Tackling Hypertension

High blood pressure is among the most serious threats to health and well-being. Uncontrolled hypertension increases the risk of conditions including kidney disease, vascular disease, heart failure, and coronary artery disease. It leads to significant disability, diminishes quality of life, and in the worst cases can lead to stroke, heart attacks, or death.

Although effective treatments for hypertension exist, many people still have uncontrolled or poorly controlled hypertension. Some people may be unaware that they have hypertension, or if they are aware, they may have difficulty accessing and maintaining the needed care.

A new program at Duke Health, supported through a contract from the Patient-Centered Outcomes Research Institute (PCORI), is working to change that.

The project, known as the Duke Hypertension Management Acceleration Program (HTN MAP), was awarded a contract to begin in the summer of 2026, supported through PCORI’s Health Systems Implementation Initiative (HSII), which funds implementation projects designed to improve care delivery at health systems by incorporating evidence-based practices that benefit patients.

The HTN MAP program enables teams of healthcare providers to focus on overcoming specific barriers through evidence-based practices, many of which were first developed via PCORI-supported research.

These team-based interventions will allow clinicians to provide the best hypertension care for adult patients and support health systems in implementing these practices in a sustainable way.

“We’re trying to address this challenge by making sure that we’re doing all of things we know work, individually and together, to control hypertension,” said Anthony Viera, MD, MHS, principal investigator of HTN MAP and chair of the Department of Family Medicine and Community health. “This means improving the quality of the care we provide and engaging with patients and the community we serve.”

An expert in the management of hypertension, Viera looks for ways to close stubborn gaps in diagnosis and treatment for the condition. He notes that there are already detailed, evidence-based, and continuously updated guidelines for effective, patient-centered approaches to caring for patients with high blood pressure. The next step is to locate and fill the gaps that prevent some patients from getting effective screening, treatment, and follow-up.

“Data in our patient electronic health records is a critical tool for driving improvement,” said Michael Pignone, AB’88, MD, MPH, who serves as a co-principal investigator for the program and, with Rick Shannon, MD, as co-lead for Duke’s participation in the HSII program. “When that high-quality data is available and can be used to prompt timely action, whether that relates to diagnosis, treatment, management, or education, we can keep patients from falling through the cracks in the system and work toward eliminating disparities, both in terms of clinical outcomes and access to the best evidence-based care.”

Pignone is also the director of the Duke Collaborative to Advance Clinical Health Equity, (CACHE), which was the foundation for Duke’s original PCORI-funded capacity-building program, whose results helped shape the approach used in HTN MAP.

“Our pilot studies in hypertension control with CACHE showed some encouraging findings in terms of closing the gaps in quality of hypertension care,” said Pignone, who noted that these gaps often correspond to socioeconomic factors including income, education, and race and ethnicity.

Ultimately, HTN MAP investigators are planning to enroll approximately 37,000 patients with hypertension in the main program at 54 sites within the Duke Health system; an accompanying pilot program focused specifically on patients with undiagnosed hypertension may enroll around 19,000.

“Hypertension presents a frustrating paradox,” noted Viera. “We have effective tools for identifying and treating it. We know we have the potential to make a real difference in patients’ health and quality of life, but first we’ve got to be able to link up those tools with the patients who need them. With this support from PCORI, we’re moving closer to making that a reality.”