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Blood Pressure Screening and Control
Once assessment and planning have been completed, including analysis of the collected data, the next step is implementing the strategies and interventions that will comprise the workplace health program. The intervention descriptions on this page include the public health evidence-baseThe development, implementation, and evaluation of effective programs and policies in public health through application of principles of scientific reasoning, including systematic uses of data and information systems, and appropriate use of behavioral science theory and program planning models. for each intervention, details on designing interventions for blood pressure screening and control, and links to examples and resources.
Before implementing any interventions, the evaluation plan should also be developed. Potential baseline, process, health outcomes, and organizational change measures for these programs are listed under evaluation of blood pressure screening and control programs.
Blood pressure is the force of blood against the walls of arteries. Blood pressure is usually measured with a blood pressure cuff and stethoscope and is reported as the systolic pressure over the diastolic pressure. “Systolic” refers to the highest pressure the heart exerts against the arteries in each heart beat, and “diastolic” refers to the lowest pressure as the heart relaxes between beats.
High blood pressure or hypertension is defined as a diastolic blood pressure of 90 mm Hg or higher or a systolic pressure of 140 mm Hg or higher.1-2 Hypertension is one of the 10 most expensive health conditions for U.S. employers.3
- One in three Americans have high blood pressure and it is more common in African Americans and older adults4
- Hypertension (i.e., high blood pressure) is the most common primary diagnosis in the United States and is responsible for 35 million office visits each year5
- The estimated direct and indirect cost of High Blood Pressure for 2010 is $76.6 billion4
Chronic high blood pressure can cause heart disease, stroke, kidney disease, and blindness. The purpose of blood pressure screening is to identify people with high blood pressure levels and refer them for clinical evaluation and treatment.
In 2010, the economic costs of cardiovascular diseases and stroke were estimated at $444.2 billion, including $272.5 billion in direct medical expenses and $171.7 billion in indirect costs10
- Clinicians screen adults aged 18 and older for high blood pressure
In Rankings of Preventable Services for the U.S. Population, the Partnership for Prevention provides an approach to ranking preventive services according to their clinically preventable burden (CPB) and cost effectiveness (CE). CPB is the disease, injury and premature death that would be prevented if the service were delivered to all people in the target population. With this approach, blood pressure screening for adults aged 18 years and above received a ranking of 8 on a scale of 1-10, with 10 the highest ranking.
Controlling blood pressure with medications is one of the most cost-effective methods of reducing premature cardiovascular morbidity and mortality. A 12 to 13-point reduction in blood pressure can reduce the number of heart attacks by 21%, strokes by 37%, and all deaths from cardiovascular disease by 25%.3
High blood pressure is treated by a combination of medication and lifestyle changes. Worksite programs related to physical activity, nutrition, alcohol use, stress, type 2 diabetes and obesity can aid employees in prevention and reducing high blood pressure.
Health-related programs for blood pressure screening and control6-8
Employee programs refer to activities that include active employee involvement, such as classes, seminars or competitions. Employee programs are frequently provided on-site at the workplace.
Employee health surveys in the workplace provide assessment and implementation opportunities
- Information from employee health surveys can be used to identify the percent of employees that have received blood pressure screening. Survey information can be used not only in obtaining baseline group data on employee health but also to educate individual employees to their needs for counseling and follow-up for specific health concerns
- Other surveys can be used as planning guides to assess if a worksite has provided services, programs, policies, and environmental interventions to support healthy lifestyles and prevent risk factors such as high blood pressure
Worksite blood pressure screening, health education, and lifestyle counseling can identify employees with high blood pressure and help them control it
- Periodic blood pressure screening and health risk assessment programs at the worksite through occupational health clinics, health fairs, and other activities can provide blood pressure information to employees. Employees who have elevated values should get therapeutic lifestyle counseling and be referred to clinical care for follow-up. Health care professionals or human resources staff can provide information about the benefits and availability of screening to encourage and motivate employees to be screened
- One-on-one education and lifestyle counseling with clinical referral and follow-up should be provided for employees who were determined to have high blood pressure or pre-hypertension. A lifestyle management program is an ongoing series of services designed to teach and counsel participants on how to make healthy choices, such as exercise, diet, and tobacco cessation
- Lifestyle counseling, either provided at the worksite or covered through employee health insurance plans, can be provided by health care or allied health professionals (i.e., health educators) or by lay health advisors or volunteers, This type of counseling provides employees with information by telephone or face-to-face in an office or clinic settings or at a workplace
- Screening and lifestyle counseling can be supplemented by brochures, informational letters, videos, newsletters, health fairs, or reminders. The interventions can be tailored to address risks of developing high blood pressure, questions, or barriers relevant to the individual or to a group
- Seminars, educational workshops, or classes (including online, telephone conference or self study guide) on preventing and controlling high blood pressure can be provided
- Blood pressure monitoring devices available for employees to do their own self assessments can also be provided at the worksite with information or training on how to use them
Worksite lifestyle programs can help employees control their blood pressure
- The health-related program strategies and interventions listed for physical activity, alcohol use, nutrition, stress, type 2 diabetes, and obesity include lifestyle activities recommended to control blood pressure
Tools and Resources (more)
- The National Institutes of Health have developed Prevent and Control America’s High Blood Pressure: Mission Possible (http://hp2010.nhlbihin.net/mission/), a website which includes fact sheets on healthy activities in English and Spanish, posters for businesses, lists of potential community partners, and recommendations for action in employee populations
- High Blood Pressure Fact Sheet developed by the Centers for Disease Control and Prevention (CDC)
- The American Heart Association Start! Walking for a Healthier Lifestyle website is designed for companies to create a culture embracing physical activity and health. The website provides a free online tool that will track distances travelled by walking as well as dietary information through a nutrition diary
- The American Heart Association High Blood Pressure website provides information on blood pressure risk, an online high blood pressure health risk calculator, quizzes, and an opportunity to ask experts questions
- 10 Ways to Control your Blood Pressure fact sheet developed by the American Heart Association
- The Stroke Collaborative, a partnership of the American Heart Association, American Stroke Association, American Academy of Neurology, and the American College of Emergency Physicians, has developed the Give Me 5 for Stroke website which provides a number of educational materials in English and Spanish related to stroke risk factors including high blood pressure and lifestyle changes to prevent stroke
Health-related policies for blood pressure screening and control6-8
Workplace policies promote a corporate “culture of good healthThe creation of a working environment where employee health and safety is valued, supported and promoted through workplace health programs, policies, benefits, and environmental supports. Building a Culture of Health involves all levels of the organization and establishes the workplace health program as a routine part of business operations aligned with overall business goals. The results of this culture change include engaged and empowered employees, an impact on health care costs, and improved worker productivity..”
Policies that enhance worksite lifestyle programs can help employees control their blood pressure
- The health-related policy strategies and interventions listed for physical activity, alcohol use, nutrition, stress, type 2 diabetes, and obesity include lifestyle activities recommended to control blood pressure
Employee health benefits are part of an overall compensation package and affect an employee’s willingness to seek preventive services and clinical care.
Provide coverage for blood pressure screening, counseling, and treatment for employees
- The United States Preventive Services Task Force and the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) recommends:
- Clinicians screen adults aged 18 and older for high blood pressure
- Blood pressure should be measured in every clinical encounter. Since this is a routine intake assessment in outpatient settings, providing coverage at every preventive care visit per year will ensure regular employee screening in clinical settings
- If high blood pressures is detected, coverage for the following will
enhance clinical care:
- Counseling to promote therapeutic lifestyle changes
- Office visits to monitor hypertension and treatment efforts
- Medications used to treat hypertension
- For individuals who have been diagnosed with high blood pressure, disease management programs are recommended to improve hypertension care. Disease management is an organized, proactive, multicomponent approach to health care delivery for specific diseases such as high blood pressure. Disease management programs involve tracking and monitoring individuals with high blood pressure by a coordinated care team to prevent complications and the development of co-morbid conditions such as diabetes
- The health-related benefits strategies and interventions listed for
physical activity, alcohol use, nutrition,
stress, type 2 diabetes, and obesity include major lifestyle activities recommended to control blood pressure
- The National Business Group for Health’s A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage [PDF - 13KB] provides benefits package language for clinical screening plus six counseling, treatment, and monitoring sessions per calendar year for employees with diagnosed high blood pressure
- Blood Pressure and Its Relationship to Stroke fact sheet developed by the American Stroke Association includes treatment guidelines for prehypertension
- Cardiac Medications fact sheet developed by the American Heart Association describes the major types of medications for high blood pressure
Environmental support for blood pressure screening and control6-8
Environmental support provides a worksite physically designed to encourage good health.
Worksite environmental support activities for lifestyle change can be used to control high blood pressure among employees
- The health-related environmental support strategies and interventions listed for physical activity, alcohol use, nutrition, stress, type 2 diabetes, and obesity include lifestyle activities recommended to control blood pressure
Tools and Resources
- Leading by Example: Creating Healthy Communities through Corporate Engagement published in 2011 by the Partnership for Prevention features 19 businesses and business groups who are providing leadership and reaching out to improve the health and wellness of their communities providing many benefits to their organizations.
- Leading by Example: The Value of Worksite Health Promotion to Small- and Medium-sized Employers published in 2011 by the Partnership for Prevention provides best practices and strategies for creating or enhancing a worksite health promotion program as well as worksite health program descriptions from almost 20 small employers
- The Successful Business Strategies to Prevent Heart Disease and Stroke Toolkit developed by CDC provides employers with guidelines and recommendations to reduce costs through investing in cardiovascular health programs including collaborating and establishing partnerships with state health organizations
- Reducing the Risk For Heart Disease and Stroke: a Six-Step Guide for Employers [PDF - 1.2MB] developed by CDC, the Six-Step Guide is designed to show employers how they can reduce costs by investing in worksite health promotion and negotiate with health plans to cover preventive services. It also provides steps and resources on how to get started
- Moving into Action: Promoting Heart-Healthy and Stroke-Free Communities
Employers develop by CDC, the American Heart Association/American Stroke Association,
and the Association of State and Territorial Health Officials provides a
range of actions for employers to promote heart-healthy and stroke-free
communities revolving around four themes:
- Demonstrating leadership
- Implementing policies and incentives to make healthy choices the easy choices
- Promoting coverage for and use of preventive health services; and
- Implementing life-saving improvements in health services and medical response
- CDC’s Division for Heart Disease and Stroke Prevention has developed a case study of policy, environmental, and systems-level interventions for managing high blood pressure and high cholesterol in health care settings
- CDC’s Division for Heart Disease and Stroke Prevention website contains multiple tools and resources, information and data, and
links to other websites on heart disease and stroke