S.C. program aims to reduce high blood pressure
By Chris M. Curtis
An organization in South Carolina is having success improving control of hypertension among residents suffering from high blood pressure.
The Hypertension Initiative, a collaboration among primary care doctors, their patients and the medical academic community, seeks to decrease hypertension, or high blood pressure, in South Carolina. In 2007, 65 percent of the patients in the Hypertension Initiative database improved their control of hypertension, up from 49 percent in 2003.
Dr. Brent Egan started the Hypertension Initiative in 1999 to take South Carolina from a leader in cardiovascular disease to a model of "heart health."
Hypertension is a high-risk factor for heart disease, heart attack, stroke and kidney failure, according to the S.C. Department of Health and Environmental Control.
DHEC's Division of Cardiovascular Health estimates 30.4 percent of adults in South Carolina had high blood pressure in 2007 compared with 27.8 percent for the entire nation. The number of adults with high blood pressure in South Carolina increased from 28.8 percent in 2003 and 23.5 percent in 1995.
Khosrow Heidari, the director of chronic disease epidemiology in DHEC's Bureau of Community Health and Chronic Disease Prevention, says complete hypertension numbers for South Carolina are not available because hypertension is not on the list of reportable conditions that the state requires health care facilities, physicians and laboratories report to the local health department.
"However, as a chronic condition and risk factor for other chronic diseases, we monitor our population at risk," Heidari says. DHEC maintains a chronic disease surveillance system for South Carolina that includes mortality records, hospital and ER visit claims, and a population-based survey run by the Centers for Disease Control and Prevention called the Behavioral Risk Factor Surveillance System.
The Hypertension Initiative created its own network database to monitor patient treatment trends, facilitate clinical trials and collaborate with academic partners to identify continuing medical education topics. The patient data is obtained from a variety of primary care sources including community clinics, Veterans' Affairs clinics, physicians in training clinics, and solo and group practices. The database contains patient demographics, vital signs, diagnoses, medications and laboratory numbers.
The Initiative was established because effective treatment is best performed and monitored by the local primary care physician. It is based on healthy lifestyles, good nutrition and physical activity, and access to effective health care and medications.
The Initiative adopted the Dietary Approaches to Stop Hypertension eating plan, which describes a variety of food options geared toward a southern lifestyle style, Egan says. The program features a comprehensive list of monthly eating plans broken down into daily segments, recipes, food facts, and approximate cost for the listed food.
Egan says the Initiative works with over 120 primary care practices across the state to monitor the treatment and control of high blood pressure in over 250,000 adults. He says he's seen someimprovements recently.
"While stroke and heart disease remain a serious threat in South Carolina," Egan says. "Death from these two causes has fallen more in South Carolina than most other Southeastern states in a recent 10-year period."
The Initiative has received two national awards from the United States Department of Health and Human Services.
The Hypertension Initiative's success is a result of patient treatment within a primary care program, but the successes are not yet being reflected in statewise hypertension rates.
One of the problems is that hypertension generally has no obvious symptoms. About one-third of people with hypertension are not aware they have it. DHEC data show that African-Americans have a disproportionate number of cardiovascular deaths, hospitalizations and risk factors, specifically hypertension.
Egan says statewide hypertension numbers will decrease as access to care and medication improves. He says the Initiative and its database will continue to grow and continue to control and decrease patient hypertension. RCT