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Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices


Interventions for blood pressure (BP) control have positive effects on outcomes for patients with hypertension. Research on these effects in small- and medium-sized practices is limited. Our retrospective analysis used data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016–2018 as part of the Agency for Healthcare Research and Quality’s EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. Thirty-eight H3 practices met inclusion criteria and were assigned to an implementer group (high or low) based on the number of interventions implemented with the support of a practice facilitator during the study. Practices in the high-implementer group implemented a mean of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had greater improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were greater for the high-implementer group. These outcomes show that implementing additional interventions had a positive association with measures of BP control, though clinical significance was unknown or limited. Future research is needed to understand the impact of interventions for BP control in small- and medium-sized practices, including the interactions among intervention implementation, practice facilitation, and practice and patient characteristics.

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Data availability

The datasets generated and/or analyzed for this study are not publicly available. A limited dataset is available from the corresponding author on reasonable request.


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We would like to thank the staff of the clinical practices that participated. We also acknowledge all the contributes made by study staff of the Healthy Hearts in the Heartland (H3), Feinberg School of Medicine, Northwestern University for their support during the project.


This work was supported by the Agency for Healthcare Research and Quality (AHRQ) Grant R18HS023921 and T32-HS000078/T32-HS00008.

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Authors and Affiliations



SMR designed the present study and analysis, conducted the analysis, interpreted the analysis, and wrote the paper. AW designed the present study and analysis, collected the data, conducted the analysis, interpreted the analysis, and wrote the paper. LA designed the present study and analysis and interpreted the analysis. SDP collected the data, interpreted the analysis, and supervised the project. ANK designed the present study and analysis, collected the data, interpreted the analysis, and supervised the project.

Corresponding author

Correspondence to Samuel M. Ross.

Ethics declarations

Competing interests

The authors declare no competing interests. SDP receives unrelated research support from Omron Healthcare Co. Ltd.

Ethical approval

All data collected during the Healthy Hearts in the Heartland Study was governed by the Northwestern University Institutional Review Board Study #STU00201720. All practice participants consented to study participation.

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Ross, S.M., Wang, A., Anthony, L. et al. Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices. J Hum Hypertens (2023).

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