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1 Introduction
Pages 33-48

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From page 33...
... Hypertension, or high blood pressure, describes the condition in which systemic arterial blood pressure remains elevated over time. High blood pressure is caused primarily by an increase in the resistance to the flow of blood through arteries and an increase in cardiac output, which is a function of the heart rate and stroke volume.
From page 34...
... Since then, additional medications including calcium channel blockers and beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin receptor antagonists can be found among the antihypertensive therapies available 1 The NHLBI administers the National High Blood Pressure Education Program Coordinat ing Committee, a coalition of 39 major professional, public, and voluntary organizations and 7 federal agencies.
From page 35...
... SOURCE: NHLBI, 2004a. FIGuRE 1-2 Increased risk of death from stroke associated with blood pressure by decade of life.
From page 36...
... The CDC Division for Heart Disease and Stroke Prevention (DHDSP) provides national leadership to reduce the burden of disease, disability, 2 A review of data from the Medical Expenditure Panel Survey (MEPS)
From page 37...
... increase awareness of the signs and symptoms of heart attack and stroke and of the need to call 911, and (6) eliminate health disparities related to heart disease and stroke.
From page 38...
... Chapter 2 provides a discussion of the public health importance of hypertension and an overview of hypertension trends in the United States. Chapter 3 provides an overview of the CDC's Division for Heart Disease and Stroke Prevention and background information on its budget and activities.
From page 39...
... In Chapter 6, the committee specifically recommends the action steps state and local health jurisdictions can take to implement the priority actions (response to question 2)
From page 40...
... The second meeting focused on learning more about the CDC Division for Heart Disease and Stroke Prevention's activities and reviewing data on blood pressure trends. At that meeting the committee also received information on the lessons learned from the National High Blood Pressure Education Program, the Hypertension Detection and Follow-up Program, and the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
From page 41...
... will affect primarily the distribution of blood pressure; in contrast the adequate control of high blood pressure will likely require the consid Societal factors Community/workplace factors Production and distribution of foods Access to healthy foods and physical Regulations regarding food activity resources composition Design of communities and workplaces Transportation/urban design Local and workplace access to Organization and financing of the screening and treatment health care system Social and cultural norms Population blood pressure distribution Incidence and prevalence of hypertension Blood pressure control among individuals with hypertension Personal factors Health system factors Genetic predispositions Treatment factors Socioeconomic resources Side effects Behavioral characteristics Complexity of treatment Health insurance status Quality of care Access to health care Provider training Trust in provider Insurance coverage (cost, co-pays) FIGuRE 1-3 Schematic framework of factors affecting blood pressure.
From page 42...
... For example, societal factors related to the sodium content of processed foods may primarily affect the population distribution of blood pressure, but may also have important effects on blood pressure control among individuals diagnosed with hypertension. In addition, blood pressure control, including adherence to medication, among hypertensive individuals will be affected by personal factors such as health insurance status, access to providers, socioeconomic resources and other behavioral factors, but may also be impacted by societal health system organization as well as access to follow-up and monitoring in communities and workplaces.
From page 43...
... Uniqueness Is there a special role for Organizational authorities and the CDC and its partners mandates and roles in implementing the strategy or intervention? Synergy with other CDC Will the strategy or Division for Heart Disease programs intervention leverage or and Stroke Prevention core duplicate activities in other efforts and resources CDC units or activities conducted by other partners?
From page 44...
... Although the ideal evidence would incorporate information on changes in blood pressure distributions rather than changes in arbitrarily defined dichotomous outcomes, very little information on the former exists. However, it is reasonable to make the assumption that the prevalence or incidence of hypertension is at least partly a function of the underlying blood pressure distribution.
From page 45...
... Thus, there already is substantial activity and prevention programming in place at the CDC and in state and local health departments. CDC priorities for hypertension prevention and control should not be duplicative of, but rather synergistic with, existing prevention programs in place within the CDC and in state and local health departments and in the community or individual health care settings.
From page 46...
... 2006. Healthy People 2010 Midcourse Review: Section 12: Heart disease and stroke.
From page 47...
... 2009. Heart disease and stroke statistics -- 2009 update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.


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