematic or critical or methodologic or quantitative or qualitative or literature or evidence or evidence-based).ti.

84 76 or 77

85 78 or 79

86 84 and 85

87 82 and 83

88 78 or 79 or 81

89 80 and 88

90 77 and 85

91 76 or 87 or 89 or 90

92 76 or 86 or 87 or 89

93 91 or 92

94 case report/

95 (case* or report).ti.

96 (editorial or comment or letter).pt.

97 94 or 95 or 96

98 93 not 97

99 (randomized or randomised or controlled or intervention* or evaluation* or impact* or effective* or study or studies or comparative feasibility or program* or design*).ti.

100 (clinical trial or randomized controlled trial).pt. or epidemiologic studies/ or evaluation studies/ or comparative study/ or feasibility studies/ or intervention studies/ or program evaluation/ or epidemiologic research design/

101 99 or 100

102 98 or 101

103 75 and 102

104 exp Animals/

105 exp Humans/

106 104 not 105

107 103 not 106

108 limit 107 to (english language and yr=”2012 – 2019″) 1571

109 (201908* or 201909* or 201910* or 201911* or 201912* or 2020*).ed.

110 107 and 109 248

111 limit 110 to (abstracts and english language)

112 limit 110 to english language

Cochrane

ID Search Hits

#1 MeSH descriptor: [Patient Care Planning] this term only

#2 MeSH descriptor: [Disease Management] this term only

#3 MeSH descriptor: [Patient-Centered Care] this term only

#4 MeSH descriptor: [Primary Health Care] this term only

#5 MeSH descriptor: [Progressive Patient Care] this term only

#6 MeSH descriptor: [Critical Pathways] this term only

#7 MeSH descriptor: [Delivery of Health Care, Integrated] this term only

#8 MeSH descriptor: [Health Services Accessibility] this term only

#9 MeSH descriptor: [Managed Care Programs] this term only

#10 MeSH descriptor: [Patient Care Team] this term only

#11 MeSH descriptor: [Behavior Control] this term only

#12 MeSH descriptor: [Counseling] this term only

#13 MeSH descriptor: [Health Promotion] this term only

#14 MeSH descriptor: [Patient Compliance] this term only

#15 MeSH descriptor: [After-Hours Care] this term only

#16 (coordination or coordinated or multifactorial or multicomponent or multidisciplinary or interdisciplinary or integrated or community-based or organized):ti

#17 (care or approach or intervention or strategy or strategies or management or managing or center* or clinic*):ti

#18 #16 AND #17

#19 MeSH descriptor: [Organization and Administration] this term only

#20 #1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 25682

#21 #18 OR #19 OR #20

#22 MeSH descriptor: [Total Quality Management] this term only

#23 MeSH descriptor: [Quality Control] this term only

#24 (“TQM” OR “CQI”):ti

#25 quality:ti

#26 (continuous OR total):ti

#27 #25 AND #26

#28 (management OR improvement):ti

#29 #27 AND #28

#30 #22 OR #23 OR #24 OR #29

#31 MeSH descriptor: [Education, Continuing] this term only

#32 (education):ti

#33 (continuing):ti

#34 #32 AND #33

#35 (medical OR professional* OR nursing OR physician* OR nurse*):ti

#36 #34 AND #35

#37 outreach:ti

#38 (visit* OR educational):ti

#39 academic:ti 7

#40 detailing:ti

#41 #39 AND #40

#42 #38 OR #41

#43 #31 OR #36 OR #42

#44 MeSH descriptor: [Diffusion of Innovation] this term only

#45 diffusion:ti

#46 (innovation or technology):ti

#47 #45 AND #46

#48 #44 OR #47

#49 MeSH descriptor: [Medical Audit] this term only 221

#50 (audit or feedback or compliance or adherence or training):ti

#51 (improvement* or improving or improves or improve or guideline* or practice* or medical or provider* or physician* or nurse* or clinician* or academic or visit*):ti

#52 MeSH descriptor: [Practice Guidelines as Topic] this term only

#53 #51 OR #52

#54 #50 AND #53

#55 (financial or economic or physician*):ti

#56 (patient*):ti,ab,kw

#57 #55 OR #56

#58 (incentive*):ti (Word variations have been searched)

#59 #57 AND #58

#60 MeSH descriptor: [Reminder Systems] this term only

#61 reminder:ti

#62 MeSH descriptor: [Reimbursement Mechanisms] this term only

#63 #49 OR #54 OR #59 OR #60 OR #61 OR #62

#64 MeSH descriptor: [Medical Informatics] this term only

#65 MeSH descriptor: [Internet] this term only

#66 MeSH descriptor: [Telemedicine] this term only

#67 MeSH descriptor: [Telephone] this term only

#68 #64 OR #65 OR #66 OR #67

#69 (computer* OR ” decision support” OR telemedicine OR telecommunication* OR modem OR (mobile NEAR/2 phone) OR (cell NEAR/2 phone) OR telephone*):ti

#70 #21 OR #30 OR #43 OR #48 OR #63 OR #68 OR #69

#71 MeSH descriptor: [Hypertension] this term only

#72 MeSH descriptor: [Blood Pressure] this term only

#73 (hypertension OR (blood NEAR/2 pressure)):ti

#74 #71 OR #72 OR #73

#75 #70 AND #74

#76 meta-analysis:ti,ab,kw,pt

#77 (review or guideline):pt

#78 (consensus or guideline* or literature or overview or review):ti

#79 MeSH descriptor: [Decision Support Techniques] this term only

#80 #77 or #78 or #79

#81 ((medline or cinahl):ti,ab, kw) (Word variations have been searched)

#82 (“national library”:ti,ab,kw) (Word variations have been searched)

#83 (handsearch* or search* or searching):ti,ab,kw 1

#84 (hand or manual or electronic or bibliograph* OR database*):ti,ab,kw

#85 (synthesis or overview or review or survey):ti

#86 (systematic or critical or methodologic or quantitative or qualitative or literature or evidence or evidence-based):ti

#87 #76 OR #80

#88 #81 OR #82

#89 #87 and #88

#90 #85 and #86

#91 #81 or #82 or #84

#92 #83 and #91

#93 #80 and #88

#94 #76 or #90 or #92 or #93

#95 #76 or #89 or #90 or #92

#96 #94 or #95

#97 ((case* OR report):ti)

#98 ((editoral OR comment OR letter)):pt 12326

#99 #97 OR #98

#100 #96 NOT #99

#101 ((randomized or randomised or controlled or intervention* or evaluation* or impact* or effective* or study or studies or comparative feasibility or program* or design*)):ti

#102 ((clinical trial or randomized controlled trial)):pt (Word variations have been searched)

#103 MeSH descriptor: [Epidemiologic Studies] this term only

#104 MeSH descriptor: [Evaluation Study] this term only

#105 MeSH descriptor: [Comparative Study] this term only

#106 MeSH descriptor: [Feasibility Studies] this term only

#107 MeSH descriptor: [Program Evaluation] this term only

#108 MeSH descriptor: [Epidemiologic Research Design] this term only

#109 MeSH descriptor: [Clinical Trial] this term only

#110 #102 OR #103 OR #104 OR #105 OR #106 OR #107 OR #108 OR #109

#111 #101 OR #110

#112 #100 OR #111

#113 #75 AND #112 with Publication Year from 2012 to 2019, in Trials (Word variations have been searched)

#114 #75 AND #112 with Cochrane Library publication date Between Jan 2012 and Aug 2019, in Cochrane Reviews

#115 #75 AND #112

#116 #115 AND (“2019, Issue 8” OR “2019, Issue 9” OR “2019, Issue 10” OR “2019, Issue 11” OR “2019, Issue 12” )

#117 #115 with Cochrane Library publication date Between Jan 2020 and Jul 2020, in Cochrane Reviews, Trials

#118 #116 OR #117

Economic Review

A research librarian searched for published studies in the following databases: Medline, CINAHL, EconLit, Cochrane. Additional studies were identified via suggestions from subject matter experts and hand-searches from reference lists. Studies searched and screened for inclusion were published in English from January 2011 through January 2021 and were limited to countries with high income economies as defined by the World Bank.

Search terms and strategies were adjusted to each database, based on controlled and uncontrolled vocabularies and search software.

Medline

1 exp Hypertension/ or (hypertens* or ((essential or isolate*) adj3 hypertension) or ((elevat* or high or increase*) adj3 (blood adj pressur*))).ti,ab.

2 exp “costs and cost analysis”/ or exp health care costs/ or exp “cost of illness”/ or *economics/

3 exp Quality-Adjusted Life Years/ or (benefit or cost$ or expenditure$ or Life years or “disability adjusted life years” or effectiveness or qaly*).tw.

4 2 and 3

5 exp cost-benefit analysis/ or Health care costs/

6 ((cost-effectiveness adj3 analysis) or (cost-utility adj3 analysis) or (economic adj3 evaluation) or “cost effective” or health care cost* or (cost-benefit adj3 analysis)).tw.

7 4 or 5 or 6

8 1 and 7

9 (afghanistan or albania or algeria or american samoa or angola or “antigua and barbuda” or antigua or barbuda or armenia or armenian or aruba or azerbaijan or bahrain or bangladesh or barbados or republic of belarus or belarus or byelarus or belorussia or byelorussian or belize or british honduras or benin or dahomey or bhutan or bolivia or “bosnia and herzegovina” or bosnia or herzegovina or botswana or bechuanaland or brazil or brasil or bulgaria or burkina faso or burkina fasso or upper volta or burundi or urundi or cabo verde or cape verde or cambodia or kampuchea or khmer republic or cameroon or cameron or cameroun or central african republic or ubangi shari or chad or colombia or comoros or comoro islands or iles comores or mayotte or democratic republic of the congo or democratic republic congo or congo or zaire or costa rica or “cote d’ivoire” or “cote d’ ivoire” or cote divoire or cote d ivoire or ivory coast or croatia or cuba or cyprus or czech republic or czechoslovakia or djibouti or french somaliland or dominica or dominican republic or ecuador or egypt or united arab republic or el salvador or equatorial guinea or spanish guinea or eritrea or estonia or eswatini or swaziland or ethiopia or fiji or gabon or gabonese republic or gambia or “georgia (republic)” or georgian or ghana or gold coast or gibraltar or greece or grenada or guam or guatemala or guinea or guinea bissau or guyana or british guiana or haiti or hispaniola or honduras or hungary or india or indonesia or timor or iran or iraq or isle of man or jamaica or jordan or kazakhstan or kazakh or kenya or “democratic people’s republic of korea” or republic of korea or north korea or south korea or korea or kosovo or kyrgyzstan or kirghizia or kirgizstan or kyrgyz republic or kirghiz or laos or lao pdr or “lao people’s democratic republic” or latvia or lebanon or lebanese republic or lesotho or basutoland or liberia or libya or libyan arab jamahiriya or lithuania or macau or macao or republic of north macedonia or macedonia or madagascar or malagasy republic or malawi or nyasaland or malaysia or malay federation or malaya federation or maldives or indian ocean islands or indian ocean or mali or malta or micronesia or federated states of micronesia or kiribati or marshall islands or nauru or northern mariana islands or palau or tuvalu or mauritania or mauritius or mexico or moldova or moldovian or mongolia or montenegro or morocco or ifni or mozambique or portuguese east africa or myanmar or burma or namibia or nepal or netherlands antilles or nicaragua or niger or nigeria or oman or muscat or pakistan or panama or papua new guinea or new guinea or paraguay or peru or philippines or philipines or phillipines or phillippines or poland or “polish people’s republic” or portugal or portuguese republic or romania or russia or russian federation or ussr or soviet union or union of soviet socialist republics or rwanda or ruanda or samoa or pacific islands or polynesia or samoan islands or navigator island or navigator islands or “sao tome and principe” or saudi arabia or senegal or serbia or seychelles or sierra leone or slovakia or slovak republic or slovenia or melanesia or solomon island or solomon islands or norfolk island or norfolk islands or somalia or south africa or south sudan or sri lanka or ceylon or “saint kitts and nevis” or “st. kitts and nevis” or saint lucia or “st. lucia” or “saint vincent and the grenadines” or saint vincent or “st. vincent” or grenadines or sudan or suriname or surinam or dutch guiana or netherlands guiana or syria or syrian arab republic or tajikistan or tadjikistan or tadzhikistan or tadzhik or tanzania or tanganyika or thailand or siam or timor leste or east timor or togo or togolese republic or tonga or “trinidad and tobago” or trinidad or tobago or tunisia or turkey or turkmenistan or turkmen or uganda or ukraine or uzbekistan or uzbek or vanuatu or new hebrides or venezuela or vietnam or viet nam or middle east or west bank or gaza or palestine or yemen or yugoslavia or zambia or zimbabwe or northern rhodesia or global south or africa south of the sahara or sub-saharan africa or subsaharan africa or africa, central or central africa or africa, northern or north africa or northern africa or magreb or maghrib or sahara or africa, southern or southern africa or africa, eastern or east africa or eastern africa or africa, western or west africa or western africa or west indies or indian ocean islands or caribbean or central america or latin america or “south and central america” or south america or asia, central or central asia or asia, northern or north asia or northern asia or asia, southeastern or southeastern asia or south eastern asia or southeast asia or south east asia or asia, western or western asia or europe, eastern or east europe or eastern europe or developing country or developing countries or developing nation? or developing population? or developing world or less developed countr* or less developed nation? or less developed population? or less developed world or lesser developed countr* or lesser developed nation? or lesser developed population? or lesser developed world or under developed countr* or under developed nation? or under developed population? or under developed world or underdeveloped countr* or underdeveloped nation? or underdeveloped population? or underdeveloped world or middle income countr* or middle income nation? or middle income population? or low income countr* or low income nation? or low income population? or lower income countr* or lower income nation? or lower income population? or underserved countr* or underserved nation? or underserved population? or underserved world or under served countr* or under served nation? or under served population? or under served world or deprived countr* or deprived nation? or deprived population? or deprived world or poor countr* or poor nation? or poor population? or poor world or poorer countr* or poorer nation? or poorer population? or poorer world or developing econom* or less developed econom* or lesser developed econom* or under developed econom* or underdeveloped econom* or middle income econom* or low income econom* or lower income econom* or low gdp or low gnp or low gross domestic or low gross national or lower gdp or lower gnp or lower gross domestic or lower gross national or lmic or lmics or third world or lami countr* or transitional countr* or emerging economies or emerging nation?).ti,ab,sh,kf.

10 8 not 9

11 limit 10 to (abstracts and english language and yr=”2011 -Current”)

CINAHL

S1 (MH “Costs and Cost Analysis+”) or (MH “Health Care Costs+”) or (MH “Economic Aspects of Illness”) or (MM “Economics”))

S2 TI ( (benefit or cost* or expenditure* or Life years OR disability adjusted life years or effectiveness or qaly*) ) OR AB ( (benefit or cost* or expenditure* or Life years OR disability adjusted life years or effectiveness or qaly*))

S3 (MH “Quality-Adjusted Life Years”)

S4 S2 OR S3

S5 S1 AND S4

S6 MH Cost Benefit Analysis

S7 TI ( cost-effectiveness analysis or cost-utility analysis or economic evaluation or cost effective or health care cost* OR cost-benefit analysis ) OR AB ( cost-effectiveness analysis or cost-utility analysis or economic evaluation or cost effective or health care cost* OR cost-benefit analysis )

S8 S6 OR S7

S9 S5 OR S8

S10 (MH “Hypertension+”)

S11 TI ( (hypertens* or ((essential or isolate*) N3 hypertension) or ((elevat* or high or increase*) N3 (blood adj pressur*))) ) OR AB ( (hypertens* or ((essential or isolate*) N3 hypertension) or ((elevat* or high or increase*) N3 (blood adj pressur*))) )

S12 S10 OR S11

S13 S9 AND S12

S14 TI ( (afghanistan or albania or algeria or american samoa or angola or “antigua and barbuda” or antigua or barbuda or armenia or armenian or aruba or azerbaijan or bahrain or bangladesh or barbados or republic of belarus or belarus or byelarus or belorussia or byelorussian or belize or british honduras or benin or dahomey or bhutan or bolivia or “bosnia and herzegovina” or bosnia or herzegovina or botswana or bechuanaland or brazil or brasil or bulgaria or burkina faso or burkina fasso or upper volta or burundi or urundi or cabo verde or cape verde or cambodia or kampuchea or khmer republic or cameroon or cameron or cameroun or central african republic or ubangi shari or chad or colombia or comoros or comoro islands or iles comores or mayotte or democratic republic of the congo or democratic republic congo or congo or zaire or costa rica or “cote d’ivoire” or “cote d’ ivoire” or cote divoire or cote d ivoire or ivory coast or croatia or cuba or cyprus or czech republic or czechoslovakia or djibouti or french somaliland or dominica or dominican republic or ecuador or egypt or united arab republic or el salvador or equatorial guinea or spanish guinea or eritrea or estonia or eswatini or swaziland or ethiopia or fiji or gabon or gabonese republic or gambia or “georgia (republic)” or georgian or ghana or gold coast or gibraltar or greece or grenada or guam or guatemala or guinea or guinea bissau or guyana or british guiana or haiti or hispaniola or honduras or hungary or india or indonesia or timor or iran or iraq or isle of man or jamaica or jordan or kazakhstan or kazakh or kenya or “democratic people’s republic of korea” or republic of korea or north korea or south korea or korea or kosovo or kyrgyzstan or kirghizia or kirgizstan or kyrgyz republic or kirghiz or laos or lao pdr or “lao people’s democratic republic” or latvia or lebanon or lebanese republic or lesotho or basutoland or liberia or libya or libyan arab jamahiriya or lithuania or macau or macao or republic of north macedonia or macedonia or madagascar or malagasy republic or malawi or nyasaland or malaysia or malay federation or malaya federation or maldives or indian ocean islands or indian ocean or mali or malta or micronesia or federated states of micronesia or kiribati or marshall islands or nauru or northern mariana islands or palau or tuvalu or mauritania or mauritius or mexico or moldova or moldovian or mongolia or montenegro or morocco or ifni or mozambique or portuguese east africa or myanmar or burma or namibia or nepal or netherlands antilles or nicaragua or niger or nigeria or oman or muscat or pakistan or panama or papua new guinea or new guinea or paraguay or peru or philippines or philipines or phillipines or phillippines or poland or “polish people’s republic” or portugal or portuguese republic or romania or russia or russian federation or ussr or soviet union or union of soviet socialist republics or rwanda or ruanda or samoa or pacific islands or polynesia or samoan islands or navigator island or navigator islands or “sao tome and principe” or saudi arabia or senegal or serbia or seychelles or sierra leone or slovakia or slovak republic or slovenia or melanesia or solomon island or solomon islands or norfolk island or norfolk islands or somalia or south africa or south sudan or sri lanka or ceylon or “saint kitts and nevis” or “st. kitts and nevis” or saint lucia or “st. lucia” or “saint vincent and the grenadines” or saint vincent or “st. vincent” or grenadines or sudan or suriname or surinam or dutch guiana or netherlands guiana or syria or syrian arab republic or tajikistan or tadjikistan or tadzhikistan or tadzhik or tanzania or tanganyika or thailand or siam or timor leste or east timor or togo or togolese republic or tonga or “trinidad and tobago” or trinidad or tobago or tunisia or turkey or turkmenistan or turkmen or uganda or ukraine or uzbekistan or uzbek or vanuatu or new hebrides or venezuela or vietnam or viet nam or middle east or west bank or gaza or palestine or yemen or yugoslavia or zambia or zimbabwe or northern rhodesia or global south or africa south of the sahara or sub-saharan africa or subsaharan africa or africa, central or central africa or africa, northern or north africa or northern africa or magreb or maghrib or sahara or africa, southern or southern africa or africa, eastern or east africa or eastern africa or africa, western or west africa or western africa or west indies or indian ocean islands or caribbean or central america or latin america or “south and central america” or south america or asia, central or central asia or asia, northern or north asia or northern asia or asia, southeastern or southeastern asia or south eastern asia or southeast asia or south east asia or asia, western or western asia or europe, eastern or east europe or eastern europe or developing country or developing countries or developing nation? or developing population? or developing world or less developed countr* or less developed nation? or less developed population? or less developed world or lesser developed countr* or lesser developed nation? or lesser developed population? or lesser developed world or under developed countr* or under developed nation? or under developed population? or under developed world or underdeveloped countr* or underdeveloped nation? or underdeveloped population? or underdeveloped world or middle income countr* or middle income nation? or middle income population? or low income countr* or low income nation? or low income population? or lower income countr* or lower income nation? or lower income population? or underserved countr* or underserved nation? or underserved population? or underserved world or under served countr* or under served nation? or under served population? or under served world or deprived countr* or deprived nation? or deprived population? or deprived world or poor countr* or poor nation? or poor population? or poor world or poorer countr* or poorer nation? or poorer population? or poorer world or developing econom* or less developed econom* or lesser developed econom* or under developed econom* or underdeveloped econom* or middle income econom* or low income econom* or lower income econom* or low gdp or low gnp or low gross domestic or low gross national or lower gdp or lower gnp or lower gross domestic or lower gross national or lmic or lmics or third world or lami countr* or transitional countr* or emerging economies or emerging nation?) ) OR AB ( (afghanistan or albania or algeria or american samoa or angola or “antigua and barbuda” or antigua or barbuda or armenia or armenian or aruba or azerbaijan or bahrain or bangladesh or barbados or republic of belarus or belarus or byelarus or belorussia or byelorussian or belize or british honduras or benin or dahomey or bhutan or bolivia or “bosnia and herzegovina” or bosnia or herzegovina or botswana or bechuanaland or brazil or brasil or bulgaria or burkina faso or burkina fasso or upper volta or burundi or urundi or cabo verde or cape verde or cambodia or kampuchea or khmer republic or cameroon or cameron or cameroun or central african republic or ubangi shari or chad or colombia or comoros or comoro islands or iles comores or mayotte or democratic republic of the congo or democratic republic congo or congo or zaire or costa rica or “cote d’ivoire” or “cote d’ ivoire” or cote divoire or cote d ivoire or ivory coast or croatia or cuba or cyprus or czech republic or czechoslovakia or djibouti or french somaliland or dominica or dominican republic or ecuador or egypt or united arab republic or el salvador or equatorial guinea or spanish guinea or eritrea or estonia or eswatini or swaziland or ethiopia or fiji or gabon or gabonese republic or gambia or “georgia (republic)” or georgian or ghana or gold coast or gibraltar or greece or grenada or guam or guatemala or guinea or guinea bissau or guyana or british guiana or haiti or hispaniola or honduras or hungary or india or indonesia or timor or iran or iraq or isle of man or jamaica or jordan or kazakhstan or kazakh or kenya or “democratic people’s republic of korea” or republic of korea or north korea or south korea or korea or kosovo or kyrgyzstan or kirghizia or kirgizstan or kyrgyz republic or kirghiz or laos or lao pdr or “lao people’s democratic republic” or latvia or lebanon or lebanese republic or lesotho or basutoland or liberia or libya or libyan arab jamahiriya or lithuania or macau or macao or republic of north macedonia or macedonia or madagascar or malagasy republic or malawi or nyasaland or malaysia or malay federation or malaya federation or maldives or indian ocean islands or indian ocean or mali or malta or micronesia or federated states of micronesia or kiribati or marshall islands or nauru or northern mariana islands or palau or tuvalu or mauritania or mauritius or mexico or moldova or moldovian or mongolia or montenegro or morocco or ifni or mozambique or portuguese east africa or myanmar or burma or namibia or nepal or netherlands antilles or nicaragua or niger or nigeria or oman or muscat or pakistan or panama or papua new guinea or new guinea or paraguay or peru or philippines or philipines or phillipines or phillippines or poland or “polish people’s republic” or portugal or portuguese republic or romania or russia or russian federation or ussr or soviet union or union of soviet socialist republics or rwanda or ruanda or samoa or pacific islands or polynesia or samoan islands or navigator island or navigator islands or “sao tome and principe” or saudi arabia or senegal or serbia or seychelles or sierra leone or slovakia or slovak republic or slovenia or melanesia or solomon island or solomon islands or norfolk island or norfolk islands or somalia or south africa or south sudan or sri lanka or ceylon or “saint kitts and nevis” or “st. kitts and nevis” or saint lucia or “st. lucia” or “saint vincent and the grenadines” or saint vincent or “st. vincent” or grenadines or sudan or suriname or surinam or dutch guiana or netherlands guiana or syria or syrian arab republic or tajikistan or tadjikistan or tadzhikistan or tadzhik or tanzania or tanganyika or thailand or siam or timor leste or east timor or togo or togolese republic or tonga or “trinidad and tobago” or trinidad or tobago or tunisia or turkey or turkmenistan or turkmen or uganda or ukraine or uzbekistan or uzbek or vanuatu or new hebrides or venezuela or vietnam or viet nam or middle east or west bank or gaza or palestine or yemen or yugoslavia or zambia or zimbabwe or northern rhodesia or global south or africa south of the sahara or sub-saharan africa or subsaharan africa or africa, central or central africa or africa, northern or north africa or northern africa or magreb or maghrib or sahara or africa, southern or southern africa or africa, eastern or east africa or eastern africa or africa, western or west africa or western africa or west indies or indian ocean islands or caribbean or central america or latin america or “south and central america” or south america or asia, central or central asia or asia, northern or north asia or northern asia or asia, southeastern or southeastern asia or south eastern asia or southeast asia or south east asia or asia, western or western asia or europe, eastern or east europe or eastern europe or developing country or developing countries or developing nation? or developing population? or developing world or less developed countr* or less developed nation? or less developed population? or less developed world or lesser developed countr* or lesser developed nation? or lesser developed population? or lesser developed world or under developed countr* or under developed nation? or under developed population? or under developed world or underdeveloped countr* or underdeveloped nation? or underdeveloped population? or underdeveloped world or middle income countr* or middle income nation? or middle income population? or low income countr* or low income nation? or low income population? or lower income countr* or lower income nation? or lower income population? or underserved countr* or underserved nation? or underserved population? or underserved world or under served countr* or under served nation? or under served population? or under served world or deprived countr* or deprived nation? or deprived population? or deprived world or poor countr* or poor nation? or poor population? or poor world or poorer countr* or poorer nation? or poorer population? or poorer world or developing econom* or less developed econom* or lesser developed econom* or under developed econom* or underdeveloped econom* or middle income econom* or low income econom* or lower income econom* or low gdp or low gnp or low gross domestic or low gross national or lower gdp or lower gnp or lower gross domestic or lower gross national or lmic or lmics or third world or lami countr* or transitional countr* or emerging economies or emerging nation?) )

S15 S13 NOT S14

S16 S13 NOT S14 Limiters – Abstract Available

S17 S13 NOT S14 Limiters – Abstract Available; Published Date: 20110101-20211231

S18 S13 NOT S14 Limiters – Abstract Available; Published Date: 20110101-20211231

EconLit

S20 AB ( ( (hypertens* or ((essential or isolate*) N3 hypertension) or ((elevat* or high or increase*) N3 (blood adj pressur*))) ) ) OR TI ( ( (hypertens* or ((essential or isolate*) N3 hypertension) or ((elevat* or high or increase*) N3 (blood adj pressur*))) ) ) OR (MH “Hypertension+”)

S21 AB ( (afghanistan or albania or algeria or american samoa or angola or “antigua and barbuda” or antigua or barbuda or armenia or armenian or aruba or azerbaijan or bahrain or bangladesh or barbados or republic of belarus or belarus or byelarus or belorussia or byelorussian or belize or british honduras or benin or dahomey or bhutan or bolivia or “bosnia and herzegovina” or bosnia or herzegovina or botswana or bechuanaland or brazil or brasil or bulgaria or burkina faso or burkina fasso or upper volta or burundi or urundi or cabo verde or cape verde or cambodia or kampuchea or khmer republic or cameroon or cameron or cameroun or central african republic or ubangi shari or chad or colombia or comoros or comoro islands or iles comores or mayotte or democratic republic of the congo or democratic republic congo or congo or zaire or costa rica or “cote d’ivoire” or “cote d’ ivoire” or cote divoire or cote d ivoire or ivory coast or croatia or cuba or cyprus or czech republic or czechoslovakia or djibouti or french somaliland or dominica or dominican republic or ecuador or egypt or united arab republic or el salvador or equatorial guinea or spanish guinea or eritrea or estonia or eswatini or swaziland or ethiopia or fiji or gabon or gabonese republic or gambia or “georgia (republic)” or georgian or ghana or gold coast or gibraltar or greece or grenada or guam or guatemala or guinea or guinea bissau or guyana or british guiana or haiti or hispaniola or honduras or hungary or india or indonesia or timor or iran or iraq or isle of man or jamaica or jordan or kazakhstan or kazakh or kenya or “democratic people’s republic of korea” or republic of korea or north korea or south korea or korea or kosovo or kyrgyzstan or kirghizia or kirgizstan or kyrgyz republic or kirghiz or laos or lao pdr or “lao people’s democratic republic” or latvia or lebanon or lebanese republic or lesotho or basutoland or liberia or libya or libyan arab jamahiriya or lithuania or macau or macao or republic of north macedonia or macedonia or madagascar or malagasy republic or malawi or nyasaland or malaysia or malay federation or malaya federation or maldives or indian ocean islands or indian ocean or mali or malta or micronesia or federated states of micronesia or kiribati or marshall islands or nauru or northern mariana islands or palau or tuvalu or mauritania or mauritius or mexico or moldova or moldovian or mongolia or montenegro or morocco or ifni or mozambique or portuguese east africa or myanmar or burma or namibia or nepal or netherlands antilles or nicaragua or niger or nigeria or oman or muscat or pakistan or panama or papua new guinea or new guinea or paraguay or peru or philippines or philipines or phillipines or phillippines or poland or “polish people’s republic” or portugal or portuguese republic or romania or russia or russian federation or ussr or soviet union or union of soviet socialist republics or rwanda or ruanda or samoa or pacific islands or polynesia or samoan islands or navigator island or navigator islands or “sao tome and principe” or saudi arabia or senegal or serbia or seychelles or sierra leone or slovakia or slovak republic or slovenia or melanesia or solomon island or solomon islands or norfolk island or norfolk islands or somalia or south africa or south sudan or sri lanka or ceylon or “saint kitts and nevis” or “st. kitts and nevis” or saint lucia or “st. lucia” or “saint vincent and the grenadines” or saint vincent or “st. vincent” or grenadines or sudan or suriname or surinam or dutch guiana or netherlands guiana or syria or syrian arab republic or tajikistan or tadjikistan or tadzhikistan or tadzhik or tanzania or tanganyika or thailand or siam or timor leste or east timor or togo or togolese republic or tonga or “trinidad and tobago” or trinidad or tobago or tunisia or turkey or turkmenistan or turkmen or uganda or ukraine or uzbekistan or uzbek or vanuatu or new hebrides or venezuela or vietnam or viet nam or middle east or west bank or gaza or palestine or yemen or yugoslavia or zambia or zimbabwe or northern rhodesia or global south or africa south of the sahara or sub-saharan africa or subsaharan africa or africa, central or central africa or africa, northern or north africa or northern africa or magreb or maghrib or sahara or africa, southern or southern africa or africa, eastern or east africa or eastern africa or africa, western or west africa or western africa or west indies or indian ocean islands or caribbean or central america or latin america or “south and central america” or south america or asia, central or central asia or asia, northern or north asia or northern asia or asia, southeastern or southeastern asia or south eastern asia or southeast asia or south east asia or asia, western or western asia or europe, eastern or east europe or eastern europe or developing country or developing countries or developing nation? or developing population? or developing world or less developed countr* or less developed nation? or less developed population? or less developed world or lesser developed countr* or lesser developed nation? or lesser developed population? or lesser developed world or under developed countr* or under developed nation? or under developed population? or under developed world or underdeveloped countr* or underdeveloped nation? or underdeveloped population? or underdeveloped world or middle income countr* or middle income nation? or middle income population? or low income countr* or low income nation? or low income population? or lower income countr* or lower income nation? or lower income population? or underserved countr* or underserved nation? or underserved population? or underserved world or under served countr* or under served nation? or under served population? or under served world or deprived countr* or deprived nation? or deprived population? or deprived world or poor countr* or poor nation? or poor population? or poor world or poorer countr* or poorer nation? or poorer population? or poorer world or developing econom* or less developed econom* or lesser developed econom* or under developed econom* or underdeveloped econom* or middle income econom* or low income econom* or lower income econom* or low gdp or low gnp or low gross domestic or low gross national or lower gdp or lower gnp or lower gross domestic or lower gross national or lmic or lmics or third world or lami countr* or transitional countr* or emerging economies or emerging nation?). ) OR TI ( (afghanistan or albania or algeria or american samoa or angola or “antigua and barbuda” or antigua or barbuda or armenia or armenian or aruba or azerbaijan or bahrain or bangladesh or barbados or republic of belarus or belarus or byelarus or belorussia or byelorussian or belize or british honduras or benin or dahomey or bhutan or bolivia or “bosnia and herzegovina” or bosnia or herzegovina or botswana or bechuanaland or brazil or brasil or bulgaria or burkina faso or burkina fasso or upper volta or burundi or urundi or cabo verde or cape verde or cambodia or kampuchea or khmer republic or cameroon or cameron or cameroun or central african republic or ubangi shari or chad or colombia or comoros or comoro islands or iles comores or mayotte or democratic republic of the congo or democratic republic congo or congo or zaire or costa rica or “cote d’ivoire” or “cote d’ ivoire” or cote divoire or cote d ivoire or ivory coast or croatia or cuba or cyprus or czech republic or czechoslovakia or djibouti or french somaliland or dominica or dominican republic or ecuador or egypt or united arab republic or el salvador or equatorial guinea or spanish guinea or eritrea or estonia or eswatini or swaziland or ethiopia or fiji or gabon or gabonese republic or gambia or “georgia (republic)” or georgian or ghana or gold coast or gibraltar or greece or grenada or guam or guatemala or guinea or guinea bissau or guyana or british guiana or haiti or hispaniola or honduras or hungary or india or indonesia or timor or iran or iraq or isle of man or jamaica or jordan or kazakhstan or kazakh or kenya or “democratic people’s republic of korea” or republic of korea or north korea or south korea or korea or kosovo or kyrgyzstan or kirghizia or kirgizstan or kyrgyz republic or kirghiz or laos or lao pdr or “lao people’s democratic republic” or latvia or lebanon or lebanese republic or lesotho or basutoland or liberia or libya or libyan arab jamahiriya or lithuania or macau or macao or republic of north macedonia or macedonia or madagascar or malagasy republic or malawi or nyasaland or malaysia or malay federation or malaya federation or maldives or indian ocean islands or indian ocean or mali or malta or micronesia or federated states of micronesia or kiribati or marshall islands or nauru or northern mariana islands or palau or tuvalu or mauritania or mauritius or mexico or moldova or moldovian or mongolia or montenegro or morocco or ifni or mozambique or portuguese east africa or myanmar or burma or namibia or nepal or netherlands antilles or nicaragua or niger or nigeria or oman or muscat or pakistan or panama or papua new guinea or new guinea or paraguay or peru or philippines or philipines or phillipines or phillippines or poland or “polish people’s republic” or portugal or portuguese republic or romania or russia or russian federation or ussr or soviet union or union of soviet socialist republics or rwanda or ruanda or samoa or pacific islands or polynesia or samoan islands or navigator island or navigator islands or “sao tome and principe” or saudi arabia or senegal or serbia or seychelles or sierra leone or slovakia or slovak republic or slovenia or melanesia or solomon island or solomon islands or norfolk island or norfolk islands or somalia or south africa or south sudan or sri lanka or ceylon or “saint kitts and nevis” or “st. kitts and nevis” or saint lucia or “st. lucia” or “saint vincent and the grenadines” or saint vincent or “st. vincent” or grenadines or sudan or suriname or surinam or dutch guiana or netherlands guiana or syria or syrian arab republic or tajikistan or tadjikistan or tadzhikistan or tadzhik or tanzania or tanganyika or thailand or siam or timor leste or east timor or togo or togolese republic or tonga or “trinidad and tobago” or trinidad or tobago or tunisia or turkey or turkmenistan or turkmen or uganda or ukraine or uzbekistan or uzbek or vanuatu or new hebrides or venezuela or vietnam or viet nam or middle east or west bank or gaza or palestine or yemen or yugoslavia or zambia or zimbabwe or northern rhodesia or global south or africa south of the sahara or sub-saharan africa or subsaharan africa or africa, central or central africa or africa, northern or north africa or northern africa or magreb or maghrib or sahara or africa, southern or southern africa or africa, eastern or east africa or eastern africa or africa, western or west africa or western africa or west indies or indian ocean islands or caribbean or central america or latin america or “south and central america” or south america or asia, central or central asia or asia, northern or north asia or northern asia or asia, southeastern or southeastern asia or south eastern asia or southeast asia or south east asia or asia, western or western asia or europe, eastern or east europe or eastern europe or developing country or developing countries or developing nation? or developing population? or developing world or less developed countr* or less developed nation? or less developed population? or less developed world or lesser developed countr* or lesser developed nation? or lesser developed population? or lesser developed world or under developed countr* or under developed nation? or under developed population? or under developed world or underdeveloped countr* or underdeveloped nation? or underdeveloped population? or underdeveloped world or middle income countr* or middle income nation? or middle income population? or low income countr* or low income nation? or low income population? or lower income countr* or lower income nation? or lower income population? or underserved countr* or underserved nation? or underserved population? or underserved world or under served countr* or under served nation? or under served population? or under served world or deprived countr* or deprived nation? or deprived population? or deprived world or poor countr* or poor nation? or poor population? or poor world or poorer countr* or poorer nation? or poorer population? or poorer world or developing econom* or less developed econom* or lesser developed econom* or under developed econom* or underdeveloped econom* or middle income econom* or low income econom* or lower income econom* or low gdp or low gnp or low gross domestic or low gross national or lower gdp or lower gnp or lower gross domestic or lower gross national or lmic or lmics or third world or lami countr* or transitional countr* or emerging economies or emerging nation

S22 S20 NOT S21

S23 S20 NOT S21 Limiters – Published Date: 20110101-20201231

S24 S20 NOT S21 Limiters – Published Date: 20110101-20201231

Narrow by Language: – english

Cochrane

#1 MeSH descriptor: [Costs and Cost Analysis] explode all trees

#2 MeSH descriptor: [Economics] this term only

#3 #1 OR #2

#4 (benefit or cost* or expenditure* or Life years or “disability adjusted life years” or effectiveness or qaly*):ti,ab

#5 MeSH descriptor: [Quality-Adjusted Life Years] explode all trees

#6 #4 OR #5

#7 #3 AND #6

#8 MeSH descriptor: [Cost-Benefit Analysis] explode all trees

#9 (cost-effectiveness analysis or cost-utility analysis or economic evaluation):ti,ab

#10 #8 OR #9

#11 #7 OR #10

#12 MeSH descriptor: [Hypertension] explode all trees

#13 hypertens*:ti,ab

#14 ((essential or isolate*) NEAR/3 hypertension):ti,ab

#15 ((elevat* or high or increase*) NEAR/3 (blood adj pressur*)):ti,ab

#16 #12 OR #13 OR #14 OR #15

#17 #11 AND #16

#18 (afghan OR afghans OR afghani OR albanian OR albanians OR algerian OR algerians OR “american samoan” OR “american samoans” OR angolan OR angolans OR antiguan OR antiguans OR barbudan OR berbudans OR armenian OR armenians OR aruban OR arubans OR azerbaijani OR azerbaijanis OR bahraini OR bahrainis OR bangladeshi OR bangladeshis OR bangalees OR bajan OR bajans OR belarusian OR belarusians OR byelorussian OR byelorussians OR belizean OR belizeans OR beninese OR benineses OR bhutanese OR bolivian OR bolivians OR bosnian OR bosnians OR botswana OR batswana OR brazilian OR brazilians OR brasilian OR brasilians OR bulgarian OR bulgarians OR burkinabe OR burkinese OR burundian OR burundians OR “cape verdean” OR “cape verdeans” OR “cabo verdean” OR “cabo verdeans” OR cambodian OR cambodians OR khmer OR cameroonian OR cameroonians OR “central african” OR “central africans” OR chadian OR chadians OR chinese OR colombian OR colombians OR comorian OR comorians OR congolese OR “costa rican” OR “costa ricans” OR ivorian OR ivorians OR croatian OR croatians OR cuban OR cubans OR cypriot OR cypriots OR czech OR czechs OR djiboutian OR djiboutians OR dominican OR dominicans OR ecuadorian OR ecuadorians OR egyptian OR egyptians OR salvadoran OR salvadorans OR “equatorial guinean” OR “equatorial guineans” OR equatoguinean OR equatoguineans OR eritrean OR eritreans OR estonian OR estonians OR swazi OR swazis OR swati OR swatis OR ethiopian OR ethiopians OR fijian OR fijians OR gabonese OR gabonaise OR gambian OR gambians OR georgian OR georgians OR ghanaian OR ghanaians OR gibraltarian OR gibraltarians OR greek OR greeks OR grenadian OR grenadians OR guamanian OR guamanians OR guatemalan OR guatemalans OR guinean OR guineans OR “bissau guinean” OR “bissau guineans” OR guyanese OR haitian OR haitians OR honduran OR hondurans OR hungarian OR hungarians OR indian OR indians OR indonesian OR indonesians OR iranian OR iranians OR iraqian OR iraqians OR iraqi OR iraqis OR manx OR jamaican OR jamaicans OR jordanian OR jordanians OR kazakhstani OR kazakhstanis OR kenyan OR kenyans OR kirabati OR kirabatian OR kirabatians OR “north korean” OR “north koreans” OR korean OR koreans OR kosovar OR kosovars OR kosovan OR kosovans OR kyrgyzstani OR kyrgyzstanis OR kyrgyz OR lao OR laotian OR laotians OR latvian OR latvians OR lebanese OR lesothan OR lesothans OR lesothonian OR lesothonians OR mosotho OR basotho OR liberian OR liberians OR libyan OR libyans OR lithuanian OR lithuanians OR macanese OR macedonian OR macedonians OR malagasy OR madagascan OR madagascans OR malawian OR malawians OR malaysian OR malaysians OR maldivian OR maldivians OR malian OR malians OR maltese OR marshallese OR marshalleses OR mauritanian OR mauritanians OR mauritian OR mauritians OR mexican OR mexicans OR micronesian OR micronesians OR moldovan OR moldovans OR mongolian OR mongolians OR mongol OR montenegrin OR montenegrins OR moroccan OR moroccans OR mozambican OR mozambicans OR burmese OR myanma OR namibian OR namibians OR nauruan OR nauruans OR nepali OR nepalese OR “netherlands antillean” OR “netherlands antilleans” OR nicaraguan OR nicaraguans OR nigerien OR nigeriens OR nigerian OR nigerians OR “northern mariana islander” OR “northern mariana islanders” OR mariana OR marianas OR omani OR omanis OR pakistani OR pakistanis OR palauan OR palauans OR panamanian OR panamanians OR “papua new guinean” OR “papua new guineans” OR paraguayan OR paraguayans OR peruvian OR peruvians OR philippine OR philippines OR philipine OR philipines OR phillipine OR phillipines OR phillippine OR phillippines OR filipino OR filipinos OR filipina OR filipinas OR polish OR pole OR poles OR portuguese OR romanian OR romanians OR russian OR russians OR “soviet people” OR “soviet population” OR rwandan OR rwandans OR rwandese OR ruandan OR ruandans OR ruandese OR samoan OR samoans OR “sao tomean” OR “sao tomeans” OR santomean OR santomeans OR “saudi arabian” OR “saudi arabians” OR saudi OR saudis OR senegalese OR serbian OR serbians OR montenegrin OR montenegrins OR seychellois OR seychelloise OR seychelloises OR “sierra leonean” OR “sierra leoneans” OR slovak OR slovaks OR slovene OR slovenes OR “solomon islander” OR “solomon islanders” OR somali OR somalis OR “south african” OR “south africans” OR “south sudanese” OR “sri lankan” OR “sri lankans” OR ceylonese OR kittitian OR kittitians OR nevisian OR nevisians OR “saint lucian” OR “saint lucians” OR vincentian OR vincentians OR sudanese OR surinamese OR surinameses OR syrian OR syrians OR tajik OR tajiks OR tajikistani OR tajikistanis OR tanzanian OR tanzanians OR tanganyikan OR tanganyikans OR thai OR timorese OR timoreses OR togolese OR tongan OR tongans OR trinidadian OR trinidadians OR tobagonian OR tobagonians OR tunisian OR tunisians OR turk OR turks OR turkish OR turkmen OR turkmens OR tuvaluan OR tuvaluans OR ugandan OR ugandans OR ukrainian OR ukrainians OR uzbek OR uzbeks OR vanuatu OR vanuatuan OR vanuatuans OR venezuelan OR venezuelans OR vietnamese OR yemeni OR yemenis OR yemenite OR yemenites OR yemenese OR yugoslav OR yugoslavs OR yugoslavian OR yugoslavians OR zambian OR zambians OR zimbabwean OR zimbabweans):ti,ab,kw 62510

#19 #17 NOT #18 with Cochrane Library publication date Between Jan 2011 and Jan 2021, in Cochrane Reviews

#20 #17 NOT #18 with Publication Year from 2011 to 2021, in Trials

#21 #19 OR #20

Review References

Walsh JM, McDonald KM, Shojania KG, Sundaram V, Nayak S, Lewis R, et al. Quality improvement strategies for hypertension management: a systematic review. Med Care 2006;44(7):646-57.

Considerations for Implementation

The following considerations for implementation are drawn from studies included in the existing evidence review, the broader literature, and expert opinion, as noted below.

Several resources offer guidance on the use and translation of team-based care interventions to control blood pressure.

  • The Surgeon General’s Call to Action to Control Hypertension (2020) provides team-based care strategies to promote and optimize care for blood pressure control.
  • The Best Practices Guide for Cardiovascular Disease Prevention from CDC’s Division of Heart Disease and Stroke Prevention describes and summarizes scientific evidence behind eight effective strategies health care systems can implement with communities to help patients lower blood pressure and cholesterol. The guide is a resource for state and local health departments, decision makers, public health professionals, and others interested in using proven strategies to improve cardiovascular health. Specific information is available on team-based care, its effectiveness, and strategies for implementation.
  • The Hypertension Control Change Package from Million Hearts presents a list of process improvements that outpatient clinical settings can implement to promote blood pressure control. It is composed of change concepts, change ideas, and evidence- or practice-based tools and resources.

The CPSTF recommends the following intervention approaches that complement this one.

Crosswalks

Healthy People 2030

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.