May is National High Blood Pressure Education Month
Margo Kerrigan, M.P.H., Area Director
Indian Health Service California Area Office
Diabetes increases the risk of developing high blood pressure, as does being overweight or obese, or being physically inactive. A high salt and sodium intake, low potassium intake (due to not eating enough fruits and vegetables), and excessive alcohol consumption can also contribute to developing high blood pressure.
Why is it important to control blood pressure? Blood pressure is the force of blood against the walls of arteries. When that force is too high, and stays that way over time, the heart works too hard, the walls of the arteries harden, and there can be damage to the heart, brain, or kidneys. High blood pressure contributes to 67 percent of heart attacks in the United States, and 77 percent of strokes. Lowering blood pressure can reduce the chance of heart attacks, strokes, and death from cardiovascular disease.
Many American Indians and Alaska Natives have high blood pressure. Researchers measured blood pressure in 4,549 American Indians ages 45 to 74 from 13 communities. The prevalence of hypertension ranged from 27% to 56%. More than 70% of these patients were aware that they had high blood pressure, and more than 50% were receiving treatment, but only 30% had controlled their hypertension with medication.
Preventing and Controlling High Blood Pressure
Adherence to Treatment is the theme of the 2007 National High Blood Pressure Education Campaign.
About half of patients who have been prescribed medication for high blood pressure do not receive the full benefits because they do not adhere to treatment. Studies have shown that while many patients initially adopt lifestyle changes such as healthy diets and exercise regimens, they tend not to maintain these changes after 1-2 years. Other studies have found that up to half of patients who remain in treatment after one year take less than 80% of their medications. Some patients do not see their physicians regularly; others stop taking medications because of their schedules or because they have trouble getting refills. Still others stop taking medications because they begin to "feel better" or because of side effects, complexity of dosage, or cost.
For hypertensive patients, adhering to prescribed treatment regimens, which include lifestyle (diet, physical activity) changes and medication, is an essential part of controlling blood pressure and reducing the associated risks.
If you have high blood pressure, it can be controlled. See your doctor regularly and take your medication as directed. Make sure you understand what each medication is for and how and when to take it; do not hesitate to ask your primary care provider or pharmacist for information. Do not stop taking medication because you begin to "feel better." If you experience side effects, tell your doctor.
If you don't have high blood pressure, you can prevent it. Simple lifestyle changes can help prevent and control high blood pressure, as well as improve overall health and quality of life:
- Lose weight, if overweight, and maintain a healthy weight. Being overweight increases the likelihood of developing high blood pressure.
- Healthy eating: follow an eating plan that emphasizes fruits, vegetables, and low fat dairy foods. Reduce salt and sodium intake.
- If you drink alcohol, do so in moderation. For men, that means a maximum of 2 drinks per day; for women, a maximum of 1 drink per day.
- Physical activity: being physically active is one of the most important steps you can take to prevent or control high blood pressure. Do some kind of physical activity every day.
- Quit smoking: smoking injures blood vessel walls and speeds up the process of hardening of the arteries.
- Control your blood sugar if you have diabetes.
Government Performance and Results Act (GPRA)
The Indian Health Service has partnered with the National Heart Lung and Blood Institute to deliver the message about controlling high blood pressure. IHS also has two GPRA measures that address the issue of blood pressure control. The first measure, Diabetes: Blood Pressure Control, measures the percentage of patients diagnosed with diabetes who have controlled blood pressure (under 130/80). In FY 2006, IHS met the national GPRA target of 37% of all diabetic patients with controlled blood pressure. In California, 34% of diabetic patients had controlled blood pressure. The FY 2007 GPRA target is to maintain the FY 2006 rate of 37%. The Healthy People 2010 goal is 50%.
Blood pressure screening is also part of a new comprehensive Cardiovascular Disease prevention measure as of FY 2007. The measure includes blood pressure screening, cholesterol screening, tobacco screening, BMI (body mass index) screening, and lifestyle counseling for all heart disease patients ages 22 and older. The FY 2007 target for this new measure is to set a baseline of all eligible patients receiving all five screenings and interventions.
For more information:
National Heart Lung and Blood Institute:
Indian Health Service, CRS/GPRA performance improvement page:
Power Point presentation available on new comprehensive CVD measure under section "Clinical GPRA measure information"