Nearly 93 million adults in the United States (US) have uncontrolled hypertension, a leading risk factor for heart disease and stroke. Increasing the use of fixed-dose combination antihypertensives (FDCs) has been proposed as a strategy to improve hypertension control. Using publicly available 2022 coverage information from 282 state Medicaid fee-for-service and managed care plans, we assessed coverage of FDCs in the 50 US states and Washington, D.C. No FDC had preferred coverage status in all plans. Losartan/hydrochlorothiazide had preferred status in 99.3% of plans. At least two FDCs—containing an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) plus a thiazide diuretic, and an ACEI or ARB plus a calcium channel blocker—had preferred status in 100 and 80.1% of plans, respectively. At least one triple combination FDC was preferred in nearly half (49.6%) of plans. Comprehensive coverage was limited. To enhance hypertension control, State Medicaid plans may consider approaches to remove barriers to accessing FDCs.

INTRODUCTION:This study examined cardiovascular disease (CVD)-related emergency department (ED) visits among children aged 0-17 years using data from the 2017-2021 National Emergency Department Sample (NEDS). METHODS:CVD-related primary diagnoses were classified at ED admissions into 14 clinically meaningful primary diagnosis categories. Unweighted counts, weighted counts, percentages, and rankings were stratified by diagnosis categories, sex, and age group. RESULTS:Among 126,376 pediatric ED visits for CVD-related primary diagnoses, the most common diagnoses were cardiac arrhythmias (48,279 ED visits; 38.2%, 95% confidence interval [CI] [36.6%, 39.8%]), essential hypertension (17,767; 14.1%, 95% CI [13.3%, 14.8%]), and congenital heart disease (14,488; 11.5%, 95% CI [10.0%, 12.9%]). Males had more CVD-related ED visits than females. Children under 5 years primarily presented with congenital heart disease and cardiac arrhythmia, while children aged 5 years and older presented with cardiac arrhythmias and essential hypertension. DISCUSSION:These findings highlight the need for targeted CVD management strategies in pediatric emergency care.

BACKGROUND Cardiomyopathies, particularly peripartum cardiomyopathy (PPCM), significantly contribute to maternal morbidity in the United States. OBJECTIVES The authors estimated the prevalence and mortality of PPCM and other cardiomyopathies (OCMs) during pregnancy among women aged 15 to 55 years from 2010 to 2020 in the United States using a cross-sectional analysis of multiple data sets. METHODS We identified PPCM, OCM, and deliveries using International Classification of Diseases and diagnosis related group codes in the National Inpatient Sample. We calculated PPCM and OCM prevalence and adjusted prevalence ratios (aPRs) by select covariates. We identified pregnancy-related deaths from all cardiomyopathies combined and PPCM exclusively from 2015 to 2020 Pregnancy Mortality Surveillance System. We calculated pregnancy-related mortality ratios (PRMR) by select covariates. RESULTS The overall PPCM and OCM prevalence were 105.1 (95% CI: 101.8-108.3) and 76.1 (95% CI: 73.6-78.7) cases per 100,000 delivery hospitalizations, respectively. PPCM prevalence increased with advancing maternal age and decreasing neighborhood income and exhibited marked differences among Black and American Indian or Alaska Native women (aPR: 3.58 [95% CI: 3.36-3.82] and aPR: 1.96 [95% CI: 1.57-2.45], respectively). PPCM prevalence was higher among those with chronic hypertension and diabetes (aPR: 12.17 [95% CI: 11.51-12.88] and aPR: 6.25 [95% CI: 5.77-6.78], respectively). The overall cardiomyopathy and PPCM PRMR were 2.1 and 1.0 deaths per 100,000 live births, respectively. PRMR were highest among those aged >= 40 years and among American Indian and Black women (overall cardiomyopathy PRMR: 7.3, 6.0 deaths per 100,000 live births respectively). CONCLUSIONS Intensifying efforts to address cardiomyopathies and enhance cardiovascular health before, during, and following pregnancy may reduce the burden of maternal morbidity. (c) 2025 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background: Cardiovascular diseases are among the leading causes of maternal morbidity and mortality in the United States. During 2010-2020, 1 in 10 severe maternal morbidities (SMMs) during delivery hospitalization was heart disease (HD)-related. This report synthesizes science, including methodologies, challenges, and opportunities, and summarizes national estimates on HD during pregnancy, focusing on congenital heart disease (CHD), cardiomyopathies (CM), valvular heart disease (VHD), arrhythmias (ARR), and heart failure (HF).Methods and Results: We analyzed large nationwide databases, including the National Inpatient Sample and the Nationwide Readmissions Database. The prevalence of HD complicating deliveries ranges from approximately 20-40 cases per 10,000 deliveries. Increasing trends were observed in CHD, ARR, and HF. HF, particularly peripartum CM, is a leading cause of adverse maternal outcomes, including in-hospital mortality and SMM. VHD prevalence has declined, whereas ARR has become the most prevalent HD during pregnancy hospitalizations. Significant gaps exist due to inconsistent definitions and methodologies, limiting comparability and clinical utility. Proposed solutions include adopting standardized definitions, developing a core outcome set, improving data quality through structured documentation and standardized data models, and using validated algorithms and indices. Collaboration among multidisciplinary teams is essential to enhance research quality.Conclusion: The efforts aligning definitions of HD, outcomes, and indices with public health measures and initiatives present an opportunity to create a unifying framework that connects patient-level data to system-wide improvements. This integration helps ensure that advances in methodology translate into better care delivery, billing accuracy, research quality, and public health surveillance, and ultimately enhance outcomes for pregnant women with HD.

BACKGROUND:Among the 119.9 million US adults with hypertension, an estimated 92.9 million have systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 80 mm Hg. Million Hearts is an initiative co-led since 2011 by the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. The program drives improvement in hypertension control by celebrating high-achieving clinicians, practices, and health systems each year as Million Hearts Hypertension Control Champions. Champions have validated control rates of 80% or higher. METHODS:Using data from each Champion, we summarized their key characteristics and quantified their use of various evidence-based strategies. We calculated summary statistics for application data provided by Champions based on the initiative's 5-year cycles of operation (2012-2015; 2017-2020; and 2022-2024). RESULTS:From 2012 to 2024, a total of 199 Hypertension Control Champions from 44 states were recognized; the mean prevalence of systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg was 82%. Overall, Champions reported using multiple evidence-based strategies to help their patients achieve hypertension control. The top 3 strategies were use of electronic medical record IT tools, patient support including self-measured blood pressure monitoring and team-based care. CONCLUSIONS:The Million Hearts Hypertension Control Champions demonstrate that hypertension control may be achievable among patients across diverse settings through the implementation of evidence-based approaches.

Hypertension in pregnancy, which includes both chronic hypertension and pregnancy-associated hypertension, is on the rise in the United States and is associated with an increased incidence of maternal and neonatal complications and future cardiovascular disease. Recent clinical recommendations suggest a lower blood pressure threshold for initiating treatment of chronic hypertension in pregnancy. Here we present a new quality improvement resource for outpatient clinicians to support changes to care processes for managing chronic hypertension in pregnancy and the postpartum period.

PURPOSE:This study examines national trends in mortality from cardiovascular disease (CVD) and select subtypes among U.S. young adults aged 18-34 years from 2000 to 2023. METHODS:National mortality data from the National Vital Statistics System were used to identify CVD, heart disease, stroke, and hypertension-related CVD deaths among U.S. residents aged 18-34 from 2000 to 2023. Crude and age-standardized death rates were calculated overall and by age group, sex, and race and ethnicity. Temporal trends were calculated as percent change using a log-linear model. RESULTS:From 2000-2023, age-standardized CVD and heart disease death rates among young adults did not statistically change (percent change: -2.2 % [95 % CI: -7.8, 3.7] and -2.4 % [95 % CI: -8.3 %, 3.8 %], respectively). Stroke death rates decreased (percent change: -15.7 % [-21.0 %, -10.0 %])). However, hypertension-related CVD death rates increased by 78.5 % [95 % CI: 63.6 %, 94.7 %]). Patterns across demographic groups were broadly similar. CONCLUSION:Despite stability or modest declines in CVD death rates among young adults, hypertension-related CVD death rates increased sharply during 2000-2023. These findings merit public health action and underscore the need for better identification and management of hypertension and other CVD risk factors among young adults.

Cardiomyopathies, particularly peripartum cardiomyopathy (PPCM), significantly contribute to maternal morbidity in the United States. The authors estimated the prevalence and mortality of PPCM and other cardiomyopathies (OCMs) during pregnancy among women aged 15 to 55 years from 2010 to 2020 in the United States using a cross-sectional analysis of multiple data sets. We identified PPCM, OCM, and deliveries using International Classification of Diseases and diagnosis related group codes in the National Inpatient Sample. We calculated PPCM and OCM prevalence and adjusted prevalence ratios (aPRs) by select covariates. We identified pregnancy-related deaths from all cardiomyopathies combined and PPCM exclusively from 2015 to 2020 Pregnancy Mortality Surveillance System. We calculated pregnancy-related mortality ratios (PRMR) by select covariates. The overall PPCM and OCM prevalence were 105.1 (95% CI: 101.8-108.3) and 76.1 (95% CI: 73.6-78.7) cases per 100,000 delivery hospitalizations, respectively. PPCM prevalence increased with advancing maternal age and decreasing neighborhood income and exhibited marked differences among Black and American Indian or Alaska Native women (aPR: 3.58 [95% CI: 3.36-3.82] and aPR: 1.96 [95% CI: 1.57-2.45], respectively). PPCM prevalence was higher among those with chronic hypertension and diabetes (aPR: 12.17 [95% CI: 11.51-12.88] and aPR: 6.25 [95% CI: 5.77-6.78], respectively). The overall cardiomyopathy and PPCM PRMR were 2.1 and 1.0 deaths per 100,000 live births, respectively. PRMR were highest among those aged ≥40 years and among American Indian and Black women (overall cardiomyopathy PRMR: 7.3, 6.0 deaths per 100,000 live births respectively). Intensifying efforts to address cardiomyopathies and enhance cardiovascular health before, during, and following pregnancy may reduce the burden of maternal morbidity.

Introduction: Peripartum cardiomyopathy (PPCM) is cardiomyopathy of unknown etiology occurring in pregnant people shortly before or following delivery. Cardiovascular diseases are a large contributor to maternal morbidity in the US. We estimated PPCM prevalence to understand its contribution to this burden. Methods: We used National Inpatient Sample (NIS) data, a nationally representative sample of US hospital discharge records, from 2010-2020. We identified PPCM and deliveries among people aged 15-55 years using ICD and DRG codes. We excluded discharges missing age and race or ethnicity (n=512,639), and those with other cardiomyopathy codes (n=1010), leaving 7,820,420 delivery discharges. Using NIS survey weights, we calculated PPCM prevalence by age, race and ethnicity, comorbidities, and neighborhood income and adjusted prevalence ratios (aPR) using Poisson regression. Results: After weighting, our analytic set represented 38,672,513 delivery discharges and 41,182 PPCM cases. The overall PPCM prevalence was 109.4 (95% CI: 106.0-112.7) cases per 100,000 delivery discharges (Figure). Overall, PPCM prevalence remained steady from 2010-2020, but increased with advancing maternal age and decreasing neighborhood income. The prevalence in the lowest income quartile was more than double that of the highest income quartile (aPR: 2.4, 95% CI: 2.2-2.6). Compared to non-Hispanic (NH) White people, NH Black people had the highest prevalence (aPR: 3.7, 95% CI: 3.4-3.9), followed by Native American people (aPR: 1.9, 95% CI: 1.5-2.4). Hispanic and NH Asian people both had an aPR of 0.7 (95% CI: 0.6-0.8). Compared to those with no comorbidities, PPCM prevalence was significantly higher among those with certain comorbidities, notably diabetes (aPR: 5.6, 95% CI: 5.1-6.1) and chronic hypertension (aPR: 17.1, 95% CI: 16.0-18.2). Discussion: PPCM prevalence presents significant racial and ethnic, and economic disparities. The higher PPCM prevalence among those with diabetes and hypertension emphasizes the need to strengthen management of chronic conditions. Intensification of efforts to address root causes of these disparities and to enhance cardiovascular health before and during pregnancy may be needed.

Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.

ImportanceUncontrolled hypertension is a major contributor to cardiovascular disease (CVD) in the US.ObjectiveTo determine the prevalence of hypertension control cascade outcomes (hypertension awareness, treatment recommendations, and medication use) among individuals with uncontrolled hypertension to inform action across cascade levels.Design, Setting, and ParticipantsThis weighted cross-sectional study used January 2017 to March 2020 National Health and Nutrition Examination Survey (NHANES) data from noninstitutionalized adults aged 18 years or older in the US with uncontrolled hypertension. Data analysis occurred from January to February 2024.ExposureCalendar year of response to the NHANES survey.Main Outcomes and MeasuresMean blood pressure (BP) was computed using up to 3 measurements. Uncontrolled hypertension was defined as systolic BP of 130 mm Hg or greater or diastolic BP of 80 mm Hg or greater, regardless of medication use. Outcomes included patient awareness of hypertension, treatment recommendations, and medication use. To estimate population totals by subgroup, the age-standardized proportion of each outcome was multiplied by the estimated number of adults with uncontrolled hypertension.ResultsThe study included 3129 US adults with uncontrolled hypertension (1675 male [weighted percentage, 52.3%]; 775 aged 18 to 44 years [weighted percentage, 29.4%]; 1306 aged 45 to 64 years [weighted percentage, 41.4%]; 1048 aged 65 years or older [weighted percentage, 29.2%]), resulting in a population estimate of 100.4 million adults (weighted percentage, 83.7%) with uncontrolled hypertension. More than one-half of study participants (57.8 million adults [weighted percentage, 57.6%]) were unaware that they had hypertension, and of the 35.0 million who were aware and met criteria for antihypertensive medication, 24.8 million (weighted percentage, 70.8%) took the medication but had hypertension that remained uncontrolled. These negative outcomes in the hypertension control cascade occurred across demographic groups, with notably high prevalence among younger adults and individuals engaged in health care. Among an estimated 30.1 million adults aged 18 to 44 years with hypertension, 10.4 of 11.3 million females (weighted percentage, 91.8%) and 17.7 million of 18.8 million males (weighted percentage, 94.3%) had uncontrolled hypertension. Of the 10.4 million females, 7.2 million (weighted percentage, 68.8%) were unaware of their hypertension status, and of the 17.7 million males, 12.0 million (weighted percentage, 68.1%) were unaware. Additionally, 9.9 of 13.0 million adults with uncontrolled hypertension (weighted percentage, 75.7%) reported no health care visits in the past year and were unaware. Conversely, among 70.6 million adults with uncontrolled hypertension reporting 2 or more health care visits, approximately one-half (36.6 million [weighted percentage, 51.8%]) were unaware.Conclusions and RelevanceIn this cross-sectional study, more than 50% of adults with uncontrolled hypertension in the US were unaware of their hypertension and were untreated, and 70.8% of those who were treated had hypertension that remained uncontrolled. These findings have serious implications for the nation’s overall health given the association of hypertension with increased risk for CVD.

The coronavirus disease 2019 (COVID-19) pandemic has underscored the need to prevent chronic disease and promote health.1,2 More than a million American lives have been lost to COVID-19, and life expectancy decreased between 2018 and 2020.3,4 Chronic diseases are major risk factors for COVID-19 morbidity and mortality.5 In addition, COVID-19 morbidity and mortality have been higher among persons from racial and ethnic groups such as those who are African American, Hispanic or Latino, and American Indian or Alaska Native as well as those living at lower SES.

Hypertension is highly prevalent in the United States, and many persons with hypertension do not have controlled blood pressure. Self-measured blood pressure monitoring (SMBP), when combined with clinical support, is an evidence-based strategy for lowering blood pressure and improving control in persons with hypertension. For years, there has been support for widespread implementation of SMBP by national organizations and the federal government, and SMBP was highlighted as a primary intervention in the 2020 Surgeon General's Call to Action to Control Hypertension, yet optimal SMBP use remains low. There are well-known patient and clinician barriers to optimal SMBP documented in the literature. We explore additional high-level barriers that have been encountered, as broad policy and systems-level changes have been attempted, and offer potential solutions. Collective efforts could modernize data transfer and processing, improve broadband access, expand device coverage and increase affordability, integrate SMBP into routine care and reimbursement practices, and strengthen patient engagement, trust, and access.

More than 56 million women in the United States have hypertension, including almost one in five women of reproductive age. The prevalence of hypertensive disorders of pregnancy is on the rise, putting more women at risk for adverse pregnancy-related outcomes and atherosclerotic cardiovascular disease later in life. Hypertension can be better detected and controlled in women throughout their life course by supporting self-measured blood pressure monitoring. In this study, we present some potential strategies for strengthening our nation's ability to address hypertension in women focusing on pregnancy-related considerations for self-measured blood pressure monitoring.

Background Amid stagnating declines in national cardiovascular disease (CVD) mortality, documenting trends in county‐level hypertension‐related CVD death rates can help activate local efforts prioritizing hypertension prevention, detection, and control. Methods and Results Using death certificate data from the National Vital Statistics System, Bayesian spatiotemporal models were used to estimate county‐level hypertension‐related CVD death rates and corresponding trends during 2000 to 2010 and 2010 to 2019 for adults aged ≥35 years overall and by age group, race or ethnicity, and sex. Among adults aged 35 to 64 years, county‐level hypertension‐related CVD death rates increased from a median of 23.2 per 100 000 in 2000 to 43.4 per 100 000 in 2019. Among adults aged ≥65 years, county‐level hypertension‐related CVD death rates increased from a median of 362.1 per 100 000 in 2000 to 430.1 per 100 000 in 2019. Increases were larger and more prevalent among adults aged 35 to 64 years than those aged ≥65 years. More than 75% of counties experienced increasing hypertension‐related CVD death rates among patients aged 35 to 64 years during 2000 to 2010 and 2010 to 2019 (76.2% [95% credible interval, 74.7–78.4] and 86.2% [95% credible interval, 84.6–87.6], respectively), compared with 48.2% (95% credible interval, 47.0–49.7) during 2000 to 2010 and 66.1% (95% credible interval, 64.9–67.1) for patients aged ≥65 years. The highest rates for both age groups were among men and Black populations. All racial and ethnic categories in both age groups experienced widespread county‐level increases. Conclusions Large, widespread county‐level increases in hypertension‐related CVD mortality sound an alarm for intensified clinical and public health actions to improve hypertension prevention, detection, and control and prevent subsequent CVD deaths in counties across the nation.

More than 40 years after the 1978 Bethesda Conference on the Declining Mortality from Coronary Heart Disease provided the scientific community with a blueprint for systematic analysis to understand declining rates of coronary heart disease, there are indications the decline has ended or even reversed despite advances in our knowledge about the condition and treatment. Recent data show a more complex situation, with mortality rates for overall cardiovascular disease, including coronary heart disease and stroke, decelerating, whereas those for heart failure are increasing. To mark the 40th anniversary of the Bethesda Conference, the National Heart, Lung, and Blood Institute and the American Heart Association cosponsored the "Bending the Curve in Cardiovascular Disease Mortality: Bethesda + 40" symposium. The objective was to examine the immediate and long-term outcomes of the 1978 conference and understand the current environment. Symposium themes included trends and future projections in cardiovascular disease (in the United States and internationally), the evolving obesity and diabetes epidemics, and harnessing emerging and innovative opportunities to preserve and promote cardiovascular health and prevent cardiovascular disease. In addition, participant-led discussion explored the challenges and barriers in promoting cardiovascular health across the lifespan and established a potential framework for observational research and interventions that would begin in early childhood (or ideally in utero). This report summarizes the relevant research, policy, and practice opportunities discussed at the symposium.