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State of Alaska

Health Indicator Report of Blood Pressure: Screening

Blood pressure is the force of blood pushing against arterial walls. Blood pressure is one of the most not have warning signs or symptoms, and is only identified through measurement. About 13 million U.S. adults with hypertension aren't even aware they have it and are not being treated.^2^ Most people with uncontrolled blood pressure have health insurance and see their providers at least twice a year,^3^ but still remain undiagnosed. Approximately 75 million U.S. adults (29%)^4^ and 28% of Alaska adults^5^ have high blood pressure. In 2014, high blood pressure was a primary or contributing cause of death for more than 1,100 Americans each day.^5^ An additional one in three American adults has prehypertension--blood pressure numbers that are higher than normal, but not yet in the high blood pressure range.^2^ Prehypertension increases risk for cardiovascular disease,^7^ but improving health metrics such as weight, diet, and physical activity, and tobacco cessation substantially reduces the risk of developing hypertension and related diseases.^8^ High blood pressure raises a person's risk for heart disease and stroke-- the 2nd and 6th leading causes of death in Alaska.^3,9^ High blood pressure is also a significant risk factor for coronary artery disease, arteriosclerosis (hardening of the arteries), and kidney failure. Risk for high blood pressure increases substantially with age.^10^ Diet, exercise and tobacco cessation are effective prevention and management opportunities; medication is also an effective treatment option. Treatment works best when high blood pressure is identified early. High blood pressure costs the nation more than $48 billion each year.^11^[[br]][[br]] ---- {{class .SmallerFont 2. Mozaffarian D, et al. (2016). Heart Disease and Stroke Statistics -- 2016 Update. Circulation; 133: e38-e360. doi: 10.1161/CIR.0000000000000350. 3. Yoon S, Fryar C, Carroll M. Hypertension Prevalence and Control Among Adults: United States, 2011-2014. NCHS Data Brief, No. 220. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept. of Health and Human Services, 2015. 4. 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 5. Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion. Behavioral Risk Factor Surveillance System. Available at: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx] 6. 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. 7. Guo X, Zhang X, et al. Association between pre-hypertension and cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Curr Hypertens Rep; 2013 Dec; 15(6); 703-16 (abstract) 8. Gao J, Sun H, et al. Ideal cardiovascular health behaviors and factors prevent the development of hypertension in prehypertensive subjects. Clin Exp Hypertens 26 Jun 2015; Epub ahead of print; 1-6. 9. 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. 10. Gillespie CD, Hurvitz KA. Prevalence of hypertension and controlled hypertension - United States, 2007-2010. MMWR; 2013 Nov 22; 62(3); 144-148. 11. 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. }}

Notes

Questions on blood pressure testing within the past 2 years were asked on the Alaska BRFSS in 1991-1993, 1995, 1997, 1999, and 2014 onward.

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Interpretation Issues

The high blood pressure was asked on the Alaska BRFSS on odd-numbered years between 1991 and 1999, with the addition of 1992. The blood pressure screening question was added as a state-added question starting in 2014. Data for this indicator report are from the Behavioral Risk Factor Surveillance System (BRFSS), which is the primary source for estimating hypertension screening 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.^1^ Due to these changes, data collected from 2011 and later are not directly comparable to previous years' data.[[br]][[br]] ---- {{class .SmallerFont 1. National Center for Health Statistics. High blood pressure: adults 18 + (percent) (Source: BRFSS). Health Indicators Warehouse. [http://www.healthindicators.gov/Indicators/High-blood-pressure-adults-18-percent-Source-BRFSS_123/Profile]. Accessed December 21, 2016. }}

Definition

Percentage of adults aged 18 years and older who reported on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] having had their blood pressure measured within the preceding 2 years.

Numerator

Weighted number of adults (18+) who responded on the BRFSS to having their blood pressure measured within the preceding 2 years.

Denominator

Weighted 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.

Healthy People Objective: 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

U.S. Target: 94.9 percent

Other Objectives

Healthy People 2020: Heart Disease and Stroke: 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. HDS-25 (Developmental) Increase the proportion of patients with hypertension in clinical health systems whose blood pressure is under control.

How Are We Doing?

Over 90% (91.9%) of Alaska adults have had their blood pressure checked in the past 2 years by a health professional. There is remarkable consistency in the subsets of adults having their blood pressure screened within the past 2 years.

How Do We Compare With the U.S.?

In 2015, the percentage of Alaskans who have had a blood pressure checked in the past 2 years on the BRFSS at 92.6% was similar to national rate of 91.8% from the National Health Interview Survey (NHIS).^12^ Alaska met the Healthy People 2020 Target (92.6%) in 2015.^12^[[br]][[br]] ---- {{class .SmallerFont 12. Search the Data | Healthy People 2020. 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. [https://www.healthypeople.gov/2020/data-search/Search-the-Data#objid=4594;] Accessed March 16, 2017. }}

What Is Being Done?

Alaska's Heart Disease and Stroke Prevention Program (HDSP) provides staffing and support for the statewide coalition, 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

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for adults aged 40 years or older and for those who are at increased risk for high blood pressure.^13^ Persons at increased risk include those who have high-normal blood pressure (130 to 139/85 to 89 mm Hg), those who are overweight or obese, and African Americans. Adults aged 18 to 39 years with normal blood pressure (less than 130/85 mm Hg) who do not have other risk factors should be rescreened every 3 to 5 years. The USPSTF recommends rescreening with properly measured office blood pressure and, if blood pressure is elevated, confirming the diagnosis of hypertension with Ambulatory blood pressure monitoring (ABPM). The CDC provides the following four steps to help identify patients with potentially undiagnosed hypertension who are hiding in plain sight: 1. Establish clinical criteria for potential undiagnosed hypertension using current evidence-based guidance. Work with your health care team to determine the number of elevated blood pressure readings and the degree of elevation that should trigger a red flag for a patient. 2. Search electronic health record (EHR) data for patients who meet your established clinical criteria. For example, some providers have searched EHR registries using algorithms to extract relevant information. Pick the approach that works best for your practice based on your available resources. 3. Implement a plan to communicate with these patients and to treat those with hypertension. The plan could include 24-hour ambulatory or home blood pressure monitoring, automated office blood pressure readings, or repeated in-office measurement. For patients with confirmed hypertension, follow standardized treatment protocols and provide feedback to your care team about how best to support patients in achieving and maintaining blood pressure control. 4. Calculate the hypertension prevalence in your practice and compare your data against local, state, or national prevalence data. Comparing the prevalence of hypertension among your patients to national or local values could add much-needed context to blood pressure control rates and may help identify more patients who might benefit from additional clinical action.[[br]][[brr] ---- {{class .SmallerFont 13. Sui AL. Screening for High Blood Pressure in Adults: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2015;163:778-786. doi:10.7326/M15-2223. [http://annals.org/aim/article/2456129/screening-high-blood-pressure-adults-u-s-preventive-services-task]. Accessed March 7, 2017. }}

Available Services

Walgreens Pharmacies in Alaska offer free blood pressure test. For services and information visit: [https://www.walgreens.com/health/heart-health/900004] The Million Hearts initiative is a national effort to prevent 1 million heart attacks and strokes by 2017. Million Hearts encourages health care providers to take steps to identify patients with potentially undiagnosed hypertension. [http://www.millionhearts.hhs.gov.] '''More Information and Resources:''' American Heart Association (AHA) Check. Change. Control. Community Partner Resources [http://www.heart.org/HEARTORG/Conditions/More/ToolsForYourHeartHealth/Community-Partner-Volunteer-Resources_UCM_445512_Article.jsp#.WF2QzP7FCmw] AHA Heart-Health Screenings [http://www.heart.org/HEARTORG/Conditions/Heart-Health-Screenings_UCM_428687_Article.jsp#.WF2Qyv7FCmw] Centers for Disease Control and Prevention: Undiagnosed Hypertension [https://www.cdc.gov/features/undiagnosed-hypertension/] National Heart, Lung, and Blood Institute: Explore High Blood Pressure [https://www.nhlbi.nih.gov/health/health-topics/topics/hbp/prevention] U.S. Dept of Health and Human Services Agency for Healthcare Research and Quality: Guide to Clinical Preventive Services, 2014 [http://www.thecommunityguide.org/index.html] U.S. Preventive Services Task Force: High Blood Pressure in Adults [https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/high-blood-pressure-in-adults-screening] The Guide to Community Preventive Services [http://www.thecommunityguide.org/index.html] Centers for Disease Control and Prevention: Workplace Health Promotion - Blood Pressure Interventions [https://www.cdc.gov/workplacehealthpromotion/health-strategies/blood-pressure/interventions/programs.html] Resources for Blood Pressure Screening Programs in Low Resource Settings: A Guide From the World Hypertension League https://www.ncbi.nlm.nih.gov/pubmed/25689038] Undiagnosed Hypertension Change Package [http://mylearning.nachc.com/diweb/fs/file/id/229350]

Health Program Information

In 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.
Page Content Updated On 09/22/2017, Published on 09/22/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sat, 21 July 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Fri, 22 Sep 2017 10:43:19 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sat, 21 July 2018 1:54:43 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Fri, 22 Sep 2017 10:43:19 AKDT