1. HYPERTENSION The Alabama Department of Public Health’s Hypertension Program

2. What is Blood Pressure? Blood pressure is the result of two forces. One is created by the heart as it pushes blood into the arteries and through the circulatory system. The other is the force of the arteries as they resist the blood flow

3. What Do the Pressure Numbers Mean? The higher (systolic) number represents the pressure while the heart is beating The lower (diastolic) number represents the pressure when the heart is resting between beats The systolic number is always stated first and the diastolic number is listed second. For example: 122/76 (122 over 76); systolic =m 122, diastolic = 76

4. What is High Blood Pressure (Hypertension)? Blood pressure of less than 140 over 90 is considered a normal blood pressure reading for adults. A diastolic pressure of 85 to 89 needs to be watched carefully A blood pressure reading equal to or greater than 140 over 90 is considered elevated or high

5. Why is Hypertension Bad? Elevated blood pressure indicates that the heart is working harder than normal, putting both the heart and arteries under a great strain. This increases the risk of having attacks, strokes, kidney failure, damage to the eyes and atherosclerosis

6. HYPERTENSION LINKED TO HEART ATTACKS, KIDNEY FAILURE, & STROKES Stroke - $30 Billion Hypertension is a major contributing factor for up to 70% of strokes Stroke - $48 Million Cardiovascular Disease - $326 Billion National Costs (Direct & Indirect) Alabama Costs (Direct & Indirect) Cardiovascular Disease - $5.2 Billion

7. National Trends in the Awareness, Treatment, and Control of High Blood Pressure in Adults, U. S. A.., 1976-1994

8. Risk of Cardiovascular Events in Subjects with Hypertension Kannel WB, et. Al. Hypertension Primer 2 nd ed. AHA; 199-202. CARDIOVASCULAR EVENTSAGE-ADJUSTED RISK RATIO MEN WOMEN Coronary Heart Disease Stroke Peripheral Arterial Disease 2.0 2.2 3.8 2.6 2.0 3.7 Cardiac Failure Cardiovascular Events 4.0 3.0 2.2 2.5

9. ALABAMA OVERVIEW SINGLE COUNTY DEMONSTRATION FULL CARE SERVICES OFFERED PROGRAM BEGAN IN 1974 IN EAST CENTRAL ALABAMA

10. BP > 140/90 < 150% poverty level Not under private care Non – Medicaid - Nursing Workup w/Lab - Contract Physician Physical, EKG & Rx - Nurse Monitoring & Education - Return to HD Quarterly & As Needed FULL CARE HYPERTENSION SERVICE

11. BP > 140/90 < 150% poverty Private care referral with Rx for program medication Non - Medicaid - Nursing Workup - Program Medications - Nurse Monitoring & Education - Return to Private Physician Every Six Months & As Needed JOINT CARE OR JOINT MANAGEMENT (1977)

12. PATIENT LOAD HISTORY 1975 1980 1985 1990 1995 2000

13. HYPERTENSION PATIENT PROFILE Average number of client visits to Health Department is 4.8 per year 56% of clients with controlled blood pressure Average clinic staff costs per visit is $16 ($78 per year) Annual drug cost per client is under $100 Average clients direct coverage cost for clinic and medications is approximately $178 annually

14. Approximately 15,000 patients were served in Fiscal Year 2001 Presently serving less than 10% of “in-need” population ELIGIBLE POPULATION SERVED Estimated eligible in state are 233,456

15. Expenditures $64,382.00 $483,766.00

16. DECLINING PATIENT LOAD Strong local clinic support for HTN program, yet accept no new clients Lack of local funds for clinic staff Outsource services to FQHC clinics or local hospitals Outsource drug dispensing to local pharmacists Allocate additional funds for program expansion Obstacles Potential Solutions

17. FUTURE OF THE HYPERTENSION PROGRAM (DUAL STRATEGY) Drug therapy Community health ……….Improve dietary intake ……….Increase physical activity..……..Discourage tobacco use

18. Community Health (continued) ……….Limit alcohol intake ……….Reduce sodium intake ……….Maintain adequate intake of dietary potassium, calcium, and magnesium ……….Reduce intake of saturated fat and cholesterol

19. Community Health Teaches the Role of Personal Responsibility in Maintaining Good Health The daily decisions we make – lifestyle modifications - can play a significant role in maintaining good health

20. FUTURE (continued) Uphill Financial Climb for Hypertension Program Price of Medication doubles in Fiscal Year 2002 In the Fiscal year 2002 the Hypertension Program goal is to hold the patient population at 15,000 Provide increased state funds to help defray drug price increases

21. ALABAMA HTN 2005 GOAL 1975 1980 1985 1990 1995 2000 2005

22. If you have questions about this presentation contact the Bureau of Health Promotion and Chronic Disease Hypertension Division at 334/206-5627