There is an untapped opportunity for stakeholders across the industry to enhance women’s care for hypertension (high blood pressure). Hypertension is the top risk factor for heart disease, which is the leading cause of death for U.S. women. While hypertension isn’t associated with gender, conditions like pregnancy and menopause can increase the risk of developing hypertension. We interviewed 16 healthcare leaders who shared several opportunities to improve care for hypertension with high chance of efficacy. And the opportunity to act isn’t limited to providers. Health plans, pharmacy benefit managers (PBMs), digital health, and medical device companies can also effect change in their spheres of influence.

• 51% of all U.S. deaths caused by hypertension were women, yet women represented only 43% of the total U.S. population with hypertension in 2020
• 57% of Black women had hypertension, compared to 40% of white women and 47% of white men in the U.S. from 2017-2020
• 77% of U.S. women with hypertension had uncontrolled hypertension (blood pressure not controlled to <130/80 mm Hg) from 2017-2020
• 47% of U.S. women with uncontrolled hypertension who were recommended hypertension medication by a clinician remained untreated from 2017-2020
• 61% of U.S. primary care providers ranked weight issues and breast health over heart disease as health issues of concern about among women in 2014
• Women at high risk for or with established cardiovascular disease are 15% less likely to be prescribed medications that lower blood pressure (ACE inhibitors) than men in primary care settings, according to an international meta-analysis

The health industry often fails to acknowledge the cardiovascular disease risks that women face. Because women show signs of blood pressure (BP) elevation earlier in life than men, providers should regularly screen women with BP measurement before starting any treatments. Additionally, some clinicians are hesitant to prescribe antihypertensives to women of reproductive age irrespective of their pregnancy intentions or family-planning goals. Clinicians should instead engage in shared decision-making with all women to create the most appropriate hypertension treatment plans that follow evidence-based guidelines. And health plans should encourage women’s hypertension diagnosis and management through targeted population health management strategies and wellness programs.

No organization can solve for women’s health inequities on its own. But every organization has a role to play in dismantling inequities in women’s care delivery to improve outcomes. Below are some initial steps for those with the greatest potential to make a difference in hypertension care.

Provider organizations

• Optimize early identification and management of hypertension in primary and specialty care settings. As women often see both internal medicine and ob/gyn providers for primary care, both types of providers have an opportunity to proactively identify and offer timely follow-up care for women with elevated BP using electronic health record (EHR) alerts or a nurse navigator program. 

Digital health and device companies

• Create solutions to enable home blood pressure monitoring and follow-up care for women. Partner to foster innovative solutions for home BP screening and management, such as Bluetooth-enabled BP monitors and cuffless BP sensors that automatically transmit results into EHRs. The Dallas Heart Study showed that home blood pressure screenings produced more accurate results among African American men and women than those done in medical settings.

Health plans and PBMs

• Offer convenient avenues for women to identify and manage hypertension. Given the high utilization of telehealth among women, consider opportunities to offer BP screenings and hypertension management services via virtual primary care visits or web-based wellness programs.
• Embed hypertension identification and care in chronic disease management programs. Hypertension is twice as frequent in patients with diabetes than those without. Hypertensive enrollees of CVS Caremark’s diabetes management program are proactively given a digitally connected BP cuff, as well as access to an app-based management plan and connections with health coaches. 

University of Wisconsin (2022)

• The University of Wisconsin tested the BP Connect protocol in primary and specialty care clinics in multiple Wisconsin health systems including Gundersen Health System, UW Health, and Froedtert & Medical College of Wisconsin.
• The goal of this study on the BP Connect protocol was to improve primary care follow-up for gynecologic patients with hypertension. The protocol consisted of:
  1. Tailored staff engagement focus groups
  2. Staff education defining hypertension and CVD risk
  3. EHR alerts prompting staff to remeasure BP and order timely follow-up
  4. Staff feedback (monthly audits)
  5. Patient education and tools (brochure and BP log)
• After six months, implementation of the protocol increased the rate of timely primary care follow-up for BP in gynecologic clinics from 28% to 48%.