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Measure: CMS165

Controlling High Blood Pressure

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS165v12 2024 12.0.000 Controlling High Blood Pressure
CMS165v11 2023 11 Controlling High Blood Pressure
CMS165v10 2022 10.0.000 Controlling High Blood Pressure
CMS165v9 2021 9.2.000 Controlling High Blood Pressure
CMS165v8 2020 8.5.000 Controlling High Blood Pressure
CMS165v7 2019 7.3.000 Controlling High Blood Pressure
CMS165v6 2018 6.2.000 Controlling High Blood Pressure
CMS165v5 2017 5.0.000 Controlling High Blood Pressure


Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period


In reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. Do not include BP readings: -Taken during an acute inpatient stay or an ED visit -Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests. -Reported by or taken by the member If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled." If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationPatients 18-85 years of age who had a visit and diagnosis of essential hypertension overlapping the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsPatients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period. Exclude patients whose hospice care overlaps the measurement period. Exclude patients 66 and older who are living long term in an institution for more than 90 days during the measurement period. Exclude patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured.Webchart Instructions
NumeratorPatients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement periodWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone


Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS165v8 165 2020 8.5.000 Not Applicable abdc37cc-bac6-4156-9b91-d1be2c8b7268
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance
Scoring Method Measure Type Stratification Risk Adjustment
Proportion INTERMEDIATE None None

Rate Aggregation


Improvement Notation

Higher score indicates better quality


High blood pressure (HBP), also known as hypertension, is when the pressure in blood vessels is higher than normal (Centers for Disease Control and Prevention [CDC], 2016). The causes of hypertension are multiple and multifaceted and can be based on genetic predisposition, environmental risk factors, being overweight and obese, sodium intake, potassium intake, physical activity, and alcohol use. High Blood Pressure is common, according to the National Health and Nutrition Examination Survey (NHANES), approximately 85.7 million adults >= 20 years of age had HBP (140/90 mm Hg) between 2011 to 2014 (Crim, 2012. Between 2011-2014 the prevalence of hypertension (>=140/90 mm Hg) among US adults 60 and older was approximately 67.2 percent (Benjamin et al., 2017). HBP, known as the “silent killer,” increases risks of heart disease and stroke which are two of the leading causes of death in the U.S. (Yoon, Fryar, & Carroll, 2015). A person who has HBP is four times more likely to die from a stroke and three times more likely to die from heart disease (CDC, 2012) The National Vital Statistics Systems Center for Disease Control and Prevention reported that in 2014 there were approximately 73,300 deaths directly due to HBP and 410,624 deaths with any mention of HBP (CDC, 20145).Between 2004 and 2014 the number of deaths due to HBP rose by 34.1 percent (Benjamin et al., 2017). Managing and treating HBP would reduce cardiovascular disease mortality for males and females by 30.4 percent and 38.0 percent, respectively (Patel et al., 2015). The estimated annual average direct and indirect cost of HBP from 2012 to 2013 was $51.2 billion (Benjamin et al., 2017). Total direct costs of HBP is projected to increase to $200 billion by 2030 (Benjamin et al., 2017). A study on cost-effectiveness on treating hypertension found that controlling HBP in patients with cardiovascular disease and systolic blood pressures of >=160 mm Hg could be effective and cost-saving (Moran et al., 2015). Many studies have shown that controlling high blood pressure reduces cardiovascular events and mortality. The Systolic Blood Pressure Intervention Trial (SPRINT) investigated the impact of obtaining a SBP goal of <120 mm Hg compared to a SBP goal of <140 mm Hg among patients 50 and older with established cardiovascular disease and found that the patients with the former goal had reduced cardiovascular events and mortality (SPRINT Research Group et al., 2015). Controlling HBP will significantly reduce the risks of cardiovascular disease mortality and lead to better health outcomes like reduction of heart attacks, stroke, and kidney disease (James et al., 2014). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.

Clinical Recommendation Statement

The U.S. Preventive Services Task Force (2015) recommends  screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation. 

American College of Cardiology/American Heart Association (2017)
-For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a blood pressure target of less than 130/80 mmHg is recommended
-For adults with confirmed hypertension, without additional markers of increased CVD risk, a blood pressure target of less than 130/80 mmHg may be reasonable (Note: clinical trial evidence is strongest for a target blood pressure of 140/90 mmHg in this population. However observational studies suggest that these individuals often have a high lifetime risk and would benefit from blood pressure control earlier in life)

American College of Physicians and the American Academy of Family Physicians (2017):  
-Initiate intensifying pharmacologic treatment in adults aged 60 and older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mmHg (Grade: weak recommendation, quality of evidence: low)
-Initiate intensifying pharmacologic treatment in adults aged 60 and older with a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mmHg to reduce the risk of recurrent stroke (Grade: weak recommendation, quality of evidence: moderate)

American Diabetes Association (2018):
Most patients with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg (Level of evidence: A)

Report from the Eighth Joint National Committee (2014)
-In the general population younger than 60 years, initiate pharmacologic treatment to lower blood pressure at diastolic blood pressure (DBP) of 90 mmHg or higher and treat to a goal of DBP of lower than 90 mmHg (Grade: A (for ages 30-59), Grade: E (for ages 18-29))
-In the general population younger than 60 years, initiate pharmacologic treatment to lower blood pressure at systolic blood pressure (SBP) to 140 mmHg or higher and treat to a goal of SBP of lower than 140 mmHg (Grade: E)
-In the general population aged 60 years and older, initiate pharmacologic treatment to lower blood pressure at SBP of 150 mmHg or higher or a DBP of 90 mmHg or higher and treat to a goal of SBP lower than 150 mmHg and goal of DBP lower than 90 mmHg



Transmission Format


Applicable Value Sets

Category Value Set OID
Diagnosis Chronic Kidney Disease, Stage 5 2.16.840.1.113883.3.526.3.1002
Diagnosis End Stage Renal Disease 2.16.840.1.113883.3.526.3.353
Diagnosis Essential Hypertension 2.16.840.1.113883.3.464.1003.104.12.1011
Diagnosis Frailty Diagnosis 2.16.840.1.113883.3.464.1003.113.12.1074
Diagnosis Kidney Transplant Recipient 2.16.840.1.113883.3.464.1003.109.12.1029
Diagnosis Pregnancy 2.16.840.1.113883.3.526.3.378
Encounter, Performed Acute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1083
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed Care Services in Long-Term Residential Facility 2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed ED 2.16.840.1.113883.3.464.1003.101.12.1085
Encounter, Performed Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed ESRD Monthly Outpatient Services 2.16.840.1.113883.3.464.1003.109.12.1014
Encounter, Performed Frailty Encounter 2.16.840.1.113883.3.464.1003.101.12.1088
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Nonacute Inpatient 2.16.840.1.113883.3.464.1003.101.12.1084
Encounter, Performed Nursing Facility Visit 2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed Observation 2.16.840.1.113883.3.464.1003.101.12.1086
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Outpatient 2.16.840.1.113883.3.464.1003.101.12.1087
Encounter, Performed Preventive Care Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Intervention, Order Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Medication, Active Dementia Medications 2.16.840.1.113883.3.464.1003.196.12.1510
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1
Procedure, Performed Dialysis Services 2.16.840.1.113883.3.464.1003.109.12.1013
Procedure, Performed Kidney Transplant 2.16.840.1.113883.3.464.1003.109.12.1012
Procedure, Performed Vascular Access for Dialysis 2.16.840.1.113883.3.464.1003.109.12.1011
Symptom Frailty Symptom 2.16.840.1.113883.3.464.1003.113.12.1075


American Diabetes Association. (2018). 9. Cardiovascular disease and risk management: Standards of medical care in diabetes 2018. Diabetes Care, 41(Suppl. 1), S86-S104.
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., et al. (2017). Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 135(10), e146-e603.doi: 10.1161/CIR.0000000000000485
Centers for Disease Control and Prevention. (2012). Vital signs: Getting blood pressure under control. Retrieved from
Centers for Disease Control and Prevention. Division for Heart Disease and Stroke Prevention. (2016). High blood pressure fact sheet. Retrieved from
Centers for Disease Control and Prevention, National Center for Health Statistics. (2015). Underlying Cause of Death 1999-2013 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Retrieved from
Crim, M. T., Yoon, S. S., Ortiz, E., et al. (2012). National surveillance definitions for hypertension prevalence and control among adults. Circulation: Cardiovascular Quality and Outcomes. 2012, ;5(3), :343-–351. doi: 10.1161/ CIRCOUTCOMES.111.963439.
James, P. A., Oparil, S., Carter, B. L., et al (2014). 2014 evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC8). JAMA. 311(5), 507-520. doi:10.1001/jama.2013.284427
Moran, A. E., Odden, M. C., Thanataveerat, A., et al.Tzong KY, Rasmussen PW, Guzman D, Williams L, Bibbins-Domingo K, Coxson PG, Goldman L. (2015). Cost-effectiveness of hypertension therapy according to 2014 guidelines. [published correction appears in N Engl J. Med. 2015;372:1677]. New England Journal of Medicine,. 2015 ;372, :447-–455. doi:  10.1056/NEJMsa1406751. [published correction appears on page 1677] 
Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38:600-9.
Patel, S. A., Winkel, M., Ali, M. K., et al. (2015). Cardiovascular mortality associated with 5 leading risk factors: National and state preventable fractions estimated from survey data. Annals of Internal Medicine, 163(4), :245–253. doi: 10.7326/M14-1753
Qaseem, A., Wilt, T. J., Rich, R., et al. (2017). Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 166(6), 430-437.
SPRINT Research Group,; Wright, J. T., Jr., Williamson,  J. D., et al. (2015). A randomized trial of intensive versus standard blood-pressure control. New England Journal of Medicine, 373(22), 2103–2116.
U.S. Preventive Services Task Force. (2015). Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 163(10), 778-787.
Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2017). Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, .
Yoon, S. S., Fryar, C. D., & Carroll, M. D. (2015). Hypertension prevalence and control among adults: United States, 2011-2014. NCHS Data Brief No. 220. Hyattsville, MD: National Center for Health Statistics.


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