Improving hypertension control in a community health center through dedicated appointments

Introduction Blood pressure (BP) control is critical in patients from low-income households as they disproportionately experience hypertension (HTN) related cardiovascular complications. Primary care providers face challenges managing these patients within the constraints of regular visits due to competing priorities of comorbid conditions and socioeconomic health barriers. In 2023, one community health center in Harris County, Texas, fell below target and national HEDIS benchmarks for BP control. Subsequently, a dedicated HTN clinic was founded as a pilot quality improvement project to provide a targeted chronic disease approach through patient education and pharmacologic optimization. Methods Every Thursday afternoon, an ambulatory panel of appointment slots was dedicated to HTN management. As patients attended routine clinic appointments, any provider could refer individuals with difficult-to-control BP to the HTN clinic managed by two family physicians. Patients eligible to be referred were adults aged 18-85 on at least one BP medication and with the most recent BP >140/90. Patients on dialysis or pregnant were excluded. Outcome measures included mean reductions in BP, achievement of BP control, and number of encounters. Results Between January and December 2024, 11 physicians referred 54 patients to the HTN clinic. 37 patients (68.5%) attended at least one appointment. The mean patient age was 57.4 years, with 62.2% of patients being women, and 51.4% identifying as Hispanic – aligning with the overall demographics of the clinic. After an average of 1.68 encounters, most patients (88%) experienced a significant BP reduction. The mean systolic BP reduction was 15.5 mmHg and the mean diastolic BP reduction was 7.0 mmHg. By the end of 2024, 56.8% of referred patients achieved BP control. Discussion As managing HTN requires considerable negotiation, counseling, and discussion, focus singularity as a cost-neutral approach improved a pilot cohort’s BP control metrics. Other community health centers may be able to work toward closing the gap in cardiovascular health disparities for medically underserved populations by intentionally prioritizing access to hypertension care.