ABSTRACT
Hypertension affects about 65 million people in the United States, and its prevalence remains at 30%, which did not signi cantly change over the past 10 years (1999-2008) [1]. Based on data from the National Health and Nutrition Examination Survey (NHANES) (2003-2004), it was found that awareness about high blood pressure (BP) (i.e., a positive response to the question, “Have you ever been told by a doctor or health professional that you had hypertension, also called high blood pressure?”) was 76% and that 65% of patients were receiving treatment. However, BP control (i.e., BP levels <140 mmHg systolicand <90 mmHg diastolic) [2] was
8.1 Introduction .................................................................................................. 141 8.2 Provider-Centered Interventions ................................................................... 142
8.2.1 Technical Support ............................................................................. 143 8.2.2 Provider Reminders .......................................................................... 143 8.2.3 Decision-Support Systems ................................................................ 143 8.2.4 Communication and Clinic Organization ......................................... 146
8.3 Patient-Centered Interventions ..................................................................... 146 8.3.1 Educational Interventions ................................................................. 147 8.3.2 Behavioral Interventions ................................................................... 147
8.4 Interventions Implemented at the System Level ........................................... 148 8.5 New Developments ....................................................................................... 149 8.6 Conclusion .................................................................................................... 150 References .............................................................................................................. 152
achieved only in 37% of patients. According to more recent NHANES data [3], these gures have improved between 2007 and 2008, with 50.1% of individuals having a BP below 140/90. Interestingly, lifestyle changes are not a likely reason for the observed improvement in BP control since most patients with hypertension are still obese [4] and their dietary habits have deteriorated [5]. Despite this progress, it is evident that adequate BP control is not achieved in about half of patients with high BP, particularly in speci c age groups (less than 40 and over 60 years old) and in Hispanic patients [3].
