Community Intervention: Hypertension Screening


One of the U.S. Preventive Services Task Force (USPSTF) Grade A recommendations is the screening for high blood pressure in adults over 18 years. Hypertension is among the most common non-communicable diseases worldwide. In 2008, nearly 1 billion people of 25 years and older had hypertension, which equates to about 40% of the global population (Mangat et al., 2015). This adverse health condition is a major risk for the development of various cardiovascular disorders. For instance, as stated by Mangat et al. (2015), hypertension is responsible for “45% of deaths caused by ischemic heart disease and 51% of deaths caused by stroke” (p. 418). It means that community-based screening for elevated blood pressure among adults can help to reduce the risk of hypertension-related morbidity and mortality, increase individuals’ longevity and quality of life.

Conceptual Model

Screening for any disease may be regarded as an initial phase in the prevention and intervention process as it is expected to lead to behavioral changes. Therefore, one of the theories applicable to the proposed initiative is the Theory of Planned Behavior, which aims to predict a person’s motivation to engage in certain activities (Hackman & Knowlden, 2014). The theory suggests that one’s health-related behavior is affected by his/her attitude (favorable or unfavorable evaluation of that behavior), subjective and social norms (common and personal beliefs about the value of certain behaviors), perceived power to engage in a particular behaviors (existence of facilitating factors), and perceived behavioral control (Hackman & Knowlden, 2014). Based on these theoretical constructs, the suggested initiative for hypertension prevention will aim to promote a positive attitude to screening, instill a sense of its value at both subjective and normative levels, and facilitate access to blood pressure screening. Overall, the objective of this initiative is to stimulate community members’ intention to undergo regular screening and, preferably, choose healthier lifestyles that would reduce their risk of hypertension progression.

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Screening Purpose

The population chosen for the initiative includes the residents of West Virginia. This state has the highest rate of hypertension in the United States as per the statistical data collected throughout 2017. The prevalence of hypertension among adults in West Virginia that year was 43.5%, and the state showed one of the highest increases in the incidence rate since 1990 as well (Robert Wood Johnson Foundation, 2019). Besides that, West Virginia is the least healthy state in terms of heart disease rate, which equates to 7.4% compared to 2.5% in the healthiest state of Hawaii (United Health Foundation, 2019a). The rate of deaths due to cardiovascular diseases has been steadily declining since 1990 in the selected population, but it still remains above the national average (United Health Foundation, 2019b).

The statistics demonstrate that hypertension is a significant burden in West Virginia, and it is likely linked to the high incidence of cardiovascular problems in the community. The fact that hypertension often has no signs and symptoms only complicates the situation because affected individuals stay unaware of the immense health risks they face (United Health Foundation, 2019c). At the same time, hypertension is a modifiable condition, and screening can facilitate its early identification and intervention, resulting in much better patient outcomes.

Screening Population

The initiative will be launched in Charleston, WV, a large urban area with a multiculturally diverse population. In accordance with, the USPSTF recommendation, all adults of 18 years old and older will be eligible for screening. However, considering that the risk of hypertension increases with age, particular focus will be on individuals of 45 years old and older (United Health Foundation, 2019c). In addition, the risk of elevated blood pressure is also slightly higher in men than in women, and in Black individuals than in all other races (United Health Foundation, 2019c). Therefore, the initiative must primarily reach out to these population groups.

Screening Activity and Outcomes

The main goals of the screening initiative will be as follows:

  • Identification of pre-hypertension condition and prevention of hypertension development,
  • Diagnosis of hypertension and prevention of cardiovascular and other complications,
  • Promotion of awareness of hypertension signs and symptoms,
  • Promotion of healthier lifestyle and the use effective prevention methods.

The main screening procedure will be at-office blood pressure measurement. Consistently with guidelines, at least two readings will be obtained from participants on two different occasions (USPSTF, 2015). A probable interval between office screenings may be one week, throughout which participants will be asked and educated to conduct regular blood pressure monitoring at home during nighttime and daytime to increase the diagnosis precision. Following this pattern, hypertension type 1 will be diagnosed in participants merely when two consecutive screenings will identify systolic blood pressure within the range of 130-139 mm/Hg or diastolic blood pressure – within 80-89 mm/Hg (Whelton et al., 2017). Type 2 hypertension will be diagnosed if systolic blood pressure is 140 mm/Hg or diastolic blood pressure is 90 mm/Hg (Whelton et al., 2017). Pre-hypertension condition/elevated blood pressure will be diagnosed in case a participant’s systolic blood pressure will be 120-129 mm/Hg and diastolic blood pressure – <80 mm/Hg (Whelton et al., 2017).

In all three cases, patients will be educated on lifestyle modifications, including weight loss, healthy dieting, reduced intake of sodium, physical activities, and so forth (Whelton et al., 2017). Patients with hypertension diagnosis will also be referred to their physicians for medication prescription. Participants with elevated blood pressure will be advised to repeat screening 3 months after the initiation of a lifestyle intervention, whereas healthy individuals will be advised to repeat testing within the next 3 years.

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Setting

The initiative can be carried out on a regular basis, in partnership with one of the local organizations specialized in cardiovascular health, such as the American Heart Association (AHA). The AHA has extensive experience in fighting heart disease and stroke, and it employs thousands of volunteers and competent employees across the country (AHA, 2019). The ability to tap into the AHA’s knowledge, informational resources, and customer base and secure their professional support will be to a significant advantage to this project.

Cost

Table 1: Estimated initial price for conducting the hypertension screening initiative in Charleston, WV.

Needs Estimated Price
Space rental US $1000-2000 per month
At least 15 manual or automated sphygmomanometers US $30-70 per one unit
At least two laptops/computers for record keeping, correspondence, and other administrative activities Approximately US $400 per one unit
Educational materials design and print (about 1000 pieces) US $20 per 100 leaflets
US $50-100 per high-quality design
Attendees’ services (at least four new graduate nurses) Minimum US $130 per 8-hour shift per one professional
Total initial cost: US $19,000 (minimum)

Summary

Prevention and screening programs targeted at hypertension can enhance the quality of life and potentially save lives. The proposed solution is relatively easy to implement and the costs of its implementation can be easily outweighed by its benefits. When carried out in the community where the incidence of the disease is particularly high, this initiative will provide multiple advantages. Through early identification of elevated blood pressure and hypertension, it can significantly decrease both individual and public financial burdens, improve the local health-related ranks, and reduce risks of further aggravation of symptoms and development of complications in all program participants.

References

American Heart Association. (2019). About us. Web.

Hackman, C. L., & Knowlden, A. P. (2014). Theory of reasoned action and theory of planned behavior-based dietary interventions in adolescents and young adults: A systematic review. Adolescent Health, Medicine and Therapeutics, 5, 101-114.

Mangat, B. K., Campbell, N., Mohan, S., Niebylski, M. L., Khalsa, T. K., Berbari, A. E.,… Zhang, X. (2015). Resources for blood pressure screening programs in low resource settings: A guide from the World Hypertension League. Journal of Clinical Hypertension, 17(6), 418-420.

Robert Wood Johnson Foundation. (2019). Hypertension in the United States. Web.

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Community Intervention: Hypertension Screening
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U.S. Preventive Services Task Force. (2015). Final recommendation statement. High blood pressure in adults: Screening. Web.

United Health Foundation. (2019a). About heart disease. Web.

United Health Foundation. (2019b). Cardiovascular deaths in West Virginia. Web.

United Health Foundation. (2019c). About high blood pressure. Web.

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey Jr., D. E., Collins, K. J., Himmelfarb, C. D.,… Wright Jr., J. T. (2017). 2017 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Web.

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