Brief description of measure CMS22: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented: Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive. Description of issue ​The 2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure guidelines include a recommendation regarding the use of blood pressure lowering medications for secondary prevention of cardiovascular disease in patients with a diagnosis of clinical ASCVD or estimated 10-year ASCVD risk of >= 10% where Stage 1 hypertension was indicated. The measure developer proposes adding the 2017 ACC/AHA recommendations in the Rationale section to allow providers to better identify appropriate treatment, but is not proposing updates to the logic to incorporate the recommendation. The measure developer is specifically interested in the perspectives from the clinical community to evaluate the proposed text to include in the measure specifications. Goal of review Obtain clinical feedback

Proposed solution Add the following language to the Rationale section: The ACC/AHA 2017 Guidelines recommends a 10-year ASCVD risk assessment for all adults age 40 or older. In adults with stage 1 hypertension (SBP 130 mmHg to 139 mmHg OR DBP 80 mmHg to 89 mmHg) the 10-year risk assessment is recommended to determine if BP-lowering medications should be considered for treatment. Adults with an estimated 10-year ASCVD risk of 10% or higher should be managed initially with a combination of non-pharmacological and BP-lowering medication and be reassessed within four weeks. Rationale for change Including this recommendation statement in the header would allow providers to better target recommended therapy. Recording and tracking clinical ASCVD diagnoses and 10-year ASCVD risk may facilitate improved outcomes for patients at risk. Encouraging providers to use ASCVD risk estimators may improve identification and treatment of both hypertension and ASCVD. This measure is currently a broad-based measure and is used by both primary care and specialist physicians. The measure developer does not plan to incorporate ASCVD risk into the logic., as doing so would increase complexity and may discourage providers (especially specialists) from reporting Quality ID#317/CMS22 due to the extra requirements, such as obtaining additional lab values (e.g., lipid panel) and/or performing a 10-year ASCVD risk assessment.