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					Controlling High
 Blood Pressure




    Legislator Policy Brief
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                                                                    on	public	health	issues.	The	initiative	brings	together	state	legislators,	Centers	for	Disease	Control	and	Preven-
                                                                    tion	 (CDC)	 officials,	 state	 health	 department	 officials	 and	 public	 health	 experts	 to	 share	 information	 and	 to	
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                                                                    Why public health?
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                                                                    cies	dedicated	to	protecting	the	public’s	health.	Public	health	agencies	educate	the	public	and	offer	interventions	
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                                                                      n   	Ensuring	that	children	and	at-risk	adults	are	immunized	against	deadly	diseases;
                                                                      n   	Assisting	victims	of	chronic	conditions	such	as	cancer,	heart	disease	and	asthma;	
                                                                      n   	Preventing	disease	and	disability	resulting	from	interactions	between	people	and	the	environment;
                                                                      n   	Researching	how	HIV/AIDS	infections	and	other	sexually	transmitted	diseases	can	be	prevented;	
                                                                      n   	Promoting	the	health	and	well-being	of	people	with	disabilities;	and
                                                                      n   	Working	with	schools	to	prevent	risky	behavior	among	children,	adolescents	and	young	adults.


                                                                    Information resources for state policymakers
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                                                                      n   Forums	and	Web	Conferences.	Web	conferences	are	offered	to	allow	public	health	experts,	legislators	and	
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                                                                          tion,	vaccines,	health	disparities	and	school	health.	


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                                            Controlling High Blood Pressure
                                                                                                               Overview
	 More	than	65	million	American	adults—one	in	three—have	high	blood	pressure,	and	an	additional	59	million	have	prehy-
pertension.	Almost	70	percent	of	those	who	have	high	blood	pressure	do	not	have	it	under	control,1	and	30	percent	are	un-
aware	they	have	it.2		High	blood	pressure	is	costly;	it	causes	more	doctor	visits	than	any	other	condition—a	10	percent	decline	
in	the	number	of	visits	would	save	$478	million	each	year	in	health	care	costs.3		The	total	annual	costs	of	high	blood	pressure	
and	its	complications	to	the	U.S.	economy	are	more	than	$64	billion.1
	 This	Legislator	Policy	Brief	provides	state	policymakers	with	key	background	information	about	high	blood	pressure	and	
identifies	proven	and	cost-effective	prevention	strategies	for	states.


What Do State Legislators Need to Know About High Blood Pressure?
	 Blood	pressure	(BP)	is	the	force	of	blood	against	the	walls	of	arteries.	When	that	force	stays	too	high,	it	becomes	a	life-threat-
ening	condition—high	blood	pressure	(also	called	hypertension).	It	makes	the	heart	work	too	hard,	hardens	the	walls	of	arter-
ies	and	can	cause	the	brain	to	hemorrhage	or	the	kidneys	to	function	poorly	or	not	at	all.3
	 High	blood	pressure	is	a	factor	in	69	percent	of	heart	attacks,	77	percent	of	strokes	and	74	percent	of	cases	of	heart	failure.3	
As	blood	pressure	increases,	so	does	the	risk	of	heart	attack,	heart	failure,	stroke	and	kidney	disease	regardless	of	whether	
smoking,	high	cholesterol	and	obesity	are	present	or	not.2	It	is	estimated	that	adults	over	55	have	a	90	percent	lifetime	risk	of	
developing	high	blood	pressure.4
	 Fortunately,	complications	from	high	blood	pressure	can	largely	be	prevented	through	screening,	treatment,	healthy	eating	
and	exercise.	Many	state	programs—including	Wisconsin’s	Cardiovascular	Health	Program	and	Georgia’s	Stroke	and	Heart	
Attack	Prevention	Program	(SHAPP)—are	working	toward	this	prevention-based	goal.	Through	collaboration	with	health	
systems	and	key	partners,	these	state-based	programs	influence	quality	improvements	in	controlling	blood	pressure.


What Can State Legislators Do to Help Prevent and Control High Blood Pressure?
  State	legislators	have	an	important	role	to	play	in	reducing	the	number	of	people	with	high	blood	pressure	and	increasing	
the	number	of	people	who	have	their	high	blood	pressure	under	control.	State	legislators	can:	
  n   Bring	visibility	to	the	issue	of	high	blood	pressure;
  n   	Implement	policies	and	incentives	to	make	healthy	choices	easier;	
  n   	Focus	on	groups	at	high	risk	for	high	blood	pressure;	and
  n   	Promote	coverage	for	and	use	of	preventive	health	services.	




Legislator Policy Brief                             Controlling High Blood Pressure                                               1
Actions for State Legislators




Demonstrate Leadership
    n   Know	the	burden	high	blood	pressure	and	its	complications	place	on	your	state.	Promote	the	development	of	assess-
        ment	tools	for	tracking	blood	pressure	treatment	and	control	rates	in	the	population	if	they	do	not	exist.

    n   Display	educational	materials	about	high	blood	pressure	in	your	office.

    n   Spread	the	word	about	high	blood	pressure.	Make	sure	your	constituents	know	that	high	blood	pressure	is	a	major	risk	
        factor	for	heart	disease	and	stroke,	and	that	they	can	take	steps	to	control	their	blood	pressure.



Promote Visibility for High Blood Pressure
    n   Support	statewide	awareness	campaigns	about	blood	pressure	screening.	

    n   Ensure	education	and	support	for	health	care	providers	to	encourage	the	use	of	science-based	treatments.	

    n   Work	with	your	local	American	Heart	Association	to	organize	a	Blood	Pressure	Challenge	between	the	House	and	Sen-
        ate	to	see	which	group	has	the	lowest	average	blood	pressure	in	your	state.	Publicize	the	results.



Make Healthy Choices Easier
    n   Provide	attractive,	safe	and	convenient	opportunities	for	exercise	by	enhancing	access	to	parks,	walking	trails	and	bike	
        paths,	which	research	has	shown	to	be	a	useful	means	of	increasing	physical	activity	in	the	general	population.5

    n   Work	with	employers	in	your	state	to	promote	worksite	wellness:	

        ®   Promote	healthful	food	options	in	cafeterias	and	vending	machines.

        ®   Encourage	using	stairs	instead	of	riding	elevators.

        ®   Provide	blood	pressure	screening	and	follow-up	services.

    n   Assure	blood	pressure	screening	and	follow-up	services	for	state	employees.

    n   Promote	school	health	programs	that	maintain	or	enhance	physical	education	classes	and	offer	healthful	foods	in	caf-
        eterias	and	vending	machines.	Research	shows	that	children	who	have	high	blood	pressure	are	more	likely	to	have	high	
        blood	pressure	as	young	adults.6




2                                             Controlling High Blood Pressure                                 Legislator Policy Brief
Extend Insurance Coverage
  n   Support	policies	that	encourage	health	care	coverage	to	include	blood	pressure	screening,	treatment	and	control.	

  n   Work	with	the	office	that	oversees	the	state	employee	health	benefits	plan	to	include	preventive	services	and	incentives	
      for	prevention.	

  n   Recommend	changes	to	your	state	Medicaid	program	to	provide	incentives	for	members	with	high	blood	pressure	and	
      other	chronic	illnesses	to	participate	in	programs	that	promote	healthy	behaviors,	such	as	smoking	cessation	and	nutri-
      tion	counseling.

  n   Recommend	changes	to	your	state	Medicaid	program	to	promote	reimbursement	for	preventive	services	that	empha-
      size	quality,	cost-effective	medical	care.



Focus on High-Risk Groups
  n   Provide	blood	pressure	screening	programs	focused	on	high-risk	groups,	such	as	African-Americans	and	older	Ameri-
      cans,	in	health	care	settings,	senior	centers	and	faith-based	organizations.5	

  n   Fund	community	programs	to	monitor	progress	and	promote	adherence	to	treatment	in	high-risk	populations.	A	study	
      conducted	in	Seattle	found	that	clients	who	received	enhanced	tracking	and	follow-up	services	were	39	percent	more	
      likely	to	complete	medical	follow-up	visits	than	those	in	usual	care.7




Legislator Policy Brief                             Controlling High Blood Pressure                                          3
State Policy Examples


Saving Lives and Money with the Georgia Heart Health Program
	 Georgia’s	Stroke	and	Heart	Attack	Prevention	Program	(SHAPP),	an	aggressive	high	blood	pressure	reduction	pro-
gram	targeted	at	low-income	Georgians,	serves	more	than	15,000	patients.	The	program	pairs	patients	with	nurses	who	
serve	as	case	managers.	The	nurses	conduct	health	assessments	and	help	patients	get	the	screening,	lifestyle	counseling	
and	medication	they	need.	The	nurses	also	encourage	patients	to	take	their	medications	regularly	and	make	necessary	
follow-up	visits	to	doctors	and	clinics.	The	program	supplies	eligible	patients	with	prescription	drugs	at	low	or	no	cost.	
A	recent	cost-effectiveness	evaluation	found	that	while	SHAPP	costs	an	average	of	$486	per	patient	per	year,	patients	
receiving	no	preventive	care	had	health	care	costs	of	$534	per	year	and	patients	receiving	care	typical	of	the	private	sector	
had	costs	of	$624	per	year.	


http://www.health.state.ga.us/programs/cardio/shapp.asp




Reducing Death, Disability and Health Care Costs in Maine
	 In	2002,	heart	disease	and	stroke	accounted	for	nearly	one-third	of	all	deaths	in	Maine.	Maine’s	Cardiovascular	Health	
Program,	which	receives	funding	from	the	CDC,	leads	multiple	strong	partnerships	and	collaborations	for	the	prevention	
of	heart	disease	and	stroke.	
	 In	 2004,	 Maine’s	 Cardiovascular	 Health	 Program	 (MCVHP)	 awarded	 funds	 to	 three	 primary	 care	 practice	 sites	 to	
promote	system	change	and	increase	quality	of	care	in	patients	with	cardiovascular	disease	and	risk	factors.	A	primary	
goal	of	the	project	was	the	control	of	hypertension	through	patient	and	provider	adherence	to	recognized	cardiovascular	
disease	prevention	guidelines.	The	project	also	tested	innovative	strategies	for	assisting	medical	providers	to	work	as	
partners	with	their	patients	in	a	collaborative	care	process.	This	included	enhancing	patient	self-management	through	
community	supports	and	resources.	For	example,	a	federally	qualified	health	center	in	rural	western	Maine,	which	fo-
cused	on	80	patients	with	hypertension,	increased	the	number	of	patients	with	controlled	blood	pressure	by	22	percent.	
The	evaluation	and	findings	of	the	strategies	funded	through	this	initiative	are	being	disseminated	to	encourage	imple-
mentation	and	replication	by	other	primary	care	practices	in	Maine.


http://www.healthymainepartnerships.org/MCVHP/index.aspx?hmpp=true




4                                          Controlling High Blood Pressure                                 Legislator Policy Brief
Preventing and Controlling Heart Disease and Stroke in Washington
  Heart	disease	is	the	second	leading	cause	of	death	in	Washington,	accounting	for	almost	25	percent	of	the	state’s	deaths	
in	2002.	Stroke	is	the	third	leading	cause	of	death,	accounting	for	approximately	8	percent	of	the	state’s	deaths	in	2002.	In	
2003,	almost	one	in	four	adults	in	Washington	had	high	blood	pressure.	
	 One	of	14	state	programs	receiving	basic	implementation	funding	from	the	CDC,	the	Washington	Heart	Disease	and	
Stroke	Prevention	(HDSP)	Program	is	working	to	build	statewide	support	and	begin	programs	for	people	with	estab-
lished	heart	disease	or	stroke,	as	well	as	those	at	high	risk	for	developing	the	diseases,	including	people	with	high	blood	
pressure,	high	blood	cholesterol	and	diabetes.	Key	partners	include	the	American	Heart	Association,	insurers,	profes-
sional	medical	associations,	local	health	jurisdictions	and	academia.	The	HDSP	Program	is	developing	innovative	strate-
gies	and	enhancing	existing	strategies	to	improve	the	quality	of	cardiovascular	medical	care	provided	in	the	state.	For	
example,	the	Washington	State	Collaborative	provides	primary	care	practices	with	resources	and	support	to	enable	them	
to	transition	their	systems	of	care	to	a	population-based,	prevention-focused	approach.	In	a	recent	yearlong	collaborative	
series,	participating	practices	increased	patient	blood	pressure	control	from	23.7	percent	to	29.1	percent—a	22.7	percent	
relative	increase.


http://www.doh.wa.gov/cfh/heart_stroke/default.htm




Improving Control of High Blood Pressure in Wisconsin
	 Wisconsin’s	Cardiovascular	Health	Program	collaborated	with	a	statewide	group	of	20	HMOs	and	health	systems,	as	
well	as	other	public	and	private	health	organizations,	to	increase	the	percentage	of	patients	who	have	their	high	blood	
pressure	controlled.	Participating	HMOs	represented	84	percent	of	patients	enrolled	in	HMOs	in	the	state	in	2000	and	
more	than	98	percent	of	those	enrolled	in	2001	(nearly	1.5	million	people).	The	Cardiovascular	Health	Program	asked	
that	the	20	participating	health	plans	with	commercial	enrollees	collect	data	on	measures	of	cardiovascular	health.	Based	
on	these	data,	health	plans	made	quality	 improvements	in	blood	pressure	control.	Among	participating	health	plans,	
the	percentage	of	patients	who	had	their	high	blood	pressure	controlled	increased	from	48	percent	to	58	percent—a	21	
percent	relative	increase.


http://dhfs.wisconsin.gov/Health/cardiovascular/index.htm




Legislator Policy Brief                              Controlling High Blood Pressure                                        5
Advice from a State Legislator
Helping People Lead Healthier Lives


                                                 William Purcell
                                                 North Carolina Senate



                                                 Sen.	William	Purcell,	a	retired	pediatrician	and	chairman	of	North	Carolina’s	Jus-
                                               tus-Warren	Heart	Disease	and	Stroke	Prevention	Task	Force,	said	he	believes	states	
                                               can	 help	 people	 lead	 healthier	 lives	 through	 programs	 and	 policies	 that	 enhance	
                                               everyone’s	ability	to	make	healthy	choices	at	home,	at	work	and	in	the	health	care	
                                               system.	In	2005,	Purcell	sponsored	legislation	that	would	have	created	the	“Strike	
                                               Out	Stroke”	program,	which	targets	high	blood	pressure	and	stroke	awareness	in	
                                               high-risk	groups.


His Advice to State Legislators:
    n   Get involved.	“Make	health	a	priority	issue	in	your	district	and	your	state.	Work	with	your	health	care	and	public	health	
        professionals.	Set	an	example	by	the	right	kind	of	lifestyle	for	your	people	back	in	your	district.”

    n   	Make prevention a priority.	“What	I’ve	learned	over	a	lifetime	of	taking	care	of	children	is	that	keeping	people	well	
        and	teaching	them	to	take	good	care	of	themselves	is	the	highest	form	of	health	care,	yet	our	system	rarely	reimburses	
        physicians	for	preventive	efforts.	Unless	we	(in	state	government)	can	find	a	way	to	invest	in	prevention	and	soon,	our	
        costs	for	treating	preventable	conditions	will	overwhelm	us.”

    n   	Start with the young. “Schools	have	gotten	away	from	physical	activity,”	Purcell	said,	“as	the	demand	for	excellence	in	
        education	has	taken	all	the	time.”	But,	he	points	out,	it	makes	little	sense	to	focus	on	intellectual	development	to	the	ex-
        clusion	of	teaching	healthy	habits.	Legislating	physical	activity	requirements,	as	well	as	nutrition	guidelines,	for	schools	
        is	one	way	to	ensure	that	children	grow	to	be	healthier	adults.
Source: Healthy States March 2005 Web Conference—Prevention Works: Promising Strategies for Heart-Healthy & Stroke-Free States. Archive available at http://
www.healthystates.csg.org/Events+and+Conferences/Web+Conferences/.



Want to Know More?
We’ll help you find experts to talk to about this topic
If you would like to explore this topic in greater depth, contact us at the Healthy States Initiative and we’ll help
you connect with…
    n   an expert on this issue from the CDC.
    n   fellow state legislators who have worked on this issue.
    n   other public health champions or officials who are respected authorities on this issue.

Send your inquiry to http://www.healthystates.csg.org/ (keyword: inquiry) or call the health policy group at
(859) 244-8000 and let us help you find the advice and resources you need.

6                                                  Controlling High Blood Pressure                                                   Legislator Policy Brief
                                                                       Advice from a State Health Official
                                                                 What Works in Controlling High Blood Pressure


                                         Maxine Hayes, MD, MPH, State Health Officer
                                            Washington State Department of Health



  Dr.	Maxine	Hayes	is	the	state	health	officer	for	the	Washington	State	Department	
of	 Health.	 As	 the	 state’s	 top	 public	 health	 doctor,	 her	 role	 includes	 advising	 the	
governor	and	the	secretary	of	health	on	issues	ranging	from	health	promotion	and	
chronic	disease	prevention	to	emergency	response,	including	pandemic	influenza	
preparedness.	She	also	works	closely	with	the	medical	community,	local	health	de-
partments	and	community	groups.	Prior	to	her	appointment	as	health	officer,	Dr.	
Hayes	 was	 the	 assistant	 secretary	 of	 community	 and	 family	 health.	 Dr.	 Hayes	 is	
clinical	professor	of	pediatrics	at	the	University	of	Washington	School	of	Medicine,	
and	is	on	the	faculty	of	the	School	of	Public	Health.


Her Advice to State Legislators:
  n   Promote physical activity and healthy eating habits.	“Programs	aimed	at	increasing	physical	activity	and	promoting	a	
      healthy	diet	are	effective	in	lowering	blood	pressure	and	could	delay	or	prevent	the	onset	of	high	blood	pressure.”

  n   Promote early identification of high blood pressure.	“High	blood	pressure	is	a	well-known	risk	factor	for	heart	disease	
      and	 stroke	that	can	be	prevented.	 Early	 intervention	through	 detection	and	treatment	is	a	fundamental	strategy	for	
      public	health.”

  n   Develop community programs.	“Successful	community	programs	should	be	convenient	for	your	population	and	con-
      ducted	in	a	culturally	sensitive	manner.	Programs	should	be	targeted	to	those	populations	who	are	most	likely	to	de-
      velop	high	blood	pressure	and	those	with	limited	access	to	health	care.”

  n   Promote access to the health care system for all.	“Less	than	half	of	your	constituents	diagnosed	with	high	blood	pres-
      sure	have	it	under	control.	Lack	of	access	to	health	care	providers	and	medical	care	will	lead	to	uncontrolled	high	
      blood	pressure.”

  n   Encourage quality improvement efforts in the health care setting.	“Systems	that	support	providers	and	patients	in	fol-
      lowing	established	guidelines	are	needed.	Quality	improvement	programs	in	the	primary	care,	specialty	care	and	hos-
      pital	settings	can	transform	the	care	that	is	provided	to	patients	with	high	blood	pressure.”

Resources: Washington State Department of Health Web site— http://www.doh.wa.gov/.
“The Health of Washington State High Blood Pressure”: Available at http://www.doh.wa.gov/HWS/doc/CD/CD_HBP.doc.




Legislator Policy Brief                                       Controlling High Blood Pressure                               7
Key Facts and Terms


What Is High Blood Pressure?
    n   High	blood	pressure	is	defined	as	systolic	blood	pressure	over	140	mm	Hg,	diastolic	blood	pressure	over	90	mm	Hg	or	
        current	use	of	blood	pressure	medication.	

    n   There are	often	no	signs	or	symptoms,	which	is	why	high	blood	pressure	is	often	called	the	“silent	killer.”3


Who Gets High Blood Pressure?
    n   More	than	one	of	every	two	adults	over	age	60	has	high	blood	pressure.	The	lifetime	risk	of	developing	high	blood	pres-
        sure	for	adults	over	age	55	is	90	percent.4,5	

    n   Groups	at	high	risk	include	those	with	high-normal	blood	pressure	(130-139/85-89	mm	Hg),	a	family	history	of	high	
        blood	pressure,	African-American	ancestry,	overweight	or	obesity,	diabetes,	sedentary	lifestyle,	excess	intake	of	dietary	
        sodium,	insufficient	intake	of	potassium	or	excess	consumption	of	alcohol.3,4

    n   High	blood	pressure	increases	the	risk	of	heart	disease	and	stroke,	both	leading	causes	of	death	in	the	United	States.	
        About	one	in	three	American	adults	have	high	blood	pressure.	High	blood	pressure	affects	about	two	in	five	African-
        Americans,	one	in	five	Hispanics	and	Native	Americans,	and	one	in	six	Asians.14


Health Disparities
    n   High	blood	pressure	is	a	major	factor	underlying	African-Americans’	lower	life	expectancy.	It	is	also	the	most	important	
        reason	why	African-Americans	are	four	times	more	likely	than	whites	to	develop	kidney	failure.3

    n   African-American	 women	 are	 especially	 affected.	 They	 are	 three	 times	 more	 likely	 to	 die	 of	 heart	 disease	 or	 stroke	
        before	age	60	than	white	women.3

    n   Between	2000	and	2003,	adults	55	and	over	with	public	health	insurance	had	higher	rates	of	high	blood	pressure	than	
        adults	of	the	same	age	who	had	private	health	insurance.8

    n   High	blood	pressure	is	consistently	associated	with	low	income	and	low	educational	levels.7


Share of Health Care Costs
    n   High	blood	pressure	and	its	complications	cost	the	U.S.	economy	more	than	$64	billion	each	year.1

    n   Intensified	blood	pressure	control	can	cut	health	care	costs	by	$900	(in	2000	U.S.	dollars)	over	the	lifetime	of	a	person	
        with	type	2	diabetes.	It	can	also	extend	life	by	six	months.9

    n   U.S.	adults	substantially	lowered	their	blood	pressure,	high	cholesterol	levels	and	other	heart	disease	risk	factors	during	
        the	1980s.	As	a	result,	U.S.	costs	associated	with	coronary	heart	disease	declined	by	an	estimated	9	percent,	from	about	
        $240	billion	in	1981	to	about	$220	billion	in	1990.10




8                                               Controlling High Blood Pressure                                        Legislator Policy Brief
                                                                      What Scientific Research Says



Cost Effectiveness
  n   Screening	for	high	blood	pressure	by	checking	it	every	two	years	is	cost-effective—45	percent	of	the	service	costs	will	
      be	recovered	in	the	long	run.11	


Screening Rates
  n   Most	adults	are	up-to-date	with	screening—93	percent	of	men	and	97	percent	of	women	over	age	18	report	that	they	had	
      their	blood	pressure	checked	in	the	previous	two	years.12

  n   Screening	rates	are	generally	high	for	all	states	and	demographic	groups:12

      ®   Between	1991	and	1999,	rates	were	highest	among	non-Hispanic	blacks,	women	and	people	with	greater	than	12	
          years	of	education.

      ®   For	the	same	time	period,	rates	were	comparatively	lower	among	men,	Hispanics,	people	with	less	education	and	
          younger	adults.


Screening and Treatment Saves Lives
  n   Blood	pressure	screening	and	treatment	are	proven	to	be	cost-effective	for	identifying	adults	at	increased	risk	for	car-
      diovascular	disease	due	to	high	blood	pressure.6,	11

  n   A	12-	to	13-point	reduction	in	blood	pressure	can	reduce	heart	attacks	by	21	percent,	strokes	by	37	percent,	deaths	from	
      cardiovascular	disease	by	25	percent	and	all	deaths	by	13	percent.13	

  n   Even	a	small	decrease	in	the	population	average	blood	pressure	is	likely	to	result	in	a	substantial	reduction	in	the	pro-
      portion	of	the	population	affected	by	blood	pressure	related	illness.5




Legislator Policy Brief                             Controlling High Blood Pressure                                          9
References


	Thom	T.;	Haase,	N.;	Rosamond,	W.,	et	al.	“Heart	disease	and	stroke	statistics—2006	update:	A	report	from	the	American	Heart	Association	Statistics	
1


Committee	and	Stroke	Statistics	Subcommittee.” Circulation	2006;	113:	e85-e151.


	National	Heart,	Lung	and	Blood	Institute.	“The	seventh	report	of	the	Joint	National	Committee	on	Prevention,	Detection,	Evaluation,	and	Treatment	of	
2


High	Blood	Pressure.”	December	2003.	NIH	Publication	03-5233.

3
 	National	Heart,	Lung	and	Blood	Institute.	“Prevent	and	control	America’s	high	blood	pressure:	Mission	Possible.”	NIH	Publication	04-5072.	


	Vasan	R.S.;	Beiser,	A.;	Seshardi,	S.,	et	al.	“Residual	lifetime	risk	for	developing	hypertension	in	middle-aged	women	and	men:	The	Framingham	Heart	
4


Study.”	The Journal of the American Medical Association.	2002;	287:1003-10.


	Whelton,	P.K.;	He,	J.;	Appel,	L.J.,	et	al.	“Primary	prevention	of	hypertension:	Clinical	and	public	health	advisory	from	the	National	High	Blood	Pressure	
5


Education	Program.”	The Journal of the American Medical Association.	2002;	288:1882-1888.


	U.S.	Preventive	Services	Task	Force.	“Screening	for	high	blood	pressure:	Recommendations	and	rationale.”	American Journal of Preventive Medicine.	2003;	
6


25:159-164.

7
 	Washington	State	Department	of	Health.	“High	blood	pressure.”	2002.	Accessed	from	http://www.doh.wa.gov/HWS/doc/CD/CD_HBP.doc	January	12,	2007.


	Schoenborn	C.A.;	Vickerie,	J.L.;	Powell-Griner,	E.	(CDC).	“Health	characteristics	of	adults	55	years	of	age	and	over:	United	States,	2000-2003.”	Advance
8


Data	2006;	370.


	The	CDC	Diabetes	Cost-effectiveness	Group.	“Cost-effectiveness	of	intensive	glycemic	control,	intensive	hypertension	control,	and	serum	cholesterol	
9


level	reduction	for	type	2	diabetes.”	The Journal of the American Medical Association.	2001;	287(19):2542-51.


	Goldman,	L.;	Phillips,	K.A.;	Coxson,	P.,	et	al.	“The	effect	of	risk	reductions	between	1981	and	1990	on	coronary	heart	disease	incidence,	prevalence,	
10


mortality	and	cost.”	Journal of the American College of Cardiology.	2001;	38(4):1012-1017.


 	 Partnership	 for	 Prevention.	 “Hypertension	 screening:	 Charts.”	 2006.	Accessed	 from	 http://www.prevent.org/index.php?option=content&task=view&id=53	
11


January	12,	2007.


 	Centers	for	Disease	Control	and	Prevention.	“State-specific	trends	in	self-reported	blood	pressure	screening	and	high	blood	pressure—United	States,	
12


1991–1999.”	Morbidity and Mortality Weekly Report.	2002;	51:456-460.


 	He,	J.;	and	Whelton,	P.K.	“Elevated	systolic	blood	pressure	and	risk	of	cardiovascular	and	renal	disease:	overview	of	evidence	from	observational	epi-
13


demiologic	studies	and	randomized	controlled	trials.”	American Journal of Medicine.	1999;	3:211-219.


 	CDC’s	Division	for	Heart	Disease	and	Stroke	Prevention,	National	Center	for	Chronic	Disease	Prevention	and	Health	Promotion.	2006.	Accessed	from	
14


http://www.cdc.gov/nccdphp/	January	12,	2007.




10                                                 Controlling High Blood Pressure                                                   Legislator Policy Brief
                                                                                                   Resources

Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion:
Division of Heart Disease and Stroke Prevention
http://www.cdc.gov/nccdphp/publications/aag/cvh.htm


Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion:
State Profiles
http://www.cdc.gov/nccdphp/states


Healthy States Initiative’s Heart Disease and Stroke Web Conference Archive and Issue Brief
http://www.healthystates.csg.org/Events+and+Conferences/Web+Conferences/Heart+Disease+and+Stroke+Web+Conference.htm


Healthy States Initiative’s Heart Disease and Stroke Web Page
http://www.healthystates.csg.org/Public+Health+Issues/Heart+Disease+and+Stroke


Healthy States Initiative’s State Official’s Guide to Wellness
http://www.healthystates.csg.org/Publications


Healthy States Initiative’s TrendsAlert: Costs of Chronic Diseases: What Are States Facing?
http://www.healthystates.csg.org/Public+Health+Issues/Chronic+Diseases


American Heart Association
http://www.americanheart.org


National Heart, Lung and Blood Institute
http://www.nhlbi.nih.gov


Partnership for Prevention
http://www.prevent.org/content/view/46/96


Prevent and Control America’s High Blood Pressure: Mission Possible
http://hp2010.nhlbihin.net/mission/aboutmp/action_paper.pdf


U.S. Preventive Services Task Force: High Blood Pressure Screening
http://www.ahrq.gov/clinic/uspstf/uspshype.htm




Legislator Policy Brief                            Controlling High Blood Pressure                                    11
Preventing Diseases:
Policies that work based on the research evidence

1) Promote healthy eating.
     Policies	that	give	kids	healthier	food	choices	at	school	can	help	curb	rising	rates	of	youth	obesity.	Ensuring	that	every	
     neighborhood	has	access	to	healthy	foods	will	improve	the	nutrition	of	many	Americans.

2) Get people moving.
     Policies	that	encourage	more	physical	activity	among	kids	and	adults	have	been	proven	to	reduce	rates	of	obesity	and	
     to	help	prevent	other	chronic	diseases.

3) Discourage smoking.
     Policies	 that	 support	 comprehensive	 tobacco	 control	 programs—those	 which	 combine	 school-based,	 community-
     based	and	media	interventions—are	extremely	effective	at	curbing	smoking	and	reducing	the	incidence	of	cancer	and	
     heart	disease.	

4) Encourage prevention coverage.
     Policies	that	encourage	health	insurers	to	cover	the	costs	of	recommended	preventive	screenings,	tests	and	vaccinations	
     are	proven	to	increase	the	rates	of	people	taking	preventive	action.	

5) Promote health screenings.
     Policies	that	promote—through	worksite	wellness	programs	and	media	campaigns—the	importance	of	health	screen-
     ings	in	primary	care	settings	are	proven	to	help	reduce	rates	of	chronic	disease.

6) Protect kids’ smiles.
     Policies	that	promote	the	use	of	dental	sealants	for	kids	in	schools	and	community	water	fluoridation	are	proven	to	
     dramatically	reduce	oral	diseases.

7) Require childhood immunizations.
     Requiring	immunizations	for	school	and	child	care	settings	reduces	illness	and	prevents	further	transmission	of	those	
     diseases	among	children.	Scientific,	economic	and	social	concerns	should	be	addressed	when	policies	to	mandate	im-
     munizations	are	considered.

8) Encourage immunizations for adults.
     Policies	that	support	and	encourage	immunizations	of	adults,	including	college	students	and	health	care	workers,	re-
     duce	illness,	hospitalizations	and	deaths.	

9) Make chlamydia screenings routine.
     Screening	and	treating	chlamydia,	the	most	common	sexually	transmitted	bacterial	infection,	will	help	protect	sexu-
     ally	active	young	women	against	infertility	and	other	complications	of	pelvic	inflammatory	disease	(PID)	that	are	
     caused	by	chlamydia.	

10) Promote routine HIV testing.
     Making	HIV	testing	part	of	routine	medical	care	for	those	aged	13	to	64	can	foster	earlier	detection	of	HIV	infection	
     among	the	quarter	of	a	million	Americans	who	do	not	know	they	are	infected.

Learn	more	about	these	and	other	proven	prevention	strategies	at	http://www.ahrq.gov/clinic/uspstfix.htm,	http://www.thecommu-
nityguide.org/policymakers.html	and	http://www.prevent.org/images/stories/health_policy.pdf.




12                                         Controlling High Blood Pressure                                 Legislator Policy Brief
                                                                                                                    What the CDC Does for States
	
	 The	 Centers	 for	 Disease	 Control	 and	 Prevention	 (CDC)	 is	 part	 of	 the	 United	 States	 Department	 of	
Health	and	Human	Services,	which	is	the	main	federal	agency	for	protecting	the	health	and	safety	of	all	
Americans.	Since	it	was	founded	in	1946	to	help	control	malaria,	CDC	has	remained	at	the	forefront	of	
public	health	efforts	to	prevent	and	control	infectious	and	chronic	diseases,	injuries,	workplace	hazards,	
disabilities	and	environmental	health	threats.
	 Helping	state	governments	enhance	their	own	public	health	efforts	is	a	key	part	of	CDC’s	mission.	
Every	year,	CDC	provides	millions	in	grants	to	state	and	local	health	departments.	Some	funds	are	in	the	
form	of	categorical	grants	directed	at	specific	statutorily-determined	health	concerns	or	activities.	Other	
funds	are	distributed	as	general	purpose	block	grants,	which	the	CDC	has	more	flexibility	in	deciding	
how	to	direct	and	distribute.	
	 The	CDC	does	not	regulate	public	health	in	the	states.	Rather,	it	provides	states	with	scientific	advice	in	
fields	ranging	from	disease	prevention	to	emergency	management.	It	also	monitors	state	and	local	health	
experiences	in	solving	public	health	problems,	studies	what	works,	provides	scientific	assistance	with	
investigations	and	reports	the	best	practices	back	to	public	agencies	and	health	care	practitioners.	
	 For	state	legislators	who	are	interested	in	improving	their	state’s	public	health,	the	CDC	offers	a	wealth	
of	resources,	including:

  n   			Recommendations	for	proven	prevention	strategies;
  n   			Examples	of	effective	state	programs;
  n   			Access	to	top	public	health	experts	at	the	CDC;
  n   			Meetings	specifically	aimed	at	state	legislative	audiences;
  n   			Fact	sheets	on	policies	that	prevent	diseases;	and
  n   			State-specific	statistics	on	the	incidence	and	costs	of	disease.


	 This	publication	from	the	Healthy	States	Initiative	is	also	an	example	of	CDC’s	efforts	to	help	states.	
The	Healthy	States	Initiative	is	funded	by	a	cooperative	agreement	with	the	CDC.	
	 The	CDC	has	developed	partnerships	with	numerous	public	and	private	entities—among	them	medical	
professionals,	schools,	nonprofit	organizations,	business	groups	and	international	health	organizations—
but	its	cooperative	work	with	state	and	local	health	departments	and	the	legislative	and	executive	branches	
of	state	government	remains	central	to	its	mission.	
The	 Council	 of	 State	 Governments'	 (CSG)	 Healthy	 States	 Initiative	
is	designed	to	help	state	leaders	make	informed	decisions	on	public	
health	issues.	The	enterprise	brings	together	state	legislators,	officials	
from	 the	 Centers	 for	 Disease	 Control	 and	 Prevention,	 state	 health	
department	officials,	and	public	health	experts	to	share	information,	
analyze	trends,	identify	innovative	responses,	and	provide	expert	ad-
vice	 on	 public	 health	 issues.	 CSG's	 partners	 in	 the	 initiative	 are	 the	
National	Black	Caucus	of	State	Legislators	and	the	National	Hispanic	
Caucus	of	State	Legislators.



Funding	 for	 this	 publication	 is	 provided	 by	 the	 U.S.	 Department	 of	 Health	 and	 Human	
Services,	Centers	for	Disease	Control	and	Prevention,	under	Cooperative	Agreement	U38/
CCU424348.	Points	of	view	in	this	document	are	those	of	the	author	and	do	not	necessarily	
represent	the	official	position	or	policies	of	the	U.S.	government.

Published May 2007

				
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