Sectors and Strategies

At a glance

Millions of people who have high blood pressure do not have it under control. Many different groups will need to come together to support the use of proven strategies in every community and for every population group.

Collage of people in different health care settings along with the CDC logo saying, “We’ve Got This!”

Overview

Millions of people who have high blood pressure do not have it under control.

Control is possible, but little progress has been made in the past 10 years. Some population groups also have higher rates of disease and death associated with high blood pressure, which creates health disparities across communities, and programs and interventions likely require tailoring to increase effectiveness.

We know that high blood pressure can be controlled to reduce health risks.

Many different groups will need to come together to support the use of proven strategies in every community and for every population group.

High blood pressure control must be a national priority.

Individuals

How you can help

If you have high blood pressure, take action to control it and improve your health.

Changing your lifestyle can be hard. You will need support from your family, friends, and other members of your community.

You can also get help from a health care team that may include physicians, nurse practitioners, physician assistants, nurses, pharmacists, and other types of health care professionals.

Your health care team can help you make lifestyle or medication changes that can help you reduce your risk of heart attack or stroke.

Actions you can take

  • Control your blood pressure (under 130/80 mmHg for most people) to reduce your risk of heart attack, stroke, kidney disease, and other conditions.
  • Work with your health care team to create a personal treatment plan with the goal of controlling your blood pressure.
  • Follow your treatment plan and ask your health care team for help.
  • Be physically active and eat a healthy diet. Start by taking a daily walk and eating more fruits and vegetables.
  • Make sure to take your medication as prescribed and let your health care team know if you have questions or concerns.
  • Learn to check your blood pressure at home by using a blood pressure monitor.
  • Ask your health care team to teach you how to monitor your blood pressure and share your results.

Selected resources

American College of Cardiology: CardioSmart High Blood Pressure Fact Sheet

Target: blood pressure:

National Heart, Lung, and Blood Institute: DASH Eating Plan

Centers for Disease Control and Prevention:

Department of Health and Human Services: Move Your Way

Department of Agriculture: Choose My Plate

Million Hearts®: Self-Measured Blood Pressure Monitoring

Federal government

How you can help

The mission of the U.S. Department of Health and Human Services (HHS) is to enhance and protect the health and well-being of all Americans.

The agency provides effective health and human services and fosters advances in medicine, public health, and social services.

As a federal agency, you can support HHS's efforts to improve high blood pressure control in the United States.

You can work with partners across multiple sectors, including public health, health care, business, government, and academia.

You can also support and help expand actions like the ones recommended here.

Actions you can take

  • Conduct research to test innovative interventions and models.
  • Implement innovative interventions through current and emerging technology.
  • Recognize and reward clinicians, health centers, health systems, and health plans that routinely monitor and report success in high blood pressure control.
  • Use funding to create policies that make high blood pressure control a priority in health care systems and communities.
  • Fund research to identify how to integrate proven strategies into clinical and community settings.
  • Use research results to find ways to identify, expand, and share best practices.
  • Expand public health insurance and public employee health plans to cover effective interventions and reduce costs. Examples include
    • Paying for automated home blood pressure monitors and community health worker services.
    • Reducing copays for antihypertensive medications.
    • Removing pre-authorization for treatments that improve overall cardiovascular health (such as tobacco cessation and type 2 diabetes prevention programs).
  • Promote policies and principles of community design that increase physical activity for people of all abilities.
  • Create activity-friendly routes to everyday destinations and improve transit systems.
  • Increase access to healthy food and drink options.
  • Implement healthy food service guidelines in federal facilities and encourage their use in other settings.
  • Support efforts to modernize data systems to improve high blood pressure control surveillance at the national, state, and local levels.
  • Fund activities and strategies that address social determinants of health.

Selected resources

Million Hearts®:

Federal Employees Health Benefits Program: Plan Performance Assessment – High Priority Measures [PDF – 229 KB]

Patient-Centered Outcomes Research Institute (PCORI): PCORI, NIH Partnership to Fund Research Asking How to Reduce Hypertension Disparities

State and local governments

How you can help

As a state or local government agency or representative, you can play an important role in protecting and improving the health of your residents.

You can support efforts to improve high blood pressure control across the country by working with multiple sectors.

You can work with clinical and public health partners to focus on population groups with the greatest need.

You can also help build diverse public and private partnerships to coordinate the efforts of multiple groups, prevent duplication of efforts, and use resources efficiently.

Actions you can take

  • Fund activities and strategies that address social determinants of health.
  • Recognize and reward clinicians, health centers, health systems, payers, and communities that report success in high blood pressure control.
  • Share best practices and effective models with other partners.
  • Enact policies that expand the scope of practice for pharmacists, community health workers, and nurses.
  • Expand public health insurance and public employee health plans to cover effective interventions and reduce costs. Examples include
    • Paying for automated home blood pressure monitors and community health worker services.
    • Reducing copays for antihypertensive medications.
    • Removing pre-authorization for treatments that improve overall cardiovascular health (such as tobacco cessation and type 2 diabetes prevention programs).
  • Promote policies and principles of community design that increase physical activity for people of all abilities by creating activity-friendly routes to everyday destinations and improving transit systems.
  • Create or enhance access to public spaces for physical activity through shared use agreements.
  • Support community programs that promote safe environments, such as crime reduction initiatives.
  • Increase access to healthy food and drink options.
  • Implement healthy food service guidelines in public buildings.

Selected resources

Million Hearts®: Hypertension Control Champions

Centers for Disease Control and Prevention:

Public health professionals

How you can help

As a public health professional, you and the organizations you work for are in a unique position to help improve high blood pressure control.

You can help bring together partners from multiple sectors to address this public health problem at federal, state, and local levels.

You can also share data to show what works, and promote the use of effective strategies.

Actions you can take

  • Work with public health insurance programs and public employee health plans to cover effective interventions and reduce costs. Examples include
    • Paying for automated home blood pressure monitors and community health worker services.
    • Reducing copays for antihypertensive medications.
    • Removing pre-authorization for treatments that improve overall cardiovascular health (such as tobacco cessation and type 2 diabetes prevention programs).
  • Convene quality improvement collaboratives that help clinical teams and health systems achieve high levels of high blood pressure control.
  • Promote policies and principles of community design that increase physical activity for people of all abilities.
  • Create activity-friendly routes to everyday destinations and improve transit systems.
  • Increase access to healthy food and drink options.
  • Support food service guidelines that encourage more healthy food and drink options in state and local buildings, hospitals, worksites, and other community venues.
  • Invest in evidence-based programs that link clinical services with community resources.
  • Help people make lifestyle changes and get access to food assistance programs.
  • Conduct public health surveillance to identify groups and communities at highest risk of uncontrolled high blood pressure.
  • Use data to monitor the effectiveness of your efforts to improve control.

Selected resources

Million Hearts®: Hypertension Control Change Package [PDF – 1.84 MB]

Centers for Disease Control and Prevention:

Health care professionals

How you can help

As a health care professional, you see many patients with high blood pressure who do not have this condition under control.

You can help improve high blood pressure control in the United States by identifying populations at highest risk and highlighting needed resources.

You can also share your firsthand knowledge about the problems associated with uncontrolled high blood pressure.

Commit to following the most current clinical guidelines for high blood pressure control to ensure that your care is cost-effective, evidence based, and focused on achieving control across all populations.

Actions you can take

  • Implement protocols to standardize patient care and empower all members of the clinical team to engage in patient management.
  • Refer all patients with high blood pressure to lifestyle change resources and ensure follow-up with patients after referrals.
  • Prescribe to improve adherence by lowering patient costs, reducing access barriers, and simplifying regimens.
  • Prescribe medications electronically and synchronize medication regimens to reduce the chance that patients will lose or not fill their prescriptions.
  • Suggest self-measured blood pressure monitoring with clinical support for patients with high blood pressure.
  • Use data from clinician dashboards and patient registries to highlight gaps in care so they can be addressed through quality improvement efforts.
  • Encourage the use of multidisciplinary care teams to help patients manage their blood pressure.
  • Support shared decision making and effective communication between health care teams and patients.

Selected resources

Million Hearts®:

Target: BP: CME Course: A Look at Self-Measured Blood Pressure

American Medical Association:

Centers for Disease Control and Prevention:

Professional associations and societies

How you can help

Members of public health and health care professional associations and societies can help improve blood pressure control by changing policies, systems, and environments that make it hard for people to control their high blood pressure.

As a professional association or society, you can play a key role in calling attention to the problems associated with uncontrolled high blood pressure, including negative health outcomes and disparities in certain populations.

You can also share information, provide training, and mobilize your members to support policy changes.

Actions you can take

  • Promote the inclusion of evidence-based and guideline-recommended interventions and strategies in professional training programs.
  • Host speakers to discuss evidence-based strategies for high blood pressure control at meetings or webinars.
  • Support the development of national guidelines and recommendations on high blood pressure.
  • Share national guidelines and recommendations with members through newsletters, social media, and continuing education courses.
  • Support policies, best practices, and scope of practice that help members improve high blood pressure control among their patients.
  • Recognize and reward clinicians, health centers, and health systems that report success in high blood pressure control, especially among populations at high risk or with high rates of disease and death.
  • Share best practices with other members.

Selected resources

Target: BP: How to Measure Your Blood Pressure at Home

Health care practices, health centers, and health systems

How you can help

To help improve high blood pressure control in the United States, health care practices, health centers, and health systems can deliver patient care services in ways that have been proven to work.

You can use multidisciplinary care teams to ensure comprehensive care and use protocols to standardize patient care.

You can also use high-quality data to track and encourage high performance among your health care professionals.

Actions you can take

  • Put validated and calibrated automated blood pressure monitors with correct-size cuffs in all exam rooms.
  • Provide regular training on how to measure and document blood pressure accurately to all staff who provide patient care.
  • Implement protocols to standardize patient care and empower all members of the clinical team to engage in patient management.
  • Include high blood pressure control in your quality improvement efforts.
  • Use data from clinician dashboards and patient registries to highlight gaps in care so they can be addressed through quality improvement efforts.
  • Ensure that the interventions you use are culturally and linguistically appropriate to the communities you serve.
  • Recognize and reward clinical teams that achieve high levels of success in high blood pressure control, especially among populations at high risk or with high rates of disease and death.

Selected resources

Target: BP: In-Office Measuring Blood Pressure Measurement Graphic

Million Hearts®:

Health plans and managed care organizations

How you can help

For insurance companies, there are short-term costs associated with treatments and interventions designed to improve high blood pressure control among their beneficiaries.

Examples of treatments and interventions include antihypertensive medications, home blood pressure monitors, and approved lifestyle programs.

Treatments and interventions reduce the risk and costs associated with adverse cardiovascular outcomes over time.

The costs associated with adverse cardiovascular outcomes include hospitalization for a heart attack, stroke, or heart failure, as well as care services related to cardiac rehabilitation or management of end-stage kidney disease.

Actions you can take

  • Reduce or eliminate out-of-pocket costs for antihypertensive medications, especially in ways that encourage medication adherence, such as longer-duration prescriptions, fixed-dose combination pills, and lower dosing frequency.
  • Provide coverage for automated home blood pressure monitors for patients.
  • Reimburse clinicians for the time they spend training patients to use home blood pressure monitors.
  • Reimburse clinicians for the time they spend interpreting the readings submitted by patients.
  • Reimburse pharmacists who provide medication therapy management, medication adherence assessments, and counseling.
  • Expand access to prevention programs designed to help people make lifestyle changes and improve their overall cardiovascular health.
  • Provide incentives to clinicians and beneficiaries to encourage them to achieve high blood pressure control, especially among populations at high risk or with high rates of disease and death.

Selected resources

Centers for Disease Control and Prevention:

Million Hearts®: Cardiovascular Health Medication Adherence: Action Steps for Health Benefit Managers

American Medical Association: SMBP CPT® Coding [PDF – 264 KB]

Employers and health plan purchasers

How you can help

For employers and individuals who purchase health plans, there are short-term costs associated with treatments and interventions designed to improve high blood pressure control.

Examples of treatment and interventions include antihypertensive medications, home blood pressure monitors, and approved lifestyle programs.

These treatments and interventions reduce the risk and costs associated with adverse cardiovascular outcomes over time.

The costs associated with adverse cardiovascular outcomes include hospitalization for a heart attack, stroke, or heart failure, as well as care services related to cardiac rehabilitation or management of end-stage kidney disease.

Costs also include costs associated with employees who are less productive or miss work because of illness.

Actions you can take

  • Select health plans that reduce or eliminate out-of-pocket costs for antihypertensive medications, especially in forms that encourage medication adherence, such as longer-duration prescriptions, fixed-dose combination pills, and lower dosing frequency.
  • Select health plans that provide coverage for automated home blood pressure monitors.
  • Select health plans that reimburse clinicians to train patients to use home blood pressure monitors and interpret the readings submitted by patients.
  • Provide environmental supports to help people be more physically active at their job. Examples include
    • Free on-site exercise facilities.
    • Subsidized or discounted off-site exercise facilities.
    • Walking trails.
    • Bicycle racks.
    • Signs that encourage activity.
  • Provide organized individual or group physical activity programs and give employees time to participate during the workday.
  • Provide virtual programs for physical activity or nutrition education.
  • Provide a variety of healthy food and drink options in vending machines and cafeterias in the workplace.
  • Encourage healthier food and drink choices at work through pricing, price incentives, marketing, and education.
  • Join community coalitions that promote healthy lifestyle opportunities and clinical enhancements to improve high blood pressure control.

Selected resources

Million Hearts®: Cardiovascular Health: Action Steps for Employers

Academic institutions and researchers

How you can help

Your university or school helps to train scientific and medical researchers who can expand our knowledge of what works to control high blood pressure.

More high blood pressure control research is needed to understand what interventions are most effective for a variety of populations and to identify the best way to implement them.

The curricula of training programs in medicine, nursing, and pharmacy regularly integrate blood pressure assessment and related management. However, reinforcement of appropriate and effective activities is useful.

Expanded training using a variety of research methods is likely needed, including quality improvement and population health management techniques.

Actions you can take

  • Conduct effectiveness and comparative effectiveness studies to address gaps in high blood pressure management.
  • Ensure that research clearly defines and incorporates social determinants of health.
  • Expand educational curricula across clinical professions to include more training in quality improvement and population health management techniques.
  • Build capability in implementation science, health systems, and policy assessment research to expand the use of best practices in clinical and community settings.
  • Expand public health curricula for epidemiologists and other public health professionals to use data from electronic health records.
  • Develop research programs in cardiovascular epidemiology.
  • Implement a standardized treatment protocol that university health centers can use to identify and treat staff and students with high blood pressure.

Selected resources

Million Hearts®:

Community organizations, public-private partnerships, and foundations

How you can help

A variety of partners, including health advocacy, minority-serving, and faith-based organizations, are needed to help make high blood pressure control a national priority.

As a member of these organizations and partnerships, you can support funding at national, state, and local levels for policies and programs that have been proven to work.

You can also help ensure that scientific findings and resources are translated into actions that best serve your communities.

Actions you can take

  • Support links between clinical services and community resources.
  • Convene experts to develop clinical guidelines and to identify high performers in clinical management.
  • Use your organization's assets to address social determinants of health.
  • Identify resources to support equity and improvements in high blood pressure prevention, awareness, treatment, and control.
  • Support policies that make high blood pressure control easier. Examples include
    • Policies that expand the scope of practice for pharmacists, nurses, and community health workers.
    • Covering costs related to self-measured blood pressure monitoring and weight reduction.
    • Providing supportive environments for tobacco cessation, physical activity, and healthy eating.
  • Use multiple communication channels to share messages about the importance of high blood pressure control and the potential health consequences of uncontrolled high blood pressure.
  • Fund research to expand the use of best practices for high blood pressure control in clinical and community settings.
  • Support or host community programs to help people make healthy lifestyle changes and manage their blood pressure.

Selected resources

Centers for Disease Control and Prevention:

Agency for Healthcare Research and Quality: Clinical-Community Linkages

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; About the Division for Heart Disease and Stroke Prevention