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Pages 1-32

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From page 1...
... entire Heart Disease and Stroke Prevention portfolio. The lack of attention to hypertension goes against the objective facts.
From page 2...
... THE CHARGE TO THE COMMITTEE The CDC Division for Heart Disease and Stroke Prevention (DHDSP) provides national leadership to reduce the burden of disease, disability, and death from heart disease and stroke.
From page 3...
... 12-11. Increase the proportion of adults with high blood pressure who are taking action (for example, losing weight, increasing physical activity, or reducing sodium intake)
From page 4...
... The committee was not expected to conduct a new, detailed review of peer-reviewed literature on hypertension because such literature reviews, meta-analyses, and syntheses already exist and have been used to inform existing guidelines and recommendations. FINDINGS AND RECOMMENDATIONS The CDC, through the Division for Heart Disease and Stroke Prevention, has leveraged its broader cardiovascular disease prevention and control programmatic efforts to address hypertension primarily through its state heart disease and stoke prevention programs.
From page 5...
... to ensure that hypertension is included as a dimension of other population-based activities around healthy lifestyle im provement, particularly greater consumption of potassium-rich fruits and vegetables, increased physical activity, and weight management o strengthen CDC's leadership in monitoring and reducing sodium intake in the American diet to meet current dietary guidelines o improve the surveillance and reporting of hypertension to better characterize general trends and trends among subgroups of the population • Promote policy and system change approaches to: o improve the quality of care provided to individuals by assuring that individuals who should be in treatment are in treatment and receive care that is consistent with current treatment guidelines ♦ increase the importance of treating systolic hypertension, especially among the elderly o remove economic barriers to effective antihypertensive medications o provide community-based support for individuals with hyper tension through community health workers who are trained in dietary and physical activity counseling. The population-based policy and systems approach recommended is not only limited to the CDC and DHDSP but also extends and applies to state and local health departments and to other partners.
From page 6...
... Based on the review of the literature there is strong evidence linking overweight and obesity, high sodium intake, low potassium intake, unhealthy diet, and decreased physical activity to hypertension. These risk factors contribute substantially to the burden of hypertension in the United
From page 7...
... The committee recommendations follow; the number appearing before the recommendation refers to the chapter and number of the recommendation in that chapter. 4.1 The committee recommends that the Division for Heart Disease and Stroke Prevention integrate hypertension prevention and control in programmatic efforts to effect system, environmental, and policy changes through collaboration with other CDC units and their external partners, to ensure that population-based lifestyle or behavior change interventions where delivered, are delivered in a coordinated manner that includes a focus on the prevention of hypertension.
From page 8...
... 6.1 The committee recommends that state and local public health ju risdictions give priority to population-wide approaches over individual based approaches to prevent and control hypertension. 6.2 The committee recommends that state and local public health jurisdictions integrate hypertension prevention and control in pro grammatic efforts to effect system, environmental, and policy changes that will support healthy eating, active living, and obesity prevention.
From page 9...
... The DHDSP's sponsorship of an IOM study to identify a range of interventions to reduce dietary sodium intake is an important step. The committee believes that the DHDSP is well positioned to take greater leadership in this area through it role as co-leader of Healthy People 2010 Focus Area 12: Heart Disease and Stroke, co-leader of the National Forum for Heart Disease and Stroke Prevention, and as the sponsor of grants to state health departments and other entities.
From page 10...
... . 6.3 The committee recommends that all state and local public health jurisdictions immediately begin to consider developing a portfolio of dietary sodium reduction strategies that make the most sense for early action in their jurisdictions.
From page 11...
... Some state and localities have begun to develop local level HANES to better monitor hypertension. 6.4 The committee recommends that state and local public health jurisdictions assess their capacity to develop local HANES as a means to obtain local estimates of the prevalence, awareness, treatment, and control of hypertension.
From page 12...
... 4.7 The committee recommends that the Division for Heart Disease and Stroke Prevention and other CDC units explore methods to develop and implement data-gathering strategies that will allow for more accu rate assessment and the tracking of population-level dietary sodium and potassium intake including the monitoring of 24-hour urinary sodium and potassium excretion. System Change Strategies Directed at Individuals with Hypertension Although patient nonadherence to treatment is one reason for lack of hypertension control, the lack of physician adherence to Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines (JNC)
From page 13...
... Once these factors are better understood, strategies should be developed to increase the likelihood that primary provid ers will screen for and treat hypertension appropriately, especially in elderly patients. 5.2 The committee recommends that the Division for Heart Disease and Stroke Prevention work with the Joint Commission and the health care quality community to improve provider performance on measures focused on assessing adherence to guidelines for screening for hyperten sion, the development of a hypertension disease management plan that is consistent with JNC guidelines, and achievement of blood pressure control.
From page 14...
... 5.4 The committee recommends that the Division for Heart Disease and Stroke Prevention collaborate with leaders in the business com munity to educate them about the impact of reduced patient costs on antihypertensive medication adherence and work with them to encourage employers to leverage their health care purchasing power to advocate for reduced deductibles and copayments for antihypertensive medications in their health insurance benefits packages.
From page 15...
... In the absence of such programs, the division should work with state partners to de velop programs of community health workers who would be deployed in high-risk communities to help support healthy living strategies that include a focus on hypertension. 6.7 State and local public health jurisdictions should promote and work with community health worker initiatives to ensure that preven tion and control of hypertension is included in the array of services they provide and are appropriately linked to primary care services.
From page 16...
... To effectively support the change and maintain a population-based focus, new expertise and guidance may be required beyond that which may be available through the DHDSP's partnership with the National Forum for Heart Disease and Stroke Prevention. 6.10 The committee recommends that the Division for Heart Disease and Stroke Prevention identify and work with experts grounded in population-based approaches to provide guidance and assistance in de signing and executing hypertension prevention and control efforts that focus on population-based policy and system change.
From page 17...
... The visible impacts of removing economic barriers to effective antihypertensive medications and employing the use of community health workers to provide community-based support for individuals with hypertension would be improved access to treatment, particularly for vulnerable populations. The committee observes that hypertension may provide an opportunity unparalleled in public health chronic disease prevention for program evaluation through outcome measurement.
From page 18...
... Recommendations to Enhance Population-Based Efforts and to Strengthen Efforts Among CDC Units and Partners Short-Term Outcomes (or process input or Intermediate Priority Recommendation outputs) Short-Term Indicator Outcomes Intermediate Indicators 4.1 The DHDSP should integrate Better targeting Budget allocated to Reduction of Prevalence of hypertension prevention and control in and integration population-based hypertension risk overweight/obesity programmatic efforts to effect system, of hypertension policy and system factors in the environmental, and policy changes prevention in approaches by the population Proportion of individuals through collaboration with other other CDC unit CDC who consume a healthy CDC units and their external partners.
From page 19...
... elements and focus to nonhypertension programs 6.2 SLHJs should integrate Strong federal, Number of SLHJs hypertension prevention and control in state, and local with comprehensive programmatic efforts to effect system, public health agency programs for environmental, and policy changes leadership that gives population that will support healthy eating, active priority to reducing hypertension control living, and obesity prevention. Existing the prevalence of programs and new programmatic efforts should hypertension through be assessed to ensure they are aligned population-based with populations, most likely to be approaches integrated affected by hypertension such as older throughout agency populations, which are often not the activities target of these programs.
From page 20...
... for the general population implementation of local budgets and of hypertension and 1,500 mg/day (equivalent to 70 federal, state, land plans for programs to mmol/day) for blacks, middle-aged ocal programs to reduce sodium intake and older adults, and individuals with reduce sodium intake hypertension.
From page 21...
... Reduction of hypertension risk factors in the population continued 21
From page 22...
... at the understudied populations including: national, state, and children, racial and ethnic minorities, local levels the elderly, and socioeconomic groups. 6.4 SLHJs should assess their Increased number of Number of states Access to local data Number of states capacity to develop local HANES as state and localities and localities with on hypertension and localities that are a means to obtain local estimates of with a NHANES-like data systems that trends implementing program the prevalence, awareness, treatment, survey provide estimates changes based on local and control of hypertension.
From page 23...
... 4.6 The DHDSP and other CDC Improved systems Availability of data Data on high-sodium- Percent of high content units, should explore methods for measuring or on specific foods containing foods are sodium products that to develop and implement data- estimating sodium that are important tracked and used to have reduced their sodium gathering strategies that will allow content in food contributors to develop strategies for content for more accurate assessment and are designed and dietary sodium intake reduction tracking of specific foods that are implemented by the American important contributors to dietary people sodium intake by the American people. 4.7 The DHDSP and other CDC Improved systems Availability of Data on dietary Reduction in mean dietary units should explore methods for measuring or mean population sodium consumption sodium intake to develop and implement data- estimating dietary dietary sodium and are available and gathering strategies that will allow sodium and potassium intake at used to target dietary for more accurate assessment and potassium intake the national, state, sodium reduction the tracking of population-level are designed and and local levels programs dietary sodium and potassium intake implemented including the monitoring of 24-hour urinary sodium and potassium excretion.
From page 24...
... Once these factors guidelines according to JNC systolic blood are better understood, strategies guidelines pressure control should be developed to increase the Targeted strategies among the elderly likelihood that primary providers to improve Proportion of will screen for and treat hypertension provider awareness, providers who follow appropriately, especially in elderly understanding, JNC pharmacologic patients. acceptance, and therapies for adherence to JNC treatment of treatment guidelines hypertension
From page 25...
... to develop physician groups, a plan to engage and leverage skills purchasers of and resources for improving the health care services, medical treatment of hypertension. quality improvement organizations, and employers around hypertension prevention and control continued 2
From page 26...
... hypertension control, medication regimens The DHDSP should work with the especially in the pharmaceutical industry and its trade poor, elderly, and Degree of disparity in organizations to standardize and simplify those without health blood pressure control applications for patient assistance insurance coverage between general and programs that provide reduced-cost or priority populations free antihypertensive medications for low-income, underinsured, or uninsured individuals.
From page 27...
... antihypertensive medications continued 2
From page 28...
... In targeting hypertension Degree of reduction in the absence of such programs, the control Number of disparities in blood pressure DHDSP should work with state community health control between general partners to develop programs of worker programs population and populations community health workers who targeting hypertension served by community would be deployed in high-risk health workers communities to help support healthy living strategies that include a focus on hypertension. 6.7 SLHJs should promote and work with community health worker initiatives to ensure that prevention and control of hypertension is included in the array of services they provide and are appropriately linked to primary care services.
From page 29...
... 2006. Healthy People 2010 Midcourse Review: Section 12: Heart disease and stroke.
From page 30...
... 2007. Community health workers national workforce study.
From page 31...
... 2008. Healthy People 2010 progress re view: Focus area 19: Nutrition and overweight presentation.


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