DefinitionPercentage of adults aged 18 years and older who responded "yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question "Have you EVER been told by a doctor, nurse or other health professional that you have high blood pressure?" High blood pressure is defined as a systolic (upper) number of 140 or greater and a diastolic (lower) number of 90 or greater.
NumeratorWeighted number of adults (18+) who responded "yes" on the BRFSS to the question "Have you EVER been told by a doctor, nurse or other health professional that you have high blood pressure?"
DenominatorWeighted number of adults (18+) who provided complete and valid responses to the BRFSS question, excluding those with missing, "Don't know/Not sure" or "Refused" responses.
Data Interpretation IssuesThe high blood pressure question has been included in the national BRFSS on odd-numbered years since 1991. It was also asked in 1992 and as a state-added question in 2014 and 2016.
In order to be accurately diagnosed with hypertension a patient must have had a blood pressure reading of more than 140/90 on two separate visits. The questionnaire does not capture whether a patient was told they had high blood pressure on a single visit or whether they were actually diagnosed with hypertension.
Data for this indicator report are from the Behavioral Risk Factor Surveillance System (BRFSS), which is the primary source for estimating hypertension rates for Alaska. The BRFSS is a telephone survey of adults 18 and over. The survey is conducted in all 50 states, D.C., and U.S. territories. Information on background and methodology of the BRFSS managed by the Centers for Disease Control and Prevention (CDC) can be found at: [http://www.cdc.gov/brfss/]. The website for the Alaska BRFSS is: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx].
Starting in 2011, BRFSS updated its surveillance and weighting methods. Due to these changes, data collected from 2011 and later are not directly comparable to previous years' data.^1^
Post-stratification weights were used for Alaska prior to 2006; raking weights were used from 2007 onward. For more on this methodological change see: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/method.aspx].
1. National Center for Disease Control and Prevention. [https://www.cdc.gov/surveillancepractice/reports/brfss/brfss_faqs.html#improvements]. Accessed September 11, 2019.
Why Is This Important?High blood pressure (hypertension) is a prevalent condition.^2^ High blood pressure does not have warning signs or symptoms, and is only identified through measurement. Approximately 75 million U.S. adults (29%) have high blood pressure.^3^ In 2014, high blood pressure was a primary or contributing cause of death for more than 1,100 Americans each day.^4^
High blood pressure is a serious condition that raises a person's risk for heart disease and stroke -- the 2nd and 6th leading causes of death in Alaska.^3,5^ High blood pressure is also a significant risk factor for coronary artery disease, arteriosclerosis (hardening of the arteries), and kidney failure. High blood pressure costs the nation more than $48 billion each year.^6^ [[br]][[br]]
2. U.S. Preventive Services Task Force. Final Recommendation Statement High Blood Pressure in Adults: Screening. [https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening]. Accessed September 9, 2019.
3. Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc., Thorpe P. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016 Nov 18;65(45):1261-1264.
4. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program: [http://wonder.cdc.gov/ucd-icd10.html]. Accessed on Feb 3, 2015.
5. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics: National Vital Statistics System: mortality 2014. [http://www.cdc.gov/nchs/data/dvs/lcwk9_2014.pdf]. Accessed October 4, 2016.
6. Mozzafarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2015 Update: a report from the American Heart Association. Circulation. 2015;e29-322.
Healthy People Objective: Reduce the proportion of adults with hypertensionU.S. Target: 26.9 percent
Other ObjectivesHealthy People 2020 goals for Heart Disease and Stroke:
HDS-4 Increase the proportion of adults who have had their blood pressure measured within the preceding 2 years and can state whether their blood pressure was normal or high.
HDS-5 Reduce the proportion of persons in the population with hypertension
HDS-9 (Developmental) Increase the proportion of adults with prehypertension who meet the recommended guidelines (for body mass index, saturated fat consumption, sodium intake, physical activity, and moderate alcohol consumption)
HDS-10 (Developmental) Increase the proportion of adults with hypertension who meet the recommended guidelines (for body mass index, saturated fat consumption, sodium intake, physical activity, and moderate alcohol consumption)
HDS-11 Increase the proportion of adults with hypertension who are taking the prescribed medications to lower their blood pressure.
HDS-12 Increase the proportion of adults with hypertension whose blood pressure is under control.
How Are We Doing?The percentage of Alaska adults who have ever been told they have high blood pressure by a health professional increased from 1991 (19.2%) to 2018 (29.9%). In 2014-2018, non-Hispanic Blacks had a higher prevalence of hypertension (46.1%) than all other racial groups, including Alaska Native people (29.4%) and non-Hispanic Whites(29.5%). Hypertension increases with age, and is higher among adults who are obese (44.9%) or overweight (29.8%).
How Do We Compare With the U.S.?The prevalence of hypertension in Alaska and the U.S. is similar. In 2017, the rate of hypertension among Alaskan adults was 31.9% compared to 32.3% for the U.S.
What Is Being Done?[http://dhss.alaska.gov/dph/Chronic/Pages/Cardiovascular/default.aspx Alaska's Heart Disease and Stroke Prevention Program (HDSP)] has hired quality improvement facilitators for health care practice to provide on-site coaching for Federally Qualified Health Centers (FQHCs) in order to improve care of patients with high blood pressure. The quality improvement (QI) project models its processes from [http://www.ihi.org/Pages/default.aspx The Institute for Healthcare Improvement]. The coaching includes how to use these QI processes and offers evidenced-based resources on how to improve blood pressure control.
The HDSP program also provides staffing and support for the statewide coalition, [http://dhss.alaska.gov/sites/takeheart/Pages/main.aspx Take Heart Alaska]. Take Heart Alaska is a partnership of agencies, organizations, and individuals working to promote cardiovascular health, prevent cardiovascular disease and improve cardiovascular care.
Additional information on current cardiovascular disease prevention efforts in Alaska is available at: [http://dhss.alaska.gov/dph/Chronic/Pages/Cardiovascular/default.aspx] or [http://dhss.alaska.gov/sites/takeheart/pages/main.aspx].
Evidence-based Practices[https://www.uspreventiveservicestaskforce.org/ The U.S. Preventive Services Task Force (USPSTF)] recommends screening for high blood pressure in adults aged 18 and older.^7^ The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8), published online Dec. 18 by JAMA: The Journal of the American Medical Association, outlines nine specific recommendations for initiating and modifying pharmacotherapy for patients with elevated blood pressure (BP). [http://jama.jamanetwork.com/article.aspx?articleid=1791497]
Million Hearts Evidence Based Treatment Protocols for Improving Blood Pressure Control: [https://millionhearts.hhs.gov/tools-protocols/index.html] (2019)
Community Guide Recommendations (Cardiovascular Disease):
[https://www.thecommunityguide.org/findings/cardiovascular-disease-clinical-decision-support-systems-cdss Clinical Decision-Support Systems (CDSS)]
CDSS are computer-based information systems designed to assist healthcare providers in implementing clinical guidelines at the point of care. CDSS use patient data to provide tailored patient assessments and evidence-based treatment recommendations for healthcare providers to consider. Patient information is entered manually or automatically through an electronic health record (EHR) system.
[https://www.thecommunityguide.org/findings/cardiovascular-disease-reducing-out-pocket-costs-cardiovascular-disease-preventive-services Reducing Out-of-Pocket Costs for Cardiovascular Disease Preventive Services for Patients with High Blood Pressure and High Cholesterol]
Reducing out-of-pocket costs (ROPC) for patients with high blood pressure and high cholesterol involves program and policy changes that make cardiovascular disease preventive services more affordable. These services include:
* Behavioral counseling (e.g., nutrition counseling)
* Behavioral support (e.g., community-based weight management programs, gym membership)
Costs for these services can be reduced by providing new or expanded treatment coverage and lowering or eliminating patient out-of-pocket expenses (e.g., copayments, coinsurances, deductibles).
[https://www.thecommunityguide.org/findings/cardiovascular-disease-team-based-care-improve-blood-pressure-control Team-Based Care to Improve Blood Pressure Control]
Team-based care to improve blood pressure control is a health systems-level, organizational intervention that incorporates a multidisciplinary team to improve the quality of hypertension care for patients. Team-based care is established by adding new staff or changing the roles of existing staff to work with a primary care provider.
Each team includes the patient, the patient's primary care provider, and other professionals such as nurses, pharmacists, dietitians, social workers, and community health workers. Team members provide process support and share responsibilities of hypertension care to complement the activities of the primary care provider. These responsibilities include medication management; patient follow-up; and adherence and self-management support.[[br]][[br]]
7. Final Recommendation Statement: High Blood Pressure in Adults: Screening - US Preventive Services Task Force. [https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening]. Accessed September 9, 2019.
Health Program InformationIn December 1998, the Alaska Division of Public Health developed a comprehensive plan to reduce heart disease and stroke (cardiovascular disease) in Alaska. The Take Heart Alaska Cardiovascular Disease Prevention Plan was developed in collaboration with the American Heart Association, Alaska Health Fair, and representatives from hospitals, tribal organizations, and governmental offices, and with help from experts in cardiology, wellness, nutrition, and physical activity. Starting in October 2001, the Centers for Disease Control and Prevention began providing the State of Alaska with a grant to address cardiovascular health in the state. [http://dhss.alaska.gov/sites/takeheart/pages/main.aspx Take Heart Alaska] is currently working on updating the Heart Disease and Stroke Prevention Plan.