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Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health  & Joy McGee-Cory - Senior Vice President, Advanced Plan for Health

We have been working on this 2-part blog series
throughout January, and are pleased to release it in
February – Heart Health Month.

Hypertension (High blood pressure) affects more than 75 million — or nearly one-third of American adults according to the Centers for Communicable Disease (CDC) in Atlanta. About 28 percent of American adults ages 18 and older, or about 59 million people, have pre-hypertension, a condition that raises the chances of having heart disease or stroke or developing chronic kidney disease. Hypertension is often called the “silent killer” because many people do not have symptoms when their blood pressure is elevated.

Providing intervention and education to those who have high blood pressure is critical, since 1 in 3 American women die from heart and vascular disease and heart disease is also the leading cause of death for men. Large studies have shown a strong relationship between blood pressure and the risk of cardiovascular events, even where there are no other risk factors.

The High Risk of Uncontrolled Hypertension

Hypertension causes great force in blood flow, which can harm arteries and organs such as the heart, kidneys, brain, and eyes. The higher the blood pressure, the greater the risk for heart attacks, heart failure, strokes and kidney disease.

Some find it surprising that hypertension is responsible for more deaths in individuals with cardiovascular disease than any other modifiable risk factor. However, hypertension is second only to smoking as a preventable reason of death compared to all other reasons.1

Also according to the CDC in Atlanta:

  • Hypertension contributes to 1,100 deaths per day in America alone

  • Those with high blood pressure are 3 times more likely to die from heart disease and 4 times more likely to die of a stroke

  • Only about half of those with hypertension have their blood pressure under control

  • 69% of those having a first heart attack also have high blood pressure

  • 77% of those having their first stroke also have high blood pressure

  • 74% of those with chronic heart failure have high blood pressure

Lowering blood pressure even by as little as 12 or 13 mmHg has a positive impact on reducing strokes, coronary heart disease and death.


In addition to the human toll, “high blood pressure costs the nation $46 billion each year” according to the Centers for Disease Control. “This total includes the cost of health care services, medications to treat high blood pressure, and missed days of work.”

The more education and influence we can provide to those with high blood pressure, the better the chances they will make the right decisions and take the right actions to help to keep their readings low.

Areas of Education as a Start

As children and adolescents become obese, their chances of having elevated blood pressures or hypertension rise. Be sure to encourage screening of all of your members, especially if there is a family history of high blood pressure or if they are in a high-stress situation.

The risk of hypertension rises in those who weigh too much, live a sedentary life, consume too much sodium, drink in excess, smoke, have diabetes, have high cholesterol or triglycerides or get too little potassium or calcium in their daily diet. They need to be encouraged to eat healthier, exercise, manage other contributing habits and also to inform their physician or nurse care manager of their over-the counter health supplements, amphetamines or street drugs, prescriptive drugs and cold or flu medications as they can affect blood pressure.

Once someone has high blood pressure, it lasts a lifetime. It’s important that you make sure they know that unless directed by a physician, they should not stop taking their hypertensive medications just because they can’t feel their high blood pressure, or because they do not feel any differently with or without their medicine. This is important to communicate to hypertensive members – particularly when there is evidence of medication non-adherence. It is also prudent to monitor the newly-diagnosed who may not be as familiar with the risks of blood pressure and the importance of taking their medication as prescribed.

Highlights of the New 2017 Hypertensive Guidelines

In November of 2017 the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines published new hypertension clinical practice guidelines. These guidelines are more stringent than the standards in common contemporary practice. The American Heart Association had this to say about the new guidelines: “High blood pressure redefined for first time in 14 years: 130 is the new high."


 Measurement Systolic† (mmHg)‡ — Top Number
Diastolic† (mmHg) ‡ —
Bottom  Number
Result
   Normal Blood Pressure
 Less than 120 and
  Less than 80
 Positive
  Elevated Blood Pressure
120–129 and 
Less than 80
There may be a problem. Consult physician, especially if there are other health conditions like diabetes, stroke, heart failure cardiac diseases or chronic kidney failure.
  Hypertension Stage 1
130-139 or
Between 80-89
Consult physician to verify these readings, then monitor and treat as instructed.
  Hypertension Stage 2
>/=140 or higher or
>/=90  
Contact health care provider for prompt help in diagnosing and controlling hypertension.
* For adults ages 18 and older who are not on medicine for high blood pressure and do not have a serious short-term illness.
† If systolic and diastolic pressures fall into different categories, overall status is the higher category.
‡ Blood pressure is measured in millimeters of mercury (mmHg).

The 2017 Guidelines get very specific about associated health conditions, appropriate medications depending on an individual’s health conditions, and ideal levels of blood pressure control for those with various health co-morbidities. 

Suffice it to say, that individuals with high blood pressure need to work collaboratively with their health care providers and others on their care team such as nurse care managers to determine the right treatment and control for their unique individual circumstances. It is also important to know what medications and over-the-counter drugs they are taking to avoid due to potential adverse interactions. 

 

Advanced Plan for Health has the Tools to Target, Monitor and Measure Hypertension Program Results

Advanced Plan for Health (APH) has an advanced and predictive analytics system called Poindexter. It enables Plans and care managers to access useful information such as predictive risk modeling, visibility into medical and prescription claims and biometrics, identification of Plan members with hypertension – including their compliance with medication, evidence-based medicine guidelines, care gaps, and much more. 

Care managers can utilize extremely user-friendly point-and-click analytics to access a list of hypertensive individuals who are not complying with their physician’s treatment plan and evidence-based guideline elements. Building reports at either the aggregate (macro) or individual (micro) level and tracking of goals is simple, because group or individual detail is just a few clicks away. 

With Poindexter’s advanced technology, monitoring hypertension to enable delivering early, proactive intervention and education is possible for Plan and member health improvement. The system also allows clients to measure results before and after programs targeted at hypertensive populations are launched. This provides the avenue to truly understand clinical and financial outcomes of these programs.

Contact APH today so that we can show you how easily Poindexter can support your needs with the hypertensives in your population, and other costly areas of care.


Reference

[1.] Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6:e1000058

In honor of Heart Health Month, our next February blog will provide hypertension management tips for you to share with member / patient / employee populations. Check back for that here