What’s Wrong With this Diagram? The Case for Hypertension and Health 2.0

In April of this year, I swtiched gears slightly, from spending time to discover the determinants of patient access / connectivity to their care system through personal health records, to examining the possibilities of creating connectivity with the California Healthcare Foundation.

We’ve been talking to several people and the Foundation is allowing me to present our ideas in sequence, here, for critique, improvement, and interest among potential partners. The goal is to launch a project that will connect multiple stakeholders in the health ecosystem, to improve chronic care management, in California. Timeline and details are going to be posted over time.

Let’s start with the case for hypertension as a chronic illness worthy of examination, though. Take a look at this graphic. What does it say to you about the state of high blood pressure care in the United States? What are the opportunities using HIT and Health 2.0? Are there corrections to be made?

Welcome to my PDCA cycle. Sources are underneath – feel free to ask questions about any of this data. I’ll begin posting regularly under this category.

Update: After finding an error in the image, I decided to leave it in, with this note that it’s incorrect, and a corrected version is in this post. PDCA is about iteration.

Quote: “…undiagnosed hypertension and treated but uncontrolled hypertension occur largely under the watchful eye of the healthcare system.” – Hyman and Pavlik

Sources (formatted for Zotero):

1. Fang J, Alderman MH, Keenan NL, Ayala C, Croft JB. Hypertension Control at Physicians’ Offices in the United States. Am J Hypertens. 2008;21(2):136-142. Available at: http://dx.doi.org/10.1038/ajh.2007.35 [Accessed May 8, 2008].

2. Rosamond W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics–2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-146. Available at: http://circ.ahajournals.org [Accessed May 7, 2008].

Tomorrow: Impact to Californians



Two things (both minor):

1. The graphic is not appearing on my browsers (but I did see it earlier)

2. How can you have untreated and yet controlled HTN?


First customer! Thanks for commenting…

1.I added the old graphic back in. On a blog, I want to figure out a way to put stuff up that's incorrect and show how it's changed, so it can get better any time. Maybe I'll construct a link to a gallery of images or something….

2. This was a tricky model to put together – depending on the way the data is/was collected, the definition of hypertension is different. In a study of office visits coded with a hypertension diagnoses, patients could have a controlled blood pressure with no evidence of ongoing treatment. The studies based on BP measurement as opposed to Dx codes don't provide a category for untreated – controlled hypertension. There may be a small bit of overlap. I would like to come back to this when I post the plan in a few days, and see if it still make sense to include.

Thanks for calling these out,


Ted Eytan, MD