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National High Blood Pressure Education Program

PROGRAM DESCRIPTION

Origin and Purpose

The National High Blood Pressure Education Program (NHBPEP), established in 1972, is a cooperative effort among professional and voluntary health agencies, state health departments, and many community groups. The NHBPEP is coordinated by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

The goal of the NHBPEP is to reduce death and disability related to high blood pressure through programs of professional, patient, and public education. The NHBPEP also strives to achieve the heart disease and stroke Healthy People 2010 objectives for the Nation. Strategies to achieve the program goal include developing and disseminating stimulating educational materials and programs that are grounded in a strong science base as well as developing partnerships among the program participants.

Partnerships

Throughout its history, the NHBPEP has employed a comprehensive strategy to mobilize, educate, and coordinate resources of groups interested in hypertension prevention and control. The NHBPEP is comprised of a network of Federal agencies, voluntary and professional organizations, state health departments, and numerous community-based programs. At the core of the program is the NHBPEP Coordinating Committee, composed of representatives from 38 national professional, public, and voluntary health organizations and 7 Federal agencies.

The NHBPEP follows a consensus-building process to identify major issues of concern and to develop program activities. As part of this approach, representatives from the NHBPEP Coordinating Committee member organizations work together to provide guidance to the program and each other as well as to develop and promote educational activities through their own constituencies. This multidisciplinary committee also defines national priorities for the NHBPEP, examines critical issues, explores future opportunities, sponsors national activities, and promotes collaboration among the many organizations involved in the prevention, detection, treatment, and control of high blood pressure.

The partnership encompasses a wide distribution network supporting a mass media effort and the distribution of professional, patient, and public education materials and documents. Among publications developed and distributed are fact sheets, pamphlets, and brochures dealing with lifestyle changes, planning kits to stimulate program activities, posters, print ads, radio messages, and working group reports. One consensus document, the “Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure” (JNC), first published in 1976, has had five subsequent updates. The JNC reports serve as guidelines for clinicians and community groups. The reports have been distributed to all state health departments, nearly every primary care clinician and all hypertension control programs in the Nation, and they have been translated into foreign languages as well.

Issues and Scope

The NHBPEP represents a wide range of perspectives. Major hypertension control issues examined by the program encompass these items:

  • Excessive stroke mortality in the southeastern United States
  • Effective treatment practices
  • Utility of lowering the systolic blood pressure in older Americans
  • Role of lifestyle changes in preventing and treating hypertension
  • Population-based strategies for primary prevention of high blood pressure
  • Issues regarding special populations and situations (e.g., African Americans, renal disease, women, children, and adolescents)
  • Educational strategies directed at professional, patient, and public audiences, and community organizations
  • Development and support of HEDIS hypertension measures

Supporting Services

To assist program participants in carrying out their diverse efforts, the NHBPEP offers resources in several major areas:

  • Information Collection and Dissemination—The NHLBI Health Information Network is a source of hypertension-related information for consumers, health professionals, and planners. Network services include response to inquiries, collection and dissemination of information and education materials, and production of program bulletins to inform health professionals about NHLBI activities.

  • Public, Patient, and Professional Education—The NHBPEP develops and maintains an inventory of program materials for consumers, patients, and professionals, which include pamphlets for patients and consumers, posters, and a catalog of NHLBI materials. In addition, the NHBPEP distributes recommendations for managing high blood pressure, and professional educational materials.

  • Community Program Development—The NHBPEP offers limited help in developing and evaluating community programs using established local resources. The staff maintains liaisons with state health departments and community organizations. Assistance also is provided in planning continuing education programs, workshops, and regional conferences.

  • Evaluation and Data Analysis—The NHBPEP identifies and evaluates the results of major studies; provides data analysis information and technical assistance to health professionals in the field; assists in planning, conducting, and evaluating special studies; and identifies and provides potential new sources of data for assessing progress in hypertension prevention and control.

  • Technology Transfer and Electronic Distribution—The NHBPEP makes its documents available on the Internet. Working group reports, coordinating committee rosters, summaries of the NHBPEP Coordinating Committee meetings, and program announcements may be accessed for viewing and downloading. The NHBPEP can be accessed through the NHLBI home page at http://www.nhlbi.nih.gov.

Progress

The effectiveness of the NHBPEP can be measured in several ways. Public knowledge regarding the sequelae of high blood pressure has increased dramatically. For example, in 1972, the year the program began, less than one-fourth of the American population knew of the relationship between hypertension and stroke and hypertension and heart disease. Today, more than three-fourths of the population know of that relationship. In addition, the Nation's population has received the message to get their blood pressure measured. Virtually all Americans have had their blood pressure measured at least once, and three-fourths of the population have it measured every 6 months.

In the last 2 decades, the number of persons with hypertension who are aware of their condition has increased dramatically. In addition, the percentage of persons with hypertension who are on medication and controlling their condition also has improved substantially (table 1), but recent data indicate this trend is subsiding, a new program concern.

Table 1
Trends in Awareness, Treatment, & Control of HBP

Mean blood pressures compared in four national health surveys conducted between 1960 and 1991 suggest a reduction of 10 mm Hg systolic pressure and 5 mm Hg diastolic pressure during this time period. These remarkable decreases indicate that the U.S. population has heard and acted upon NHBPEP messages. More importantly, this significant reduction in mean blood pressures has had a significant effect on death rates from heart disease and stroke.

Because uncontrolled high blood pressure is a major risk factor for stroke and coronary heart disease (CHD), the changing mortality rate for cardiovascular events is another indication of NHBPEP progress. The age-adjusted mortality rate for stroke and CHD has declined nearly 60 and 53 percent, respectively (figure 2). The decline is real and can be observed for men, women, whites, and African Americans. This decline can be attributed in part to improved hypertension control, and it is evident in women and men as well as in African Americans and whites.

Figure 1
Percent Decline in Stroke Mortality Rate By Race

Figure 2
Percent Decline in CHD Mortality Rate By Race

CHD and stroke, two of the major complications of untreated hypertension, are still the first and third causes of death, respectively, in the United States. From 1972 to 1994, the mortality rate from CHD per 100,000 declined from 195.4 to 92.4. During that same time period, the mortality rate from stroke per 100,000 declined from 64.6 to 26.7. These decreases are impressive and represent many tens of thousands of lives saved in 20 years. However, much remains to be done. The NHBPEP, using its extensive network and partnerships, is focusing its efforts so that this important public health problem continues to be addressed and progress will continue into the next decade.

Year 2010 Goals

In January 2000, the Department of Health and Human Services launched Healthy People 2010, a national health promotion and disease prevention initiative that brings together national, state, and local government agencies; nonprofit, voluntary, and professional organizations; businesses; communities; and individuals to improve the health of all Americans, eliminate disparities in health, and improve years and quality of healthy life. The NHBPEP has adopted the Healthy People 2010 goals that address reductions in hypertension-related mortality rates. Table 2 lists the goals and progress toward meeting them.

Table 2
Classification of Blood Pressure for Adults


NHBPEP Coordinating Committee Member Organizations American Academy of Family Physicians
American Academy of Insurance Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Physician Assistants
American Association of Occupational Health Nurses
American College of Cardiology
American College of Chest Physicians
American College of Occupational and Environmental Medicine
American College of Physicians
American College of Preventive Medicine
American Dental Association
American Diabetes Association
American Dietetic Association
American Heart Association
American Hospital Association
American Medical Association
American Nurses Association
American Optometric Association
American Osteopathic Association
American Pharmaceutical Association
American Podiatric Medical Association
American Public Health Association
American Red Cross
American Society of Health-System Pharmacists
American Society of Hypertension
Association of Black Cardiologists
Citizens for Public Action on High Blood Pressure and
Cholesterol, Inc.
Council on Geriatric Cardiology
International Society on Hypertension in Blacks
National Black Nurses' Association, Inc.
National Hypertension Association, Inc.
National Kidney Foundation, Inc.
National Medical Association
National Optometric Association
National Stroke Association
Society for Nutrition Education

Federal Agencies

Agency for Healthcare Research and Quality
Health Care Financing Administration
Health Resources and Services Administration
National Center for Health Statistics, Centers for Disease
Control and Prevention
National Heart, Lung, and Blood Institute
National Institute of Diabetes and Digestive and Kidney
Diseases
NHLBI Ad Hoc Committee on Minority Populations

For more information about the NHBPEP, contact:

National High Blood Pressure Education Program
NHLBI Health Information Center
P.O. Box 30105
Bethesda, Maryland 20824-0105
(301) 592-8573 phone
(301) 592-8563 fax
http://www.nhlbi.nih.gov

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