NEJM Interviews NEJM Interview: Robert Kocher on strategies for improving blood-pressure control in the United States.
Jan 28, 2026
Robert Kocher, adjunct professor at Stanford and health-policy expert, discusses why U.S. blood-pressure control has stalled. He explores causes of low awareness, misaligned incentives, and short insurance tenures. He describes AI and EMR tools for real-time home BP monitoring and automated treatment workflows. Policy levers like payment models and copay changes are also examined.
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U.S. Blood-Pressure Control Has Stalled
- The U.S. has regressed in blood-pressure control despite overall healthcare improvements.
- Robert Kocher found national control fell from 54% to 50% over a decade, prompting deeper analysis.
Many With Hypertension Are Undiagnosed
- Roughly 40% of adults with hypertension are unaware of their condition.
- Kocher argues a business and attention problem reduces diagnosis and patient engagement.
Incentives, Not Biology, Drive Poor Control
- Incentive misalignment, not biology, explains poor U.S. control rates.
- Kocher notes Kaiser reaches 90% control and Canada 70%, showing systems can succeed.