HYPERTENSION

The Alabama Department of Public Health’s Hypertension Program

What is Blood Pressure?

Blood pressure is the result of two forces. One is created by the heart as it pushes blood into the arteries and through the circulatory system. The other is the force of the arteries as they resist the blood flow

What Do the Pressure Numbers Mean?

• The higher (systolic) number represents the pressure while the heart is beating

• The lower (diastolic) number represents the pressure when the heart is resting between beats

• The systolic number is always stated first and the diastolic number is listed second. For example: 122/76 (122 over 76); systolic =m 122, diastolic = 76

What is High Blood Pressure (Hypertension)?

• Blood pressure of less than 140 over 90 is considered a normal blood pressure reading for adults. A diastolic pressure of 85 to 89 needs to be watched carefully

• A blood pressure reading equal to or greater than 140 over 90 is considered elevated or high

Why is Hypertension Bad?

Elevated blood pressure indicates that the heart is working harder than normal, putting both the heart and arteries under a great strain. This increases the risk of having attacks, strokes, kidney failure, damage to the eyes and atherosclerosis

HYPERTENSION LINKED TO HEART ATTACKS, KIDNEY FAILURE, &

STROKES

• Stroke - $30 Billion

Hypertension is a major contributing factor for up to 70% of

strokes

• Stroke - $48 Million

• Cardiovascular

Disease - $326 Billion

National Costs

(Direct & Indirect)

Alabama Costs

(Direct & Indirect)

• Cardiovascular

Disease - $5.2 Billion

National Trends in the Awareness, Treatment, and Control of High Blood Pressure in Adults, U.

S. A.., 1976-1994

0

10

20

30

40

50

60

70

1976-1980

1988-1991

1991-1994

AwarenessTreatmentControl

Risk of Cardiovascular Events in Subjects with Hypertension

•Kannel WB, et. Al. Hypertension Primer 2nd ed. AHA; 199-202.

CARDIOVASCULAR EVENTS AGE-ADJUSTED RISK RATIO

MEN WOMEN

Coronary Heart DiseaseStrokePeripheral Arterial Disease

2.0 2.2 3.8 2.6 2.0 3.7

Cardiac FailureCardiovascular Events

4.0 3.0 2.2 2.5

ALABAMA OVERVIEW

• SINGLE COUNTY DEMONSTRATION

• FULL CARE SERVICES OFFERED

• PROGRAM BEGAN IN 1974 IN EAST CENTRAL ALABAMA

• BP > 140/90• < 150% poverty level• Not under private care• Non – Medicaid

- Nursing Workup w/Lab- Contract Physician Physical, EKG & Rx- Nurse Monitoring & Education- Return to HD Quarterly & As Needed

FULL CARE HYPERTENSION SERVICE

• BP > 140/90• < 150% poverty• Private care referral with Rx for

program medication• Non - Medicaid

- Nursing Workup- Program Medications- Nurse Monitoring & Education- Return to Private Physician Every Six Months & As Needed

JOINT CARE OR JOINT MANAGEMENT (1977)

PATIENT LOAD HISTORY

1975 1980 1985 1990 1995 2000

HYPERTENSION PATIENT PROFILE

• Average number of client visits to Health Department is 4.8 per year

• 56% of clients with controlled blood pressure

• Average clinic staff costs per visit is $16 ($78 per year)• Annual drug cost per client is under $100

• Average clients direct coverage cost for clinic and medications is approximately $178 annually

• Approximately 15,000 patients were served in Fiscal Year 2001

• Presently serving less than 10% of “in-need” population

ELIGIBLE POPULATION SERVED

• Estimated eligible in state are 233,456

Local Services

Admin Cost

Expenditures

$64,382.00

$483,766.00

DECLINING PATIENT LOAD

• Strong local clinic support for HTN program, yet accept no new clients

• Lack of local funds for clinic staff

• Outsource services to FQHC clinics or local hospitals

• Outsource drug dispensing to local pharmacists

• Allocate additional funds for program expansion

Obstacles Potential Solutions

FUTURE OF THE HYPERTENSION PROGRAM (DUAL STRATEGY)

• Drug therapy

• Community health

……….Improve dietary intake

……….Increase physical activity

..……..Discourage tobacco use

Community Health (continued)• ……….Limit alcohol intake

• ……….Reduce sodium intake

• ……….Maintain adequate intake of dietary potassium, calcium, and magnesium

• ……….Reduce intake of saturated fat and cholesterol

Community Health Teaches the Role of Personal Responsibility in Maintaining

Good Health

• The daily decisions we make – lifestyle modifications - can play a significant role in maintaining good health

FUTURE (continued)

• Uphill Financial Climb for Hypertension Program

• Price of Medication doubles in Fiscal Year 2002

• In the Fiscal year 2002 the Hypertension Program goal is to hold the patient population at 15,000

• Provide increased state funds to help

defray drug price increases

ALABAMA HTN 2005 GOAL

1975 1980 1985 1990 1995 2000 2005

If you have questions about this presentation contact

the Bureau of Health Promotion and Chronic

Disease

Hypertension Division at

334/206-5627