DOCUMENT RESUME

ED 299 229 SP 030 593

TITLE National High Blood Pressure 12-Month Kit. May1988.

INSTITUTION National Heart and Lung Inst. (DHHS/NIH), Bethesda,MD. National. High Blood Pressure EducationProgram.

PUB DATE May 88NOTE 80p.

PUB TYPE Guides - Non-Classroom Use (055)

EDRS PRICE MFOI/PC04 Plus Postage.DESCRIPTORS )(Educational Resources; Heart Rate; *Hypertension;

)(Information Sources; )(Medical Care Evaluation;Phy.ical Health; )(Preventive Medicine; Special HealthProblems

ABSTRACT

Part I of this kit provides information for programplanners and health professionals on ways to overcome barriers tohealth care among the medically underserved, promote high bloodpressure control through the media and other community channels, andimprove adherence to treatment among hypertensive patients. It listsadditional resources for information, publications and otherservices, and highlights ideas and efforts of specific communityprograms and health practitioners across the country. Part IIprovides reproducible materials suitable for distribution toprofessionals and consumers. These resources include handouts onnutrition, exercise, smoking, home blood pressure measurementdevices, and the latest data on hypertension. Materials in Spanishare included as well as items in large print for the visuallyimpaired. Part III is a combined evaluation and order form. (JD)

XXXXXXXXXXXXXXXXXXXXXXXXXXXAMMMXXXXXXXXXXXXXXXXXXXXXXXXX*XXXXXXXXXXXXXXX Reproductions supplied by EDRS are the best that can be made M

M from the original document. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXAXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

.a"

Be a Champion o Control2

NATIONALHIGH BLOODPRESSURE

12-MONTH KITMay 1988

U.S. Department ofHealth and Human Services

Public Health Service

National Institutes of Health

National Heart, Lung,and Blood Institute

National High Blood PressureEducation Program

U S DEPARTMENTOF EDUCATIONOffice or Educational

Research and ImprovementEDUCATIONALESOURCES INFORMATION

CENTER (ERIC)Th,S 00CUMeht

NIS been reproducedasre( e ve0 I/0'n the person

organ zattonorrgr,atong rtC Minor changes

have been 'bade to improveeceOduCtion qualrty

Ro,rs or view 0r cornrons stated,n thrsdocuen! Co

nonot necesSrPriy

((I/Resent officait,posilpohcy

National Institutes of Health

NATIONAL HEART, LUNG,AND BLOOD INSTITUTE

c

PLE-

TO: Participants in 1988 National High Blood Pressure Month

FROM: Claude Lenfant, M D , DirectorNational Heart, Lung, and Blood Institute

andEdward I Roccella, Ph D, MPH, CoordinatorNational High Blood Pressure Education Program

The National High Blood Pressure Education Program which is administered by the NationalHeart, Lung, and Blood Institut _ is pleased to report that stroke moitality rates have declined bymore than 50 percent since the program began in 1972 This remarkable success has been achievedbecause many organizations, including yoas, have contributed to increased awareness, treatment,and control of high blood pressure Although we have come a long way, we cannot stop now and reston our accomplishments We must continue our efforts to control high blood press e by extendingour messages to those who have yet to be serve-4 and to help those on therapy stay on theirtreatment

May National High Blood Pressure Month is the ideal time to begin a yearlong campaign tocontrol high blood pressure This year's National High Blood Pressure 12-Month Kit is specificallydesigned to assist you in planning, promoting, implementing, and evaluating your hypertensioneducation activities This year, National High Blood Pressure Month and all the year-round activitiesdescribed in the kit focus on lifelong adherence to therapy, including pharmacologic and non-pharmacologic approaches to hypertension control The kit provides information about adherence,weight loss, exercise, reducino intake of sodium, fat, and calories, and other lifestyle changes toencourage cardiovascular health The kit also stresses the importance of personal responsibility forcontro' ling high blond pressure

We encourage you to use this Nit throughout the entire year and especially in May to help Americans"Go for Their Goal" and -Be Champions of Control If we continue our ioint efforts for high bloodpressure control, we can demonstrate unprecedented changes in reducing morbidity and mortalityfrom this important public health problem

Address cot-respondence to:

National High Blood Pressure Education Program120/30 National Institutes of HealthBethesda, MD 20892

Part I

Go for Your Goal:Be a Champion of Control

Resource Materials

Part ITable of Contents

Goals and Champions

How to Use This Year's Kit

Make Every Month High Blood Pressure Month

Year-Round Activity Calendar

Build a Winning Team

Line Up Your Team

Know Your State High Blood Pressure Contacts

What's New in High Blood Pressure Control

Go for Your Goal: Reach the Medically Underserved

Community Champions

Go for Your Goal: Master the Media

Resources

6

7

8

9

10

11

12

14

17

22

23

28

5t-o

Goals and Champions

Those who enter competitionswork hard to win them They knowthat ",-Jing for the gold- onlycomes when they prepare them-selves, set goals, and then striveto make the extra effort to winAmericans with high blood pres-sure need your help solid coach-ing, expert advice, good "training"tips, and a great deal of supportto become champions of hyper-tension control Your support canmake a difference!

Nearly 58 million Americanshave elevated blood pressure Hy-pertension is a major contributorto stroke and heart disease Thegood news is that you can do some-thing about high blood pressureWhen people take control of theirlives by controlling their hyper-tension, they become champions

High blood pressure control isa team effort The team membersare Federal agencies state healthdepartments, community organi-

6

6

zations, hospital personnel, physi-cians, nurses, health educators,pharmacists, podiatrists, dentists,optometrists, and dietitians Vol-unteers such as those who helplead support groups or who ad-minister community hypertensiontracking programs are also im-portant members of the team To-gether, these teams can spreadthe word that high blood pressurecontrol can lead to healthier livesfor all Americans

This is the 14th year that theNational High Blood Pressure Ed-ucation Program (NHBPEP) has pro-duced a kit with up-to-date infor-mation and reproducible materialsconcerned with the prevention,detection, treatment, and controlof hypertension We trust this kitwill be useful and valuable to yourwork We thank you for your pastefforts and applaud your continu-ing work to champion the cause ofhigh blood pressure control

How to Use This Year's Kitt

The 1988 National High BloodPressure 12 -Month Kit encouragesteamwork among patients, healthprofessionals, and community andnational organizations in the ef-fort to detect, treat, and controlhigh biood pressure

It is designed to help you pro-mote National High Blood Pres-sure Month in May and reinforcethese health messages throughoutthe year Suggested activities, ad-ditional resources, practical tips,and reproducible materials areprovided to cupport your specialand ongoing efforts to controlhypertension

Part I of this year's kit providespractical information for programplanners and health professionalsIt suggests ways to overcome bar-riers to health care among themedically underserved, promotehigh blood pressure control throughthe media and other communitychannels, and improve adherenceto treatment among hypertensivepatients It also lists additionalresources for information, publi-cations, and other services Thisyear's kit highlights the ideas andefforts of specific community pro-grams and health practitionersacross the country

Part 2 provides reproduciblematerials suitable for distribution nto professionals and consumers

These resources include handoutson nutrition, exercise, smoking,home blood pressure measure-ment devices, and the latest dataon hypertension In response touser requests, the kit includesmaterials in Spanish as well asitems in large print for the elderlyand visually impaired By reprint-ing these materials yourself, youwill have a ready supply of mate-rials for immediate use

Part 3 is a combined evaluationand order form When placing yourorder for NHBPEP materials, takethe time to let us know how youliked this year s kit Please com-plete and return the evaluationform, even if you are not orderingadditional materials Your com-ments and suggestions can helpus to improve next year's kit

This kit has been produced toserve as an impo, tant resource inpromoting high blood pressurecontrol Use it for facts, ideas, andmaterials However, it is just a be-ginning Tailor the suggestions tomeet the needs of your communi-ty Add your own resources andinnovations Help make hyperten-sion control an attainable goal forall Americans

7

Fa.

4

onth

Throughout the year, your pro-gram can inform the public, pa-tients, employees, and health pro-fessionals about high blood pres-sure to be aware of it, to controlit, and to live longer, healthierlives

Months pass, seasons change,and the public's awareness of highblood pressure needs to be con-tinually reinforced Most remind-ers take minimal time and efforton your part Just be sure yourmessages are clear, concise, andfrequent You want people to re-member them Using the informa-tion and data in this kit can helpassure accurate and consistentmessages

A number of health campaignstake place at specific times duringthe year Try to tie in your effortswith these Thu can accomplishthis by using and expanding theMonth Chart Promotion activi,

ties you might try include provid-ing materials for community eventsand placing these materials atstrategic locations, posting signsin windows of community busi-nesses, scheduling interviews onlocal radio programs, arrangingspeakers at meetings of civic andbusiness groups, and placing ar-ticles in newsletters of local or-ganizations

Take advantage of ongoing ac-tivities within your communityParades, county fairs, picnics,malls, libraries, and sports con-tests all provide opportunities tospread the message about highblood pressure control

Start to fill in your own calendarnow!

8

Year-Round Activity Calendar

Month Theme

May

June

July

August

Go for Your Goal:Be a Champion of HighBlood Pressure Control

Make NowYour Best Time

Take Aim and Win

Train to Be a Winner

September Invest in Good Health

October Be a Health Champion

Noveinher Cast a Votefor Good Health

December Give the Gifi. of Life

January Start the Year With aHealthy Slate in 1988

February Be a Hero for Health

March

April

Make Your Life Work

A Health Plate in 1988

Team Up for Health

Tie-Ins

National High BloodPressure Month

Father's DayFlag DaySummer Begins

Fourth of July

Summertime

Grandparents DayFall Begins

Summer Olympics

Election DayVeterans DayGreat American Smokeout

Holiday SeasonWinter Begins

Martin Luther King'sBirthday

President's Day

American Red CrossMonth.

National Kidney Month

National Nutrition Month

National PhysicalEducation andSports Week

9

Activities and Promotion Ideas

Select suggested activities from theNational High Blood Pressure 12-Month Kit.

Show your family that you care bytaking care of your health

Target the hard-to- reach populationswho are at risk for high blood pres-sure.

Set up a high blood pressure exhibitin a park or at a county fair.

Provide information about high bloodpressure to the elderly.

Distribute information about adher-ence to treatment and achievingblood pressure control

Work with other organizations onsmoking cessation efforts.

Provide recipes for heart-healthyfoods that make great gifts.

Involve the community in a highblood pressure control program toreach minority populations.

Prornot' messages about health is-sues delivered by community leaders

Work with other organizations tospread the message about high bloodpressure and its relationship to kid-ney disease.

Educate the community about hearthealthy eating practices.

Encourage a program of regular walk-ing and other exercise

Build a Winning Team

Networks for hypertension con-trol exist everywhere Big citiesand small communities, urban andrural areas, all present opportuni-ties to control high blood pressure

All organizations and agenciesimolved in health promotion ac-tivities at the national, state,and local level are doing morework these days with fewer re-sources Involve seleral groups ina joint project and communicatewith other organizations to letthem know what you are doing Itcan make a difference in the visi-bility of your programs Take thelead in involving the communityin high blood pressure controlprograms

Team efforts require commit-ment from the players Before youassign, or volunteer for, a position,learn the strengths of the playerson the team For example, someorganizations maintain excellentmailing lists that they can be en-couraged to share Other agencieshave expertise in promoting andpublicizing events, and some can

provide facilities for meetings andother functions NAL:ny organiza-tions have speakers or volunteerswho can work with you on specificprotects Some organizations maybe willing to lend their names toan event The endorsement of anorganization with a good reputa-tion can be a great help to you

How can you recruit active play-ers for your team") First, define theactivity Then determiile what needsto be done When you initiallycontact organizations, agencies,and individuals, identify your goalsand objectives, and explain yourexpectations This way, each playerhas a clear understanding ol whatis to be accomplished, who will doit, and the anticipated outcome

Remember, your program maynot be the only game in townFor example, if you learn of anevent where a blood pressure mes-sage would be appropriate, callthe sponsoring organization andoffer your services or material ,This is another important way ofgetting to know the people and

10 10

services in your community andletting them know more aboutyour efforts in high blood pres-sure control

It is important not only to knowhow your community works butalso what works in your communi-ty Familiarize yourself with theleaders of organizations, agencies,associations, businesses and in-dustries, health professionals,health care settings, and mediaresources with whom you canwork Let your network know whoyou are, and express your interestin knowing more about each of theparticipants

Finally, remember that recogni-tion is crucial Always identify yourprogram as a sponsor or cospon-sor of a program or event Don'tforget tH) use your group's logo onall handouts as well as informa-tion ,ent to the media If you donot hie a logo or other visualgraphic that identifies your group,consider developing one You wantand need people to remember whoyou ire and what you do

Line Up Your Team

FederalHealth

Agencies

StateHealth

Agencies

LocalHealth

Agencies

Health Health CareProfessionals Settings

Media

Civic and Educational Business,Community Groups Industry,

Groups and Labor

Medical Voluntary Privateand Other Health Health

Professional Organizations PromotionAssociations Programs

H 11

Know Your State High Blood i Pressure ContactsMost states and territories have designated individ-

uals in their health department to serve as a contact orliaison for high blood pressure activities These peoplecan advise you of services offered by state and localhealth departments as well as other sources of assis-tance Contact the individuals listed below for adviceon planning your program, training in blood pressuremeasurement, and obtaining free education materials

AlabamaRichard AdamsDirectorHypertension BranchAlabama Department of

Public HealthState Office Building Room 754Montgomery AL 36130,2051261 -5128

Alaskalean LuciusHypertension CoordinatorSection of NursingAlaska Department of Fiealth

and Social ServicesP 0 Box Hluneau AK 9981119071 465-3150

ArizonaFrancine MartinAdministratorPreventive Health Block

Grant ProgramDivision of Diseast., Pre erif ionArizona Department of

Health Smites3008 North 3rd StreetPhoenix AZ 8501?16021230 -5809

ArkansasBeth BroylesHealth Education DepartmentArkansas Department of Health4815 West Markham StreetLittle Rock AR 72205-3867I501 661-2495

CaliforniaArthur lordanHypertension Program ManagerPreventive Health Sectii,nCalifornia Department

Health Ser\ Les714 744 P Street Room 428Sacramento CA 05814i916i 324-3989

ColoradoLinda DIPieflbilr\, R N 11s \

lane Pri'zlDivision of Prewntlk,p ProgramsColorado Department Lit Health4210 Last Ilth AvenueDenver CO d0220I3031 331-8303

ConnecticutErnelia De \1usisProgram CoordinatorOffice of Health Eclacat onState of Connecticut Department

of Health Services150 Washington StreetBuilding A 3rd rio;rHartford CT 06106(2031 566-7867

DelawareLori ChristiansenHigh Blood Pressure CoordinatorDRiston of Pupil,. HealthRobbinc Building802 Siker Lake Boulevard

and Walker ReadDoer DE 1990113021736 -4651

District of ColumbiaRobert 11 Conn Ed t)ChiefOrtice of Health Promotidn Lind

F1.pertension LontrolDC Department of HuMarlScn,1875 Connecticut \enae \WWashington DL. 2000012021 673-0738

Florida:sandrci Schocintisch " I)Nurse ConsultantDepartment of Health arid

Rehabilitative Scir\ icesChronic Disease Program! 317 Wiifoxood "iiTcflahassee Fl 3'301190 11 488-2,4.);

Georgiaepee P

Priigram ManagerStarke and Hear; rut, k

Prei.ention ProgramPea, htree and Ith 1: iom 102878 Peachtiee Street \E\ticint,i 30300

1404; 891 5301

Hawaiim,

t L_oordinatistate n Proles'PubliL HealthI idLdii state Departmen Health3627 enue R illHonolulu HI 9681618081 735-5332

12

Idaholoanni MittenHealth Education SpecialistHealth Promotion

Disease Prevention SectionIdaho Department of Health

and Welfare450 West State Street 4th FloorBoise ID 8372012081 334-59 33

IllinoisShemood ZimmermanChiefDI% ision of Chronic DiseasesIllinois Department of Public Health935 West Jefferson streetSpringtt:Id IL 62 76112171 782-3300

IndianaMar\ Marr,;t.iihronic Disease Coordin,diiirIndiana State Board of Health1330 West Michi,i,,an Street

Room 213Indianapolis IN 46206- 1904317) 633-0399

IowaLorrie I Laradt R \

arse Consultantti,pertension 1):abLites Pr igaiiBureau of Health Promotionoaa Department sit Pohl riealrh

L uca, State' Ottl,C B1111,i1,14Des Moines I \ 50310-00751515i 281 6830

KansasMar, \nriAdnunistratHealth E ii,.ati i in IP.,tBureau Lit I i,111leairl, 1, es

kanc,. ikiparrtnent t 111 r1'111

and Lmilr,Imeritoon W '71

I ,pt (4)61 2-010191 31 296 1206

1;entuckyDdl i 6

riertL risHri P1 4;' 1111

priltnit Pt 1,, titrri.`Itir. t I, 9 flu,- s 1,r, s

275 I dsr Mainlanktorr, K`i 106in

1502i 564 -7906

12

Loulsian.Idnice Boa:ner RSr-it

Nurse LonsultantHigh Blod Pre,-dire

Control ProgramDepartment cat Health and

seri.P Box 00630325 LoN.ola wnue Rourn 308Nev. Orleans LA 70100i5041 568-7210

Mainehael F

DirectorLoin mun it% 11101 Blood Pr es-iure

Programiston of Health Promotion

and FAUCationBureau of HealthDepartment of Human Set-% icesState House Station 11Augusta Mr 043331207 289-5180

MarylandMarsha BieniaChiefDivision ot High Blood Pressure

Controlamik Health Sen. ices

Mandand Department of Healthand Mental 11\ gdene

201 West Preston Street kooill 30 1Baltimore MD 212013011 225-6783

MassachusettsLisa ciiersteinProgrdm Coordinator\lassdLhusetts Depdrt MOM of

Public HealthlAtritc, tor Health 'rotrotiorl and

[nor, nmenrdi Disease pftiLetitkir150 Iremont streetB iston 11 \0211161 71 727 -2661

MichiganR smith

tiL"tensi, n t cadasrLrn Rep, i, 'nal DI', ',Ion

Ru'ea1 ot r,f11111,11'11%

\tichlgan IAl)irirnetl11C,1

I

301)0Pik)(N

i3' 8)I

Minnesota

s..eritr" in, rn :10f1

diincs, ,i'th717 oPi 8,, \ 9331\lirini at ihs \ 5511016121 23 "i;179

MississippiWendell CoxDirectorChronic Disease ProgramBureau of Health ServicesMississippi Mate Department

of HealthP C. Box '700lackson, MS 39215-1700

New MexicoMaria FaceySection HeadAault HealthHealth Services DivisionNew Mexico Health and

Environment DepartmentPO box 968Santa Fe, NM 87504-0968

OregonBarbara Taylor M P HHealth Education ConsultantOregon State Health DivisionP 0 Box 231Portland OR 972071503) 229-5691

Pennsylvania

Utahloan Ware R NDirectorCardiovascular ProgramBureau cr -hromc Disease ControlUtah Department of Health288 North 1460 WestP 0 Box 16660Salt Lake City UT 84116-0660

(601) 960-7857 1505) 827-2504 Robert Ranberg 18011 538-6141Chief

Missouri New York High Blood Pressure Control VermontJeannette lackson Thompson David C Momrcw Program Marge Hamrell

MSPH.PhD Acting rectc. Pennsylvania Department of Health Director Heald PromotionCoordinator Bureau of Adult and P C) box 90 Vermont Department of HealthHypertersion Control Program Gerontological Health H.,rrisburg PA 17108 1193 North Avenue, P 0 Box 70Missouri Department of Health New York State Department o; 17) 787-7073 Burlington VT 05402Bureau of Chronic Disease of Health 1802) 863-7330P 0 Box 570 Nelson A RocKefeller Puerto Rico1730 East Elm Empire State Plaza Ramon Aixala, M D Virgin Islandslefferson City. MO 65102 Tower Building Room 557 Director Hypertension Protect i.nne T Hatches Edith Moore(314) 751 -0257 AllJany, NY 12237 Puerto Rico Department of Health Hypertension Program

(518) 474.0512 Budding A (Annex D) Box 70184 Virgin Islands Department of HealthMontana San luan, PR 00936 Charles Harwood ComplexRobert W Moon M P H Sonia Hedlund 18091 767-6060 ext 2480 ChristianstedMontana Department of Health Assistant Director St Croix, U S Virgin Islands 00820

and Environmental Sciences Heart and Hypertension Institute Rhode Island (809) 773-1059 at 300Cogswell Building New York Department of Health Janice CataldoHelena. MT 59620 8 East 40th Street Community Health Research Virginia(406) 444-4488 New York. NY 10017 Rhode Island Department of Health lanice Bowie

)2121340 -3340 103 Cannon Building DirectorNebraska,Barbara oearson North Carolina

75 Davis StreetProvidence, RI 02908

Division of Chronic Disease ControlVirginia Department of Health

Program Coordinator ludy Britt (401) 277.6957 109 Governor Street Room 515High Blood Pressure Control Risk Reduction Program Manager Richmond. VA 23219

Grogram North Carolina Department of South Carolina 1804) 786-41)65Ne6ra5ka Department of Health Public Health Tom Gillette301 Centennial Mall South P 0 Box 2091 High Blood Pressure Prog,am WashingtonP 0 Box 95007 Raleigh NC 27602 Coordinator Catherine TurkLincoln, NE 68509-5007 1919) 733-2775 Division of Chronic Disease Manager14021 471-2101 South Carolina Department of Cardiovascular Risk Reduction

North Dakota Health and Environmental ProgramNevada Susan Pederson R N Control Department of Social andloseph lams, M D Coordinator 2600 Bull Street Health ServicesState Health Officer Health Risk Reduction F oiect Columbia, SC 29201 Mail Stop LK 13Nevada State Health Division Division of Community Health 1803) 734-4790 Olympia WA 98504505 E King Street. Room 201 Nursing 1206) 586-6082Carson City, NV 89710 State Department of Health South Dakota(702) 885-4740 Capitol Building 2nd Floor Paula Goddard R N West Virginia

Bismarck ND 58505 Deputy Director Brian Loshbough R N CNew Hampshire 17011 224-4320 Community Health Nursing DirectorElizabeth Donahue-Davis BS South Dakota Department of Health LightHeartsHealth Promotion Advisor Ohio 523 East Capitol Street West Virginia Department of HealthBureau of Health Promotion Esther Lenhert RN MPH Pierre SD 57501 1800 Washington Street EastDepartment of Health and Project Director 16051 773-3737 Roo,a 413

Human Services Ohio Hypertension Control Program Charleston WV 253056 Hazen Drive Division of Chronic Diseases Tennessee 1301i 348-4007Concord NH 03301 Ohio Department of Health Connie Pearson M N1603) 271-4475 246 North High Street 8th Floor Director Wisconsin

Columbus Ohio 43266-0588 Adult Wellness Hypertension Mary Manering R NNew jersey (6141 466-2144 Programs Cardiovascular Health ConsultantPhyllis Dower Tennessee Department of Health Cardiovascular Risk ReductionCoordinator Oklahoma and Environment ProgramHypertension Program Adeline Yerkes 100 Ninth Avenue North Wisconsin Division of healthDivision of Epidemiology and Director of Chronic Disease Nashville TN 37219.5405 PO Box 309

Disease Control Control and Eldercare 16151 741-7366 Madison WI 53701New Jersey Department of Health Hypertension Diabetes Program 16081 266-2757CN 360 Coordinator Texas3635 Ouakerbridge Road State Department of Health Donna Nichols WyomingTrenton NI 08625 P 0 Box 53551 Health Program Speciali,,t II Menlo 1-uta16091 588-7479 Oklahoma City OK 73152 Adult Health Program Health eduction Coordinator

1405) 271-4072 Texas Department of Health Health and Medical Services1 100 West 49th StreetAustin TX 78756

Wyoming Department of Healthand Social Services

15121 458-7534 Hathaway Building 4th floorChe enne WY 820021307) 777-6011

13 J -

What's Newin High Blood Pressure

Control

Keeping up with new develop-ments in high blood pressure con-trol whether related to detec-tion, awareness, evaluation, ortreatment is a constant chal-lenge for busy health care practi-tioners As part of the hypertensioncc -itrol team, your personal chal-lenge is to provide the highestquality of health services to yourpatients Your expert advice, knowl-edge, and support are key elementsin the personal strategies andplans that your patients undertaketo control their high blood pres-sure Your patients look to you forthe latest information, and the,,rely on your advice and supportThis section highlights new re-sources and reports to keep youan informed, involved member ofthe hypertension control team

Hypertension in Diabetes

Hypertension in Diabetes, a new reportfrom a National High Blood Pres-sure Educatron Program (NHBPEP)working group, provides new guide-lines for practicing physicians and

14 1`Y

other health professionals in theircare of persons with the CinCOMI-tant problems of high blood pres-sure and diabetes mellitus Morethan 2 5 million Americans haveboth diabetes and hypertensionWhen these two conditions arepresent in the same person, therisk for cardiovascular disease in-creases dramatically This new re-port stresses the critical Impor-tance of controlling high bloodpressure in persons with diabetesThe authors conclude that thecontrol of hypertension in diabetesmay help slow the progression ofboth vascular and renal disease,conditions that commonly accom-pany and complicate diabetes Thereport stresses the importance ofmany nonpharmacongic approachesrecommended for the control ofboth conditions The report waspublished as "Statement on Hy-pertension in Diabetes Mellitus-in Archives of Internal Medicine, 147( 51

839-842, May 1986 Copies of thereport are available from theNHBPEP (See Evaluation andOrder Form

The Physician's Guide:Improving Adherence AmongHypertensive Patients

While substantial progress hasbeen made in improving publicawareness and knowledge abouthypertension and the problemsassociated with uncontrolled highblood pressure, many challengesremain in getting hypertensivepatients to stay on their treatmentPrepared by the NHBPEP WorkingGroup on Health Education andHigh Blood Pressure Control, thisnew guide provides the healthcare practitioner with educationalmethods to encourage long-termadherence and control The guideemphasizes actions and systemsphysicians can use to increase theproportion of hypertensive patientswho reach and maintain goal bloodpressure The approaches suggestedin the guide affect the influencephysicians and other health careprofessionals have over factorssuch as ( 1 I the information theygive to patients as well as its com-pleteness and relevance, (2) thequality of their interactions withpatients and how they manageproblems that interfere with ad-herence, and (3) office proceduresthat reinforce the behaviors theyask patients to adhere to or changeThe guide offers sample interven-tions in a format specifically de-signed to help busy practitionersThe guide is available from theNHBPEP (See Evaluation andOrder Form )

./117/ 7,dy),

4-14,70;f7

.4;;;;,7/ /74,

It's Your Business:A Guide to Heart andLung Health at the Workplace

The workplace provides an ex-cellent opportunity for programsto reduce cardiovascular and pul-monary risk Worksite programsouter relatively easy and continualaccess to large numbers of at-riskemployees Prepared by the Na-tional Heart, Lung, and Blood In-stitute, this guide provides basicbackground and programmatic in-formation to those interested orinvolved in workplace programs Itexplains the scientific basis forreducing cardiovascular and pul-monary risk and discusses keyworkplace program elen-,_L (in-cluding a section on economicanalysis) and a resource guide foradditional assistance and mate-rials The guide is available fromthe Communications and PublicInformation Branch, National Heart,Lung, and Blood Institute, NationalInstitutes of Health, Building 31,Room 4A2 1 , Bethesda, MD 20892NIH Publication No 86-2210

Churches as an Avenue forHigh Blood Pressure Control

This new guide is designed toassist leaders of churches, syna-gogues, and other religious insti-tutions in working with health careprofessionals and local health or-ganizations to e,,tablish high bloodpressure control programs in theircommunity It provides backgroundinformation on the unique rolethat churches can play in the spon-sorship of such programs Theguide discusses issues of concern,approaches to take, ways to ex-pand and coordinate existing pro-grams, and resources to contactfor additional information andsupport Detailed guidelines arepresented for planning, establish-ing, and maintaining hypertensioncontrol programs, including \,ol-unteer recruitment and training,designing and implementing bloodpressure screening events, refer-rals, followup activities, and eval-uation A number of sample foimsand instructions are includedSingle copies of the guide areavailable from the NHBPEP (SeeEvaluation and Order Form )

15

Detection, Evaluation,and Treatment ofRenovascular Hypertension

Th...; new report from the NHBPEPWorking Group on RenovascularHypertension reviews Current di-agnostic techniques such as Intra-venous digital subtraction angi-ography and computer-generatedrenal flow scans These techniqueshave helped to identity more ac-curately patients in whom renalarteriography is indicated The re-port states that more sensitive andspecific tests are still needed toestablish the hemodynamic sig-nificance of renal artery lesionsNew classes of antihypertensivedrugs are described, particularlybeta-blockers and angiotensin-converting enzyme inhibitors, whichhave enabled the control of highblood pressure in most patientswith renovascular hypertensionbut do not assure preservation ofrenal function The report waspublished in Archives of InternalMedicine, 147 820-828, May 1987Reprints are available from theNHBPEP (See Evaluation andOrder Form I

The identificationand Examination of theStroke Belt

In thel5 yearssince the NHBPEPbegan, age-adjusted mortality ratesfor stroke have declined more than50 percent However, despite thisdramatic decline, cerebrovasculardisease remains the third leadingcause of death in the United StatesThe black population continues toexperience a higher rate of strokedeaths than does the white popu-lation, and more than half of thestroke deaths among blacks in1980 riccurrea in the southeasternUnitea States, now known as thestroke belt High blood pressure isthe major risk factor for stroke,therefore, the NHBPEP has initi-ated a major intervention programto reduce the high number of stroke

deaths One facet of this approachinvolves detailed analyses thatprovide Important information con-cerning the magnitude of the prob-lem and to identify factors thatmay be affecting it This posterpresentation includes an anno-tated evaluation of rates for age-adjusted and crude stroke mor-tality, rates for hypertension prev-alence, awareness, treatment, andcontrol, and rates for severe dia-stolic elevations, obesity, andsmoking behavior by region, race,and sex The presentation is avail-able from the NHBPEP (See Eval-uation and Order Form )

With Every Beat ofYour Heart: AnIdeabook for CommunityHeart Health Programs

Designed for community healthprogram professionals in a varietyof settings, this book presentsseveral ideas for heart health pro-gram activities Section I, "GettingStarted," contains key facts aboutsmoking, high blood pressure, andhigh blood cholesterol the threemajor risk factors for heart diseasethat people can do somethingabout Section 2, "Growing Build-ing for the Long Term,- describesthe benefits of addressing morethan one heart disease risk factorat the same time and outlines dif-ferent complementary approachesto improving community hearthealth Section 3, "CommunityProgram Activity Ideas," highlightsspecific approaches for solvingprogram development problemsand sponsoring creative, mean-ingful risk reduction activities inpublic and voluntary health agen-

16 16

ties, health care settings, worksiteprograms, religious organizationprograms, and school-based pro-grams Section 4, "InterACTION,'lists some of the first places tolook for help in local coordination,technical assistance in programdevelopment, packaged programs,and consumer and patient educa-tion materials The book is avail-able from the Communicationsand Public Information Branch,National Heart, Lung and BloodInstitute, National Institutes ofHealth, Building 31, Room 4A2 1 ,

Bethesda, MD 20892 NIH Publi-cation No 87-7'.641

,, , Medically .,Underserved

Barriers to Health Care

1 Language or communication problems (patientswith minimal education or with difficulty under-standing English)

17

Health professionals often workwith medically underserved andhard-to-reach populations, includ-ing ethnic minorities, low-incomegroups, the elderly, the chronicallyill or handicapped, and rural popu-lations Health practitioners needto be sensitive to issues that pre-vent these groups from utilizinghealth care facilities and adheringto medical therapy Although thesegroups represent diverse cultures,lifestyles, and health patterns,some common issues serve as bar-riers to health care This sectionfocuses on how you, the healthcare provider, can overcome theseobstacles

Suggestions

Develop materials that are tailored to their needsand level of communication skills (e g , simple,direct, and illustrative) Use more pictures, boldtype, color, and fewer words

* Adaptor translate existing education materials topatients' native language Some minority groups(e g , Hispanic youth, Filipinos, and second- andthird-generation Japanese) may take pride inknowing how to read and speak English, whileothers (e g , elderly minorities and recent Indo-chinese reiagees) may prefer Lheir native language

Use a combination of teaching materials bro-chures, audiovisuals (videotapes, audiotapes,radio novellas, and public service announce-

1"'

2 Socioeconomic factors le g , unemployment, lackof financial resources, insufficient or no medicalcoverage Medicare, Medicaid health insurance)

3 Ac 2ssIbillty of health care facilities

4 Availability of programs ailci services

18

ments with appropriate music), cartoons, andparticipatc,sry teck clues such as games, quizboards, and puzzles

Use bilingual or bicultural workers and volunteersfrom the client community to explain health mes-sages and physicians' recommendations

Use forms cr questionnaires that are brief andbilingual (e g , written in English and Spanish)

Provide clear and direct instructions For example,when counsel.ng patients to reduce sodium oralcohol intake, use familiar terms such as -tea-spoons- of salt and number of -cans- of beer and-glasses of wine, rather than "grams- of sodiumand -ounces- of liquor

Check with patients' physicians to see if genericor low-cost medicines are appropriate

Arrange for reduced cost or sliding scale accord-ing to patients' ability to pay

Take patients' economic condition into accountwhen recommending exercise and nutrition pro-grams For example, a walking program requireslittle or no expense, whereas jogging may requirespecial shoes or equipment Nutrition classesshould consider appropriate ethnic foods

Refer patients to existing community resourcesCivic organizations ,e g , Kiwanis or Mooseduos) may be able to help defray the cost ofmedicationDrug companies may be able to provide medi-cation at little or no cost through participatingphysicians and pharmacists

Make sure that the health facility is easily acces-sible by way of public transportation with aminimum of travel time and cost If necessary,recruit volunteers to drive patients to and fromthe facility

Solicit and distribute bus or subway passes toneedy patients

Make sure that the facility is accessible to physi-cally handicapped persons

Make sure that schedules are flexible to accom-modate working patients For example, the China-town Health Center in New York offers services inthe evenings and on weekends

Have available bilingual or bicultural staff to ex-plain procedures and health instructions

5 Lack of knowledge of available health programsand services ie g , recent immigrants, rural people,non-English-speaking minorities)

6 Lack of familiarity with the Western medical sys-tem le g , complete medical checkup that includeslaboratory tests and formal appointments)

7 Lack of understanding of the complexity and longduration of medical regimen, side effects, and therisks of uncontrolled high blood pressure

Use bilingual er culturally adapted health educa-tion materials

If possible, make the health facility a one-stop-facility where individuals and families can receivecomplete health care le g , medical checkup, WICprogram, laboratory tests, family services, etc )

Publicize programs and services using variousmedia such as ethnic radio and television, bro-chures or flyers, and ethnic or tribal newspapers

Encourage use of the health care facility by pro-viding services based on community needs andpromoting these services at ethnic markets, work-sites, churches, and cultural events le g , Chinesenew year, powwows, heritage weeks, religiousevents)

Take time to educate patients about the Westernmedical system For example, making doctor'sappointments is alien to some rural residentsand minority groups where "no appointmentnecessary" is the general practice

Use bilingual and bicultural staff to explain orinterpret messages and instructions

Allow a family member to accompany the patientinside the examining room, to explain procedures,and to provide support Medical procedures suchas drawing blood can be very scary and unnervingExposing one's body for physical examinationle g , Pap smear, breast and pelvic examination)can be culturally embarrassing for a female pa-tient, especially if the examiner is a male

Realize that minorities, like any other patients,need to be educated about the need for continu-ous medication, the reasons for taking medica-tion, when and how to take it le g , before, during,or after meals), side effects, possible interactionswith other drugs, and possible results if hyper-tension is not controlled This can be done byusing bilingual or bicultural staff and health edu-cation materials, by providing time for questions,and by showing genuine concern for patients'welfare

Enlist the help of family members and friends toprepare foods according to the doctor's adviceand to remind patients to take their medication

Make telephone calls or send letters or remindercards either before visits or after missed appoint-ments to emphasize the importance of continu-ous medical therapy

8 Cultural values and attitudes

9. Health beliefs and practices

Hospitals as "places of death"

"Hot-cold imbalance"

iY

\.\\\\

VPVIA\:\\\\\

\ k kW I s

\\\\\;Av,i

Take time to learn more about patients' values.For example, Buddhism emphasizes acceptanceof situations, tolerance to pain and suffering, andself-reliance. This may affect the attitudes of AsianBuddhists toward seeking health care. SomeJapanese patients may suppress their feelingsand ignore warning signals of impending illnessbecause of "enryo" (reservation) or "gaman" in-ternalization and suppressior of pain). "Hiya"(shame) and respect for authority and elders maykeep Filipino patients from asking questions orexpressing their feelings to physicians. With theassistance of a bilingual or bicultural staff, physi-cians may be able to elicit more information aboutpatients' behavior

Patients must be convinced that hospitals areplaces where they can recover from illness.

Get endorsements (such as letters, posters, ortapes) from well-known and respected localcelebrities (e.g., actors, singers, sports per-sonalities)Ask former hospital patients from the com-munity to talk about their treatment in groupdiscussions.

Respect patients' cultural beliefs. Many minoritypatients still believe that illness is caused by animbalance of hot and cold forces inside and out-side the body or by an imbalance of natural andsupernatural forces. To create a balance, patientsresort to herbs, massage, poultices, hot foods forcold conditions and vice versa, and prayers. Ratherthan criticizing these practices, physicians mustaccept those that are harmless and carefully ex-plain those that may be harmful Fitting Easternmedicine into Western medicine is possible ifphysicians take time to know more about theirpatients

Reliance on folk practitioners

Sharing of medicines with relatives, friends, orneighbors

Illness as a punishment from God or the result ofwitchcraft or disregarding religious taboos

;\

\\11\\\i

'10\\\\\\

All of the foregoing suggestionsare important in reaching themedically underserved and hard-to-reach groups The involvementof bilingual or bicultural staff andthe use of culturally adapted healtheducation materials cannot be

Explain and emphasize the value of the prescribedregimen as an adjunct to folk remedies Manyminority patients still consult herbalists, psychichealers, curanderos, "medicine men," etc, be-cause they belong to the same ethnic group, speakthe same language, provide free or low-cost ser-vices, and are either relatives, neighbors, or friends.Health care providers, instead of criticizing folkremedies, should accept those that are harmlessand not work against folk healer

Inform patients that they should not take medi-cines prescribed for other persons It is not un-common for some groups to share medicinesw.th someone from the same community withsimilar health problems

Ask patients to bring these medicines to the clinicExplain that there may be some interactions withdrugs that are being prescribed or with otherdrugs patients are currently taking.

Try to show concern, understanding, and accep-tance of various cultural practices that are harm-less (e g , wearing religious symbols) Do not criti-cize patients who use prayers, rituals, or objectsto ward off evil spirits

Take time to explain the nature of patients' ill-ness, incluclIng physical causes and remedies

overemphasized For those orga-nizations that lack resources todevelop ethnically oriented healtheducation materials, resources arelisted on the Evaluation and Or-der Form

21

National High Blood PressureMonth can be an opportunity toinitiate and promote year-longhealth education activities Or-ganizations around the countryare sponsoring innovative programsin a variety of settings to reducethe risk of cardiovascular diseasePuppet theatres, cooking classes,newsletters, and interactive tele-vision programs are lust a few ofthe different approaches that havebeen used to increase public awarness in communities like yoursWe have listed some examples ofthese local efforts to promote highblood pressure control and cardio-vascular disease prevention

The Middletown Department ofHealth in Connecticut conductscourses that include cooking dem-onstrations and recipe testing andculminate with the preparation ofa heart-healthy supper for a localchurch group

The Palm Beach Cou ntyCardio-vascular Disease Prevention andControl Program in Florida pro-vides group education classes forarea residents Four I -hour sessionsaim to lower the risk of cardio-vascular disease by emphasizingnonpharmacologic approaches

The Pharmacy High Blood Pres-sure Program of the University ofMaryland in Baltimore, Maryland,is designed to reduce the preva-lence of uncontrolled high bloodpressure by having communitypharmacists provide informationand monitor treated patients for

Community Championsadherence to therapy and for bloodpressure control

Pressure Pointers is a public edu-cational newsletter sponsored bythe Metropolitan Detroit Coalitionfor Blood Pressure Control inMichigan The newsletter high-lights articles on the treatmentand management of high bloodpressure and related cardiovascu-lar risk factors.

The Organic Puppet Theatre,sponsored by the Model CitiesHealth Center in St Paul, Min-nesota, is designed to preventchildren from becoming over-weight, from starting smoking, andfrom leading sedentary lifestylesThe theatre uses puppets to ex-plain the functions of the body'sorgans

The Physical Management Pro-gram in Montana public schoolsis a physical education classadapted to the special needs ofchildren who are overweight Theprogram has been adopted in 12other states

The High Blood Pressure RiskReduction Program in Buffalo,New York, has developed strate-gies for screening, structured fol-lowup of elevated readings, andpromoted educational counselingfor hard-to-reach, high-risk, mi-nority groups

In Toledo, Ohio, second- andthird-graders in public schools aretaught about high blood pressureand its risks with the help of pup-pets audiovisual aids, costumes,food tasting, and magic tricks

Kaiser Permanente Health Ser-vices, a health maintenance organi-zation in Portland, Oregon, workedwith a commercial television stationto offer an interactive televisionprogram to more than 600 viewerswho wanted to lose weight

The Southeastern PennsylvaniaHigh Blood Pressure Control Pro-gram in Philadelphia, Pennsyl-

22

vania, has a professional supportservices program that offers con-sultation and educational ser-vices to physicians in southeasternPennsylvania These services focuson patient adherence and physi-cian education

The Richmond Area High BloodPressure Center in Virginia pro-vides free comprehensive hyper-tension control services to com-munity residents who have nomedical coverage These servicesinclude free diagnostic workup,ongoing monitoring, patient edu-cation and counseling, as well asfree medication for those on drugtherapy

Let us know about activities youare sponsoring in your communi-ty Write Editor, National HighBlood Pressure Education Program,120 80 National Institutes ofHealth, Bethesda, Maryland 20892

7 "1

Go for Your Goal:Master the Media

Now is the time to gain recogni-tion for your organization's effortsand contributions to a "winningcampaign" to control high bloodpressure Its more important thanever to promote adherence to treat-ment because, despite high aware-ness of the importance of control-ling hypertension, the number ofpeople with high blood pressurewho are lctually doing so remainsalarmingly low Only 11 percent ofadults with blood pressure levelshigher than 140:90 mm Hg aresuccessfully controlling it

Spreading your message of hy-pertension control through themedia and other community chan-nels can increase attendance atthe activities you'll be conductingwith the help of this year's kit It

never hurts to get the credit yourorganization deserves for its partin the drive to control high bloodpressure

Promotion doesn't have to be

costly or overly time-consumingAll it takes is some careful plan-ning and a commitment to recog-nizing and taking advantage ofavailable opportunities The fol-lowing explains the who, what,when, where, and why of promo-tion, as well as how to make it allhappen

Who?

High blood pressure informationis beneficial to all Americans Diet,those people who don't have highblood pressure generally know afamily member, friend, or cowork-er who does Thus, hypertensioncontrol messages to the generalpublic are valuable

Some groups are at higher riskof developing high blood pressurethan others and need additionalinformation and encouragement

Elderly The elderly are the fast-

est growing population in theUnited States today And theyhave the highest rates of highblood pressure 76 percent ofblack adults between the agesof 65 and 74 years and 63 ptr-cent of white adults of similaragesBlacks High blood pressure ratesare one and a half times high-er among blacks than whitesAmong adults age 18 to 74years, the highest prevalencerate is for black women (38 6percent) The prevalence ratefor black men is 37 9 percent,compared to 32 6 percent forwhite men and 25 3 percent forwhite womenStroke belt residents The strokebelt is an area in the south-eastern United States wherehigh blood pressure prevalenceand stroke mortality rates areunusually high, especially amongblacks Although only 47 per-

1 1976-80 National Health and Nutrition Examination Survey2 The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure

23 a.0

cent of the total black popula-tion resides in the South, thisgroup accounts for 56 percentof the total number of blackstroke deaths in the country

What?

During the early years of theNational High Blood Pressure Ed-ucation Program, most messagesemphasized detection encour-aging people to have their bloodpressure measured to discover ifit was high.

Today, 94 percent of adult Amer-icans have had their blood pres-sure measured and can identify itas high, low, or normal. Accord-ingly, the focus of education ef-forts has shifted from detection toadherence to treatment and main-tenance of control.

Promotion efforts should stressthe importance of an ongoing com-mitment to controlling high bloodpressure through medication,weight control, reducing sodiumintake, increasing exercise, andmoderating alcohol consumption.

Throughout this kit, you'll findinformation on these ways to con-trol high blood pressure, as wellas tips for maintaining adherencethat can make your promotion ac-tivities real winners

When?

May is National High BloodPressure Month, the ideal time toplace special emphasis on pro-moting hypertension control Thiskit is designed to be a I 2-monthresource of ideas and materialsThink of May as the starting pointfor launching your year-round cam-oaign to control high blood pres-sure in your community

Take advantage of the sugges-tions provided in the kit to makeevery month "High Blood PressureMonth" because, just like the treat-ment of hypertension, promotionis something that should be doneeveryday to be truly successful

Where?

You'll want your message toreach the greatest number of peo-ple in your target audience. Thereare a number of channels of com-munication that exist right in yourown community Your promotionefforts should use a mix of mediaand community activities to takeadvantage of these channels

Local newspapers publisheddaily and weeklyArea or regional magazinesCommunity newslettersWire services, including state,regional, and local bureaus ofAssociated Press or UnitedPress InternationalRadio stationsTelevision stationsPublic access cable televisionstationsWorksite health promotion pro-gramsCommunity groups such as Jay-cees, women's clubs, Elks clubs,and professional groupsSenior centersChurch service groupsSporting events and arenasThe possibilities are only as

limited as your imaginatio,'.1

Why?

Some people may feel that pro-motion is not worth the time andplanning it requires However, aproperly implemented promotionprogram can make the differencebetween a crowded, successfulevent and an embarrassing turn-out of two for a panel discussion

Promotion can yield numerousbenefits for both your organiza-tion and its campaign to controlhigh blood pressure Promotioncan let people know when an eventwill be held, publicizeyour organi-zation's contributions to the com-munity, build credibility for yourgroup, and enable you to reach fargreater numbers of people in yourtarget audiences.

Promotion puts your goalsand audiences within reach

24

How?

Knowing now to apprs ach themedia and community group canbe the telling factor in the sLccessor failure of your promotion cam-paign The following guidelinessuggest ways to work with mediagatekeepers individuals whocontrol information channels inyour community to promote yourorganization and high blood pres-sure control These individuals in-clude editors of newspapers, mag-azines, and newsletters, produc-ers of radio and television shows,station managers, public servicedirectors, leaders of local civic andcommunity groups, and employeehealth directors and worksites

Determine if your idea or eventis newsworthy The media are morelikely to be interested in your storyif it is new, timely, or unusual, hasa human interest angle, involves apublic figure or well-known orga-nization, is centered around anevent or campaign, effects a largenumber of people, or is a variationof a theme already receiving mediaattention

Develop Publicity Tools

Media list Consult media direc-tories in your local library Makea list of print and broadcastoutlets in your area, includingaddresses and telephone num-bers Call each outlet to iden-tify the appropriate contactperson (e g , editors, reporters,producers, public service direc-tors, programming directors)Be sure to get Lite Lorred spell-ing of all names and titles.

News release Using your organ i-zatiod's letterhead, type yourstory double-spaced, using anactive voice and short sentencesBe brief, your news releaseshould be no longer than oneto three pages List a contactperson's name and telephonenumber in the upper righthandcorner, and proofread it care-fully, checking all names, num-

bers, dates, etc A sample newsrelease is included in the MediaMaterials section of this kit

Media kit A media kit is a 9" x12" two-pocket folder contain-ing a news release and back-ground on your organization,such as a fact sheet highlight-ing specific information aboutyour group or project, a bio-graphical sketch of your spokes-person, and a description ofyour organization's servicesInclude a copy of the fact sheeton high blood pressure as wellas any other pertinent informa-tion The first page of each itemin your media kit should beprinted on your organization'sletterhead

Public semce announcements (PSA's)

PSA's are messages preparedby nonprofit groups to announceevents or generate awarenessof a specific problem or issueThe media air or print PSA's atno cost because they do notadvertise products or servicesfor sale The sample PSA's in-cluded in this kit are examplesof live-announcer copy a

script intended for use over theair during a station break or ina community calendar seg-ment Other types of PSA's in-clude slides of your group's logoor event, information for useon television, prerecorded mes-sages, and print ads A samplePSA is included in the MediaMaterials section of this kit

Contact the Media

Send the press release or mediakit to the appropriate contactson your media list Allow 4 to 7days for the materials to arrive,and then call your contacts Askif they have received the mate-rials, and offer to answer anyquestions Highlight the im-portant points related to yourcommunity. At this point, theywill probably tell you whetheror rot the story will receive

coverage Regardless of theanswer, thank them for theirtime If a story does appear onthe air, send a short note cfthanks

The procedure outlined aboveis similar for arranging an in--,erview or appearance on a talkshow Send the press releaseor media kit to the appropriatecontacts on your media list Tryto provide a picture of yourspokesperson in the kit, anduse a pitch letter, a sample let-ter is included in this kit Allowseveral days for the materialsto arrive Call yo .ontact,emphasize your spokesperson'sexpert knowledge of the topic,and offer your help in arrang-ing an interview If you are suc-cessful, get details about theshow, such as if it is live ortaped, if there will be call-ins,the length of the program, etcBrief your spokesperson, andsend a note of thanks to thecontact

The National High Blood Pres-sure Education Program producesa series of radio and televisionpublic service announcements anddistributes them twice a year, inthe fall and in the spring. Theradio PSA's are mailed directly toradio stations around the countryThe television PSA's are distrib-uted on a state-by-state basis byone state media contact in eachstate For more information onthe NHBPEP PSA's in your com-munity, call or write the state con-tact for your state A list of statemedia contacts is included in thissection

Take Advantage of PublicAccess Cable Programming

There are 1,000 public accesscenters nationwide. Most havefull-service facilities available foruse by groups like yours Someprovide training and have produc-ers on hand to lend special assis-

25 25

tance Follow the steps outlinedbelow

Consult the Video Register to iden-tify a center near your com-munity.

Contact the station operator todetermine if the station pro-vides community programmingand what resources or trainingare available

Arrange to attend the trainingsessions, and discuss the pro-gram format and topic you havein mind with the producer

Proceed under the producer'sdirection to develop the pro-gram and schedule air time

Obtain Time and Space

Contact the public service di-rector at the media outlet Con-firm the preferred format, and mailthe materials Call the contact aftera few days, and offer your assis-tance. You can also try to workwith local distributors to arrangespace on billboards and transitads

When you really think about it,promotion is anything you can doto reach your audiences with amessuge about high blood pres-sure control Don't confine yourefforts to the ideas presented here,every community is different, withits own unique opportunities forpromotion Take a close look atyour town, and reach for high bloodpressure control

State Media ContactsAlabamaRichard AdamsDirectorHypertension BranchAlabama Department of

Public HealthState Office Building Room 754Montgomery AL 36130

FloridaSandra Schoenhsch R N Ph DNurse ConsultantChronic Disease Progra,Department of Health and

Rehabilitative Services1317 Winewood BoulevardTallahassee FL 323W

KentuckyDavid GoodloeDirectorHpertencion DrogramDepartment of Health ServicesCabinet for Human Resources275 East Main StreetFrankfort KY 4060!

MississippiNancy K SullivanPublic Relations Directori't 5,st- ,pp. State Departmentof Health

P 0 Box 1700Jackson MS 39215-1700

MissouriArizona Georgia Louisiana leannette Jackson ThompsonBecky Tucker Mary Iohrison Shirley Kirks onnell MSW MPH M S P Ft PhDHealth Educator Public information Director n istrac CoordinatorOffice of Health Education American Heart Association Adult Servic Hypertension Comiol ProgramArizona Department of PO Box 6997 Department of Health and Missouri Department of Health

Health Services Maretta GA 30065 Human Services Bureau of Chronic Diseases3008 North Third Street P 0 Box 60630 P 0 Box 570Phoenix, AZ 850 i 2 Hawai 325 Loyola Avenue Room 308 1730 East Elm

lane Kac.ohiro RN PH N New Orleans LA 70160 lefferson City MO 65102Arkansas Protects AdministratorBarbara Kumpe Public Health Nursing Branch Maine MontanaAdministrative Assistant Hawaii State Department of Health Michael 1 Gay Robert W Moon M P HAmerican Heart Association P 0 Box 3378 Director Montana Department of HealthPO Box 1610 Honolulu, HI 96801 Community High Blood Pressure and Environmental SciencesLittle Rock, AR 72201 Program Cogswell Building

Idaho Division of Health Promotion Helena, MT 59620California loanne Mitten and EducationSara !Metzger Health Education Specialist Bureau of Health NebraskaHealth Analyst Health Promotion Disease Department of Human Services Barbara PearsonHypertension Control Program Prevention Section State House, Station 11 Program CoordinatorCalifornia Department of Idaho Department of Health Augusta ME 04333 High Blood Pressure Control

Health Services and Welfare Program714 744 P Street Room 43C 450 West State Street 4th Floor Maryland Nebraska Department of HealthSacramento CA 95814 Boise, ID 83720 Edna Amador 301 Centennial Mail South

Assistant Director P 0 Box 95007Colorado Illinois Maryland Commission on Lincoln NE 68509-5007Linda Dusenbury RN MSN Sherwood Zimmerman High Blood Pressure and RelatedCardiovascular Disease Consultant Chief Cardiovascular Risk Factors NevadaDivision of Prevention Programs Division of Chronic Diseases 201 West Preston Street Joseph laivis MColorado Department of Health Illinois Department of Public. Health Baltimo,e MD 21201 State Health Officer4210 East I 1th Avenue 535 West Jefferson Street Nevada State Health DivisionDenver, CO 80220 Springfield IL 62761 Massachusetts 505 East King Street Room 201

John Stobierski Carson City NV 89710Connecticut Indiana DirectorEmelia DeMusis Mary Marrs Office of Public Information New HampshireProgram Coordinator Chronic Disease Coordinator Department of Public Health Elizabeth Donahue-Day is B SOffice of Health Education Indiana State Board of Health 150 Tremont Street Health Promotion AdvisorState of Connecticut Department 1330 West Michigan Street Boston MA 0211 1 Bureau of Health Promotion

of Health Services Room 213 Department of Health and150 Washington Street Indianapolis IN 46 206 -1 964 Michigan Human ServicesBuilding A 3rd Floor Harlie R Smith 6 Hazen DriveHartford CT 06106 Iowa Hypertension Lead Concord NH 03301

Lorne I Graaf R N Eastern Regional DivisionDelaware Nurse Consultant Bureau of Community Services New JerspyMark Delmerico Hypertension Diabetes Program higan Department of Reza Bebehanian MPH H S DSocial Services Administrator Bureau of Healtn Prornct.on Public Health Puhlic Health ConsultantDivision of State Service Centers Iowa Department of Public Health 3500 North Logan Street tiealth EducationDepartment of Health and Lucas State Office Building P 0 Box 30035 Nevv lersey State Department

Social Services Des Moines IA 50319-0075 Lansing M148909 of Health1901 North DuPont Highway 3635 Ouakerbridge Road CN 360New Castle DE 19720 Kansas Minnesota Trenton NJ 08625

Mary Ann Humphries Kelly McCoyDistrict of Columbia Administrator Health Education Specialist New MexicoRobert H Conn, Ed D Health Education Unit Center for Health Promotion Edna Sceviour R NChief Bureau of Local Health Services and Education Health Services DivisionOffice of Health Promotion and Kansas Department of Health Minnesota Department of Health New Mexico Health and

Hypertension Control and Environment 717 S E Delaware Street Environment DepartmentD C Department of Human Services 900 S W Jackson P 0 Box 9441 P O 13ox 9681875 Connecticut Avenue, NW Topeka KS 66612 0001 Minneapolis MN 55440 Santa i e NM 87504-0968Washington, DC 20009

26

New YorkSusan DoolittleDirectorBureau of Health PromotionNelson A Rockefeller

Empire State PlazaTower Building Room 1084Albany NY 12231

North CarolinaMeredith SmithDirector, Public AffairsPepartment of Human Resource,325 North Sallsbun StreetRaleigh NC 27611

North DakotaIuLann Wiseman R NHealth Education Nurse ConsultantHealth Promotion and EducationState Department of Health cud

Consolidated laboratoriesCapitol Building 2nd FloorBismarck ND 58505

OhioFrank BrightChiefDivision of Chronic Disease,Ohio Department of Health246 North High Street 8th flourColumbus OH 43266-0588

OklahomaShelli Stephen; StidhamInformation Rep IIHealth E.ciucaf ton and

Information Ser icesOklahoma State Health DepartmentP 0 Box 535511000 N E 10th StreetOklahoma City OK 73152

OregonBarbara Tavlor NI PHealth Education C011',U ra nt

Oregon State Health DniyonPO Box 231Portland OR 97207

PennsylvaniaRobert RanbergChiefHigh Blood Pressure Control

ProgramPennsylvania Department of HealthPO Box 90Harrisburg PA 17108

Puerto RicoRamon Aixala h1 DDirectorHypertension ProtectPuerto Rico Department of HealthBuilding A (Annex Di Bo,. 70181San luan PR 00936

Rhode IslandJanice CataldoCommunity Health ResearchRhode Island Department of 11, th103 Cannon Building75 Davis StreetProvidence RI 02908

South CarolinaHerman AllenProlect Administ rat )rDivision of Chronic DiseaseSouth Carolina Department Of

Health and EnvironmentalControl

2600 Bull StreetColumbia SC 29201

South DakotaPaula Goddard R NDeputy DirectorCommunity Health NursingSouth Dakota Department of Health523 Last Capitol StreetPierre SD 57501

TennesseeConnie Pearson M NDirectorAdult Wellness Hypertension

ProgramsTennessee Departm not of Health

and Environment100 Ninth Avenue NorthNashville TN 37219-5405

TexasMargaret WilsonPublic Information coordinatorPublic Health oromotIOTI Division1100 West 49th streetAustin TX 78756

Utahloan Ware R NDirectorCardiovascular ProgramBureau of Chronic Disease ControlUtah Department of Health288 North 1460 WestP 0 Box :6660Salt Lake City UT 84116-0660

VermontMarge HamrellDirectorHealth PromotionVermont Department of Health1193 North AvenueP 0 Box 70Burlington VT 05402

Virgin IslandsAnne T Hatcherivpetension Progran

Virgin Islands Departnicof Health

Charles Harwood ComplexChristianstedSt Croix U S Virgin Islands 00820

Virginialoam) RichardsonHealth EducatorDix stun of Chronic Disease Contr.,:Virginia Department of Health109 Goxernor Street717 Madison BuildingRichmond VA 23219

27

Washingtonlo Wadsworth R N 1 AHealth EducatorOffice of Disease Prewntioti

and ControlDepartment of Social and

Health ServicesMail Stop LK 13Olympia WA 98504

West VirginiaBrian LoshboughDirectorLight heartsWest Virginia Department of health1800 Washington Street Last

Room 413Charleston WV 25305

WisconsinMary Manering R NCardiovascular Health ConsultantCardiovascular Risk Reduction

ProgramWisconsin Division of HealthPO Box 309Madison WI 53701

WyomingMenlo FutaHealth Risk Reduction CoordinatorHealth and Medical ServicesWyoming Department of Health

arid Social Ser icesHat naway Building 4th FloorCheyenne WY 82002

For Patients and Consumers

Aerobic Cxercise, by KramesCommunications 'leaflet, 6 pages,

9871

Explains how aerobic exerciseimproves health and helps thehart and other muscles use ox-ygen more efficiently Shows howto determine target heart rate ac-cording to age Covers the im-portance of warming up and cool-ing down properly Includes check-list for safe enjoyment of aerobics

Availability:Order DepartmentKrames Communications312 90th StreetDaly City, California 94015-1898(800) 228-8347,(800) 445-7267 in CaliforniaOrder No. 1235Cost. SO 50 each, 1-24 copies, SO 35each, 25-199 copies, $0 30 each,200-499 copies, $0.25 each, 500+copies

Blacks Can't Afford to GambleWith High Blood Pressure: TheStakes Are Too High! by South-eastern Pennsylvania High BloodPressure Control Program, Inc'leaflet, 6 pages, 19851

Defines high blood pressure, andprovides statistics about blacksand high blood pressure Discussesrisk factors (i e, family history,overweight, salt, fat, lack of exer-cise, smoking, alcohol, stress, andoral contraceptives), complications,and ways to control high bloodpressure.

Availability:Southeastern Pennsylvania High

Blood Pressure Control Program,Inc

311 South Juniper Street, No. 308Philadelphia, Pennsylvania 19107(215) 546-1276Cost. Free, singlecopies, bulk ratesavailable

ResourcesBlood Pressure and You, by

Colorado Hypertension ControlProgram, Colorado Department ofHealth flipchart and accompany-ing teaching guide, 20" x 25" (flip-chart), 24 pages (teaching guide),revised 19851

Designed for use by new as wellas established hypertension cor,-trol programs in both group andindividual settings Uses cartoon-like illustrations to present basicinformation about high blood pres-sure Teaching guide includes anarrative and concepts for eachpage of the flipchart and empha-sizes specific information directedtoward people who have been re-ferred for secondary screening andwho are found to have persistent-ly elevated blood pressure read-ings

Availability:Hypertension Control ProgramColorado Department of Health4210 East llth AvenueDenver, Colorado 80220(303) 32u-8303Cost $35

CSPI's Fast Food Eating Guide,by Center for Science in the PublicInterest (CSP1) 'poster, 18" x 24",19861

Presents the calories, fat, sodi-um, and sugar content of morethan 200 fast-foods, including iisli,potatoes, chicken, burgers, roastbeef, steak, ham, fast-food meals,desserts, milk shakes, breakfastitems, and other items Includesa "Gloom" rating for each item,which reflects the food's overall fat,sodium, sugar, and calorie content

Availability:Center for Science in the Public

Interest1501 16th Street, NWWashington, D C 20036(202) 332-9110Order No 94 (paper),Order No 94L (laminated)Cost. $3.95 (paper),

28

S7 95 (laminated)

"E" Is for Exercise, by AmericanHeart Associationlleaflet, 6 pages,revised 19871

Explains that regular exercisereduces the risk of having a heartattack Discusses s'arious types ofexercise, factors to consider be-fore starting ar exercise program,and how to exercise properly In-cludes an exercise checklist Alsoavailable in Spanish La "E"Simboloza Ejercicio.

Availability:local and state affiliatesAmerican Heart AssociationOrder No 51-027-A (English)Order No 51-027-B (Spanish)Cost information available fromlocal and state affiliates

Facts About Strokes, by Ameri-can Heart Association 'pamphlet,7 pages, 19871

Describes what a stroke is, typesof stroke, and the warning signalsof stroke Addresses risk factorsfor stroke that cannot be changed(age, sex, race, diabetes mellitus,and a prior stroke), risk factorsthat can be changed (high bloodpressure, heart disease, transientischemic attacks, and high redblood cell count), and other riskfactors (elevated blood cholester-ol and lipids, cigarette smoking,excessive alcohol intake, and obe-sity) Discusses treatment and re-I kibilitation following a stroke

Availability:local and state affiliatesAmerican Heart AssociationOrder No 51-1001Cost information available fromlocal and state affiliates

PS

Family Food Choices: A Guide toWeight and Diabetes Control, byIndian Health Service 'booklet, 15pages, 19861

Provides tips on controllingdiabetes by losing weight, restrict-ing fat intake, avoiding sugar, eat-ing more high-fiber foods, andavoiding alcohol Lists foods toeat often and foods to avoid, sug-gests healthier replacements forrefined foods, and presents guide-lines for eating out Geared toNative Americans

Availability:Indian Health ServiceDiabetes Program2401 12th Street, NWRoom 211NAlbuquerque, NM 87102(505) 766-3980Cost Free, single copies

A Guide to Losing Weight, byAmerican Heart Association 'pam-phlet, 16 pages, 19861

Presents and explains guidelinesfor successful dieting ( 1 ) Figureout why you want to lose weight,(2) Make sure you need to go on adiet, (3) Examine your eating hab-its, (4) Expect temptation, (5) Berealistic and expect setbacks, and(6) Plan for rough times. Discussesdaily eating habits, and provides aguide for selecting and preparingfoods.

Availability:local and state affiliatesAmerican Heart AssociationOrder No 50-034-CCost information available fromlocal and state affiliates

Heartline, by Coronary Club,Inc., in cooperation with ClevelandClinic Educational Foundation'monthly newsletter)

Provides practical advice oncoping with heart disease and car-diovascular risk factors Includeshealth articles, diet hints, nutri-tion information, and questionsfrom heart patients

Availability:Heartline9500 Euclid AvenueCleveland, Ohio 44106Cost $15, annual subscription (12issues plus spring and fail pam-phlet), $2, sample literature packet

High Blood Pressure, by Neil B.Shulman, Elijah Saunders, and WDallas Hall 'book, 138 pages, 19871

Presents important, up-to-dateinformation consumers can useto determine if they are at risk ofdeveloping high blood pressure,understand the dangers and causesof the disease, interpret what the"numbers' of blood pressure read-ings mean, know what the doctor'sexamination consists of and whatthe tests are for high blood pres-sure, and learn what they must doto help control their blood pres-sure Provides latest informationabout high blood pressure drugsand their side effects and inter-actions with other medicatio-is

Availability:Macmillan Publishii g Company866 Third AvenueNew York, New York I0022Cost $14 95

High Blood Pressure Fact Sheet,by American Heart Association'fact sheet, 2 pages, 19861

Defines blood pressure, systolicand diastolic pressure, and highblood pressure Explains why highblood pressure is unhealthy andthat it usually has no symptomsDiscusses uncontrollable risk fac-tors (age, race, heredity, and sex),controllable risk factors (obesity,sodium sensitivity, alcohol con-sumption, oral contraceptives, andlack of exercise); and the mostcommon treatments for high bloodpressure losing weight (if over-weight), reducing intake of salt(sodium), exercise, and medica-tion Statistics, high-risk popula-tions, and general information arealso covered

29 2

Availability:local and state affiliatesAmerican Heart AssociationOrder No 51 -057 -ACost information available fromlocal and state affiliates

Living Habits and Hypertension,by Asian, 'Pacific Islander TaskForce on High Blood Pressure Ed-ucation and Control 'pamphlet,12 pages, 19821

Examines effects of living hab-its on high blood pre ;sure Ad-dresses physical activity, food hab-its, snacks, holidays and specialoccasions, stress and relaxation,alcohol, and smoking Available inEnglish, Cambodian, Chinese, Jap-anese, Korean, Laotian, Tagalog,and Vietnamese

Availability:Hypertension Councii of

the Bay AreaAc'nciation of

Bay Area GovernmentsP 0 Box 2050Oakland, CA 94604-1n50(415) 464-7962Cost Free, single copies

Managing Stress, by KramesCommunications 'leaflet, 6 pages,19871

Provides four relaxation tech-niques to reduce stress Highlightsthe importance of developing apositive lifestyle Encourages read-ers to find ways to reduce stress,and provides sample solutions forstressful day-to-day situationsSuggests avoiding known stres-sots when possible and taking abreak to help ease stress levelsIncludes stress awareness check-list

Availability:Order DepartmentKrame: Communications312 90th StreetDaly City, California 94015-1898(800) 228-8347,(800) 445-7267 in CaliforniaOrder No 1234

Cost SO 50 each, 1-24 copies, $0.35each, 25-199 copies, $030 each,200-499 copies, $0 25 each, 500+copies

Nutrition, by Kra mes Corn-mu nicationsIleaflet, 6 pages, 19871

Helps readers evaluate theirnutritional patterns and create aplan to improve their diets Ex-plains how a low-cholesterol, high-fiber diet can significantly reducethe risks of heart disease and cob-rectal cancer Provides a chart ofthe six major nutritional groups(e g , protein, dairy, complex car-bohydrates, fruits and vegetables,fat, and water) Stresses a low-cholesterol, low-salt, low-sugar,high-fiber diet Includes checklistto help readers assess their nu-trition

Availability:Order Dep-artmentKrarnes (:ommunications312 90th StreetDaly City, California 94015-1898(800) 228-8347,(800) 445-7267 in CaliforniaOrder No 1233Cost SO 50 each, 1-24 copies, $0 35each, 25-199 copies, $0 30 each,200-499 copies, $0 25 each, 500+copies

For Health Professionals

Clinical Hypertension, fourthedition, by Norman M Kaplan(book, 492 pages, 19861

Focuses on significant advancesmade in recent years, and pro-vides a practical, rational approachtoward hypertension management.Pays most attention to the mostcommon problems i e , almosthalf of the text is devoted to pri-mary (essential) hypertensionCovers every form of hypertension,and includes the latest data. At-tempts to be objective and to iden-tify biases clearly

Availability:Williams & Wilkins428 East Preston StreetBaltimore, Maryland 21202Cost $54 95

Coronary Risk Factor Modifica-tion in Children: Exercise, by theCommittee on Atherosclerosis andHypertension in Childhood of theCouncil on Cardiovascular Diseasein the Young, American Heart As-sociationIstatement for physicians,3 pages, 19861

Encourages physicians to de-velop in children a desire tc bephysically active that will persistthrough adolescent and adultyears Exercise habits can lead tothe maintenance of a more effi-cient cardiovascular system andreduce other atherosclerotic riskfactors. Recommends how thisgoal can be achieved Discusseshow exercise habits are fostered,precautions and special problems,and exercise testing

Availability:local and state affiliatesAmerican Heart AssociationOrder No 72-2010Cost information available fromlocal and state affiliates

Counseling the Culturally Dif-ferent, by Dera Id W Su elbook, 303pages, 19811

Provides a conceptual frame-work for recognizing that humanand cultural diversity deserves in-creased sensitivity and awarenessDescribes some of the central cul-tural characteristics as well as cu I-tural and historical perspectivesof varying ethnic groups in theUnited States, claiming that with-out this information, it is unethi-cal to counsel persons of differentcultures Addresses concepts com-mon to most ethnic minorities aswell as the uniqueness of eachgroup Presents detailed counsel-ing methods and implications forblacks, Asians, Hispanics, and na-tive Americans. Presents a seriesof actual case vignettes portraying

30

cross-cultural counseling issuesand dilemmas to be used for help-ing students and professionals todevelop their sensitivity, knowl-edge, understanding, and skills incounseling the culturally different

Availability:Order DepartmentJohn Wiley & Sons, Inc1 Wiley DriveSomerset, New Jersey 08873(212) 850-6418Cost (if prepaid). $29 95 plus pur-chaser's local sales tax

Hypertension Control for Nursesand Other Health Professionals,second edition, by Mahendr SKochar and Karyn D Woods !book,333 pages, 19851

Contains information for nursesand other health professionals onepidemiology and critical issuesin hypertension control, bloodpressure regulation and patho-physiology of hypertension; clini-cal pharmacology of antihyper-tensive drugs, evaluation of hy-pertensive patients, treatment ofhypertension, counseling hyper-tensives, compliance with antihy-pertensive therapy, organizationof a clinic for hyperte ision detec-tion, treatment, and research, amultidisciplinary approach to pa-tient education, and hypertensioncontrol at the worksetting

Availability:Springer Publishing Company, Inc536 BroadwayNew York, New York 10012(212) 431-4370Cost $24.95

30

Other Sources of InformationAmerican Heart AssociationNational Centel7320 Greenville AvenueDallas, Texas 75231

Contact the national center if un-able to locate a state or local af-filiate.

Develops materials, conductsprograms and training, and pro-vides individual and group sup-port Distributes pamphlets, factsheets, and audiovisuals on highbloor1 pressure, smoking, exercise,diet, and general cardiovasculardisease risk reduction to the pub-lic and health professionals.

American Red CrossNational Headquarters18th and E Streets, NW.Washington, D.0 20006

Contact the national headquartersif unable to locate a nearby chap-ter

Distributes pamphlets on highblood pressure to the public andhealth professionals Offers healtheducation programs such as The

Lowdown on High Blood Pressure, acourse for hypertensive patientsand their families, How to MeasureBlood "'ressure, a teaching modulefor laypersons and health profes-sionals, and Better Eating for BetterHealth, a basic nutrition educationcourse Provides outreach to mi-norities and the elderly Checkwith local chapters for additionalcourses and materials Fees aredetermined by local chapters

Food and Drug AdministrationOffice of Consumer Affairs5600 Fishers Lane (HFE-88)Rockville, Maryland 20857(301) 443-3170

Distributes publications on pre-scription d'ugs, medical devices,and food - related subjects includ-

ing sodium, cholesterol, and vita-mins (Man,' of these publicationsare reprints from the FDA Con-sumer magazine, which is published10 times a year )Also serves as thefocal point for consumer inquiriesor FDA-related topics such as foodlabeling and nutrition.

Food and Nutrition InformationCenter

U S Department of AgricultureNational Agricultural Library10301 Baltimore BoulevardRoom 304Beltsville, Maryland 20705(301) 344-3719

Acquires and lends books, jour-nal articles, and audiovisuals onvanousaspectsof human nutrition,including alcohol, hypertension,sodium, fad diets, sports, olderAmericans, and vegetarianism Pro-vides reference assistance for con-sumer and professional inquirieson nutrition Houses extensive col-lection of microcomputer softwarefor nutrition education, dietaryanalysis, and food service man-agement, which is available foronsite preview

National Cholesterol EducationProgram

National Heart, Lung, and BloodInstitute

C-200Bethesda, Maryland 20892(301) 951-3260

Conducts educational programs,and distributes messages andmaterials to health professionals,patients, and the public to fosterthe lowering of elevated bloodcholesterol levels and to providenecessary information and skillsto use dietary changes and drugsappropriately to reduce choles-terol Responds to inquiries fromprofessionals and the generalpublic

31 31

National Clearinghouse forAlcohol and Drug Information

P 0 Box 2345Rockville, Maryland 20852(301) 468-2600

Gathers and disseminates cur-rent information on alcohol anddrugs Responds to inquiries fromthe general public and profession-als Develops publications andbibliographies on topics relatingto alcohol and drugs Distributesa variety of publications on alco-hol and drug abuse

National Council on PatientInformation and Education

1625 I Street, NWSuite 1010Washington, D C 20006(202) 466-6711

Conducts educational campaignson issues relating to patient edu-cation and responsibility Devel-ops educational materials on pre-scription drugs, and disseminatesthem to health professionals andconsumers

NHLBI Smoking EducationProgram

Dept. HINational Heart, Lung, and Blood

InstituteNational Institutes of HealthBethesda, Maryland 20892(301) 951-3260

Offers publications and audio-visuals for use by health profes-sionals in smoking cessation pre-grams Distributes a variety of ma-terials on smoking to consumers

ODPHP National HealthInformation Center

Office of Disease Preventionand Health Promotion

P.O. Box 1133Washington, D C. 20013-1133(800) 336-4797 outside

Washington metropolitan area(202) 429-9091 in Washington

metropolitan area

Serves as a central source ofinformation and referral for thehealth questions of consumersand health professionals. Refershealth questions to appropriatehealth resources that, in turn, re-spond directly to inquirers. Pro-duces directories, resource guides,and bibliographies on health top-ics. Develops and distributes Health-finder, a series of resource lists onselected health topics such as ex-ercise for older Americans, com-munity health promotion programs,health risk appraisals, minorityhealth, and stress

President's Council onPhysical Fitness and Sports

450 5th Street, NW , Room 7103Washington, D C 20001(202) 272-3430

Provides information and con-sultation in the areas of exercise,physical fitness, and sports to helppublic and private organizationsassess and reduce health risks andmotivate individuals to lead health-ier, more active lifestyles Con-ducts public information campaignstargeted to various populationsPublishes bimonthly newslettercovering the council and otheinational programs.

32

<-;-;"--." ....:,......

.-*-7 .:;,-`:,-,.%<̀s.-- -'.....--;----::-.-"' .--...--_-_,....;.. -----......,

"."-.,.....--..... -"*"......,

::.;!!!-;11111011111111111111

:---,,,''' ....

32

-..,""............ "mgr."......,..., ,..................... ...........

' \k\\\..\\\FON\91111\t\I \\\C1 ':''''

\ \ \ \\\\\RA --:::\,

tl\SA-14VtlytRitq,\\WW\v,\\losii ta

wlvtt.tivAti. ..4 --=A\ w

1,kt

,- A Eli .%'-, . it. 11; 0 A VA 11, \VOillic \\WO k i 4 tO

%N \\AVN

i\ 1k

.+6.011.1

.140411AFe. %..4

Part II

Go for Your Goal:Be a Champion of Control

Reproducible Materials

34

Part IITable of Contents

Raproduriblee fnr Health Profaccionis 3

High Blood Pressure Update 4

From One Professional to Another 7

Reproducibles for Consumers 9

Know the Score: Facts About High Blood Pressure 10

Measure Up! Track Your Goal at Home With Blood Pressure Measurement Devices 11

Rate Your Weight 13

Fast-Track Food Facts: Eating Tips for People With High Blood Pressure 15

Ask the Doctors 17

Go for Your Goal Exercise Regularly 19

Go for Your Goal: No Smoking 21

Meet the Challenge of Control: Tips for Reaching Your Blood Pressure Goal 23

You and Your Heart: A Page for Young People 25

Payroll Stuffer 26

Wallet Card 27

The "Wheel of Health" Game 28

Reproducible Certificates 29

Salute a Champion 30

Rx for Champions 31

Media Materials 32

Public Service Announcements 33

Pitch Letter 35

News Releases 36

Print Ads 38

352

11111111111111111111 MINI MS 11111111111111111111111 MI OM =I NM MI MIMI MS OM =I NM MIN MI MI MOM UM IPS Mlle 11111111

-=_

Be A Champion Of Control

LMI= MIMI NM MIN 1101111 MN MN MI MI NMI 11111311111 MOM MINI Mt MN NMI MO MO MI WIN 111111

3

Reproduciblesfor HealthProfessionals

Keep the health professionalson your team informed of the latestdevelopments in high blood pres-sure control with these reproduc-ible materials. Use the fact sheet,adherence tips, and relevant ma-terials found in Reproducibles forConsumers as

Handouts at meetings, work-shops, and conferencesCopy for newsletter articlesInserts in periodic mailingsBasic background information.

ULM% 211IletrA Drchccavrca Iirtri.mtas,..,A.mma A. 1. %. ON? Nr 16. to Niro

Definition

High blood pressure in adults isdefined as two or more bloodpressure measurements averaging140 mm Hg or higher systolic or 90mm Hg or higher diastolic, takenon three separate occasions.

Prevalence Data

Approximately 58 million adultAmericans, or more than one infour, have high blood pressureAnyone can have high blood pres-sure, but it is more common amongolder Americans. The prevalenceof hypertension also differs by sexand race, as depicted below.

Morb:( y and Mortality

Uncontrolled high blood pres-sure can lead to stroke, heart at-tack, coronary heart disease, con-gestive heart failure, kidney failure,and arteriosclerosis. High bloodpressure contributes directly orindirectly to about I million deathsa year

High blood pressure is the majorfactor contributing to the 500,000strokes and 155,000 stroke deathsthat occur in the United Statesevery year. High blood pressurealso contributes to the 1 5 millionheart attacks and 567,000 heartattack deaths in our country everyyear Heart disease is the leadingcause of death for American menand women of all races

AGE INYEARS

18-74

Hypertension and Prevalence Rates by Sex, Race, and AgeCivilian, Noninstitutionalized Population

(Ages 18-74 Years) 1976-80

FEMALES TOTAL

Blacks All Races Whites Blacks(%) (%) (%)

28 8

MALES

Whites Blacks All Races Whites( %) (%) ( %) (%)

32 6 37 9 33 0 25 3 38 6

18-24 162 109 152 23 96

25-34 21 1 23.2 20.9 5 7 15 3

35-44 26 4 44 2 28 4 16 6 37 0

45-54 42.6 55 2 43 7 36 3 67 4

55-64 51.4 66 3 52 6 50 0 74.3

65-74 59 2 67 1 60 2 66 2 82 9

26 8

3569

19.3

39 I

52 6

67 5

91

133

213

39 4

50 6

63 I

All Races(%)

38 2 29 8

102

188

40 I

61 7

70 7

76 I

92137

23 7

41 3

52664 3

Source NHANES 11*Defined as the average of three blood pressure measures 140, 90 mm Hg on a single occasion or

reported taking of antihypertensive medication

4 37

The Stroke Belt

The age-adjusted stroke mor-tality rate has declined by morethan 50 percent since the incep-tion of the National High BloodPressure Education Program(NHBPEP) in 1972 This declinehas benefitted Americans, maleand female, of all ages and races.But the black population has con-tinued to experience a higher rateof stroke deaths than has the whitepopulation, even though blackAmericans as a group are as aware,as treated, and almost as controlledas are white Americans

An examination of this phe-nomenon led to the identificationof the "stroke belt," a concentra-tion of stroke deaths in the south-eastern United States. With theexception of Florida and Maryland,every state in this region was inthe top two intervals denoting theincidence of stroke deaths.

Further examination indicatedthat stroke mortality rates in thestroke belt were elevated primari-ly because the rates for black malesand black females were consider-ably higher in the Southeast thanin other regions of the country, asshown below

The reasons for these differencesbetween blacks and whites are notdearly understood. The NHBPEPis examining factors such as highblood pressure control rates, obe-

sity, dietary habits, and cigarettesmoking. This situation has war-ranted the initiation of NHBPEPactivities and interventions in thesoutheastern United States, par-ticularly within the black com-munity

End-Stage Renal Disease

End-stage renal disease (ESRD)is that stage of renal impairmentthat is irreversible and permanentIt requires dialysis or kidney trans-plantation to ameliorate uremicsymptoms and maintain life.

High blood pressure, with heartand renal disease, is the primarydiagnosis for almost 25 percent ofnewly diagnosed ESRD patients.Diabetes, with heart and renaldisease, is the primary diagnosisfor approximately the same per-centage of newly diagnosed ESRDpatients.

ESRD patients first became eli-gible for Medicare benefits on July1, 1973. Currently, between 90 per-cent and 93 percent of ESRD pa-tients are covered by Medicare;the majority of other ESRD patientsare in the Veterans Administrationhealth system or are covered byprivate insurance.

The number of Medicare recipi-ents with ESRD ranged from 16,000in 1974 to more than 92,800 in1984 Eighty percent of these areon dialysis, the others have re-

1980 Stroke Mortality RatesAge-Adjusted per 100,000, by Region

South All Other Regions

White Male

White Female

Black Male

Black Female

Total

75 8

75 4

136 3

98 6

82 8

74 7

70.1

95 7

85 2

73 6

5 .18

ceived transplants. Annual Medi-care reimbursements have rangedfrom $228.5 million to dose to $2billion during this time, with re-imbursement per ESRD patientranging from $14,300 to more than$21,000 Although ESRD patientsrepresent only one-fourth of 1

percent of Medicare recipients,they account for 3.7 percent oftotal Medicare expenditures.

It is likely that these very highcosts for health care would havebeen even higher, had it not beenfor thewidespread success in con-trolling high blood pressure dur-ing the past 15 years. An evenmore concerted effort to controlhigh blood pressure will contributesignificantly to reducing thesecosts in the future.

High Blood Pressureand Diabetes

High blood pressure and dia-betes mellitus are commonly as-sociated diseases that coexist inmore than 2 5 million Americans,particularly in the socioeconom-ically disadvantaged. High bloodpressure contributes substantiallyto morbidity and mortality in thediabetic population.

Essential hypertension accountsfor the majority of cases of highblood pressure in the diabeticpopulation. Diabetic nephropathy,which occurs in one out of threepersons with insulin-dependentdiabetes mellitus after i 5 years ofdiabetes, is an important cause ofhigh blood pressure. Other causes

of high blood pressure in diabeticpatients are similar to those in thegeneral population. It is estimatedthat only half of the number ofpersons with diabetes and hyper-tension have their high bloodpressure controlled

Prevalence rates for diabetesdiffer by sex and race and increasewith age, as shown below

Prevalance of Diabetes in AdultsAge 20 to 74 Years, by Race, Sex, and Age:

United States 1976-80

Race and sex

All races'

Both sexesMaleFemale .

White

Both sexesMale .

Female

Black'

Both sexes.Male . .

Female .

Total,20-74years

20-44years

45-54years

Age

Go \For }1,

Yourioal

55-64years

65-74years

Percent of population

6.6 20 84 128 17,7

57 15 78 96 19273 25 9.0 155 165

62 16 81 119 16953 10 77 90 18 I

7.0 22 8.5 146 16.1

96 31 129 20 8 25 8

8.4 27 11 0 14.4 29.4

105 35 14.5 25.4 23.1

1. Includes races other than white or black.2. Sex and age estimates for black persons are presented for information only They are too unreliable

to be considered national prevalence estimates

Source. National Center for Health Statistics (NHANES !I)

6

FromOneProfessionaltoAnother

Tips on ImprovingPatient Adherence

Many health professionals findit a constant challenge to helppatients control their high bloodpressure. Some have found newand innovative ways to help theirpatients adhere to treatment. Thefollowing tips provide a few of thedifferent approaches used by prac-titioners to improve patient ad-herence. You might find theirmethods useful in your own prac-tice.

For 6 months, a group of Cali-fornia pharmacists tracked pa-tients taking antihypertensivedrugs. Reminder cards weresent to patients shortly beforeprescriptions were due to berefilled. These pharmacists found

that 65 percent of those whoreceived a reminder card refilledtheir prescriptions in a timelymanner, compared to 46 per-

cent of the control group. Thereminder card increased ad-herence to medication by 41percent Practitioners used ei-

7 f)

ther a computer program or amanual recording system totrack patients' scheduled refillsand level of medication. Bothmethods resulted in greater ad-herence to treatment. (IncreasingPatient Compliance Through the Phar-macy, Inland Counties HealthAgency, Riverside, California)

Marvin Mordkoff, M D , a NewYork cardiologist, instituted aphone-in program for patientsto report their weekly progressin following treatment instruc-tions. Patients sign a contractand agree to phone the officeonce a week These patientsagree to pay a fine if they do notcal! in. The calls are handled byDr. Mardkoff and a registereddietitian Patients state howwell they have managed to loseweight, change eating patterns,exercise more, cut down or quitsmoking, and so on. Fines areonly imposed when a patientfails to call in, no fines are as-sessed for calling in to reportlittle or no progress, or even abackslide. Even patients whohave not reached th weeklygoal are encouraged to continueefforts towerd their treatmentgoals (Medical World News, May25, 1987)

Charles Cook, M D., of Raleigh,North Carolina, found that bettercommunication (i.e , increasedcounseling) resulted in 95-percent adherence among hispatients, including hyperten-

sive black males He spendsabout 35 m inutes with patientson their first visit, 15 to 20minutes on their second visit,and from 10 to 15 minutes onsubsequent visits On each vis-it, his assistants gather nick-names, family member names,favorite sports, and other datafor a "social behavior inven-tory," which allows Dr Cook tocommunicate on a more famil-iar basis than in the usualphysician-patient relationshipThree da; after a visit, patientsreceive a letter with a record oftheir blood pressure, the dateof their next visit, and specificrecommendations regardingdiet and drugs Dr. Cook initi-ates verbal contracts with hispatients. He be;,eves that ef-forts such as these work to im-prove physician-patient com-munication and help avoid ad-herence problems among hispatients. (American Medical News,May 2, 1986.)

T 0 Z-'L P E 0-.EC TOwmmo.0 CII,,t1TOTY

Bernard W. D Fong, M D , aHawaiian physician, sees mostlyAsian patients who have a strongwork ethic and intense pride intheir children He finds work-site blood pressure screeningand school health educationprograms particularly effectivein increasing adherence to anti-hypertensive therapy among

841

this population (HypertensionHighlights, Vol 8, No 1, 1987 )

Donald 0 Fedder, Dr P H , ofthe Office of Comm Inity PharmacyPrograms, University of Maryland,suggests the following tips for im-proving adherence to treatment

Do not assume that patientspurposeful'y disregard theirtherapy program Many patientsdo not understand what to door how to do it.

Ask open-ended questions,which require more than "yes"or "no" answers, to discoverreasons fo- nonadherence.

Have a good idea of how manymodifiable risk factors (e.g.,weight, alcohol consumption,smoking, cholesterol level, so-dium intake) patients have be-fore establishing a treatmentprogram Do not expect patientsto change All behaviors at once.

Set short-term goals for modi-fiable risk factors For example,suggest that overweight patientstry to lose 3 to 4 pounds by thenext appointment, avoid chal-lenging them with 50-poundweight loss goals

Record small successes for pa-tients. Reinforce any positivebehaviors Congratulate patientswho lose 2 pounds, and dis-cuss how to maintain and evenincrease that weight loss.

Give specific instructions forall phases of treatment (e.g ,

taking medication, modifyingdiet) Remember that not allpatients are the same, and theyshould not all be treated in thesame manner List what patientsneed to do, then assess eachindividual's ne-,:d for informa-tion, intervention, or reinforce-ment so that they can achievetheir goal to adhere to ther-apy and control their high bloodpressure

ReproduciblesforConsumers

Distribute these tr.ining tips"to patients and other consumersinterested in going for their goalInformation on weight control,nutrition, exercise, and therapyadherence as well as games, pay-roll stuffers, and wallet cards canbe used as

Handouts at screenings, events,presentations, and meetingsLeaflets at hospitals and clinicsinserts in mailings or paycheckenvelopesArticles and fillers for news-lettersBulletin board notices

rill= MEM 1111111= =MB 11111 MIME MI*M MNN 1N MIM INN M MN El

- 7 ^

*...OMM.

....analoram.../.M1

nwaVOIN 110...11...forpow.v.... on*.

.11011111...INONN

=MO MN MN INN MN Ilia MIN MIII .....m.m....m.........-....., :,--

.,-,.--.- ......e.... . , ....,

.:::---7.----;" --- -1-----

......,-....

.0 ,..0--i. -....-r-,:;::

f7.---;";' 014 illii----7:::7117:,1111111

For 1\Your !)Your

NMI MN MMMMMMMM MIR MI MN MIN MN MINI MO IMM J

42

the`11

*.`410, 141 APIs

Know the score Find out whatyour blood pressure measurementis and what it means. Learn thefacts about high blood pressureand how it can be treated and con-trolled.

Blood pressure is the force ofblood as it moves through theLiiooci vessels. if brood cannot floweasily through the vessels, theforce increases. If the force is toogreat, you have high blood pres-sure.

High blood pressure is a seri-ous disease. It increases the work-load on the heart and blood ves-sels and can lead to heart disease,stroke, or kidney problems

High blood pressure usually hasno symptoms It doesn't hurt, andit usually doesn't make a personfeel sick or dizzy or nervous

The only way to know if you havehigh blood pressure is to have itchecked regularly by a healthprofessional Having your bloodpressure measured is quick andpainless It is done by placing acuff around your arm and measur-ing the force of blood against theinflated cuff.

Your blood pressure is recordedin two numbers Your systolicpressure is the first recorded num-ber and is the pressure in theblood vessel when the heart is

Facts AboutHigh Blood Pressure

pumping. Your diastolic pressureis the second recorded numberand is the pressure in the bloodvessel when the heart is restingbetween beats.

If your blood press:.re readingis consistently 140/90 mm Hg orhigher, you are at increased riskfor heart disease, stroke, and kid-ney problems You should see yourdoctor for followup and possibletreatment

In more than 90 percent of thecases, no one knows what causeshigh blood pressure However,some people are at greater riskthan others for developing thedisease

Older persons are more likelyto have high blood pressurethan are younger persons

9 People with a family history ofhigh blood pressure are morelikely to develop the diseasethan are those with no highblood pressure in their family

Blacks are more likely to havehigh blood pressure and de-velop the disease earlier in lifethan are whites.

High blood pressure cannot becured, but it can be controlledCommon treatments for highblood pressure are listed belowTreatment usually must be con-tinued for life to keep blood pres-sure under control

10

Taking prescribed medication.Follow instructions exactlyDon't skip dosages or stop tak-ing medication without a doc-tor's advice

Controlling weight. Lose anyextra pounds by cutting backon calories and getting regularexercise

Reducing salt (sodium) intake.Avoid foods with high sodiumcontent Use less salt in cook-ing and at the table Use moreherbs instead of salt for flavorEat more fresh fruits and vege-tables

Moderating alcohol intake.Follow doctor's guidelines forlimiting alcohol intake

Increasing exercise. Get regu-lar, vigorous exercise such as

isk walking swimming, or jog-ging

One in every four Americanadults has high blood pressure Itis estimated that many more havethe disease but are unaware oftheir illness Be sure you know thescore Have your blood pressurechecked regularly Be aware of therisks of high blood pressure If youhave high blood pressure, followthe treatment 'Jour doctor hasprescribed, and be champion ofcontrol

4r'O

Measure Up!Track Your Goal at Home With

Blood Pressure Measurement Devices

Be a champion of control, andreach your biood pressure goal!Many individuals with high bloodpressure use blood pressure mea-surement devices at home to trackt' dress of the program the'r

an has prescribed With, safeguards, self-measure-

ment can allow you to be moreactively involved in your treat-ment program It can help you seethe effects of medications or life-style habits on your blood pres-sure, and it can help your doctormake decisions about your treat-ment.

If your doctor recommends self-measurement of blood pressure,be sure to get instructions for tak-ing accurate measurements, main-taining your equipment, and keep-ing accurate records. Before select-ing a measurement device, acquaintyourself with the necessary equip-ment, and work with your doctoror nurse in selecting the devicethat works best for you

..

Equipment

To measure your blood pres-sure, you will need two pieces ofequipment

A sphygmomanometer is adevice that measures your bloodpressure. This piece of equip-ment usually includes an in-flatable cuff, a column of mer-cury or a gauge to record theblood pressure level, and acoittrol valve to adjust the rateof deflation of the cuff

A stethoscope or a microphoneis a device that detects thesound of your blood as it movesin your artery

These two pieces of equipmentare combined in different ways toform three different kinds of mea-surement devices a mercury sphyg-momanometer, an aneroid ma-nometer, and an electronic/digi-tal readout device. Blood pres-sure measurement devices shouldbe used with proper medical super-vision, and they should be checkedperiodically for accuracy (calibrated).The chart below shows the ad-vantages and disadvantages ofeach type of device and gives guide-lines for calibration

Three Types ofHome Blood PressureMeasurement Devices

Mercury Sphygmomanometer

DescriptionHas glass measurement gaugein which a column of mercuryrises and falls as pressure in

I I 44

the cuff rises and falls Requiresstethoscope.

AdvantagesMost accurate and reliableinstrument when properlyused.The standard for blood pres-sure measurementRarely needs calibration.Contains easily replaceableparts.

Disadvantages

Bulky and relatively heavyto carry.Has breakable glass parts.Potential leaks of toxic mer-cury.Must be kept in upright (ver-tical) position.Requires good hearing.

Calibration

Calibrated when manufac-tured.Recalibration unnecessaryas long as mercury columnis exactly at zero when cuffis deflated.If mercury column is not atzero or the mercury is dirty,return to manufacturer forcleaning and calibration

Consumer TipsMercury is a toxic substance.Inspect mercury unit carefullyfor leaks or loose beads of mer-cury before using the equip-ment. If free mercury is present,return the device to its dealer.

Aneroid Manometer

Description

Displays blood pressure oncircular dial with needle thatmoves clockwise as pres-

sure in the cuff rises andcounterclockwise as pres-sure in the cuff falls.Requires stethoscope, whichin some models is perma-nently attached to the cuff.

AdvantagesCompact and easy to carry.Gauge functions in any po-sition.Relatively inexpensiveDoesn't contain mercury.

DisadvantagesRequires good eyesight andhearingMust be calibrated at leastonce a year.Requires expert repair andreadjustment by trained tech-nician.

CalibrationCalibrate at least once a yearor whenever the needle ongauge does not measure zerowhen cuff is deflatedHave a trained technicianperform calibration (contacta local medical supply house,or ask your health care pro-fessional where calibrationcan be performed)

Consumer TipsDo not buy an aneroid ma-nometer with a hidden stoppin near the zero point on thedial This feature could preventyou from knowing when thedevice needs calibration.

Electronic/DigitalReadout Device

DescriptionBattery-operated, automateddevice that uses microphoneto detect the sound of bloodmoving through artery.Blood pressure is automati-cally displayed on dial ordigital readout.

AdvantagesEasy to handle.

Does not require stethoscopeCan be operated by hearing-impaired persons.Most units are easy to carrySome units have automati-cally inflated cuffs

DisadvantagesAccuracy influenced by out-side factors such as bodymovementRelatively expensiveRequires batteryComplex and sensitive equip-mentRequires calibration morethan once a year

CalibrationMust be calibrated more thanonce a year.

Consumer TipsElectronic devices depend onbatteries for their operationTo prevent inaccurate readings,units should alert you whenthe battery runs down either bya warning light or by ceasing towork entirely

Important Pointsto Remember

It is important to follow theproper techniques for measur-ing blood pressure. Have ahealth care professional teachyou how to use and maintainyour equipment. For help, con-tact your doctor's office, a localmedical supply house, phar-macy, hospital, health care clin-ic, health department, or vol-untary health agency such as alocal affiliate of the AmericanRed Cross, the American HeartAssociation, or the NationalKidney Foundation. Be sure toask for written instructions

When you first get your mea-surement device home, checkits accuracy against readingstaken by a doctor or nurse Also,have a health professional ob-

12

serve your measurement tech-iime to make sure you are do-ing it correctly.

Inaccurate equipment can re-sult in false readings. Inspectyour equipment frequently, andhave it calibrated according toguidelines listed on the previous chart

Most home blood pressuremeasurement devices comeequipped with a standard-sizedcuff A cuff that is too large ortoo small will result in falsereadings Check with your doc-tor or nurse to be sure your cufffits properly

Remember that your bloodpressure may vary from day today or from hour to hour Bodyposition, noise, physical activ-ity, stress, smoking, and medi-cines can affect your bloodpressure measurement Read-ings can vary by as much as 20to 30 mm Hg within the courseof a day. Don't be alarmed bythese changes, but discuss anyconcerns with your doctor.

Don't change your blood pres-sure medicine or other treat-ment based on your home bloodpressure readings Always con-sult your doctor before makingany changes

Home blood pressure measure-ment is not a substitute for amedically supervised treatmentprogram. Regular visits to adoctor or other health profes-sional are still important forcontrolling your blood pressure

Monitoring your blood pressureat home and teamwork with yourdoctor can help you become achampion of high blood pressurecontrol With proper use and su-pervision, home measurementdevices can help you to track prog-ress toward your blood pressuregoal and allow you to take an ac-tive role in your own health care

45

Rate Your Weight

Being significantly overweightis harmful to your health and mayin fact shorten your life. Obesityincreases the risk of not only highblood pressure, but also diabetes,heart disease, and many otherhealth problems Some overweightpeople may be at greater risk thanothers For example, recent re-search shows that people who tendto have their fat concentrated intheir waist and abdomen ratherthan the thighs and buttocks maybe more prone to health problemssuch as high blood pressure thatoften go along with obesity

How Much ShouldYou Weigh?

Avariety of methods are used todetermine desirable weight. Butremember that desirable weight isonly a guideline Your ideal weightshould be the weight that is thehealthiest for you Discuss thiswith your doctor In the meantime,here is one common weight calcu-lation method to get you started

Are You Fit or Fat?

Remember that height/weightcharts don't tell the whole storyYour desirable body weight is alsorelated to the size of your framesmall, medium, or large andyou can't change your basic bodystructure. While you may neverlook like a fashion model or bodybuilder, your real goal s, ould be

to obtain a desirable weight foryour body frame, age, and health,you want to be fit, not fat. Weightcharts such as the one shown pre-viously can help you decide if youhave a weight problem; however,such charts don't relate weight tofitness. The best goal is to be fitto feel good and move well whilemaintaining desirable weight Somepeople who weigh more than thechart may still be fit because their

extra weight is muscle, not fatOther people who are within thedesirable weight range for theirheight are not fit because a highpercentage of their body weight isfat For these people, an appro-priate exercise plan is very im-portant. Excess weight is a prob-lem when those extra pounds arefat Many people are both over-weight and "overfat What aboutyou? Answer these practical ques-tions to see if you might be overfat

Are you wider at the waist thanat the chest?

Can you look down and seeyour toes without bending over?

Pinch a fold of skin from theback of your upper arm Is itmore than an inch thick?

If you answered yes to any ofthese questions, you are probably

Desirable Body Weight Ranges

Height Weightwithout shoes without clothes

4'10"4'I I"5'0"5'1"5'2"5'3"5'4"5,5"5'6"5,7"5'8"5'9"5'10"5' I I"6'0"6'1"6'2"6'3"

Men(pounds)

105-134108-137111-141114-145117-149121-154125-159129-163133-167137-172141-177145-182149-187153-192157-197

Women(pounds)

92-12195-12498-127

101-130104-134107-138110-142114-146118-150122-154126-159130-164134-169

Note: For women 18-25 years, subtract I pound for each year under25

Source Adapted from the 1959 Metropolitan Desirable WeightTable

13 46

carrying around excess body fat.Losing excess body fat and bodyweight will require both exercise(to burn extra calories) and diet-ing (to cut intake of calories) Workwith your doctor, registered dieti-tian, or other health care practi-tioner to establish a weight lossand exercise plan that meets yourspecific needs.

Setting a Weight Goal

When starting a weight loss pro-gram, be realistic about how muchweight you can lose and how fastyou can lose it Your first goalshould be to lose half of the weightneeded to reach your desirablebody weight When you reach thatweight goal, talk to your doctor orregistered dietitian about losingmore

Determining YourWeight Loss Goal

To determine your total desir-able weight loss, subtract yourgoal weight from your currentweight

ExampleCurrent weight 160

Final goal weight -120Total desirable weight loss 40

If your total desirable weightloss is more than 10 pounds, divideit by 2 to determine the pounds

you need to lose to reach your firstweight loss goal (e g , 40 dividedby 2 = 20).

ExampleCurrent weight 160

Half of totaldesirable weight loss - 20

First goal weight 140

You should try to have a steadyweight loss of 4 to 8 pounds amonth, or 1 to 2 pounds a weekSet monthly weight loss goalsrather than one large goal. Decidehow much you can lose a monthUsing the example above, it wouldtake 10 weeks to lose 20 pounds.You must make a long-term com-mitment to weight loss if you wantto succeed Use the following chartto keep track of your progress.

If you are not losing weight, askyourself if you eat too much, exer-cise too little, or have set an un-realistic weight loss goal.

Avoid gimmicks and fad dietsthat promise miracles They canbe very dangerous. They are ap-pealing because they promisequick and easy weight loss Butunless a diet is nutritionally bal-anced as many fad diets are not

it could be harmful Diets thatencourage little or no eating, dietsthat promote heavy eating of onekind of food, and very-low-caloriediets can all cause health prob-lems Such diets do not promotelong-term healthy eating habitsFad diets often require drasticchanges, which are hard to main-tain That's why most people go

off their diet and end up not losingweight or even gaining moreweight

Here are some tried and truecalorie-cutting tips to help youget started with the weight lossgame

Avoid second helpings of higher-calorie foods, and gradually cutback on serving sizes

Eat low-calorie versions of foodsthat you like

Go easy on foods that are highin fat or sugar

Limit your intake of alcoholicbeverages

Roast, broil, steam, or poachfoods rather than frying them.

Select lean cuts of meat, andtrim visible fat

Remove skin from poultry be-fore cooking.

Use spices and herbs for sea-soning instead of sauces, but-ter, or margarine

Use low-fat dairy products

You can be a winner at theweight loss game But winningmeans changing your old eatingand exercise habits Start today,but give yourself some time tolearn these new habits You cansucceed

Monthly Weight Goal Goal Date Actual Weight Loss

14 4 -II

Eating Tips for PeopleWith. High Blood Pressure

For many people, the fast paceof American life demands mealsthat keep up with that lifestyleFast-food restaurants (e.g , ham-burger eateries, fried chicken carry-outs) often meet this need quicklyand relatively inexpensively How-ever, the convenience of fast foodsdoes not always mean good nu-trition

The fast foods served in theseeateries are frequently high incalories, fat, and salt, all of whichmake it harder to control yourweight and sodium intake Sincebeing overweight is known to in-crease your chances of developinghigh blood pressure, choose fastfoods carefully to help control

your high blood pressureBut how do you know which

foods are high in calories, fat, andsodium? And how do you decidewhere to eat? Many fast-food res-taurants have published informa-tion about the calorie, fat, and so-dium content of their menu itemsAsk for one of these nutrient bro-chures at your local restaurant, orwrite to the headquarters of theserestaurants (addresses are providedat the end of this article) Calorie,fat, and sodium values can varysignificantly from item to item andfrom one restaurant to anotherTo get you started, here are somegeneral tips to keep in mind wheneating at fast-food restaurants

15 d

To reduce your calorie and fat intake

Fast-food breakfasts tend to behigher in fat, calories, and cho-lesterol than are other meals.Choose cereal with low-fat milk,fruit or juice, plain toast, Englishmuffin, fruit muffin, or bagel.Plain pancakes are much lowerin fat and cholesterol than arebreakfast sandwiches. Just re-member not to add butter, andgo light on the maple syrup

Virtually all fast-food breakfastsandwiches are high in fat Ifyou do order one of the sand-wiches that also include meat,the best choice would be onemade with Canadian bacon, theleanest of all breakfast meats.Sausage sandwiches are thehighest in fat and calories

Choose broiled, baked, or grilledchicken or fish when possibleIf fried is the only choice on themenu, remove the breading orskin

Eating deep-fried chicken orfish with batter or breading of-fers no reduced-calorie or re-duced-fat advantage over redmeat In fact, a plain roast beefsandwich has half the fat of afried breast of chicken or friedfish sandwich

Extra crispy fried chicken hasmore calories and rat than reg-ular fried chicken

Mashed potatoes (even with asmall amount of gravy) are muchlower in fat and calories thanare french fries And onion ringshave even more fat and caloriesthan do french fries

The baked potato starts out asa low-fat food However, whenyou add cheese, bacon, and theworks, the calories double, andthe fat value skyrockets A bet-ter bet is to add a small amountof margarine and then add

vegetables from the salad bar,such as chopped green onion,and perhaps a tablespoon ofshredded cheese

Use small amounts of kelLhupand mustard as condiments.They are lower in calories andfat than are mayonnaise andmayonnaise-based sauces. Buteven ketchup and mustardmust be used in moderation ifyou're watching your sodiumintake

Salad bars are a healthy optionoffered at many fast-food res-taurants When lining up at thesalad bar, choose lettuce oranother variety of greens, andstick with the plain fresh fruitsand vegetables. To cut downon calories and fat, avoid may-onnaise-based items such aspotato salad, macaroni salad,and pasta salad Items such asbacon bits and cheese canquickly add calories and fat

164 s

Use salad dressing sparingly Atablespoon of most salad dress-ings contains about 100 calories

Soft ice cream has the lowestcalories and fat of most des-serts generally available on fast-food menus A plain soft icecream cone has around 190calories and 5 grams of fatCookies and pies have about100 calories more, and a muchhigher percentage of their cal-ories come from fat

Request low-fat or skim milk

Ask what kind of fat is used tofry foods at the restaurant Avoiditems that have been fried inbeef fat, lard, coconut oil, orpalm oii.

To reduce your sodium intake

Order sandwiches without thepickle (93 mg sodium) Usesmall amounts of ketchup (180mg per tablespoon) and mus-tard (180 mg per tablespoon).Cheese adds 200 to 400 mg ofsodium per slice

Skip the bacon bits, pickledvegetables, cheese, olives, andcroutons at the salad bar

French fries are not as high insodium as most people thinkThey taste salty because all thesalt is sprinkled on the outsideof the fries Ask the counter-person to hold the salt, andyou'll save yourself of couplehundred milligrams of sodium

Order pizza with vegetablessuch as mushrooms, green pep-pers, and onion Skip the pep-peroni, sausage, and ham

Fast-food meais can be eitherladen with calories, fat, and salt orrelatively low in calories andhealtny The next time you eat in afast-food restaurant, remember,you can eat wisely and healthy ifyou make the right choices

Go \Fbr '\ Ask the Doctors

High blood pressure control isa team effort between patients andtheir health care professionals Itis important that people with highblood pressure talk openly withtheir doctors, pharmacists, nurses,etc , to find out answers to ques-tions they have about their treat-ment Here, a panel of distinguishedphysicians has answered some ofthe most common questions askedabout high blood pressure

How often should I have myblood pressure measured?

A Edward D. Frohlich, M.D. Mostindividuals should have theirblood pressures measured atleast once every 2 years Indi-viduals at increased risk (per-sons with a family history ofhigh blood pressure or othercardiovascular diseases, whoare black or obese, who use oralcontraceptives, or who consumeexcessive amounts of alcohol)should have their blood pres-sure measured at least onceevery year

When I have my blood pressuremeasured, which number ismore important, the upper orlower number?

A Ray W. Gifford, Jr., M.D. Bothare important Studies indicatethat both systolic (the upper or-pumping") and diastolic (thelower or "resting ") pressurecanpredict possible cardiovascularcomplications such as strokeand heart disease For personsolder than age 50, the systolicblood pressure seems to bemore important than the dia-stolic pressure in predictingcardiovascular disease Evenwhen the diastolic blood pres-sure is normal, elevation of sys-tolic blood pressure (so-calledisolated systolic hypertension)increases risk of heart attackand stroke

Are certain people more likelyto develop high blood pressure?

A. Marvin Moser, M.D. Individ-uals with a family history ofhigh blood pressure are morelikely to develop it People whoare overweight (obese), seden-tary, and have had high salt in-take from early childhood orinfancy are also more likely todevelop high blood pressureHigh blood pressure is alsomore common in blacks Al-though there is no definitiveproof, those individuals under

'7 ,,f

;! ,,!,111111

17

JU

chronic stress over long periodsof time may be more suscepti-ble to developing high bloodpressure It has not been provenwhether or not individuals whoeat less potassium or calciumthan required are more likely todevelop high blood pressure

If my parents have high bloodpressure, will I automaticallyget it?

A Marvin Moser, M.D. A child'schances of developing highblood pressure are greater ifboth parents have it than if onlyone parent is affected However,many children of hypertensiveparents never develop high bloodpressure In families where thereis a strong positive history, it isadvisable to limit salt and so-dium intake and to prevent thechildren from becoming heavyor obese It is also a good ideato have blood pressures checkedat age 3 and again at adoles-cence If a trend toward ele-vated blood pressure is noted,something can be done about it5efore any problems occur

Is it natural for blood pressureto rise with age?

A Ray W. Gifford, Jr., M.D. No. Inmost industrialized societies,systolic and diastolic bloodpressure tends to rise with age,In myopinion, this rise is due tophysical changes in the heartand large blood vessels that arerelated to high-sodium, low-potassium diets, physical inac-tivity, and weight gain viith in-creased age This trend doesnot occur in less developedsocieties and tribes in the SouthPacific islands and the rain for-ests of Brazil. These so-called"low-blood-pressure" societieshave low-sodium, high-potas-sium diets, are very active physi-cally, and do not tend to gainweight with age

O If I lose the extra pounds I'vegained, will I be able to stoptaking my high blood pressuremedication?

A Edward D. Frohlich, M.D. Thebest answer to this question is"perhaps Recent studies showthat some individuals with mildhigh blood pressure who wereplaced on diet therapy to re-duce weight, sodium, and alco-hol consumption could be takenoff anti hypertensive medicationand maintain adequate bloodpressure control for 1 to 4 yearsHowever, these individuals hadhad their blood pressure wellcontrolled for several years withdrugs before the studies, and itis not yet known how long theirblood pressure will remain un-der control without drug therapy.In any event, numerous studieshave shown that losing weightdoes help lower blood pressureSo, even if you cannot com-pletely eliminate your medicine,it may be possible to lower thedose Patients who are on so-called "step-down therapy"should always be carefully mon-itored by their doctor

O If I am feelingwell, can I skip myblood pressure medication?

A Marvin Moser, M.D. Most pa-tients with high blood pressurehave no symptoms Therefore,it is difficult for individuals toiudge whether their blood pres-sure is under control In ourexperience, most people needmedication on a daily basis tocontrol their blood pressure

O Will I always have to take mymedication every day')

A Marvin Moser, M.D. There aresome instances, after bloodpressure has been well control-led, when the longer-actingdrugs (such as one of the betablockers or diuretics) can beused every other day or three

times a week to control bloodpressure In a few cases, afternormal blood pressure has beenestablished for I to 2 years, it ispossible to reduce the medica-tion or eliminate it This is es-pecially true if patients remainon a low-salt diet, keep theirweight down, and exercise reg-ularly.

0 What should I do if I am experi-encing side effects from my highblood pressure medicine')

A. Ray W. Gifford, Jr., M.D. Donot stop taking the medicationInstead, consult with your doc-tor. Fortunately, we now have alarge variety of blood pressuredrugs that allow doctors to beflexible when establishing regi-mens for individual patients.Not only should drugs effectivelyreduce blood pressure, theyshould also be relatively free ofside effects. If they are not,dosages can be reduced or otherdrugs substituted until a satis-factory regimen is achievedEven within classes of drugs, itis possible to find variation withregard to side effects. In otherwords, some patients tolerateone beta blocker better thananother or one calcium chan-

18 51

nel blocker better than anotherYour doctor can work with youto find the medicine that lowersyour blood pressure with no, orthe fewest, side effects

0 How accurate are blood pres-sure measurement devices forconsumers?

A Edward D. Frohlich, M.D.. Mostnonelectronic mercury and aner-oid home blood pressure mea-surement devices used with astandard stethoscope are rea-sonably accurate. ConsumersUnion recently tested 36 elec-tronic and mechanical monitorsfor accuracy and ease of useThe ratings indicated that elec-tronic models were the sim-plest to use, however, as a group,the mercury and aneroid deviceswere often more accurate thanthe electronic units Accordingto the American Heart Associ-ation and the American RedCross, home blood pressuremeasurement devices shouldbe checked for accuracy (cali-brated) at least once a yearThis can be done at your physi-cian's office. With proper safe-guards and medical supervision,most blood pressure measure-ment devices for consumers aresufficiently accurate for homeuse

Edward D Frohlich, M D , isAlton Ochsner Distinguished Sci-entist and Vice-President for Aca-demic Affairs for the Alton OchsnerMedical Foundation, and StaffMember, Hypertensive Diseases,for the Ochsner Clinic in NewOrleans, Louisiana Ray W Gifford,Jr , M D , chairs the Department ofHypertension and Nephrology atthe Cleveland Clinic Foundation,Cleveland, Ohio Marvin Moser,M D , is Clinical Professor of Med-icine at the Yale Univercity Schoolof Medicine, and Sen'or Crosult-ant to he National High BloodPressure Education Program

Go for Your Goal:Exercise Regularly

The heart, like every other mus-cle in the body, needs to stay ingood condition to work effectivelyRegular exercise, designed to in-crease heart rate, also increasesthe strength and stamina of boththe heart and the body,

Regular exercise is one of thebest things you can do for yourhealth People who develop goodexercise habits are rewarded witha variety of benefits the heartpumps blood more efficiently, thelungs develop greater capacity,bones are strengthened; and bal-ance is improved As a result, in-dividuals who exercise regularlyfeel better and look better, havemore energy, and can control theirweight. In some cases, regular ex-ercise helps to control blood pres-sure and helps smokers to stopsmoking. Best of all, exercisingcan be easy You don't have to be asuperstar athlete or sink your lifesavings into special equipmentPhysical activity can be fun, inex-pensive, and safe.

There are many different typesof exercise programs, but some

activities improve the conditionof your heart and lungs better thanothers To improve the efficiencyof the heart and increasetheamountof oxygen that the body can pro-duce, your exercise program shouldconsist of aerobic (pronounced"air-o-bic") activities -- such aswalking, swimming, dancing, bik-ing, and hiking that involverhythmic motion of the legs andarms. People with high blood pres-sure who perform aerobic exerciseregularly under a doctor's super-vision usually achieve a slowerresting heart rate that is of long-term benefit to the cardiovascularsystem.

Perhaps the easiest aerobic ex-ercise program is walking becauseit do's not require special facilitiesor equipment other than a safeplace to walk and comfortable,well-fitting shoes. Shoes should belightweight and flexible with suf-ficient arch support andcushioningfor the bottom of your feet. Wearcomfortable, loose-fitting clothingappropriate for the weather

To improve tne efficiency of your

19

52

heart and lungs and to burn offextra calories, walking must bebrisk (raising heart and breathingrate), sustained (performed at least15 to30 minutes without interrup-tion), and regular (repeated atleast three times a week)

Before setting off on the day'sbrisk walk, be sure to warm upyour muscles first Walk slowly forabout 5 minutes, and then grad-ually build up your exercise paceStarting slowly allows the body'stemperature, pulse rate, and res-piratory rate to speed up graduallyand reduces the chance of injurySimilarly, slowing your pace grad-ually at the end of your brisk walk-ing session allows your body tocool down and readjust after thedemands of exercise. The follow-ing chart below illustrates a sam-ple walking program. Notice thatthe time spent exercising is in-creased slowly over a period ofweeks and that the program in-cludes both a "warm-up" and a"cool-down" period. Repeat eachof the sessions listed three timesduring the appropriate week.

How you feel is prop ly thebest indicator of how hard youshould push yourself Exerciseshould make you sweat a bit andbreathe more rapidly and deeplythan usual, but you should still beable to carry on a conversation.Listen to your body. If you findexercising too tiring, take a littlelonger to build up your exercisetime Otherwise. you'll only windup in pain, convinced that exer-

cise is not for you before you'vegiven it a fair chance Remember,exercise should leave you feelingpleasantly tired, not exhausted orracked with pain.

Check with your doctor beforemaking significant changes in yourlevel of exercise, Remember, exer-

cising should be enjoyable and,for maximum benefit, should beperformed regularly Being a "week-end" athlete and participating in"on-again, off-again" fitness pro-grams may actually do more harmthan good Decide to begin a regu-lar exercise program, and stick with

it Tell your friends of your com-mitment, and, if you can, find anexercise partner You can help eachother to avoid slacking off andskipping sessions. Remember thatthe goal is a long and healthy life,so go for your goal exercise reg-ularly!

Sample Exercise Program(Adapted from the Pawtucket Heart Health Program)

Warm Up

Week 1 Walk slowly5 minutes

Week 2 Walk slowly5 minutes

Week 3 Walk slowly5 minutes

Week 4

Week 5

Week 6 Walk slowly5 minutes

Week 7 Walk slowly5 minutes

Week 8

Week 9

Week 10 Walk slowly5 minutes

Week 11

Week i 2 Walk slowly5 minutes

Walk slowly5 minutes

Walk slowly5 minutes

Walk slowly5 minutes

Walk slowly5 minutes

Walk slowly5 minutes

Exercise Period Cool Down

Walk briskly Walk slowly5 minutes 5 minutes

Walk br'-kly Walk slowly7 minutes 5 minutes

Walk briskly Walk slowly9 minutes 5 minutes

Walk briskly Walk slowly11 minutes 5 minutes

Walk briskly Walk slowly13 minutes 5 minutes

Walk briskly Walk slowly15 minutes 5 minutes

Walk briskly Walk slowly18 minutes 5 minutes

Walk briskly Walk slowly20 minutes 5 minutes

Walk briskly Walk slowly23 minutes 5 minutes

Walk briskly Walk slowly26 minutes 5 minutes

Walk briskly Walk slowly28 minutes 5 minutes

Walk briskly Walk slowly30 minutes 5 minutes

....

Total 7"

15 rninutes-_-__--47,

17 minutes

19 minutes

21 minutes

23 minutes

25 minutes

28 minutes

30 minutes

33 minutes

36 minutes

38 minutes

40 minutes

20 53

Go for Your Goal:No Smoking

Both high blood pressure andsmoking are known risk factors forheart disease. The combination ofthese two risk factors greatly in-creases the probability of disease.So people should not only controltheir biood pressure, but theyshould also q iii smoking

Some Commonly AskedQuestions About Smokingand High Blood Pressure

Will smoking cause my bloodpressure to rise?

Cigarette smoking temporarilyelevates blood pressure; it alsomakes the heart work harder.While no scientific evidence di-rectly links smoking to highblood pressure, smoking is arisk factor for heart diseaseCigarette smokers are two tothree times more likely to haveheart attacks than are non-smokers And following a heartattack, a smoker has a poorerchance of recovery The simpletruth is that people should not

21

smoke cigarettes, especially ifthey have high blood pressure

High blood pressure, smoking,and obesity are some of therisk factors for heart diseaseHow can 1 possibly control allthese risk factors?

Controlling several risk factorsis not as hard as it might seemat first because many are re-lated Controlling one risk fac-tor often helps control others.Also, by achieving one goal,you strengthen your ability toachieve others. For example,once you quit sn-, Jking, you'llrealize that you are indeed awinner. This will make it easierto accomplish other personalgoals that are important to youAttempt one change at a timeFor example, if you're trying toquit smoking, concentrate allyour efforts on that goal. Thismay not be the best time tolose those extra 20 poundsOnce you've quit smoking, youmay find it easier to exercise,and exercise will help you loseweight in the long run

I've known some people whohave smoked for 30 or moreyears, and they haven't devel-oped heart disease, high bloodpressure, emphysema, or anyof the other diseases associ-ated with smoking Why shouldI be concerned?

Not everyone smokes the samearriciint, and not everyone de-velops chronic diseases fromsmoking But the chances areso much greater for smokersthan for nonsmokers that itdoes not make sense to takesuch a risk

I:, there a "safe number ofcigarettes that I can smokeeach day?

No. Cutting down on the num-ber of cigarettes smoked dailycan reduce but not eliminatethe ill effects on health. Smok-ing even a few cigarettes raisesblood pressure temporarily andmakes the heart work harderCutting down is a step in theright direction, but not nea,as effective as quitting

I've been smoking for more than20 years. Will it do me any goodto quit now?

Its never too late to quit Nomatter how long you've beensmoking, the b y begins torepair damaged cells as soonas you quit, and the heart andlungs begin to function betterEven if you've already devel-oped a chronic disease, youmay help prevent the diseasefrom getting worse if you quitsmoking

Are there immediate benefitsto quitting smoking?

Yes Quitting smoking puts lessstrain on the heart since it doesnot have to work as hard. Evenone cigarette can cause theheart to beat an extra 200 or300 times The smoker's coughdisappears after quitting. Skintemperature stabilizes sincethe small blood vessels are nolonger constricted by nicotineThe wrinkling process that showsup as crow's feet around theeyes goes back to normal. Yourbreath and clothing no longersmell like tobacco Bacteriaand food debris that becometrapped on the tongue are loos-ened. Also, you immediatelystart to save the money thatotherwise would be going up insmoke And, of course, you en-joy the immeasurable personalsatisfaction of overcoming aharmrul habit

Don't I need strong willpowerto quit smoking?

Millions of people who believethat they have little or no will-power have successfully quitsmoking Many psychologistsbelieve that there is no suchthing as willpower Quittingsmoking requires strong moti-vation to quit and a personalcommitment to change moti-vation into action Some peoplebenefit from a well-designedprogram to guide them

22

Will I gain weight if I stop smok-ing and increase the risk of de-veloping high blood pressure?

Some people do gain weight,some experience no change,and others even lose weightTo some extent, this dependson whether you substitute foodfor cigarettes If you do gainweight, it is best to quit smok-ing completely first, then con-centrate on your diet and physi-cal exercise to control weightDeciding on a smoke-free lifestrengthens your ability toachieve other goals in life aswell

Is there a "best" way to quitsmoking?

There's no best way to stopsmoking not in the sensethat one method works betterthan others for all smokers"Cold turkey" may be the bestway for those who are capableof doing so But many smokerswho quit, even those who claimto have done so cold turkey,actually prepared for it overtime Unless you are truly pre-pared to quit, it may be betterto strengthen your motivation,develop an understanding ofthe reasons you smoke, andprepare yourself to cope withthe cravings or urges you haveto smoke after you quit Other-wise, your chances of goingback to former smoking prac-tices are increased Some smok-ers need a group program,where they share experiencesand successes with their peersOthers need personalized at-tention from a smoking cessa-tion professional Some smok-ers benefit from hypnosis, shocktherapy, or smoking-cessationdrugs under the direction of aphysician Still others lust quit"cold turkey If in doubt, con-sult a specialist You'll be gladyou did, and so will your heart

*Now*Naar ....ea

...wwwww.oas

-13,

owooviaI*.--r

Meet the Challenge of Control:

Tips for ReachingYour Blood Pressure Goal

Working for Control

If you have high blood pressure,ask your doctor exactly what youcan do to control it and what yourblood pressure goal should be foryour age and medical conditionBy working toward this goal, youcan take an active role in your ownhealth care Reaching your goalcan mean reducing your chancesof having a stroke, heart disease,and kidney damage

Teaming Up WithYoui Doctor

Controlling your high bloodpressure calls for teamwork be-

tween you and your doctor Hereare ways you can work with yourdoctor to treat and control yourhigh blood pressure

Keep your doctor's appoint-ments If you must cancel anappointment, be sure to sched-ule another visit as soon aspossible Mark your appoint-ment dates on your calendarAsk the doctor's office staff toremind you of your appoint-ment. Ask about evening andweekend hours if necessary.

Prepare for doctor visits Makenotes of the problems you arehaving. Keep a list of all themedicines you are taking, in-cluding nonprescription drugsWrite down all the questionsyou have for your doctor

Talk to your doctor Ask anyquestions you have about yourdoctor's instructions, and askfor these instructions to bewritten down Describe anyproblems you are having fol-lowing your doctor's adviceDiscuss any concerns or fearsyou have about your conditionand treatment Ask about yourlatest blood pressure measure-ment, ask what the numbersare and what they mean, andtalk about the progress you aremaking toward your blood pres-sure goal

23

If your doctor prescribes medi-cine, ask about the name andpurpose of the drug, how andwhen to take it; possible sideeffects and what to do if theyoccur, and what foods, drinks,and other medicines to avoidwhile you are taking your pre-scription Ask for written infor-mation on the medicine youare taking.

Ask about generic drugs, whichare often much cheaper thanbrand name drugs

Give your doctor time to findthe treatment that works bestfor you the one that lowersyour blood pressure with thefewest side effects

Taking Your Medicine

if you are prescribed medicineto control your high blood pres-sure, you must take it every dayaccording to your doctor's instruc-tions. This means building newhabits. Here are tips to help youtake your medicine properly

Try to take your medicine at thesame time each day. Combinethis activity with daily routinesIf you take one pill a day, keepyour medicine near somethingthat is parr of your morningroutine, such as your tooth-

brush If you take several pills aday, ask your doctor if you cantake them with meals. If so,keep your medicine on the din-ing table.

If you take more than one medi-cine, count out the day's pillsin advance and keep them inseparate containers that arelabeled with the time you shouldtake them

Keep a medication calendarthat you can mark each timeyou take a dose of your medi-cine Also mark when you willneed to refill your prescription

Carry a pill box with a 1-daysupply of your medicine in yourpocket or purse when you leaveyour house If you are traveling,be sure to carry your medicine.n your hand luggage Refillprescriptions before going onout-of-town trips

Don't skip taking your medi-cine because you feel good Ifyou miss a dose, call your doc-tor for instructions to get backon schedule Do not take anextra dose for ones you'vemissed If you notice any sideeffects, tell your doctor Do notchange dosages or stop takingyour medicine without yourdoctor's specific instructions

Always refill your prescriptionbefore you run out of pills. Keepalmost-empty medicine bottleshandy and in the open as areminder to get prescriptionsrefilled Ask your pharmacist ifthere is a system for remindingyou to refill your prescription,such as receiving a postcard ortelephone call from the phar-macy.

If you have trouble readingmedicine labels, ask your phar-macist for large type on thelabel Some people color codetheir medicine bottles and writedosage information on a piece

of paper the same color as thebottle

If child-proof safety caps arehard for you to remove, askyourpharmacist for easy-to-opencaps Ask your doctor to writeon your prescription that youneed easy-off caps

Asking Others to Help

Your family, friends, and com-munity service organizations canbe part of your high blood pres-sure control team Here are someways you can ask others to helpyou reach your blood pressuregoal

Ask your spouse or other closerelative to go with you to thedoctor. They can ask questionsand learn what they can do tohelp you reach and maintainyour blood pressure goal

Ask your spouse, another familymember, or a neighbor to re-mind you to take your medi-cine, refill your prescriptions,keep your doctor's appoint-ments, and follow your diet

It is easier to make diet changesif the whole household is onthe same diet plan. If you arecutting calories and reducingsalt and alcohol in your diet,ask your spouse and otherhousehold members to loinyou in this healthy habit

24

If transportation is a problem,ask a relative or neighbor todrive you to doctor's appoint-ments Try to find a drugstorethat delivers prescriptions

Ask social service agencies andpublic health departments aboutspecial programs that mightoffer assistance for prescriptioncosts, insurance questions, trans-portation, and other problems

Staying in Control

Once you have started to worktoward your blood pressure goal,you may be surprised to find iteasier and less complicated thanyou thought it would be A goodway to see progress toward yourgoal is to keep your own record ofyour blood pressure measure-ments After each doctor's visit,write down your measurement ona chart and see how close you aregetting toward your goal

Remember, because high bloodpressure cannot be cured, youmust control it for the rest of yourlife Once you have reached yourgoal and your blood pressure iscontrolled, you must continue tofollow your prescribed treatment,If you stop treatment, your bloodpressure may rise again, increas-ing your chances of stroke, heartdisease, and kidney damage Seeyour doctor for regular checkups,and continue to follow his or heradvice Mea the challenge of highblood pressure control!

Your body has many parts andsystems One very important sys-tem involves your heart and thenetwork that carries blood to therest of your body The heart and itsnetwork are called the cardio-vascular system

The heart is a hollow, strongmuscle that is located in th: center

You and Your Heart:A Page for Young People

with oxygen and food to other partsof the body Next, the blood entersthe capillaries, the smallest bloodvessels in the body the capillariesexchange the food and oxygen sentby the arteries for waste productsand carbon dioxide Next the bloodtravels through the veins and isreturned to the heart The heart iscontinually pumping blood to allparts of your body

Blood pressure is the forceneeded to circulate the blood as ittravels through your body Highblood pressure is when the forceis too strong within the walls ofthe arteries High blood pressureis a serious condition and cancause heart disease, stroke, orkidney disease It is important to

kinds of foods, get proper amountsof exercise and rest, and neversmoke A heart-healthy diet is onethat is low in cholesterol, saturatedfat, and salt, and gives you all ofthe vita, ais and minerals youneed. V should also avoid foodsthat are high in calories and havevery few vitamins and minerals.These foods include things likecandy, desserts, fried foods, andheavily salted foods

Exercise helps to keep you andyour heart in good shape, and itmakes you feel better, too Takepart in regular physical educationclasses at school and stay activeduring vacation times by walking,swimming, and joining in othersports that you enjoy

Cole ad_ Arc va title um &nu al ve flit roe ate filtie AVIA re:61c_

11........ -.dillAliararsemmr- wilmumwrimmiIMMMIIMIIIIIMI NM M'' 11111N"IMMI" Mr IW MIPMLIMMIr ...sIMI JON111.111 Mimi/MIMI/PIMMEM_ 41=NNW NW- MINIMS

s... 7 41%......"'

Yea.. ti kW e.;,:( tr.L.Ato /ma We iiii ktla..1

Arkluill V hie' retArgiro

g iira larc fig.E.fge- ra

of your chest It is the size of a fistand is divided into four parts orchambers, two on the right side,two on the left side Blood that ispumped by the heart makes acomplete c':cle as it travels inyour body. First, the blood travelsthrough the arteries carryingblood

practice good health habits whenyou are young so that your heartwill stay strong and healthy whenyou are older. This is one way toavoid developing high blood pres-sui e.

To keep your heart strong andhealthy. you clad to eat the right

25

If you have heart-healthy habitswhen you are young, you have agood chance of preventing highblood pressure or certain kinds ofheart disease when you are older

Here's a song that will help youremember to think about highblood pressure and your heart

Today, one in every four Ameri-cans has high blood pressure Highblood pressure is the leading causeof strokes and a major cause ofheart attacks

There's no better feeling than tokr ow that you can control yourhypertension by taking the pillsyour doctor has given you, losingweight, exercising, and cuttingdown on salt. Go for your goal andbe a champion of high blood pres-sure control. Treat yourself rightby controlling your high bloodpressure

So, make your life work; keep upthe fight Treat your high bloodpressure; treat yo' --elf right

GoForvo",VW

N. 001

7

/

Today, one in every four Ameri-cans has high blood pressure Highblood pressure is the leading causeof strokes and a major cause ofheart attacks

There's no better feeling than toknow that you can control yourhypertension by taking the pillsyour doctor has given you, losingweight, exercising, and cuttingdown on salt Go for your goal andbe a champion of high blood pres-sure control Treat yourself rightby controlling your high bloodpressure

So, make your life work, keep upthe fight Treat your high bloodpressure; treat yourself right

Today, one in every four Ameri-cans has high blood pressure. Highblood pressure is the leading causeof strokes and a major cause ofheart attacks

There's no better feeling than toknow that you can control yourhypertension by taking the pillsyour doctor has given you, losingweight, exercising, and cuttingdown on salt, Go for your goal andbe a champion of high bloodpres-sure control Treat yourself rightby controlling your high bloodpressure

So, make your lifework; keep upthe fight Treat your high bloodpressure, treat yourself right

la.

GoFor

YOidYG (Wii

GoFor

Your Goal

Name

Doctor's Name

Doctor's Phone Number

Medication(s)

Goal Blood Pressure

Goal Weight

i',

Go GoForIl Forozir

'Goat Your Goal

Name

Doctor's Name

Doctor's Phone Number

Medication(s)

Goal Blood Pressure

Goal Weight

GoFor

Your Goal

Name

Doctor's Name

Doctor's Phone Number

Medicationisi

Goal Blood Pressure

Goal Weight

Wallet CardBlood Pressure Record Questions to Ask the Doctor

DateBlood

Pressure WeightNextAppt

/////

/

Blood Pressure Record Questions to Ask the Doctor

DateBlood

Pressure Weight Next

/////

/

Blood Pressure Record Questions to Ask the Doctor

DateBlood

WeightPressureNextAppt

27 (-. 1 4

-k=-- I ne"Wheel

of Health"Game

Read the clue for each group ofwords or phrases. Then fill in themissing letters to solve the puzzle

A Uncontrolled high blood pres-sure can lead to

I __ EA _ _ A A __

2 S _ 0 _ E

3 1 E__ Al _ U E

B Things you should do to controlyour high blood pressure

4 E_ E__ 1_ EEU AL5 FO _ OW

0 TO _ _0 _ E _ S

6 CO _ RO OU_ El __ H__

7 SEA _ 0 _ WI _

HE _ S IN EA

0 __ AL 24 HEA

8 MA E ACO _ MI _ ME _ T

9 FO _ 0 _ _ OU _RE _ E _ _ Ai Y

10 SE GOA

I I. TA _ E YOU __ IL _ _

12 EA_ F ESF Ul _ A _ DVE __ ETA _ _ ES

C People who will be happy if youcontrol your high blood pres-sure

13 _ A _ 1_ Y

14 F IE _15 _ OU _ 0 TO _

D Key words to remember whencontrolling your high bloodpressure

16 _ Y TE _ 10

17 P _ ES 10 _

18 E _ I A 10

19 CO _ MI E T

20. _ I E _ 1_ E

21 CO__ _ _ 0__

22 C_ EC U

23 T E A _

ill I

too illill1111111rnififillifill1181111D771 HIM IIiphr ',0//,01180111/1101,1fillmilil[11111,61,1149",/till /1111! tip /14//ft87/11/::// /111

p/ll I fifyI / Tip lirfr/;01/ 0 IN I dippg Iv

hil /dr/ It'f/',

25 WE L- EI _ _

2waq-liamAipleatjAdelaqidmpaqD

IaqUODawpaili

iibewl!wwoDuopeDtp,pwuoildinsaid

uoisuailadAq

SZ

PZ

ZZ

'1ZOZ

6191L I

91

ainssaidpooiq OBI InoA 2uilla1uoDuaiim laqwawal o1 spiom AaN a

loiDop noA 51spuapj P1Al!wej £1

ains-said }Doom InoA io.puoDnoAj! Addeq aq oqm aidoad D

saiqeia2an pue ilsalj lea zsind InoA Nei I I

sieo2 las .01Aliep uawi2ailnoA molioj 6

luatmiwwoD e New 9ales

jo peaisui scpaq uoseas L1i am InoA lo.quoD 9

slaplo s,loiDop mono]. cApein2a1 asplaxa

.ains-said poolq tpitl InoA io.quoDdial 01 op pinoqs not( saint, g

-said poon

amiiej AauppiNails z

peIle inal I

01 peal ueD ainspallo.uuoDun

:awed TleaH Jo laaqMSJOMSUV

280 4;

*OM..41

X

4

MIN

LMI MI CUM NM NY MI MN I= 11111111111 MIN NMI IIMO MN MN NM MI IMO - -J

29

63

ReproducibleCertificates

Recruit and reward participantsin the team effort to promote highblood pressure control with thesecertificates. Use these materialsto

Encourage patients to go fortheir goal and adhere to theirhigh blood pressure regimen

Recognize the contribution of vol-unteers to high blood pressurecontrol in your community

O

Salute a ChampionCertificate of Recognition

This is to recognize the volunteer contributions of

for being part of the team ofhigh blood pressure control in our community.

Your championship effort to help keep high blood pressureunder control is helping Americans lead longer, healthier lives.

Signed

Title

Organization

City, State

Date

This certificate is awarded to you with appreciation!

Be a Champion of Control

VJ

Rx for Champions

Being a champion means never quitting, and that goes for high blood pressurecontrol as much as anything else. I want to be a champion of high blood pressurecontrol. Starting now, I am going to:

Take my medication every day

Control my weight

Eat right, including restricting sodium and alcohol, reducing fats, and eating morefresh fruits and vegetables

Exercise regularly

Quit smoking cigarettes

Get regular checkups

Follow my doctor's orders, and talk to him or her if I have any questions or problems.

I'm in training to be a champion (Thigh blood pressure control. I'm going towork at it every day. I'm going for my goal and winning!

signed Date

'

Be a Champion of ControlST

1-

Sample RadioPublic Service Announcements

Live-Announcer CopyGo

1. : 1 0

Go for your goal with high blood pressure control! Learn about

high blood pressure at (event) on (date/time) at (location). Call (telephone

number) for information.

2. : 1 5

Reach for your goal by keeping your high blood pressure under

control. Learn how at (event) sponsored by (organization) on (date/

time) at (location). Cail (telephone number) for information.

3. :15

Learn how high blood pressure control can help you reach your

goal! Come to (event) on (date/time) at (location). Together, you and

(organization) can help lower high blood pressure in (county/city).

Call (telephone number) for information.

33

4. :20

The (organization) has helped (hundreds/thousands) of (county/city)

residents detect and treat their high blood pressure. They can help

you, too. Visit the (event) on (date/time) at (location). Go for your goal

by keeping your good health. Call (telephone number)

5. :30

Being your best means staying healthy. Yet (percent) of (county/

city) residents have high blood pressure. Uncontrolled, it can lead

to stroke, heart attack, and other serious health problems. Eating

right, exercising, and taking medications as prescribed can help

control high blood pressure and reduce health risks. If you have

high blood pressure, keep your good health by following doctor's

orders, and go for your goal! Call (telephone number) for more

information.

34 70

Sample Pitch Letter

(date)

(Name)(Title)

(Television or Radio Station)(Street Address)

(City, State, Zip Code)

Dea, (Name)

Today, more Americans are aware of the risks of uncontrolled high bloodpressure than ever before. The efforts of the National High Blood PressureEducation Program are succeeding, thanks largely to the efforts of volunteers,health professionals, and media outlets like (Name of Station).

Unfortunately, awareness of having high blood pressure does not auto-matically lead to control. Only 11 percent of Americans with high bloodpressure are successfully controlling it Here in (City/County), health depart-ment officials estimate that (Number) residents have high blood pressure, andonly (Number) have it under control. Those who do not are living with increasedrisks of heart attack, stroke, and kidney disease

This May National High Blood Pressure Month the residents of (City/County) are joining in the spirit of this Olympic year by going for their personalgoals of high blood pressure control (Name), director ofthe (Organization), ischallenging residents to be champions of control. (His/Her) experience in thehealth community and knowledge of local needs may make (Him/Her) aninteresting guest for your (Viewers/Listeners)

The enclosed materials provide further information on (Name), the(Organization), and planned activities for May 1 would be happy to answer anyquestions you may have or arrange an interview with (Name)

I will be contacting you in a few days to discuss a potential interview Thankyou for your time

Sincerely,

(Name)(Title)

35 71

NewsRelease

GoFor

YourGoal

For Immediate Release Contact (Name)

orFor Release:

(Telephone Number)

(Organization), Local Businesses WorkingTogether to Control High Blood Pressure

The (Organization)is launching a campaign with (City/County) businesses tocontrol high blood pressure in the workplace.

Ca led (Name of the Campaign), the effort is designed to motivate employeesand management to become involved in high blood pressure control througha series of activities and events within each business

(Name of Spokesperson), (Title) of the (Organization), said the campaign will kickoff with a management seminar on various methods of controlling high bloodpressure.

"Every week we are going to feature activities such as exhibits, videos,speakers, exercise programs, and brown -bag lunch discussions," said (Name).

"Local businesses will also be distributing handouts in payroll envelopes andfeaturing 'heart-healthy' recipes in the cafeteria."

According to the National High Blood Pressure Education Program, morethan 27 million employed people, or 26 percent of workers, have high bloodpressure. A total of 58 mill'un Americans have high blood pressure, yet onlyII percent ate succes<ally controlling it

"We know that high blood pressure cannot be cured, but it can becontrolledthrough metrication, exercise, weight control, diet, and smoking cessation,"said (Naive). "Leaving it uncontrolled can be very dangerous, resulting inheart attack, stroke, or kidney disease

(Name), (Title) of the.(Local Business), explained (His/Her) company's reasonsfor joining the campaign.

"Our employees are very important to us, the continued success of ourbusiness depends on them. If they're not controlling their high bloodpressure, they could become seriously ill and even die. We just can't let thathappen," said (Name).

According to the National High Blood Pressure Education Program, 10times as many workers die from coronary heart disease, hypertensive disease,and stroke than from industrial accidents

For further information about the (Organization)' s campaign to controlblood pressure at the worksite, call (Telephone Number).

36

# # #

72

NewsRelease

, -

For Immediate Release Contact (Name)(Telephone Number)or

For Release:

(Organization) to Air High Blood PressureControl Special on Local Cable Channel

The (Organization) will present (Name ofP(ogram), a new special on controllinghigh blood pressure on (Channel) on (Day of Week), (Date), at (Time).

The program will inform viewers in the (City/County) area of the dangers ofhigh blood pressure and the steps they can take to control hypertension.

"Uncontrolled high blood pressure can lead to heart attack, stroke, andkidney disease," said (Name), (Title) of the (Organization) "Yet there are ways tocontrol this condition taking medication, maintaining desirable weight,reducing sodium intake, increasing exercise, and moderating alcohol con-sumption. These are the means of control that we will discuss during theprogram."

The show will feature a panel discussion with (Name of Local Physician), (Nameof Local Health Educator), (Title) of the (Ofganization). Residents of (City/County)will also appear on the program to discuss their personal treatment regimens

"Our viewers will also have the opportunity to call in and ask specificquestions about their experiences with high blood pressure cuitrol or askgeneral questions about the treatment of this lifelong condition," said (Nameof Spokesperson)

The cable special is just one of many activities sponsored by (Organization)this month as part of National High Blood Pressure Month. According to theNational High Blood Pressure Education Program, more than 58 millionAmericans have high blood pressure, and only I I percent are successfullycontrolling it.

The high blood pressure special was developed by (Organization) and theproducers of (Station) (Name of Spokesperson) said the (Organization) hopes todevelop the program into a regular series focusing on different health issues

For more information about the upcoming special and other activitiesbeing sponsored by (Organization), call (Telephone Number)

37

# # #

e.

The interruptions caused by uncontrolhigh bloottpressure at your wOrksiteenormous and costly. In business tentconsider the absenteeism, disability an

payments of insurance claims. And inhuman terths, just consider that a tot gpeople have lost their lives to high blopressure.'

So it makes good business sense. to:sta.. blood pressure control program wherework. Not only will it help. your etripkcontrol their high blood pressure, it wthem that you care. And that can be

-for buSiness.

Talk to us.about starting a worksiteh4blood pressure control program.

!UGH BLOOD PRESSC . 'RpLxPROGRAII

Usiness

The High Blom, PrsuUte Education ProIfttflitia4f*Ortitnn

tifia:101intelisPut

Diortmontotileamial

4

Part III0," "

Evaluation and Order Form

Evaluation and Order FormHigh Blood Pressure Information Center120 80 National Institutes of HealthBethesda, Maryland 20892(301) 951-3260

(All items are free Please allow 6 weeks for delivery 1

Name

Organization

Street

City State Zip Code

Telephone No (include area mde)

Please complete and return this section, even if you are not ordering additional materials.

What type of organization best describes your program setting") (check the appropriate response)Health DepartmentHospitalEducational InstitutionNursing HomeBusiness or IndustryCivic or Service Group

Voluntary Health AgencyNeighborhood Health CenterArmed ForcesProfessional As.:ociationSolo or Group Medical PracticeOther (specify)

2 Does your organization target its high blood pressure control activities toward any of the following specialpopulations') (check all that apply)

Elderly EmployeesRural Population YouthMinorities Other (specify)

3 How many years has your organization participated in National High Blood Pressure Month? (check oneresponse)

This Is Our First Time 6 Years or More2-3 Years Don't Know4-5 Years

4 What blood pressure activities does your organization provide? (check all that apply)Professional Education DetectionPatient Education Referral and FollowupPublic Education Other (specify)

5 Do you conduct these activities year-round or only during May? (check one response)Year-round May only

If year-round, were kit materials used year-round or only for May activities?Year-Round May only

6 How useful are the items in the National High Blood Pressure 12-Month Kit to your organization? (circle oneresponse for each type of material)

Type of MaterialVery Not

Useful Useful Useful

a Activity Guide 2 3

b Media Tools 2 3

c Reproduction Handouts 2 3

d Wheel of Health 2 3

e List of Materials Available From Other Sources 2 3

7 Will your organization place a special emphasis on any of the following issues for your high blood pressureactivities in the coming year (check all that apply)

Nondrug Therapy Risk Factor AssessmentPatience Adherence Rewards for Controlling Hypertension

8 Do you have any suggestions for ways we could improve the National High Blood Pressure 12-MonthKit?

Thank You

/'

Materials for ProfessionalsThese materials are designed for use by health professionals in conjunction with professional education

programs or as program planning resources

QUANTITYORDERED RESOURCES

*Statement on Hypertension in Dia-betes (28 pages) Final Report of theWorking Group oii Hypertension in Dia-betes Provides new information and ap-proaches to treating patients with bothdiabetes and hypertension Suggestspractical approaches in the educationcontrol, and long-term maintenance ofsuch patients

tDetection, Evaluation, and Treatmentof Renovascular Hypertension (reprint,Archives of Internal Medicine) Final report ofthe NHBPEP Working Group on Reno -vascular Hypertension Critically reviewsscreening studies useful in identifyingrenovascular hypertension, the recom-mended approaches for confirming thediagnosis, and the selection of subse-quent therapeutic options

The Physician's Guide: ImprovingAd-herence Among Hypertensive Patients(guide, 36 pages) Presents ways physi-cians can improve patient education andincrease adherence to treatment andcontrol of high blood pressure Includesstrategies to encourage behavior changesoften required of hypertensive patientsli e taking medication regularly, main-taining desirable weight, reducing dietarysodium, increasing vigorous exerciseand moderating alcohol consumption )

*tThe Identification and Exaw.inationof the Stroke Belt (presentation, 12

pages) Presents a summary of the re-sults of statistical analyses designed toprovide information concerning the mag-nitude of the problem of stroke deathsamong blacks in the southeastern UnitedStates

*t Repot t of the Second Task Force onBlood Pressure Control in Children1987 (report, 28 pages) Presents norma-tive data on blood pressure derived froma sampl ing of more than 70,000 childrenadvice on methodology and instrumen-tation for blood pressure measurementguidelines for detecting children withhigh blood pressure and strategies forappropriate diagnostic evaluation andpharmacologic and nonpharmacologictreatment

QUANTITYORDERED

*Community Guide to High Blood Pres-82-2333 sure Control (137 pages) Summarizes

approaches to program development,examines education and patient track-ing, and discusses funding

81-2204

84-1271

85-1244

86-2730

*tNHBPEP Coordinating CommitteeStatement on Hypertension in theElderly 18 pages) Updates the 1980Statement on Hypertension in the ElderlyDiscusses elevated blood pressure anddiastolic and systolic hypertension inthe elderly, based on findings of theHypertension Detection and Follow-upProgram

*t NHBPEP Coordinating CommitteeStatement on Nonpharmacologic Ap-proaches to the Control of High BloodPressure (30 pages) Reviews a variety ofnonpharmacologic approaches to con-tr^i a -* ,--11 hypertension Recommendsthree treatment modalities consideredto have sufficient scientific support towarrant recommendation for inclusionin hypertension treatment programs

*Patient Tracking for H ig'n Blood Pres-sure Control (66 pages) Outlines pro-cedures for planning and operating apatient tracking system for improvedcontrol of high blood pressure

The Physician's Guide: How to HelpYour Hypertensive Patients Stop Smok-ing (24 pages) Shows what every physi-cian can do within a busy office practiceto persuade hypertensive patients tostop smoking

*Printed Aids for High Blood PressureEdu ation: A Guide to Evaluated Pub-lications1123 pages) Describes and eval-uates lugh blood pressure educationmaterials available from a variety ofsources

*1iblic Perceptions of High BloodPressore and Sodium t35 pages) Dis-t_usse, the results of the 1982 ConsumerFood Survey, sponsored by the Food andDrug Administration and the NationalHeart, Lung and Blood Institute

*Materials may be reproduced(Single copies only

Materials for Patients and ConsumersNote on Selecting Patient and Consumer Materials

Reading level indications for pamphlets were calcu ated using the SN1(1)6 Readability Formula The le,,elsroughly correspond to these grade levels Very easy, .glades 6-7 Easy, grace 8, N,erage, grades 9-10, Fairlydifficult, grades 1 1 -13

QUANTITYORDERED PAMPHLETS

87-2024

86-1459

`Blacks and High Blood Pressure 18pagesi Describes high blood pressureits importance to blacks the need fortreatment, and the role of the patient'sfamily Very easy reading level

High Blood Pressure & What You CanDo About It (32 Pages) Describes thenature and measurement of blood pres-sure both normal and high, with a dis-cussion of drug treatment and side ef-fects as well as lifestyle changes thatmay be recommended Fairly difficultreading level

*Questions About Weight, Salt, andHigh Blood Pressure 110 pages) De-scribes 'what is known about the rela-tionship between certain diet changesand high blood pressure Average read-ing level

POSTERS

Some Hints for People Who Take HighBlood Pressure Medicine (12 x 18 I

Reminds patients to take medicationand to talk with their doctor, nurse orpharmacist when questions arise

QUANTITYORDERED

*Tomorrow 117 x 22 I Encouragespeople to treat their high blood pressurefor life beginning today

*So You Think You've Been Cured ofHigh Blood Pressure 116" x 20 Ex-plains that high blood pressure can becontrolled, not cured, and that peopleshould take their prescribed medicationeven when their blood pressure readingis normal

*Think You Know What HypertensionMeans? 116 x 20 I States that hyper-tension should not be confused withnervous tension and that high bloodpressure pills should not be taken onlywhen a person is feeling upset

*Don't Skip Your Blood Pressure Medi-cation 116 x 20 I States that althoughcontrolling weight and exercising aredesirable for people with high bloodpressure, they are not substitutes formedication

You Can Shape Your Future 126 x 14 ')Describes a variety of methods that helppatients control their blood pressure

*Materials rnav be reproduced

For more than sample copies of any item, please tell us (on a separate piece of paper) about:I Your planned activities for 1988 National High Blood Pressure Month and year-round2 The audiences for whom the materials are intended

For additional information contact the High Blood Pressure information Center In addition to distributing thematerials listed here it series as a central national Llearinghouse fur inf.,ormution on \, di IOU", cb1A-Lt5 Of high bloodpressure control

High Blood Pressure Information Center120/80 National Institutes of Health

Bethesda, Maryland 20892(301) 951-3260

SponsorsNational High Blood Pressure Month is sponsored

by the National High rood Pressure Educ?tionProgram Coordinating Committee which includesthe following member organizations

Ad Hoc Committee on CardioN.ascular Pulmonan, Disease RiskFactors in Minority PopulationsAmerican Academ, of Family PhcsiciansAmerican Academy of OphthalmologcAmerican Academ of Physician Assistant,American Association of Occupational Health NursesAmerican College of Cardiolog,American College of Chest Pk siciansAmerican College of PMsiciansAmerican College of PreN.enti,e MethcneAmerican Dental AssockvionAmerican Dietetic AssociationAmerican Heart AssociationAmerican Hospital \ssociationAmerican Medical AssociationAmerican Nurses Association IncAmerican Occupational Medical Ass,)ciat,onAmerican Optometric Acsociat ionAmerican Osteopathic Assocaf ionAmerican Pharmaceutical AssociationNmerican Podiatr, Medical ssociat,onAmerican Public liealth AssociationAmerican Red CrossAmerican Society of Hosn'tal PharmacistsAssociation of Black CardiologistsAssociation of Life Insurance Medical Directofs )t \in^ caCitizens for the Treatment of High Blood Pressu'e In,National Black Nurses Association IncNational Heart Lung and Blood Institute,National Kuincn founciation'National Medical Associat,onNational Optometric. AssociationSooet, for Nutrition Education

30