TakeCHARGE HIGH BLOOD PRESSURE. Community Health Reports. Personal actions for better health

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1 TakeCHARGE Community Health Reports Personal actions for better health HIGH BLOOD PRESSURE A nonprofit independent licensee of the BlueCross BlueShield Association

2 Key terms defined Artery: A vessel that distributes blood high in oxygen away from the heart and throughout the body. Aneurysm: An abnormal bulge in a weakened section of an artery. It can rupture (burst), bleeding into and damaging the surrounding tissue. Blood pressure: The force of blood against the artery walls, created as the heart muscle contracts and relaxes between beats to pump blood throughout the body; measured in millimeters of mercury (mm Hg). Cardiovascular disease: One of several diseases affecting the heart and blood vessels, including what are commonly known as heart disease (coronary artery disease) and stroke (cerebrovascular accident). Cerebrovascular disease: A group of conditions in which blood flow to the brain is disrupted. A common cause is plaque buildup in the arteries that supply the brain with oxygen-rich blood. Cholesterol: A waxy, fat-like substance that is the most common form of steroid found in the body s cells. Chronic kidney disease: Gradual and usually permanent loss of kidney (renal) function (ability to remove waste and excess fluid from the blood). Controlled high blood pressure: The goal of high blood pressure management. Defined as systolic pressure of 140 mm Hg or lower and diastolic pressure of 90 mm Hg or lower in an otherwise healthy adult. Coronary artery disease: A condition in which the blood vessels (coronary arteries) that supply oxygen-rich blood to the heart muscle become narrowed by plaque. Diastolic blood pressure: Refers to blood pressure when the heart is at rest between beats (also known as the bottom number in a blood pressure reading). Heart attack (myocardial infarction): Interruption of blood flow to the heart muscle. Heart muscle, deprived of oxygen as a result, begins to die and lose function. A heart attack is one outcome of coronary artery disease. Heart disease: Any disorder affecting the heart, including coronary artery disease, heart attack and heart failure. Heart failure: Weakening of the heart s pumping action, which reduces the blood supply needed for the body to function properly. High blood pressure: Occurs when the force of circulating blood against the arteries is sustained at higher than the range determined to be necessary for long-term health. Clinically called hypertension, it is defined as systolic pressure of 140 mm Hg or higher or diastolic pressure of 90 mm Hg or higher. Kidney failure: Also known as end-stage kidney (renal) disease, kidney failure is marked by near or total loss of kidney function. Dangerous accumulations of water and toxic substances in the body make dialysis or a kidney transplant necessary to keep a person alive. Stroke (cerebrovascular accident): Sudden disruption of blood flow to part of the brain, which can lead to permanent brain damage or death. Disruption of blood flow can occur if an artery becomes blocked by plaque buildup, or if it ruptures and bleeds into surrounding tissue. Systolic blood pressure: Refers to blood pressure when the heart contracts, forcing blood through the arteries (also known as the top number in a blood pressure reading). Source: MedicineNet.com. Diseases & Conditions A-Z List. Web. May 4,

3 Are we taking charge of our own health? Most of us know that proper car maintenance is necessary to assure that our vehicle runs well and lasts a long time. We take responsibility for that by periodically changing the oil, installing new filters and rotating the tires. That same sense of responsibility applies to our health. We know that routine maintenance including getting moderate exercise, eating a healthy, well-balanced diet and avoiding known health risks will keep our engines running well. In 2004, Excellus BlueCross BlueShield introduced StepUp, an online tool to encourage upstate New Yorkers to get daily physical exercise and eat healthy meals, the foundations for better health. Since then, StepUp has helped 71,000 registered users to log more than 20.9 million miles and 16.6 million servings of fruits and vegetables. Many of us have health conditions such as diabetes or heart disease stemming from our genes, past behaviors or some combination of circumstances. If you do, your doctor will recommend steps you can take to manage the condition. In addition to staying active and eating a well-balanced diet, other actions may be as simple as regularly taking your medicines or scheduling medical appointments more frequently. By taking these additional steps, we assume greater personal responsibility for staying as healthy as possible. Actively managing our health can add years to our lives, improve our quality of life and avoid the time, effort and expense of treating more serious health conditions that we might have prevented. When we don t take responsibility, our overall health is likely to suffer, our lives may be shortened, and we may contribute to the billions of dollars spent on health care that could have been saved. Excellus BlueCross BlueShield has introduced this series of proactive health reports to examine various health conditions and highlight surveys in which people indicate what they are doing and not doing to take charge of their health. We recognize that when responding to surveys, some people may report taking better care of their health than they actually do. Physicians have similarly noted that patients may exaggerate how closely they follow doctors health advice. That is why the survey-based measures reported here may overstate how well people take care of themselves. The goal of these reports is to help readers understand the important connection between personal actions and better health. We want to encourage productive discussions within families, strengthen patient and physician bonds, and prompt initiatives for healthier workplaces, all of which can improve our community s health. 1

4 High blood pressure in upstate New York: Common, serious and mostly preventable UTICA/ROME/NORTH COUNTRY Adult high blood pressure prevalence (number affected): 28.6% (169,780) Percentage of adults diagnosed with high blood pressure who reported actions known to improve blood pressure control: Reducing dietary salt: 81.5% Making overall dietary changes: 68.0% Increasing physical activity: 77.0% Abstaining from alcohol*: 50.2% Avoiding tobacco**: 41.6% Taking prescribed medication(s): 85.9% CENTRAL NEW YORK Adult high blood pressure prevalence (number affected): 31.4% (259,840) Percentage of adults diagnosed with high blood pressure who reported actions known to improve blood pressure control: Reducing dietary salt: 69.0% Making overall dietary changes: 65.0% Increasing physical activity: 71.8% Abstaining from alcohol*: 38.2% Avoiding tobacco**: 47.2% Taking prescribed medication(s): 82.8% SOUTHERN TIER Adult high blood pressure prevalence (number affected): 27.8% (108,640) Percentage of adults diagnosed with high blood pressure who reported actions known to improve blood pressure control: Reducing dietary salt: 83.3% Making overall dietary changes: 76.3% Increasing physical activity: 73.7% Abstaining from alcohol*: 50.7% Avoiding tobacco**: 41.3% Taking prescribed medication(s): 81.8% FINGER LAKES Adult high blood pressure prevalence (number affected): 31.1% (254,212) Percentage of adults diagnosed with high blood pressure who reported actions known to improve blood pressure control: Reducing dietary salt: 76.4% Making overall dietary changes: 73.7% Increasing physical activity: 76.8% Abstaining from alcohol*: 34.7% Avoiding tobacco**: 49.0% Taking prescribed medication(s): 78.2% UPSTATE NEW YORK Adult high blood pressure prevalence (number affected): 31.4% (1.2 million) Percentage of adults diagnosed with high blood pressure who reported actions known to improve blood pressure control: Reducing dietary salt: 76.3% Making overall dietary changes: 70.8% Increasing physical activity: 72.1% Abstaining from alcohol*: 39.6% Avoiding tobacco**: 46.0% Taking prescribed medication(s): 81.3% 2 WESTERN NEW YORK Adult high blood pressure prevalence (number affected): 34.7% (415,880) Percentage of adults diagnosed with high blood pressure who reported actions known to improve blood pressure control: Reducing dietary salt: 76.0% Making overall dietary changes: 72.9% Increasing physical activity: 66.2% Abstaining from alcohol*: 34.7% Avoiding tobacco**: 46.8% 3 Taking prescribed medication(s): 80.2% *Reported no current alcohol use. **Reported neither current nor former smoking as defined on page 30. Sources: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, U.S. Census Bureau. Population Estimates, Annual Estimates of the Resident Population for Counties: April 1, 2000 July 1, Dec Web. 16 April

5 High blood pressure (also known as hypertension) affects an estimated one of every three adults in the U.S., making it our nation s most common chronic health condition. It is called the silent killer because one in five people who has the condition is unaware of it. Adults who have normal blood pressure at age 50 still have a 90 percent chance of developing high blood pressure during their lifetimes. About 30 percent of U.S. adults have prehypertension, a condition in which blood pressure is above normal but not high enough to warrant a diagnosis of high blood pressure. If not controlled, high blood pressure can be deadly, because it increases the risk of heart disease, heart attack, heart failure, stroke and kidney disease. By contributing to heart disease and stroke, high blood pressure is a factor in an estimated 800,000 deaths among Americans each year. In 2008, it was either the main or an underlying cause of 350,000 U.S. fatalities. Among people ages 40 through 89, every 20 mm Hg increase in systolic pressure or 10 mm Hg increase in diastolic pressure doubles the risk of dying from heart disease or stroke, which are among the leading causes of death in the U.S. Each additional risk factor such as high cholesterol, smoking, obesity and diabetes compounds the risk of cardiovascular disease in individuals who have high blood pressure. The projected impact of reducing high blood pressure includes a 50 percent reduction in heart failure, a 35 percent to 45 percent reduction in stroke and a 25,000 decline in the number of new cases of kidney failure each year in the U.S. Yet, the Centers for Disease Control and Prevention estimates that just 50 percent of those with diagnosed high blood pressure have the condition under control. Lifestyle choices profoundly affect the risk of high blood pressure and whether the condition can be controlled when diagnosed. Maintaining a healthy body weight; consuming a low-salt, potassium rich, balanced diet; regularly engaging in physical activity; moderating alcohol use; and avoiding smoking are key to minimizing the risk of high blood pressure and related health problems. 3

6 What is blood pressure and what is too high? Blood pressure is the force exerted against the blood vessels (arteries) as the heart pumps blood throughout the body. When this force is higher than normal, over time it can damage the arteries. Because high blood pressure usually has no symptoms, getting regular blood pressure checks is critical to good health maintenance. A blood pressure check is quick and painless, involving a cuff that is wrapped around the patient s upper arm. While an air pump tightens and then releases the cuff, an attached meter displays the two numbers that make up the blood pressure reading: The first, often called the top number (systolic pressure) measures the force against the artery walls as the heart contracts to force blood through the body. For people ages 50 and older, this number is considered to be the more important determinant of cardiovascular disease risk and is more difficult to control if it is high. The second, or bottom number (diastolic pressure) measures the force against the arteries when the heart relaxes between beats. Blood pressure is written as the systolic number over the diastolic number, such as 120/80 mm Hg. As shown in the table below, high blood pressure is defined as systolic pressure of 140 mm Hg or higher, or diastolic pressure of 90 mm Hg or higher. Because blood pressure normally varies from day to day and throughout any given day, and many factors can affect a single reading, a health care provider will often diagnose high blood pressure based on an average of two or more readings taken during separate visits. The need for multiple measurements to diagnose high blood pressure further highlights the importance of regular blood pressure checks. Classification of blood pressure in adults (mm Hg)* Classification Systolic blood pressure Diastolic blood pressure Normal <120 and <80 Prehypertension or Stage 1 Hypertension or Stage 2 Hypertension 160 or 100 Source: U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Aug. 2004, page 12. Web. 11 April *Ranges apply to most healthy adults (ages 18 and older) who do not have diabetes or kidney disease. The table shows that blood pressure classification considers both systolic and diastolic measures. For example, a normal classification requires that systolic pressure be 120 mm Hg or lower and diastolic pressure be 80 mm Hg or lower. Alternatively, stage 1 hypertension can indicate that systolic pressure is in the range of 140 mm Hg to 159 mm Hg or diastolic pressure is in the range of 90 mm Hg to 99 mm Hg. Recently, the association between cardiovascular risk and blood pressure levels previously considered normal led to the classification, prehypertension, defined as systolic pressure in the range of 120 mm Hg to 139 mm Hg, or diastolic pressure in the range of 80 mm Hg to 89 mm Hg. This new category allows those at higher-than-average risk for high blood pressure to be identified, enabling them to make lifestyle changes that could delay or prevent the condition. 4

7 Why high blood pressure is so dangerous When not controlled, high blood pressure can cause serious long-term health problems because: The heart continuously works too hard, exerting damaging force against the arteries. Over time, the arteries overstretch, weaken and scar. The weakened arteries that result from high blood pressure are vulnerable to: Rupturing, leading to a stroke or other potentially fatal bleeding. Narrowing, because scarred areas are vulnerable to plaque buildup. Narrowed arteries can no longer supply enough of the oxygen-rich blood that tissues and organs need to function normally. For example, when blood flow to the kidneys is reduced, chronic kidney disease can result and progress to kidney failure. Forming clots that further restrict blood flow and can become life-threatening if they break free from one artery and block another that may supply the brain (leading to a stroke) or heart (leading to a heart attack). The overworked heart muscle becomes damage-prone, resulting in the loss of function (pumping action) known as heart failure. The higher blood pressure is, the greater are the risks for one or more related, life-threatening conditions: heart attack, heart failure, stroke and kidney disease. 5

8 Baseline risk for high blood pressure High blood pressure can strike individuals for unknown reasons, but certain factors increase a person s risk. Some of them can t be modified, including: A family history of high blood pressure. High blood pressure tends to run in families. Having a close blood relative, such as a parent or sibling who developed high blood pressure before age 60, doubles a person s risk for the condition. Non-Hispanic black race/ethnicity. Compared to other racial/ethnic groups, non-hispanic blacks, especially women, are more prone to high blood pressure, tend to develop it at an earlier age and with greater severity and are more likely to die prematurely from related health problems. Being 65 or older and female. The rate of high blood pressure increases with age for men and women, to the point where more than half of people who are between the ages of 55 and 64 are affected. Although men are at higher risk than women are prior to age 55, at older ages, a higher percentage of women than men have high blood pressure. In addition, some medical conditions, such as thyroid disease and diabetes, can increase blood pressure. Medications, such as those used to treat asthma, also can raise blood pressure. Recognizing that blood pressure control is central to cardiovascular health, the Healthy People 2010 initiative set a national objective to reduce the proportion of adults who have high blood pressure to 14 percent. 6

9 Proactive blood pressure management To prevent and control high blood pressure, The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and other professional organizations recommend: 1. Maintaining a healthy body weight. 2. Adopting a potassium-rich diet that is low in sodium, fat and sugar. 3. Regularly participating in aerobic physical activity. 4. Moderating alcohol consumption (to no more than two drinks per day for men and no more than one drink per day for women). 5. Not smoking or if you do, making and beginning a plan to quit for good. 6. Using prescribed blood pressure control medication(s) as advised by your health care provider. The remainder of this report describes the extent to which upstate New York adults (ages 18 and older) who have been diagnosed with high blood pressure are taking the steps outlined above to manage the condition proactively. These behaviors were self-reported as part of an annual survey administered by state health departments nationwide in collaboration with the Centers for Disease Control and Prevention. Appendix 2 provides additional details about data sources. Although age, gender, family and racial/ethnic background play a role, everyday decisions about diet and lifestyle greatly influence the risk of developing high blood pressure. In someone already diagnosed with high blood pressure, these personal health decisions also will determine how well the condition can be controlled to minimize the risk of it leading to serious, potentially life-threatening health problems. 7

10 1. Maintaining a healthy body weight Obesity, now widely viewed as a national epidemic affecting more than a third of U.S. adults, is a major contributor to a host of serious chronic conditions, including type 2 diabetes, cardiovascular disease, arthritis and certain cancers. Obesity also is a strong risk factor for high blood pressure, regardless of age, smoking status, alcohol use and sodium intake. Conversely, even a 10-pound weight loss can reduce blood pressure. To maintain health, the body requires the heart to circulate oxygen and nutrients through the blood. Obesity increases the heart s workload, because higher blood volume must be circulated through a greater number of blood vessels to supply excess fat tissue. This additional exertion puts extra pressure on artery walls, contributing to high blood pressure. Body mass index is one commonly used indicator of whether your weight is within a healthy range. It is calculated by dividing your weight in kilograms by your height in meters squared. A body mass index in the range of 18.5 kg/m 2 to 24.9 kg/m 2 is considered ideal. A body mass index ranging from 25 kg/m 2 to 29.9 kg/m 2 indicates overweight and a body mass index of 30 kg/m 2 or more indicates obesity. Although body mass index is the most common measure of weight status, it is not the only one. Waist circumference (measured at the iliac crest or most prominent curvature at the front of the pelvis) is another useful gauge of body weight. One advantage of this measure is that it specifically considers abdominal fat, which is linked to higher cardiovascular risk, compared to fat distributed elsewhere in the body. It also is relatively easy to self-measure and track. A healthy waist circumference is defined as 34 inches or smaller for women and 39 inches or smaller for men. Obesity is the single most important predictor of high blood pressure, accounting for 78 percent of cases among men and 64 percent among women. 8

11 Distribution of reported body mass index classifications among adults diagnosed with high blood pressure: Upstate New York, New York state and the United States, compared to Healthy People 2010 objectives Central New York Finger Lakes Southern Tier Utica/Rome/North Country Western New York Upstate New York New York State United States 16.4% 36.0% 44.2% 3.5% 17.9% 32.5% 46.4% 3.1% 22.2% 40.6% 34.9% 2.4% 17.2% 38.9% 41.5% 2.4% 23.7% 35.4% 37.6% 3.3% 19.8% 36.0% 41.2% 3.1% 22.3% 37.9% 36.4% 3.3% 21.0% 35.4% 39.0% 4.6% Healthy People 2010 objective* 35.5% 33.9% 30.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Neither overweight nor obese Overweight Obese Refused/missing Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, *Because it was not explicitly stated, the objective for overweight was inferred by subtracting the sum of the healthy weight and obesity objectives from 100 percent. The Healthy People 2010 objectives include increasing the proportion of adults who are at a healthy weight to 35.5 percent and reducing the percentage of adults who are obese to 30.6 percent. Among upstate New York adults reportedly diagnosed with high blood pressure: About one in five (19.8 percent) reported being at an ideal weight (neither overweight nor obese). The percentage reporting ideal body weight ranged from 16.4 percent in Central New York to 23.7 percent in Western New York percent reported being overweight (having a body mass index of 25 kg/m 2 to 29.9 kg/m 2 ), and 41.2 percent reported being obese (having a body mass index of 30 kg/m 2 or higher). The percentage who reported being overweight ranged from 32.5 percent in the Finger Lakes to 40.6 percent in the Southern Tier. Obesity rates ranged from 34.9 percent in the Southern Tier to 46.4 percent in the Finger Lakes. 9

12 Roots of the American obesity epidemic In recent decades, lifestyle shifts in the U.S. have contributed to a surge in obesity rates. Americans: Consume more calories (averaging about 240 more calories per day, compared to 40 years ago) and a preponderance of low-nutrient foods that undermine overall diet quality. This pattern involves consuming: Large portions of food notoriously high in fat, sodium and calories served at restaurants and fast food chains. This style of eating often is imitated at home. More sugar from refined foods and non-diet soft drinks. Lower amounts of nutrient-rich, whole grains and fresh produce, which have become more expensive than high-fat, low-nutrient, convenience foods. Have become increasingly sedentary. At home and at work, screen time with televisions, computers and other electronic gadgets increases obesity risk. Older children and adolescents spend an average of 7.5 hours with media each day. A twohour-per-day increase in television viewing alone has been associated with a 23 percent rise in obesity. Many underestimate the amount of physical activity needed to stay healthy, and most do not meet national recommendations for adequate exercise. The environment does not support a routine of healthy physical activity. Suburban sprawl, which discourages walking, and homes and offices designed to minimize physical exertion have become the norms. Resort to weight loss fads instead of adhering to proven fundamentals. Healthy weight maintenance requires long-term commitments to healthier eating and regular physical activity, yet: By some estimates, about half of Americans who are trying to lose weight do not exercise. Weight loss products and services represent a $50 billion per year industry despite their ineffectiveness long-term. Addressing obesity in the outpatient health care setting Physicians and other health care providers have a unique opportunity to counsel patients who are at risk for developing high blood pressure and other obesityrelated health problems. They face numerous obstacles, including: Time constraints. Physician counseling is most effective when it includes a specific plan or prescription for the patient to follow, and the patient perceives a strong, ongoing partnership with the provider. Pessimism about succeeding in long-term weight loss. The social stigma about discussing the need for weight loss. Limited training in effective strategies for counseling patients. Yet, advice from a health professional (especially a doctor) to lose weight can be powerful. Research has shown that 80 percent of patients so advised make a serious weight loss attempt, and that their chances of success increase three- to fourfold, compared to those who receive no intervention. 10

13 Guidelines for healthy weight maintenance The National Institutes of Health has set simple guidelines for long-term maintenance of a healthy body weight: Combine modest calorie reduction and incremental dietary changes with physical activity. Emphasize long-term weight management rather than extreme measures. A reasonable goal is to lose between a half-pound and 2 pounds per week. Consider intensive diet and exercise counseling, including behavioral interventions that support developing new skills and staying motivated. Stay physically active and integrate physical activity into your daily routine. It is at least as important as diet in maintaining a healthy weight. Consume a diet that includes a variety of healthy foods in appropriate portions. Dietary Guidelines for Americans (see Take Charge resources below) is a useful reference. Ultimately, maintaining a healthy weight requires making a total lifestyle change that includes committing to healthy choices each day. TakeCharge resources: National Heart Lung and Blood Institute. Successful Weight Loss: Evidence-Based Obesity Resources. National Institute of Diabetes and Digestive and Kidney Diseases. Weight-control Information Network. United States Department of Agriculture. ChooseMyPlate.gov. Health.gov. Dietary Guidelines for Americans. The Partnership for a Healthier America. Let s Move! America s Move to Raise a Healthier Generation of Kids. United States Department of Veterans Affairs, National Center for Health Promotion & Disease Prevention. MOVE! Weight Management Program. FamilyDoctor.org, American Academy of Family Physicians. AIM to Change Food and Activity Journal. Excellus BlueCross BlueShield. Research Health Topics. Weight Management. (Access by selecting For Your Health, choosing 6,000+ Health Topics and typing Weight management in the search field.) 11

14 2. Adopting a potassium-rich diet that is low in sodium, fat and sugar A healthy eating plan can reduce your chances of developing high blood pressure and lower your blood pressure if it is already high. A diet that is nutritious and balanced is central to weight management, especially when high blood pressure and obesity co-occur. About 90 percent of Americans consume more sodium than recommended. The Institute of Medicine advises limiting daily sodium intake to about one teaspoon of salt (2,300 milligrams), but the average American consumes about 3,400 milligrams daily. High levels of dietary sodium raise blood pressure by blocking nitric oxide, a substance that relaxes the arteries, causing the arteries to stiffen. Processed and restaurant food, especially fast food, account for about 75 percent of sodium consumption. Limiting sodium can be tricky: Some seemingly healthy foods are high in sodium (see Appendix 3 for estimates of the sodium content of some common foods). The most widely used packaged food preservatives contain sodium. The abundance of sodium in processed and packaged food cannot be removed. Sodium is often hidden in unsuspecting, common foods, including bread and store-bought chicken. To limit your sodium intake: Seek low-sodium alternatives from your grocer and in restaurants. Ask how food is prepared when eating out and choose places with made-to-order options. Avoid fast food. Eat a diet high in fresh fruits and vegetables (instead of canned varieties). Limit processed food. Restrict condiments or use low-sodium alternatives, such as balsamic vinegar or lemon juice. Judge low- or no-sodium options by reading nutrition labels. Lose the saltshaker and use spices and herbs to add flavor and variety to your diet. 12

15 The Dietary Approaches to Stop Hypertension (DASH) eating plan The Dietary Approaches to Stop Hypertension (DASH) eating plan is commonly recommended for those who are at risk for or already have high blood pressure. The DASH plan is: Low in saturated fat, total fat and cholesterol, and limited in sugar and refined meat. High in potassium, which relaxes the arteries, thereby lowering blood pressure. A sample DASH eating plan based on a 2,000-calorieper-day diet is shown in Appendix 4. High in fruits, vegetables, whole grains, low-fat dairy products, poultry, fish and nuts. 13

16 Percentage of adults diagnosed with high blood pressure who reported making dietary changes for blood pressure control: Upstate New York, New York state and the United States Central New York 65.0% Finger Lakes 73.7% Southern Tier 76.3% Utica/Rome/North Country 68.0% Western New York 72.9% Upstate New York 70.8% New York State 74.1% United States 71.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, The majority of adults across the state and nation who reported having been diagnosed with high blood pressure also said that they were making dietary changes for better blood pressure control, including: About 71 percent of upstate New Yorkers percent of New York state residents percent of Americans. In upstate New York, the percentage of adults who reported making dietary changes to control blood pressure ranged from 65.0 percent in Central New York to 76.3 percent in the Southern Tier. 14

17 Percentage of adults who reported making dietary changes according to whether a health professional had advised them to do so: Upstate New York, New York state and the United States Upstate New York 75.7% 24.3% New York State 80.2% 19.8% United States 75.1% 24.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Had received a health professional s advice Had not received a health professional s advice Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, The positive impact of having received a health professional s advice to make dietary changes was clear and consistent across geographical areas. Among the 70.8 percent of upstate New York adults diagnosed with high blood pressure who reported making dietary changes for blood pressure control, about three in four (75.7 percent) had received a health professional s advice to make these changes. 15

18 Percentage of adults diagnosed with high blood pressure who reported reducing salt intake for blood pressure control: Upstate New York, New York state and the United States Central New York 69.0% Finger Lakes 76.4% Southern Tier 83.3% Utica/Rome/North Country 81.5% Western New York 76.0% Upstate New York 76.3% New York State 75.1% United States 76.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sources: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, More than three in four upstate New York adults diagnosed with high blood pressure reported that they were reducing dietary salt to control their blood pressure (76.3 percent), comparable to statewide (75.1 percent) and national (76.9 percent) figures. This percentage varied across upstate New York, from 69.0 percent in Central New York to 83.3 percent in the Southern Tier. 16

19 Percentage of adults who reported reducing dietary salt according to whether a health professional had advised them to do so: Upstate New York, New York state and the United States Upstate New York 77.9% 22.1% New York State 82.9% 17.1% United States 76.0% 24.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Had received a health professional s advice Had not received a health professional s advice Sources: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, For upstate New York residents who reported having been diagnosed with high blood pressure, receiving a health professional s advice to reduce dietary salt corresponded with taking action. Among the 76.3 percent of upstate New York adults diagnosed with high blood pressure who reported reducing their salt intake, almost four in five (77.9 percent) had received advice to do so from a health professional. 17

20 Take-charge resources: University of Wisconsin Hospitals and Clinics Authority. Heart Health: The DASH diet - Dietary Approaches to Stop Hypertension. National Heart Lung and Blood Institute. Your Guide to Lowering Your Blood Pressure with DASH. Choosemyplate.gov, United States Department of Agriculture. 10 Tips Nutrition Education Series. Salt and sodium - 10 tips to help you cut back. Excellus BlueCross BlueShield. Research Health Topics. Sodium and High Blood Pressure: Topic Overview. (Access by selecting For Your Health, choosing 6,000+ Health Topics and finding Sodium and High Blood Pressure in the alphabetical index.) American Heart Association, Getting Healthy Nutrition Center. Sodium (Salt or Sodium Chloride). National Heart, Lung and Blood Institute. Your Guide to Lowering High Blood Pressure: Reduce Salt and Sodium in Your Diet. Centers for Disease Control and Prevention. Salt. Most Americans Should Consume Less Sodium. National Kidney Foundation. Sodium and Your CKD Diet: How to Spice Up Your Cooking. WebMD. Salt Shockers Slideshow: High-Sodium Surprises. Excellus BlueCross BlueShield. Research Health Topics. High Blood Pressure: Using the DASH Diet. (Access by selecting For Your Health, choosing 6,000+ Health Topics and typing High blood pressure in the search field.) 18

21 3. Regularly participating in aerobic physical activity While consuming a high-quality diet is important to staying healthy, physical activity (called exercise when planned and structured) is one of the best ways to strengthen and keep your heart and lungs healthy. Physical activity: Counters high blood pressure by strengthening the heart and widening capillaries (tiny blood vessels that deliver blood to the tissues), both of which improve circulation. Contributes to maintaining a healthy weight, helps your body manage insulin (lowering diabetes risk) and may provide motivation to quit smoking. Includes everyday activities, such as walking. Participating in even modest physical activity is better than not participating at all. According to current U.S. Department of Health and Human Services guidelines, in addition to muscle strengthening activities on at least two days per week, adults should engage in: A minimum of 2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (such as brisk walking, ballroom dancing or gardening) per week. OR A minimum of 1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic physical activity (such as jogging, aerobic dancing and jumping rope) per week. OR A combination of moderate- and vigorous-intensity aerobic activity that is equivalent to at least one of the two levels recommended above. Always consult with your health care provider about the types and levels of physical activity appropriate for your circumstances, especially if you have or are at risk for a a chronic disease. 19

22 Percentage of adults diagnosed with high blood pressure who reported increasing physical activity for blood pressure control: Upstate New York, New York state and the United States Central New York 71.8% Finger Lakes 76.8% Southern Tier 73.7% Utica/Rome/North Country 77.0% Western New York 66.2% Upstate New York 72.1% New York State 71.1% United States 71.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, One-third of upstate New York adults diagnosed with high blood pressure reported not having participated in any leisure-time physical activity (outside of their regular jobs) during the previous 30 days (data not shown). Just 12 percent of upstate New York adults diagnosed with high blood pressure met Healthy People 2010 objectives for moderate (at least five days per week for at least 30 minutes per occasion) and vigorous (at least three days per week for a minimum of 20 minutes per occasion) physical activity (data not shown). About 72 percent of upstate New York adults who reported having been diagnosed with high blood pressure said that they were exercising to reduce their blood pressure, similar to statewide (71.1 percent) and national (71.6 percent) percentages. The percentage of upstate New York adults reportedly diagnosed with high blood pressure who said that they were exercising to improve blood pressure control ranged from 66.2 percent in Western New York to 77.0 percent in Utica/Rome/North Country. 20

23 Percentage of adults who reported increasing physical activity according to whether a health professional had advised them to do so: Upstate New York, New York state and the United States Upstate New York 80.2% 19.8% New York State 84.2% 15.8% United States 81.9% 18.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Had received a health professional s advice Had not received a health professional s advice Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, The positive role of a health professional s advice also was evident among the 72.1 percent of upstate New York adults who reported having been diagnosed with high blood pressure and increasing their physical activity levels for blood pressure control. Among them, 80.2 percent reported having received advice from a health professional to increase physical activity. 21

24 Percentage of adults diagnosed with high blood pressure who reported increasing physical activity, making dietary changes or doing both to lower their blood pressure: Upstate New York, New York state and the United States 77.6% Upstate New York 57.8% 21.8% 75.0% New York State 58.0% 24.2% 75.4% United States 51.3% 24.3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Changing eating habits and increasing physical activity to lower blood pressure Increasing physical activity to lower blood pressure (not changing eating habits) Changing eating habits to lower blood pressure (not increasing physical activity) Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Long-term high blood pressure management depends on the combined effects of eating a nutritious, well-balanced diet and getting sufficient physical activity. Emphasizing one behavior over the other usually proves inadequate. About three-quarters of New York state and U.S. adults diagnosed with high blood pressure reported exercising and making dietary changes for blood pressure control, as did an even higher percentage of their counterparts in upstate New York (77.6 percent). Almost three of five adults diagnosed with high blood pressure in upstate New York and statewide (57.8 percent and 58.0 percent, respectively) reported increasing exercise for blood pressure control but not making dietary changes. Of American and New York state adults diagnosed with high blood pressure, about one-quarter reported changing their diets but not exercising to reduce blood pressure. A lower proportion of their upstate New York counterparts (21.8 percent) reported relying on a diet-only approach to blood pressure control. 22

25 Take-charge resources: American Heart Association. Physical Activity and Blood Pressure. Centers for Disease Control and Prevention. Physical Activity for Everyone: How much physical activity do adults need? Excellus BlueCross BlueShield. Research Health Topics. Fitness: Adding More Activity to Your Life. (Access by selecting For Your Health, choosing 6,000+ Health Topics and typing Fitness in the search field.) Excellus BlueCross BlueShield. StepUp: Your guide to being active, eating right and staying healthy every day. National Heart Lung and Blood Institute. Getting Started and Staying Active. National Heart Lung and Blood Institute. Your Guide to Physical Activity and Your Heart. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans. WebMD. Lowering Blood Pressure Slideshow: Exercise Tips for Getting Started. 23

26 4. Moderating alcohol consumption Although light to moderate alcohol consumption likely has positive cardiovascular health effects, heavy drinking increases the risk of developing high blood pressure. Heavy drinking is defined as more than two drinks per day for a man or more than one drink per day for a woman. One drink is equal to 12 ounces of beer, five ounces of wine or 1.5 ounces of 80-proof liquor. How excessive alcohol use contributes to high blood pressure is not completely understood. Alcohol is known to increase the amount of fluid and salt retained by the body, overburdening the heart and circulatory system. Alcohol is an appetite stimulant that is high in calories and low in nutrients. Therefore, it contributes to weight gain, which independently contributes to high blood pressure. If you take blood pressure control medication, alcohol can interfere with its effectiveness. Heavy drinkers who cut back to moderate drinking can reduce their systolic pressure by 2 to 4 mm Hg and their diastolic pressure by 1 to 2 mm Hg. 24

27 Percentage of adults diagnosed with high blood pressure who reported heavy* or binge** drinking during the 30 days prior to the survey: Upstate New York, New York state and the United States Central New York Finger Lakes Southern Tier 6.8% 5.1% 9.1% 2.6% 8.4% 12.2% Utica/Rome/North Country Western New York Upstate New York New York State United States 4.8% 3.2% 4.5% 3.4% 4.8% 10.0% 10.1% 10.1% 9.2% 10.9% 0% 10% 20% 30% 40% 50% Heavy drinking Binge drinking Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, *Heavy drinking is defined as a man averaging more than two drinks per day or a woman averaging more than one drink per day. **Binge drinking is defined as a man having at least five drinks on a single occasion or a woman having at least four drinks on a single occasion. Despite having been diagnosed with high blood pressure, 10.1 percent of upstate New York adults reported having had at least one binge drinking episode during the previous 30 days, as did 9.2 percent of their New York state and about 11.0 percent of their U.S. counterparts. Heavy drinking within the previous 30 days, far less common than binge drinking, was reported by 4.5 percent of upstate New York adults diagnosed with high blood pressure, 3.4 percent of those statewide and 4.8 percent of those nationally. 25

28 Percentage of adults diagnosed with high blood pressure who reported decreasing alcohol use to control their blood pressure: Upstate New York, New York state and the United States Upstate New York 59.4% New York State 62.0% United States 60.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Across the state and nation, about three in five adults diagnosed with high blood pressure reported having cut back on their alcohol consumption to lower their blood pressure. 26

29 Percentage of adults who reported moderating alcohol consumption according to whether a health professional had advised them to do so: Upstate New York, New York state and the United States Upstate New York 51.5% 48.5% New York State 59.3% 40.7% United States 54.1% 45.9% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Had received a health professional s advice Had not received a health professional s advice Compared to its impact on other behavioral changes for blood pressure control, advice from a health professional to moderate alcohol use had a weaker influence. This was especially evident among upstate New York adults diagnosed with high blood pressure, compared to those across the state and nation. Among the 59.4 percent of upstate New York adults diagnosed with high blood pressure who reported moderating their alcohol consumption, only about half (51.5 percent) said that a health professional had advised them to do so. 27

30 If your alcohol use is of concern, making small behavioral changes can have substantial positive health effects. The National Institute on Alcohol Abuse and Alcoholism offers advice for cutting back to improve your health: Keep track of your drinking in a way that works for you, and measure it according to standard alcohol units. Set goals within established, low-risk limits for how often and how much you drink. Do not consume more than one drink per hour, alternate alcoholic beverages with nonalcoholic drinks and always consume food when drinking alcohol. Develop alternative behaviors and activities, such as exercise, new hobbies and social activities, that do not involve alcohol. Be very familiar with what triggers your urge to drink. Avoid what triggers you and develop a plan for managing cravings in a healthy way. New behaviors take time to establish, so allow for that. If after trying various approaches such as these, you are unable to moderate your alcohol use, it may be time to seek help. If your alcohol use is of concern to someone close to you or has a destructive impact on your health, your abilities to meet work and family responsibilities, or your social functioning, consult your doctor about possible treatment options. Take-charge resources: Healthfinder.gov, U.S. Department of Health and Human Services. Quick Guide to Healthy Living - Drink Alcohol Only in Moderation. National Institute on Alcohol Abuse and Alcoholism. National Institute on Alcohol Abuse and Alcoholism. Rethinking Drinking Alcohol and your health Tips to Try. Mayo Clinic. High Blood Pressure (Hypertension) - Alcohol: Does it affect blood pressure? Centers for Disease Control and Prevention. Alcohol and Public Health - Frequently Asked Questions. WebMD. Quiz: Alcohol Myths and Facts. Health Videos, Health.unece.net. Excessive Drinking and High Blood Pressure. 28

31 5. Not smoking or if you do, making and beginning a plan to quit Smoking continues to be the leading cause of preventable death in the U.S. It contributes to high blood pressure by: Narrowing the blood vessels, restricting blood flow. Blood pressure rises, because the heart must work harder to supply the body with enough oxygen. Directly damaging the blood vessel linings, making them prone to the plaque accumulation and inflammation that contribute to high blood pressure. Increasing the heart rate through exposure to nicotine, further promoting clot formation in the arteries and overworking the heart muscle. Exposing the body to carbon monoxide, a toxin that displaces oxygen from blood cells. Lower blood oxygen puts extra workload on the heart, increasing blood pressure. 29

32 Distribution of smoking status* among adults diagnosed with high blood pressure: Upstate New York, New York state and the United States, compared to Healthy People 2010 objective Central New York Finger Lakes Southern Tier Utica/Rome/North Country Western New York Upstate New York New York State United States 17.7% 34.6% 47.2% 16.4% 34.7% 49.0% 24.3% 34.4% 41.3% 15.9% 42.2% 41.6% 16.0% 36.7% 46.8% 17.3% 36.5% 46.0% 16.3% 35.1% 48.2% 17.1% 32.9% 49.0% Healthy People 2010 objective* 12.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Current Former Never Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, *Current smoking is defined as lifetime consumption of 100 or more cigarettes among respondents who report currently smoking every day or on some days. Former smoking is defined as lifetime consumption of 100 or more cigarettes among respondents who report no current smoking. Among adults diagnosed with high blood pressure, 46.0 percent in upstate New York, 48.2 percent statewide and 49.0 percent nationally had never met the criteria to be classified as smokers.* The current smoking rate reported by upstate New York adults diagnosed with high blood pressure (17.3 percent) was similar to that statewide (16.3 percent) and nationwide (17.1 percent), and each of these rates was above the Healthy People 2010 objective of 12.0 percent. Smoking rates among those diagnosed with high blood pressure ranged from about 16 percent in Western New York, Utica/Rome/North Country and the Finger Lakes to 24.3 percent in the Southern Tier. 30

33 The good news is that much of the damage related to smoking can be stopped or even reversed by quitting, no matter how old you are, or for how long you have smoked. If you are a smoker, quitting is the most important action you can take to live a longer, healthier life. While it is difficult to determine which strategy for quitting will work for you, the American Cancer Society offers general guidelines to maximize success: Recognize that nicotine s addictive potential is likened to that of heroin. The physical and mental aspects of the addiction must be dealt with. Consider the many health benefits of quitting, focusing on the ones that clearly outweigh any reasons for you to continue smoking. Know why you are planning to quit. Those who conquer tobacco addiction long-term address its physical and psychological aspects and use: Some combination of short-term medications to deal with physical withdrawal. Social and behavioral counseling supports to address the psychological components and gain the tools needed for long-term behavioral change. Take-charge resources: American Cancer Society. Stay Healthy: Healthy living information to help you stay well - Guide to Quitting Smoking. American Lung Association. Freedom From Smoking Online. Centers for Disease Control and Prevention. Smoking & Tobacco Use - Surgeon General s Report on Smoking and Tobacco Use. Centers for Disease Control and Prevention. Smoking & Tobacco Use - How to Quit - Government Resources. Excellus BlueCross BlueShield. Quit for Life. Smokefree.gov. Quit Smoking TODAY! We can help. New York State Department of Health. New York State Smokers Quitline. WebMD. Slideshow: 13 Best Quit-Smoking Tips Ever. For additional information on smoking in upstate New York, see Excellus BlueCross BlueShield s report: The Facts About Cigarette Smoking Trends Among Upstate New York Adults. 31

34 Summary: Estimated impact of personal actions to control blood pressure* Modification Recommendation Approximate Systolic Blood Pressure Reduction (Range) Weight reduction Adopt DASH (Dietary Approaches to Stop Hypertension) eating plan Dietary sodium reduction Physical activity Moderation of alcohol consumption Maintain normal body weight (body mass index range of kg/m 2 ). Consume a diet rich in fruits, vegetables, and low-fat dairy products with a reduced content of saturated and total fat. Reduce dietary salt intake to no more than about a teaspoon per day. Engage in regular aerobic physical activity, such as brisk walking (at least 30 minutes per day, most days of the week). Limit consumption to no more than 2 drinks (e.g., 24 oz. beer, 10 oz. wine, or 3 oz. 80-proof whiskey) per day in most men, and to no more than 1 drink per day in women and lighter weight persons mm Hg 8 14 mm Hg 2 8 mm Hg 4 9 mm Hg 2 4 mm Hg Source: U.S. Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute, National High Blood Pressure Education Program. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Aug. 2004, page 26. Web. 11 April * For overall cardiovascular risk reduction, avoid smoking. The effects of implementing these modifications are dose and time dependent and could be greater for some individuals. 32

35 6. Using prescribed blood pressure control medication(s) as advised by your health care provider Medication is recommended for about 70 percent of Americans diagnosed with high blood pressure, but it is intended to be complementary to and not a substitute for the lifestyle recommendations described in this report. If you remain proactive in lifestyle management of your blood pressure, your need for medication will likely be reduced or altogether eliminated. For most people whose high blood pressure is not complicated by other serious health conditions, medications known as thiazide diuretics are usually recommended. Medication advice suggested by your health care provider will vary, depending on how high your blood pressure is, any risks associated with your personal health and family history, and whether you have certain health conditions, such as diabetes or kidney disease. More than one type of drug may be needed to achieve adequate blood pressure control. Maximizing the effectiveness of medication therapy is an ongoing process that requires a partnership and open communication with your provider, frequent monitoring for effectiveness and side effects and persistence in following your regimen. Types of blood pressure control medications Drug categories Diuretics Beta-blockers Angiotensin converting enzyme (ACE) inhibitors Angiotensin antagonists Calcium channel blockers Alpha-blockers Alpha-beta-blockers Nervous system inhibitors Vasodilators How they work Act on the kidneys to flush excess water and sodium from the body. Reduce nerve impulses to the heart and blood vessels so that the heart beats more slowly and with less force. As the workload on the heart is reduced, blood pressure decreases. Block formation of angiotensin II, which narrows the blood vessels. Blood pressure decreases as the blood vessels relax. Block the action of angiotensin II on the blood vessels, thereby having an effect similar to ACE inhibitors. Cause the heart and blood vessels to relax by blocking the entry of calcium. Reduce nerve impulses to the blood vessels, allowing for easier blood flow. Work similarly to alpha-blockers but with the addition of the beta-blocker mechanism of slowing the heart rate. Relax blood vessels by controlling nerve impulses. Act directly on the vessel walls to relax and widen them. Source: U.S. Department of Health and Human Services, National Heart Lung and Blood Institute. Your Guide to Lowering Blood Pressure Types of Blood Pressure Medications. Web. 27 April

36 Percentage of adults diagnosed with high blood pressure who reported taking prescription medication for blood pressure control: Upstate New York, New York state and the United States, compared to Healthy People 2010 objective Central New York 82.8% Finger Lakes 78.2% Southern Tier 81.8% Utica/Rome/North Country 85.9% Western New York 80.2% Upstate New York 81.3% New York State United States 78.0% 78.0% Healthy People 2010 objective 77.4% 74% 76% 78% 80% 82% 84% 86% 88% 90% Source: Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Of upstate New York adults diagnosed with high blood pressure, 81.3 percent reported being on medication for the condition, higher than the statewide and national percentages (both 78.0 percent), as well as the Healthy People 2010 objective of 77.4 percent. Although all exceeded the Healthy People objective, blood pressure medication rates varied across upstate New York regions, ranging from 78.2 percent in the Finger Lakes to 85.9 percent in Utica/Rome/North Country. 34

37 Take-charge resources: National Heart Lung and Blood Institute. Your Guide to Lowering High Blood Pressure. Types of Blood Pressure Medications. Excellus BlueCross BlueShield. Research Health Topics. High Blood Pressure: Taking Medicines Properly. (Access by selecting For Your Health, choosing 6,000+ Health Topics and finding High Blood Pressure: Taking Medicines Properly in the alphabetical index.) Medline Plus. Drugs, Supplements, and Herbal Information. National Heart Lung and Blood Institute. Your Guide to Lowering High Blood Pressure - Tips to Help You Remember to Take Your Blood Pressure Drugs. National Heart Lung and Blood Institute. Your Guide to Lowering High Blood Pressure - Questions to Ask Your Doctor if You Have High Blood Pressure. Mayo Clinic. High Blood Pressure (Hypertension) - Choosing blood pressure medications. 35