A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension
Approximately 73 million Americans, or nearly one in three adults, has hypertension. Hypertension, or high blood pressure, is one of the nation’s leading causes of death, responsible for roughly one in six deaths among adults annually. It also places huge economic demands on the health care system, estimated at $73.4 billion in direct and indirect costs in 2009 alone. Hypertension is relatively easy to prevent, simple to diagnose, and inexpensive to treat.
The Centers for Disease Control and Prevention (CDC), through its Division for Heart Disease and Stroke Prevention (DHDSP), provides national leadership to prevent, control, and reduce the impact of hypertension. To guide its efforts, the DHDSP developed a strategic plan that identified a number of action areas and goals. In order to ensure that these efforts are targeted most effectively, the CDC asked the Institute of Medicine (IOM) to convene a committee to identify high-priority areas on which public health organizations and professionals should focus in order to accelerate progress in hypertension reduction and control.
Adopting Population-Based Strategies
The IOM committee’s report, A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension, identifies priority areas for the DHDSP’s current and proposed hypertension prevention and control activities. As an overarching recommendation, the committee says the DHDSP should give priority to population-based strategies that can reach large numbers of people and improve the well-being of entire communities. Population-based policy interventions and interventions directed at system improvements are likely to be more practical and realistic in today’s resource-constrained environment.
The committee also recommends that the DHDSP take the lead in strengthening hypertension surveillance and monitoring efforts. Data are critical for determining the burden of hypertension, characterizing the patterns among subgroups of the population, assessing changes in the problem over time, and evaluating the success of interventions. Effective monitoring and surveillance systems need to be in place to track progress in reducing the prevalence of hypertension and increasing the awareness, treatment, and control of hypertension.
In addition, the DHDSP should collaborate with state and local public health jurisdictions on a variety of behavioral and lifestyle interventions that target risk factors known to contribute substantially to hypertension. These risk factors include eating an unhealthful diet, consuming too much salt and too little potassium, being overweight or obese, and engaging in too little physical activity. Public health jurisdictions should integrate hypertension prevention and control interventions into their policies and programs in ways that will support healthy eating, active living, and obesity prevention across their respective communities. Jurisdictions also should align their efforts with populations most likely to be affected by hypertension, such as older populations, which often are not the target of these programs.
Cutting Sodium Intake
One of the most prevalent and modifiable risk factors for hypertension is an inadequate consumption of potassium. Only about 2 percent of U.S. adults meet the current guideline for dietary potassium intake (at least 4.7 grams per day). The gap in the number of blacks and hispanics who do not meet this guideline is even greater. The DHDSP should work with state and local partners to develop and implement interventions to encourage people to eat potassium rich foods, particularly fruits and vegetables. In addition, as with sodium, the Division should foster efforts to develop better methods for assessing and tracking potassium intake.