Reduce the impact of heart disease

% of adults with hypertension

25%2020

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Story Behind the Curve

Updated 1/21/20

Hypertension is the clinical term for describing high blood pressure. A blood pressure reading consists of two numbers written as a ratio like this: 120/80. The top number, called the systolic pressure, measures the pressure in the arteries when the heart beats (when the heart muscle contracts). The bottom number, called the diastolic pressure, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood). Normal blood pressure is considered a blood pressure reading under 120/80.

Hypertension guidelines changed in November 2017, when the new guidelines were jointly released by the American Heart Association and American College of Cardiology. The old hypertension guidelines stated that someone with a blood pressure reading 140/90 and above had high blood pressure. The new guidelines say that anyone with blood pressure over 120/80 has elevated blood pressure. The chart below illustrates the new blood pressure categories. Information about the new hypertension guidelines is available at: 

If left untreated, hypertension can lead to heart attack, stroke, kidney failure, and more. Hypertension is a very common condition in the United States, and affects approximately 1 in 3 adults.[2] African Americans have an even greater risk of developing hypertension, and often have high blood pressure earlier in life and are more likely to die from hypertension related problems.[3] Being overweight or obese, eating too much salt (also called sodium), using tobacco, and not being physically active enough are all risk factors for developing high blood pressure.

According to the 2017 Vermont Behavioral Risk Factor Surveillance System (BRFSS), about 1 in 4 adult Vermonters (26%) said they have been told they have hypertension. 

It is important to note that all of the hypertension data on this page are based on the old hypertension guidelines (where hypertension = anyone with blood pressure 140/90 and above). At this time, Vermont has not collected data on the number of people who have hypertension under the new guidelines of 130/80 and above. The American Heart Association and the American College of Cardiology estimate that under the new guidelines, approximately 48% of men and 43% of women are considered to have hypertension. When Vermont specific data becomes available, information about Vermonters with hypertension will be updated.

The current rate of Vermonters with hypertension (based on the old guidelines), while above the Health Vermonters goal of 20%, has remained stable for the past several years. Among Vermonters with hypertension, three-quarters (73%) are taking medications to treat it. Income level plays an important role in hypertension prevalence: 35% of adults in low income homes (<$25,000 annually) report having hypertension, compared to adults in middle income homes ($25,000 - $50,000 annually) where 28% report having hypertension. Adults who live in the highest income homes (above $75,000 annually) have the lowest hypertension rates at only 22%.[4]

A diagnosis of hypertension increases with age. According to 2010 census data, Vermont is the second oldest state (in terms of median age) in the country. Although hypertension increases as you get older, people of all ages (including children) can be affected. The American Heart Association states that hypertension is becoming more prevalent in children in their teens because of the rise of overweight and obesity in children and teens. Vermont men have statistically higher rates of hypertension than women, with 31% of men reporting being told they have hypertension compared to only 23% of women in 2013.

The latest data gathered on this indicator is from the 2013 BRFSS. This question is asked every other year and will be asked again on the 2015 BRFSS survey.

 


[1] http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Understanding-Blood-Pressure-Readings_UCM_301764_Article.jsp

[2] http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/atrisk

[3] http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/atrisk

[4] 2013 BRFSS report.

Why Is This Important?

This indicator is important because hypertension can lead to heart attack or stroke, aneurysm, heart failure, vision loss, loss of kidney function, gum disease and other oral health complications and cognitive issues.[1] Controlled hypertension is a key priority and quality improvement focus across the state as part of health care reform efforts and is a Healthy Vermonters 2020 performance indicator. The Department of Health receives grant funds from the CDC to coordinate activities and partnerships that support strategies to reduce hypertension across the state. These Health Department activities are managed in the Division of Health Promotion and Chronic Disease Prevention, which houses other programs like the Tobacco Control Program, The Physical Activity and Nutrition Program, the heart health side of the Ladies First Program and Diabetes Prevention Activities – all of which promote strategies that play a role in reducing high blood pressure.



[1] http://www.mayoclinic.org/diseases-conditions/high...

What Works

Identifying people with high blood pressure who have not been diagnosed with hypertension and effective management of blood pressure for those who have diagnosed hypertension are important strategies to reduce the percentage of adults with hypertension in Vermont. Preventing hypertension before it starts is also a critical component in reducing the prevalence of hypertension. Evidence based strategies include maintaining a healthy weight, not smoking, limiting alcohol, and eating a healthy diet rich in fruits, vegetables and fiber and low in fats and sugars. Several programs housed within the Department of Health’s Division of Health Promotion and Chronic Disease Prevention and Division of Alcohol and Drug Prevention support activities that promote those strategies.

National organizations including the CDC, Million Hearts ®, and the American Heart Association recommend a number of evidence-based interventions to help prevent hypertension from developing, and to assist people with hypertension reduce and control their blood pressure. These include:

Self-management education programs like the Chronic Disease Self-Management Program (CDSMP) help teach people with or at risk for hypertension to manage lifestyle and behaviors that will lead to better blood pressure control and lifestyle changes that can help lower blood pressure. The CDSMP is called “Healthier Living Workshop” in Vermont and is offered throughout the state. The program specifically addresses arthritis, diabetes, lung and heart disease, but teaches skills useful for managing a variety of chronic diseases. This program was developed at Stanford University and helps individuals develop skills to cope with their condition, improve energy levels, manage pain, and learn to make the best choices for their condition and lifestyle. It covers topic such as: techniques to deal with problems associated with chronic disease, appropriate exercise, appropriate use of medications, communicating effectively with family, friends, and health professionals, nutrition, and how to evaluate new treatments. Participants who took CDSMP demonstrated significant improvements in exercise, ability to do social and household activities, less depression, fear and frustration or worry about their health, reduction in symptoms like pain, and increased confidence in their ability to manage their condition.

An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available and inexpensive, and you don't need a prescription to buy one. Many community locations, including pharmacies, grocery stores, and libraries have free on-site blood pressure monitors where people can stop in and measure their blood pressure.

An important first step is to make an appointment with your primary care provider to have your blood pressure taken. Your provider can help identify ways to maintain a healthy blood pressure level, or develop a plan that could include lifestyle changes and possibly medications, to help lower blood pressure levels. Recommendations from health care providers are among the most influential factors in convincing people to be physically active and join a self-management program.

Strategy

The Vermont Department of Health is funded by the CDC to work on hypertension prevention activities through a grant called Improving the Health of Americans Through Prevention and Control of Diabetes and Heart Disease and Stroke (CDC-1815). Our strategy is to work with providers, clinics, schools and community partners to create healthy environments, promote best practices, and support Vermonters to make healthy choices that will prevent or help control hypertension. As noted above, the CDC also funds other programs in the Health Department, including the Tobacco Control Program, The Physical Activity and Nutrition Program, the heart health side of the You First Program, and Diabetes Prevention Activities.

Although a self-management program specifically focused on hypertension is not currently available, programs such as the National Diabetes Prevention Program (that prevents diabetes and improves blood pressure control) are available across the state to qualifying Vermonters at no cost. Other strategies include the development and distribution of treatment guidelines and consumer resources for clinical management and self-management of blood sugar and blood pressure.

By focusing on the health and well-being of all Vermonters through quality health systems, physical activity, nutrition and tobacco prevention and cessation intervention – the most effective ways to prevent or control hypertension – we can help to address high blood pressure and ensure better quality of life for those who are living with hypertension.

Notes on Methodology

BRFSS

Vermont tracks the risk behaviors of its adult residents using a telephone survey, the Behavioral Risk Factor Surveillance System (BRFSS), for landlines and cellular phones leverage through funding from the Centers for Disease Control and Prevention (CDC). The inclusion of cellular phones began in 2009; this was done to ensure the survey contained an accurate representative sample of adult Vermonters as cell phone use as the primary household phone was increasing significantly. The sample of respondents is then weighted, using standardized methodology developed by the CDC, to achieve population level estimates. In 2011 this weighting methodology was changed due to the fact that cell phones became the predominant make-up of the entire sample. This new system of raking allows for the incorporation of other variables not traditionally used in the weighting process, most importantly, telephone source.

Behavioral Risk Factor Surveillance System -- BRFSS

Vermont tracks risk behaviors and chronic disease using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Since 1990, Vermont, along with the 49 other states, Washington D.C. and U.S. territories, has participated in the BRFSS with the Centers for Disease Control and Prevention (http://www.cdc.gov/brfss). The CDC provides the Vermont Department of Health with funding each year to carry out the survey. Several thousand Vermonters are randomly and anonymously selected and called annually, on both landlines and cell phones. An adult (18 or older) is asked a uniform set of questions. The results are weighted to represent the adult population of the state.

Note that beginning in 2011 the CDC implemented changes to the BRFSS weighting methodology in order to more accurately represent the adult population.While this makes calculations more representative of the population, the changes in methodology also limit the ability to compare results from 2011 forward with those from previous years.The Vermont Department of Health recommends that comparisons between BRFSS data from 2011 forward and earlier years be made with caution.Statistical differences may be due to methodological changes, rather than changes in opinion or behavior.

YRBS

The Youth Risk Behavior Survey (YRBS) is a paper survey taken by Vermont middle and school students every other year as a collaboration between the Department of Health’s Division of Alcohol and Drug Abuse Program and the Agency of Education’s Coordinated School Health Programs. It measures the prevalence of behaviors that contribute to the leading causes of death, disease, and injury among Vermont Youth. Data is weighted so as to generate population level estimates for all Vermont Middle and High Schools.

Youth Risk Behavior Survey -- YRBS

The Youth Risk Behavior Survey (YRBS) is a paper survey administered in Vermont middle and high schools every two years since 1993. The survey is sponsored by the Department of Health's Division of Alcohol and Drug Abuse Programs, and the Department of Education's Coordinated School Health Programs and the CDC. The YRBS measures the prevalence of behaviors that contribute to the leading causes of death, disease, and injury among youth. Vermont surveys over 30,000 students at each administration. Weighted data is compiled to generate a representative state sample, and local data is used by schools, supervisory unions, health programs and other local organizations. The YRBS is completed in over 40 other states and there is a national weighted sample for comparison.

VITAL STASTICS

The Vermont vital statistics system monitors vital events (births, deaths, marriages and civil unions, divorces and dissolutions, etc.). Death certificates are often completed by the funeral directors who obtain all necessary information from the family. However, a physician is required to complete and certify the cause of death in the Electronic Death Registration System (EDRS).Mortality rates are calculated based on the ICD-10 code for the underlying cause of death listed on death records received by Vital Records. Only Vermont residents are included in these calculations.Rates were calculated by comparing the number of deaths in a given time period to the overall population of Vermont in the same time period.

WHEN A MEASURE IS AGE ADJUSTED

Age adjustment is used for comparison of regions with varying age breakdowns.In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont are age adjusted.In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000.For more detailed information on age adjustment visit http://www.cdc.gov/nchs/data/statnt/statnt20.pdf

Methods

Prevalence and percentages are calculated by using descriptive statistical procedures using software such as SPSS, SAS, and/or SUDAAN.These statistics describe the proportion of individuals with a given trait in the population during a specified period of time.

Discharge rates are calculated using the Vermont Uniform Hospital Discharge data set.We look at all hospital and ED discharge among Vermont residents who utilized services at regional hospitals (including hospitals in bordering states).We compared the number of discharges in a given time period to the Vermont population in the same time period to calculate discharge rates.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy