L. *º- iſ Health and Human Services ice of Health High Blood Pressure Control: ng, and Blood Institute d Pressure Education Program Share the Success National High Blood Pressure Month May 1984 | Sponsors National High Blood Pressure Month is spon- sored by the National High Blood Pressure Educa- tion Program Coordinating Committee, which in- cludes the following member organizations: U.S. Department of Health and Human services |Public Health Service eature eets National Institutes of Ilealth National Heart. Lung, and Blood Institute National High Blood Pressure Education Program - º º | | National High Blood Pressure Month May 1984 --L-L ºn ºtſ 250 - Feature Sheets Feature Sheets in this kit are reproducible. By reprinting these materials yourself, you will have a ready, immediate supply of simple, profes- Sional, patient, and consumer publications to let you get started on activities right away. You can then use the High Blood Pressure Information Center Month Order form or the list of materials available through other organizations to get pro- fessional education materials and additional pa- tient and consumer pieces. Improving Adherence to Therapy Ideas for Health Professionals Working with Hypertensive Patients Because high blood pressure control requires a lifetime commitment from patients, they often need support and consideration from you and their family members. The professional's role in patients' achieving adherence to a treatment regimen is quite significant; your attention and interest in each patient need to be contin- uous throughout treatment. This may take some extra effort on your part but a strong patient- professional relationship can bring rewards for you and your patients. The methods available for improving adher- ence to antihypertensive therapy are simple, but do require a commitment from you, the health professional. The benefits, however, are great: the tragedy of premature death and disability from uncontrolled hypertension is avoidable. Studies show that responsibility for ensuring good adherence need not be shouldered by you alone, but is best managed when there is partici- pation by the patient and all members of the health care team. Rx FOR ALL PATIENTS: Prepare the Way for Good Adherence 1. Monitor appointment keeping; record and share progress toward goal blood pressure. 2. Make it convenient and easy for patients to remember appointments by: • reducing waiting time, and • setting the time and date of the next visit before patients leave your office. 3. Keep dietary and/or drug regimens as simple as possible. 4. Work with patients on one behavior change at a time. 5. Assist patients to participate actively in their own care by encouraging them to: • ask questions, • express concerns, and • solve problems as they arise. Actions such as those described above may be considered useful in preventing adherence problems and can be provided for all hypertensive patients as part of routine office practice. For some patients, however, these steps will not be enough to maintain adherence. Specific approaches to helping these patients are noted below. These may require additional time and energy, but keep in mind, these actions will probably need to be concentrated on only that portion of your patient population experiencing adherence problems. RX FOR PATIENTS WITH PROBLEMS: Strategies for Improving Adherence 1. Retrieve dropouts with personal contact: • make new appointments promptly after a “no show,” and • personally contact persistent nonattenders. . Increase your attention and supervision: • increase the frequency of visits until the blood pressure is stabilized or on a steady decline, • seek the cooperation of other health professionals seeing the patient, and • recruit the patient's family and friends to help support good adherence habits. 3. Use the behavioral principles of cueing (tie medication-taking to routine daily habits), feedback, and reinforcement to help patients maintain therapy and progress toward goal blood pressure. 2 “Filler” Articles (Use them in your organization's periodicals or reproduce as patient/general handouts) High Blood Pressure? A Variety of Health Professionals Can Help If you have high blood pressure, you should control it to have a longer, healthier life. Uncon- trolled high blood pressure can lead to heart or kidney disease and stroke. One way to get your blood pressure “numbers” to come down and to keep them down is to follow the advice of health professionals interested in helping you. Your doctor is the only one who can diagnose your high blood pressure. But other health pro- fessionals can help in a variety of ways. Along with medication, you may be asked to lose weight, or cut back on salt or smoking. Doing these things will help your medication work better and shorten the time for you to reach your blood pressure goal. There are a number of health professionals trained to assist you, in- cluding nurses, pharmacists, nutritionists, and health educators. Good Health Habits Help You Beat the Odds What do uncontrolled high blood pressure, Overweight, smoking, and a high cholesterol diet have in common? They all increase your odds for getting heart disease. How much? The answer is different for each person, depending on family history, and on how many of these “health risks" you have. Your doc- tor can tell you how big a chance you may be taking with your health by not controlling risks that can be modified or eliminated. How much risk is too much? Ask yourself. Then ask your doctor for help in changing every- day habits to help you beat the odds. Reducing Your Waistline and Your Blood Pressure Overweight? You may not know it, but shed- ding those unwanted pounds can do more than shrink your waistline. It might also lower your blood pressure. High blood pressure is twice as common among people who are overweight. When these patients take pounds off and keep them off, chances are they'll need less medicine (or none) to lower pressure to a healthy level. And many people with normal blood pressure can help keep it that way by watching their weight. Ask your doctor for advice about keeping your weight and your blood pressure under control. High Blood Pressure Is a Family Affair Doctors have found that high blood pressure runs in families. There is a chance of more than one member of a family having hypertension. So if family members learn early on to watch weight, cut back on salt, get more exercise, and how to deal with high blood pressure, they will benefit. They will be helped as they help you treat your high blood pressure. Give your family members things to do in order to help. Your doctor or nurse can tell you how to have someone take blood pressure readings and record progress on a chart. A family member might be asked to remind you about daily medi- cation. Family members also can help with pill refills, with doctor visits, and with getting help from other health workers like educators, nutritionists, or dietitians. Friends can help, too. Changes your doctor asked you to make—such as to reduce your weight, use less salt, exercise more, or smoke less—affect activities often done among friends. A friend can be very helpful. Tell someone you need help following your doctor's advice. WI ue16Old uoleonp= eansseld pool9 u51H ſeuoſleN eln]]]sul pool9 pue ‘6unT ‘llee H leuolleN Ullee H JO Seln]]]Sul euolleN ‘80|AuðS Ullee H OFICInd Seo!AueS ueum H pue ulſeek- JO lueullede.G ‘S’ſ) aſ T.10.1111pall ' ' ' aunssaud poola q8th ‘IIoA Se puſu InoA JJO TU3raa e axel II.]I JIasino KJO aſeo expel ao Ape S. JOloop InoA AOIIod UOIleopau oxſel e lſeS UO UAOp mno e aSIOJaxe Jeſnäa. UEId e 1U312A aSOI e :Ol noA pºol 2Abu Abu JOloop Inok Kunſeau ou Sleul AOuxi nox aq pinous iſ UEun Jaußru SI ainssaud pooja Inox aunssaid poola q8th 1púI unoCI appoS Stay on a healthy course. Keep track of your blood pressure. Know your blood pressure goal. Ask your doctor what your numbers are and keep your Own record. Follow your progress to better health. High blood pressure . . . Treat it for life! U.S. Department of Health and Human Services Public Health Service, National Institutes of Health National Heart, Lung, and Blood Institute National High Blood Pressure Education Program |A Don't skip your blood pressure medication Watching your diet, exercising, losing weight and Stopping Smoking are great if you have high blood pressure. But it's just as important to take your pills. If your doctor prescribed medication, you need it. Don't substitute for the pills. High Blood Pressure... Treat it for Life U.S. Department of Health and Human Services Public Health Service, National Institutes of Health National Heart, Lung, and Blood Institute National High Blood Pressure Education Program High Blood Pressure Month Proclamation WHEREAS local organizations and groups who work for high blood pressure control have a right to be proud of what they are doing because they are greatly increasing knowledge and awareness of the seri- ousness of hypertension and are helping to decrease the number of deaths due to hypertension-related diseases. . . WHEREAS a 1982 national survey of public knowledge about high blood pressure showed that over 90 percent of all Americans now believe high blood pressure is a very serious disease, and recognize that hypertension cannot be cured but can be controlled by continuous treatment. . . WHEREAS high blood pressure is still a leading cause of disability, and contributes to more than 750,000 deaths from cardiovascular and related diseases annually. . . WHEREAS about 60 million Americans have high blood pressure of some degree, and many of them do not know they have it because it is symptomless; and of the many who do know that they have it, mil- lions still are not under treatment, or do not have their blood pressure under adequate control. . . WHEREAS people with untreated or uncontrolled high blood pressure risk premature illness or death from coronary heart disease, stroke, heart or kidney failure, and people who effectively control their high blood pressure can lead normal, healthy lives. . . WHEREAS hundreds of America's major private, professional, voluntary, state, and Federal organi- zations work together to promote existing high blood pressure programs, and to begin new programs throughout this country; they continue to make progress in helping millions of Americans control their high blood pressure, and they deserve our recognition and support. . . THEREFORE as , I hereby proclaim the month of May 1984 as National High Blood Pressure Month. I strongly urge all civic, scientific, medical, educational, voluntary, and health care organizations and professionals to join me in using this month—and the months and years to come—to educate the public, patients, and health care professionals in the detection, treatment, and control of high blood pressure. In addition, I strongly urge you, my fellow citizens, to have your blood pressure checked regularly, as well as the blood pressures of members of your families. If your blood pressure is high, you should seek and follow your physician's advice. Signature Date CERTIFICATE OF RECOGNITION This is to recognize the volunteer contributions of to high blood pressure control in our community. Volunteer efforts such as these are fundamental to program success in reducing death and disability related to high blood pressure. This certificate is offered with appreciation and pride. S$№ººººººººººººººººººººººS? ſae signedsigned Nº. My Goal BP AIeiOI 12IIeM. Juoned Name Clinic or MD Telephone Medication Instructions My Goal BP AIeiOI 12IIeM Jueged Name Clinic Or MD Telephone Medication Instructions My Goal BP AIe/CI Joſeº Huened Name Clinic or MD Telephone Medication Instructions My Goal BP Name Clinic or MD Telephone Medication Instructions ÁIe/CI 19/Teº Juoned My Goal BP Name Clinic or MD Telephone Medication Instructions AIe|CI 19/Tew quened My Goal BP Name Clinic or MD Telephone Medication Instructions Next Things to Discuss at Next Things to Discuss at Date BP Appt. Next Visit Date BP Appt. Next Visit Next Things to Discuss at Next Things to Discuss at Date BP Appt. Next Visit Date BP Appt. Next Visit Next Things to Discuss at Next Things to Discuss at Date BP Appt. Next Visit Date BP Appt. Next Visit Selected Bibliography on Patient Adherence and Patient Education This bibliography lists a variety of references available on the topics of patient adherence and patient education. Items marked with an as- terisk (*) are available from the High Blood Pres- sure Information Center. Please contact the publisher or local libraries for all other items. Anderson, Ron J. and Matthews, Carol, “Non- compliance: Failure of the Therapeutic Partnership,” Cardiovascular Reviews and Reports, 2(5):464–470, May 1981. Becker, Marshall and Maiman, Lois, “Strategies for Enhancing Patient Compliance,” Journal of Community Health, 6(2): 113-135, Winter 1980. Daniels, Linda and Kochar, Mahendr, “Monitor- ing and Facilitating Adherence to Hyperten- sion Therapeutic Regimens,” Cardiovascular Nursing, 16(2):7-12, March-April 1980. Glanz, Karen, “Compliance with Dietary Regi- mens: Its Magnitude, Measurement, and De- terminants,” Preventive Medicine, 9(6):787–804, November 1980. Haynes, R. Brian, “Lowering Blood Pressure by Gaining Patients' Cooperation,” Journal of Cardiovascular Medicine, 6(5):451–458, May 1981. Haynes, R. Brian, Chairman, “Management of Patient Compliance in the Treatment of Hypertension: Report of the Working Group,” Hypertension, 4(3):415-423, May-June 1982. *High Blood Pressure Control: Information and Education Strategies for Messages to Public and Patient Audiences, U.S. Department of Health and Human Services, Public Health Service, National Institutes Of Health, Na- tional Heart, Lung, and Blood Institute, Na- tional High Blood Pressure Education Pro- gram, April 1982. Hunt, Gerard and Rhodes, Laura, “Patient Edu- cation: The Importance of a Reciprocal Rela- tionship,” Maryland State Medical Journal, 32(4):299-302, April 1983. Levine, David M. et al., “Health Education for Hypertensive Patients,” Journal of the American Medical Association, 241(16):1700–1703, April 20, 1979. McKenney, James M., “Methods of Modifying Compliance Behavior in Hypertensive Pa- tients,” Drug Intelligence and Clinical Pharmacy, 15(1):8-14, January 1981. Moore, Michael, “Step-Care Approach to Im- proving Hypertensive Patient Compliance,” American Family Physician, 26(1): 155-160, July 1982. Moriskey, Donald et al., “Five-Year Blood Pres- sure Control and Mortality Following Health Education for Hypertensive Patients,” Ameri- can Journal of Public Health, 73(2):153-162, February 1983. Patient Education in the Primary Care Setting: Proceedings of the Fifth Annual Conference, September 20-21, 1982, Kansas City, MO, S.S.M. Regional Family Practice Residency and National Family Practice Research and Development Center, St. Mary's Hospital, 1983. *Report of the Working Group on Critical Patient Behaviors in the Dietary Management of High Blood Pressure, U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, Na- tional Heart, Lung, and Blood Institute, Na- tional High Blood Pressure Education Pro- gram, NIH Publication No. 83-2269, Decem- ber 1982. Smith, Dorothy, “Patient Education: Working Toward a Common Goal,” Maryland State Medical Journal, 32(4):294-298, April 1983. *Working Group to Define Critical Patient Behav- iors in High Blood Pressure Control, “Patient Behavior for Blood Pressure Control: Guidelines for Professionals,” Journal of the American Medical Association, 24.1(23):2534-2537, June 8, 1979. QNV TVS THENEMA J1ſt Oº V u)|B3FI JO S3]n][]Sui Ibuout N 30IA.19s II][89H OIIqnd SNOISEſNO ºn sº, HLIvah Ho LNGIWLavdaq sºn U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute NIH Publication No. 84–1459 Reprinted January 1984 Are There Specific Diets For People With High Blood Pressure? A No, but doctors, nurses, and dietitians often provide low calorie and low Sodium diets tailored to each person’s medical con- dition, food preferences, and way of living. These professional people can also give tips on how to shop for low calorie and low sodium foods and how to fix tasty meals with little or no salt. Changing eating habits isn’t easy and takes time. Friends and relatives of persons with high blood pressure should do all they can to help them stick with their prescribed treatment, whether that means taking medicines, losing weight, eating less sodium, or all three. This help is important Qw. Is High Blood Pressure? A High blood pressure is a condition in which a person’s blood pressure goes up too high and stays there. Blood pressure normally goes up and down, depending on the person’s different activities. The prob- lem occurs when the blood pressure stays too high all the time. About one in four Americans has high blood pressure. And more than half of because to keep blood pressure down, these changes must be permanent. Qw. Can I Get More Information? A You can write to food manufacturers for sodium and calorie information. Ask your physician, nurse, or nutritionist for help in Selecting foods and dietary pro- grams. Visit the health section of your local bookstore or public library for low calorie and low Sodium cookbooks, and for calorie and Sodium counting charts. Many Organizations, Schools, hospitals, and associations in your local community will gladly provide you with more informa- tion on weight reduction and on eating less Sodium, including: these have high blood pressure that is very Serious. This disease is dangerous, because so often, it leads silently but directly to conditions that often kill or cripple: heart attack, stroke, and kidney disease. High blood pressure is especially dan- gerous because it has no clear signs. A per- son can have it and not even know it. It doesn’t hurt, and it usually doesn’t make a person feel sick or dizzy or nervous. As a result, many people with high blood pres– Sure can live for years without knowing they have it. That’s why it’s so important for people to get their blood pressure checked regular- ly and, if it is high, to follow the treatment their doctors prescribe. Along with drugs, weight loss for the overweight, exercise, and salt restriction are among the most impor- tant ways to treat high blood pressure. • The local affiliate of the American Heart Association; • The local or state office of the American Dietetic Association; • The local health department; • The medical, nutrition, and some psy- chology departments of a nearby uni- versity; • Some major grocery store chains. Other organizations such as certain weight-reducing programs or clubs, the YMCA, YWCA, health clubs, and gymna- siums help many individuals in weight reducing programs by making available not only materials, but also incentives to stay with the diet. Before beginning any of their prescribed programs to reduce weight, be Sure to check with your physician. Because there is no cure for most high blood pressure, there’s no such thing as a quick treatment that solves the problem once and for all. For each person, it usually takes a few weeks or months for the doctor to work out the best way to control blood pressure. Some ways are weight loss for the overweight, regular exercise, medicines, sodium restriction (sodium is a part of salt and is found in many foods), or a combi- nation of those. Treatment may change as the years go by, but treatment of one kind or another to control high blood pressure usually lasts for a lifetime, and blood pressure must be checked regularly. • In restaurant foods, especially fast foods, like a burger and fries; • In some medicines, like antacids. Reading the labels on foods and medicines for the terms “salt” and “sodium” may help you make better choices. Q. Much Sodium Is Too Much? As reasonable amount of Sodium in the diet of the average person is 2 grams daily, which is equal to the amount of sodium found in 1 teaspoon of salt. Most Americans eat 2 to 4 times more sodium than they need by salting their foods *_2:tº . . . . by eating foods high in Sodium. Ö Will Maintaining Normal Weight Prevent High Blood Pressure? A No One knows for sure, but main- taining the right weight may reduce the risk of getting high blood pressure. Keeping to the weight recommended for your height and build will make you feel better all around, because it will keep you healthier in general. Keeping weight down is especially important for members of families that have a history of high blood pressure, heart disease, or stroke. Will Overweight Children Get High Blood Pressure? A No One can predict that. But just as for adults, staying at the right weight will Q How Can I Cut Down On Salt? A Here are some ways to start cutting down: • Add less salt when cooking. • Use less Salt at the table. • Choose alternatives to heavily salted foods like chips, pretzels, salted nuts. • Try more spices and herbs instead of Salt, garlic, onion, or other seasoned Salt, catsup, or Soy Sauce. • Choose alternatives to processed foods with high sodium content. These changes alone can significantly re- duce Sodium intake for most people. Per- Sons with high blood pressure may have to cut down even further. They should follow the treatment program their doctor has given them. make children healthier in general and may help to prevent high blood pressure when they get older. Eating habits, like so many other habits, are often formed during childhood, so it’s important to develop good Ones. Q: People With High Blood Pressure Help Control It By Losing Weight? A As a first step in treating high blood pressure, doctors often ask overweight pa- tients to lose weight. Weight loss alone Sometimes lowers blood pressure to normal levels. ©: Losing Weight Cure High Blood Pressure? As. High blood pressure cannot be cured, but it can be controlled. Once a per- Son has lost enough weight to bring the blood pressure down, the battle is not over. Keeping blood pressure down means con- trolling weight and taking any medicine, if the doctor has prescribed it, and keeping track of your blood pressure to make sure it stays controlled. What Is The Best Way To Lose Weight? A Losing weight should be a gradual process that avoids fad diets and other gim- micks. Eat fewer calories and exercise more, because losing weight means burning up more calories than you eat. Lose weight and keep it off by finding low calorie foods and doing exercise that you like. Work out the best combination of diet and exercise for you. If you think you may be over- weight, find out for sure from your doctor or a nutritionist. Ask them to help you control your weight. © How Does Salt Affect High Blood A Actually, it’s sodium, a chemical in © Do People Who Lose Weight Also Need Medicine To Treat High Blood Pressure? A Sometimes they do. But for some per- Sons, losing weight lowers blood pressure to normal, and the doctor may decide that medicine isn’t needed so long as the extra weight is not gained back. If the person can’t lose weight, or if losing weight is not enough to bring blood pressure down to normal, the doctor usually prescribes medi- cine. Frequently, the lower a person’s weight, the Smaller the dosage of drugs needed. Smaller doses mean fewer chances of side effects from the drugs. Pressure? the salt, that may affect blood pressure. Scientists do not know for sure how So- dium affects high blood pressure, but we do know that in many people it contributes to this disease. Will Cutting Down On Salt Prevent High Blood Pressure? A There’s a good chance it may help keep your blood pressure down. Most of us eat far too much salt to provide our bodies with the small amount of sodium they need. We also get sodium in other ways besides eating salt, for example: * In Snack foods, such as chips, crackers, Salted nuts; * In processed foods, like canned soups and vegetables, pickles, hot dogs, Sausage, bacon, frozen foods, cheese, ham; © Does What We Eat Affect High Blood Pressure? Ave. How much we weigh and the amount of sodium we eat may have a lot to do with high blood pressure. Lower weight means lower blood pressure for most peo- ple. For some people eating less salt and less high sodium foods means lower blood preSSure. In recent years scientists have become more and more interested in the relation- ship between what we eat—our diet—and high blood pressure. Studying this relation- ship raises questions like “Can we prevent high blood pressure by eating right?” and ©wº About Using Salt Substitutes? A Salt substitutes can be useful for cer- tain people who want to reduce their Sodium intake. But, for some people with certain medical conditions, salt substitutes can be harmful. Ask your doctor before you make a decision to try salt substitutes. Does Eating Less Salt Help Lower High Blood Pressure? A For some people with high blood pressure, eating less Salt and other forms of sodium helps to bring high blood pressure “Can we keep high blood pressure under control by staying on a good diet?” As you read this pamphlet, you will find out what we know—first about the effects of weight on blood pressure and then about the effects of salt. Although much remains to be learned, experts agree that: • Controlling weight has many health benefits. • Most Americans eat too much salt; cutting down on salt won’t hurt most people, and in fact it may improve your health. • Health professionals can help patients make changes in food habits when they are prescribed to help control high blood pressure. • Better food habits usually help medicine work better. Sometimes a diet down. For them, this diet change becomes a regular part of their treatment. It may also mean that they will need smaller drug dosages to control their blood pressure. Can High Blood Pressure Be Controlled With Dietary Changes Alone? A Sometimes, especially if the blood pressure isn’t too much above normal, dietary changes are enough to control high blood pressure. If you’re taking medication for high blood pressure, don’t stop without talking to your doctor. Keep on taking your drugs for high blood pressure, even if you have lost weight and are eating less Salt. change is the only treatment needed to control high blood pressure. What Do We Know About Weight and High Blood Pressure? A Scientists and doctors know that: • High blood pressure is much more common in overweight people. • As a person gains weight, blood pressure tends to rise; when a person loses weight, blood pressure often goes down. • For Some, losing weight controls high blood pressure so well that no medi- cine is needed, especially if blood pres- Sure is not too high. Talk to your doctor about the exact treat- ment you should follow—usually for the rest of your life. And keep track of your blood pressure to make sure it stays con- trolled. DISCRIMINATION PROHIBITED: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall, on the grounds of race, color, national origin, handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any education program or activity) receiv- ing Federal financial assistance. In addition, Executive Order 11 141 prohibits discrimination on the basis of age by contractors and subcon- tractors in the performance of Federal contracts, and Executive Order 11246 states that no federally funded contractor may discriminate against any employee or applicant for employment because of race, col- or, religion, sex, or national origin Therefore, the NATIONAL HIGH BLOOD PRESSURE EDUCATION PROGRAM must be operated in compliance with these laws and Executive Orders. Information on high blood pressure is available from: High Blood Pressure Information Center 120/80 National Institutes of Health Bethesda, Maryland 20205 you hove high blood pressure . . Treot it for life. Do it for yourself ond oll the loved ones in your life. Notional High Blood Pressure Education Progrom A Notional Heart, Lung, ond Blood Institute 120/80 Notional Institutes of Hedlth Bethesdo, Morylond 20205 NIH Publicotion No. 80-2023 August 1980 DISCRIMINATION PROHIBITED: Under provisions of applicable public lows enocted by Congress Since 1964, no person in the United Stotes Sholl, on the ground of roce, color, notional origin, Sex, or hondicop, be excluded from porticipotion in, be denied the benefits of, or be Subjected to discriminotion Under ony progrom or octivity receiving Federolfinonciol ossistonce. In oddition, Executive Order 11141 prohibits discriminotion on the bosis of oge by controctors ond subcontroctors in the performance of Federol controcts. Therefore, the NATIONAL HIGH BLOOD PRESSURE EDUCATION PROGRAM must be operated in complionce with these lows ond executive order. HIGH BLOOD PRESURE F A C T H.T. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Notional Institutes of Health 4 - GUGSTIONS ond onSwers What is high blood pressure? Your blood pushes ogoinStyOUſ blood vessels os your heart beots. Sometimes this push is too great. Then high blood pressure results. High blood pressure Con Couse o Stroke . . . or O hedrt ottock . . . or kidney diseose. Who con get high blood pressure? High blood pressure is a common problem. Anybody con hove it. Young ond old, men ond women, reloxed people ond tense people . . . onybody. If you ore over 40, you hove o bigger chonce of hoving high blood pressure. How con you tell if you hove it? You can't tell by yourself if you hove it. YoU con feel good, or feel bod. But the Woy you feel does not tell you. There is only one Woy to find out. Hove o doctor or nurse check your blood pressure. Con you control high blood pressure? High blood pressure USUolly connot be cured. But you con control it. YoU con bring your blood pressure down to normol. How? By treotment — every doy. Then you con leod O normol, octive, hedlthy life. If you hove high blood pressure, See O doctor. The doctor con help you control yOUr blood pressure. You moy be given pills to toke every doy. The doctor moy oskyOU to do other things. Like losing weight. And Using less Solt. The doctor moyolso osk you to Stop Smoking. Or moybe to exercise more. Be sure you know just whot the doctor OSKS you to do. Ask questions to be SUre. Millions of people control their blood pressure. You con, tCO. about high blood pressure High blood pressure con couse Strokes, hedrt OttockS, ond kidney diseose. YoU USUolly connot tell if you hove high blood pressure. So hove o doctor or nurse check for it. Anybody Con hove it. YoU con control high blood pressure. When it is controlled, you Con leod o normol, octive, heolthy life. Be SUre you Understond the doctor's treotment. Then follow the treotment every doy. For life. Tell your fomily ond friends obout your treotment. They con help. Remember, millions of people control their high blood pressure. YoU Con, too. to help you control your high blood pressure USUolly, high blood pressure will not go owdy, or be cured. YoU need to Stoy on your doctor's treatment. Every doy. Do not stop your treatment Unless the doctor Soys to stop. Be SUre of Whot the doctor Soys. Some people only toke their pills when they feel bod. Some toke them when they feel good! Both woys ore wrong. Follow your treotment every doy. No motter how you feel. The doctor moy osk you to do other things besides toke pills. Moybe cut down on Solt. Moybe lose weight. Do not decide by yourself which things you will do. Do oll the things the doctor osks. Most of oll, the pills. Tell your fomily ond friends obout your treotment. They Con ſemind you to toke your pills. Or cook medls with your diet in mind. It's o foct — they con help you control your blood preSSUre. If you stop treatment, your blood pressure will go bock Up. If you Stort treatment ogoin, your blood pressure will go bock down Ogoin. SO keep trying Until you get your blood pressure Under control. Then keep it there . . . for life. KA 645 HQ H54 º Hypertension—article for health professionals and HBP-related voluntary organizations. Recently released results of a 1982 survey con- ducted by the National Heart, Lung, and Blood Institute and the Food and Drug Administration portend a continued reduction in the deaths and disabilities from hypertension-related condi- tions. This survey showed that more Americans are aware of hypertension and its dangers, know that it can be treated effectively, and are getting their blood pressure checked than was shown in a survey conducted in 1973. Results of the National Health and Nutrition Examination Surveys also show favorable trends. During the time period of 1971-72 to 1976–80, the percent of hypertensives aware of their condition increased from 51 percent to 73 percent. In addition, control rates more than doubled during this period, from 16.5 percent to 34.1 percent. Researchers regard these findings as en- couraging and as an indication that the decline in stroke and heart attack mortality is likely to continue. During the decade following 1972, stroke mortality dropped by more than 40 per- cent, and heart attack deaths decreased by nearly 30 percent. Officials of the National High Blood Pressure Education Program, the program that coordinates national efforts to control high blood pressure, point out that the increased number of hypertensives under effective treat- ment have contributed to these trends. The National High Blood Pressure Education Program was created in 1972 to work with com- munity groups, volunteer organizations, medical specialists, and industry to maintain a steady and coordinated effort to educate the public and professionals about high blood pressure and its increased risk of heart attack and stroke. Much of the Program's success has been attributed to the many organizations and agencies at federal, state, and local levels (including ) that are actively participating in the mammoth effort to control high blood pressure. Despite the recent progress, however, problems remain that require additional attention. Men lag behind women in controlling hypertension, and control rates for black men do not approach those of their white counterparts. Since the prevalence rate of hypertension is greater among the black population, detecting and treating high blood pressure among this group assume even more importance. One key to continued success in the national effort is the participation of health professionals in a number of settings, particularly in getting and keeping hypertensives under control. Health professionals at all levels can encourage adher- ence to therapy. They can: • Improve patient education and counseling. Encouraging the development of appropriate patient behavior for blood pressure control is a critical task for all health professionals. Pa- tients may need help in making a decision or personal commitment to control the disease, in forming new habits for regularly taking medication, in making lifestyle changes, in monitoring progress toward their goal, and in resolving problems related to therapy. • Become familiar with current treatment rec- ommendations. The Joint National Commit- tee On Detection, Evaluation, and Treatment Of High Blood Pressure offers guidelines for de- tection and confirmation of blood pressure elevations, referral, patient evaluation (in- cluding laboratory workup), and stepped-care drug therapy. It also addresses additional is- sues including managing mild high blood pressure, patient education for therapy main- tenance, nondrug treatment, drugs for use in stepped-care therapy, and managing the el- derly and other special patient groups. • Involve all types of health professionals. Suc- cessful control of high blood pressure requires patient access to a number of professionals participating in one or more steps within the control process. Yet barriers to interdiscipli- nary cooperation exist. Recent recommenda- tions by a multidisciplinary panel that exam- ined professional roles urge that those barriers be Overcome in order to expand individual and community high blood pressure control Services. This May, National High Blood Pressure Month, is an appropriate time for us to examine Our involvement in high blood pressure control and to determine how we might expand such efforts. Our efforts to encourage patient adher- ence can be multiplied by working with other groups that may have ongoing programs or re- sources to share. Some groups interested in cooperative efforts may be the American Red Cross, civic and fraternal organizations, com- munity centers, fire and police departments, health departments, hospitals and clinics, in- dustries, newspapers, professional societies, senior citizen and student groups, area health education centers, and extension agencies. The 1984 High Blood Pressure Month kit is available to help health professionals work with patients and the public. The kit includes a pro- gram planning guide and educational materials that may be used in publications or in other ways. Copies of the Month kit and other informa- tion for professionals may be obtained from: High Blood Pressure Month High Blood Pressure Information Center 120/80 National Institutes Of Health Bethesda, MD 20205 Hypertension—newspaper article Recently published data on high blood pres- sure awareness and control and continued de- creases in the death rates from strokes and heart attacks show encouraging trends, according to (local organization or public health depart- ment). High blood pressure, or hypertension, is one of the main risk factors for stroke and heart disease. The federal government's most recent report of the National Health and Nutrition Examination Survey (NHANES) compared 1976–80 data with that collected during a 1971-72 survey. The data showed that during that time the number of in- dividuals whose high blood pressure was ade- quately controlled had more than doubled from 16.5 percent in 1971-72 to 34.1 percent in the 1976–80 survey. Most of that increase occurred between 1976 and 1980, when the National High Blood Pressure Education Program intensified its educational messages on the importance of hypertensives adhering to their therapy. In addi- tion, the survey results also report that the per- cent of hypertensives aware that they have high blood pressure increased from 51 percent to 73 percent. Further, in the decade Since 1972, Stroke mor- tality has declined by more than 40 percent, and heart attack mortality is down nearly 30 percent. These are encouraging trends, says (Eduard Roc- cella, Ph.D., Coordinator of the National High Blood Pressure Education Program, or local HBP official). It is probable that increased awareness and control of hypertension is at least in part re- sponsible for the declines. Since 1972, a coordinated program involving the federal government, state and local public health services, community agencies, voluntary organizations, and industry has been directed at increasing the public awareness of high blood pressure and urging those who have high blood pressure to get on treatment and stay on it. This coordinated effort involves more than 30 na- tional organizations, all 50 states, and over 2,000 community groups. Although the NHANES demonstrates the prog- ress that has been made during the past decade, much remains to be done. Males lag far behind females in achieving control of hypertension, and control rates for black males are not as good as those for white males. Blacks have a higher prevalence rate of high blood pressure than do white populations and therefore should be espe- cially aware of the consequences of untreated hypertension. These and other problems, say of— ficials, will need to be addressed specifically to maintain the favorable trends in the control of high blood pressure. (Note: Local programs may wish to end this arti- cle with a calendar of events for High Blood Pres- sure Month and/or a description of the status of high blood pressure control within the community.) U.S. Department of Health and Human Services C C Public Health Service National Institutes of Health National Heart. Lung, and Blood Institute National High Blood Pressure Education Program G C d National High Blood Pressure Month May 1984 JIT º ZEL, E. EZL º National High Blood Pressure Month . May 1984 Activity Guide A Special Month for a Year-Round Issue Each year in May, National High Blood Pressure Month, many organizations join together to focus attention among the public, health professionals, and patients and their families on the disease. The organizations assist the people who work with those under therapy and encourage those who have high blood pressure to stay on their treatment. During National High Blood Pressure Month, groups at all levels participate in a wide variety of activities involving professional and public education and community action. National and state organizations encourage their local affiliates to get in- volved in high blood pressure control activities during May, as well as during the rest of the year. Controlling High Blood Pressure High blood pressure is recognized as a major public health problem. Currently 60 million American adults are at in- creased risk of stroke, heart disease, and kidney disease due to high blood pressure. The benefits of antihypertensive therapy have been well documented in both selected publications and the general community. However, the extent to which low patient adher- ence undermines the effectiveness of antihypertensive therapy is truly staggering. At each step, from detection through long-term maintenance of therapy, large numbers of patients drop out of care: • Up to 50 percent fail to follow through with referral advice. • Over 50 percent of those who begin treatment drop out of care within 1 year. • Only about two-thirds of those who stay under care take enough of their prescribed medication to achieve adequate blood pressure reduction. Dietary approaches related to sodium reduction and weight management also face adherence problems. Nonadherence to dietary regimens is believed to be at least as high as nonadherence to drug therapy. What is Nonadherence? Adherence, or compliance, refers to the extent to which the patient's behavior coincides with the desired treatment routine prescribed. Nonadherence is a complex set of behav- iors, any of which may affect a given patient from time to time. Nonadherence is not inherent in any particular personality, ethnic, or socioeconomic group; and studies have demon- strated that the professional's “clinical judgment” cannot pre- dict a patient's adherence. One indicator of nonadherence may be the lack of high blood pressure control. In a condition where continuous treatment and appoint- ment keeping is essential, nonadherence minimizes the bene- fits of therapy. Achieving and maintaining good adherence with antihypertensive therapy represent considerable chal- lenges to patients and health professionals. No single or simple technique is of value in improving chronic nonadherence in a large percentage of patients. The physician-patient relationship and the quality of communica- tions may be of critical importance. Family and other social support systems, careful tailoring of drug regimens to simplify schedules and to avoid unpleasant side effects, pa- tient rewards, and clinician-patient contracts appear to have merit, particularly when designed to the needs of each patient and when combined appropriately. The Patient-Professional Relationship For the patient, achieving and maintaining blood pressure control requires additions to and changes in behavior. An interdisciplinary working group was convened by the National High Blood Pressure Education Program to examine these changes. Because a number of different health professionals interact with the patient during high blood pressure therapy, the group included representatives from medicine, pharmacy, nursing, and health education. The major premises of the Working Group were: • Active participation by the patient favors successful control. • The patient is the ultimate decisionmaker. • The patient-professional relationship is critical in achiev- ing blood pressure control. The role of the health professional, through patient educa- tion, is to help the patient identify and adopt the behaviors necessary for controlling blood pressure. Effective patient education consists of learning experiences tailored to the individual, which lead to voluntary behavior changes. Change usually occurs when a patient is actively involved in the treatment plan. This requires an active patient-professional relationship. In many settings, staff members other than the physician conduct patient educa- tion. Through the professional's guidance, the patient sets realistic goals. Development and reinforcement of the knowl- edge, attitudes, and skills to accomplish these goals will lead to successful change. The interest of health professionals in the patient's progress will significantly affect patient adherence. Patient-physician interaction is seen as a critical factor in achieving blood pressure control. The 1980 Report of the Joint National Committee on Detection, EU aluation, and Treatment of High Blood Pressure confirms that maintenance of therapy re- quires “a special and continuing commitment from prac- titioners as well as patients.” How to Participate in National High Blood Pressure Month Your organization may want to take part in High Blood Pressure Month, either on its own or in a team effort with other groups. Your group may have special expertise in cer- tain fields with which it could assist another group in a joint Month activity. There are five major activities in which your organization can become involved: • professional education; • patient education; • public awareness; • group and membership education; and • detection, referral, and followup efforts. Professional Education Use May as a focus for educating all members of the health care team. Each member can benefit from being aware of the important part they play in controlling high blood pressure by helping patients adhere to treatment recommendations. In general, professional education encompasses a number of learning opportunities for individual professionals and aims at improving the delivery of health care. This implies that effective professional education is not a one-time activity; rather, it is a series of activities that are designed to gain a commitment from other community professionals to assist with high blood pressure control efforts and to nurture that commitment on a continuing basis. National High Blood Pressure Month can be the time to initiate a new approach to professional education for the health care providers in your organization or community. A professional education activity could be designed to: • increase knowledge of the patient behaviors critical to high blood pressure control and of the attitudes and skills nec- essary to help patients solve problems with adherence to therapy; • convey the importance of treating patients to goal blood pressures; • increase awareness of the benefits of developing support and assistance from patients' families; • increase the number of health professionals who use dietary management as a first step in therapy for mild hypertension or as adjunctive therapy in other patients; • increase practitioners' knowledge and awareness of high blood pressure monitoring and support services available in their community; • increase knowledge and foster positive attitudes about cooperating with other qualified professionals in the deliv- ery of high blood pressure control services. Activities directed at any of these objectives can serve to improve some specific aspect of hypertensive health care. A series of such activities may serve to foster a long-term com- mitment to high blood pressure control. Suggested Activities • Place hypertension articles in your organization's or society's newsletter or journal. • Place the subject of patient adherence on your group's professional education calendar by planning one of the following types of programs: —continuing education; —in-service training; —staff development; and —lectures and symposiums. • Send copies of the items for health professionals (which appear among the feature sheets in this kit) to your membership, or assemble your own packet of hypertension information. (See order form for resource materials to help you plan a program.) • Encourage members to volunteer on local blood pressure committees and councils. • Suggest that members become involved in setting up referral, followup, patient tracking, and patient education programs. • Distribute samples of professional and patient education materials to your professional membership. Suggested Organizations Professional societies (dental, medical, nursing, nutrition, optometric, pharmaceutical, public health, etc.), hospitals, clinics, health maintenance organizations; public health pro- grams, health professional schools, American Heart Associa- tion affiliates, National Kidney Foundation affiliates, Ameri- can Red Cross chapters, high blood pressure coalitions and councils, and area health education centers. Patient Education Much can be done to improve the effectiveness of attempts to control high blood pressure by applying methods that increase the ability of hypertensive patients to follow treat- ment recommendations. Effective patient education is an essential aspect of successful patient adherence. In discussing patient education, it is important to note that we are talking about more than information transfer. It is a process for promoting behavior change by developing and reinforcing appropriate patient knowledge, attitudes, and skills. In this way, the patient is recognized as an active participant in therapy. Improving patient knowledge and skills through patient education is an integral part of the entire high blood pressure control process. Every patient interaction is an opportunity for education. Recent studies have identified at least a few of the basic elements to consider when developing effective pa- tient education activities: increases in the number of patients with controlled blood pressure were achieved by offering sys- tematic patient education that encouraged action on the part of the patients, i.e., patient education activities were planned, focused on behavior change, and recognized that lasting behavior change is voluntary, not mandated by a health professional. Suggested Activities • Show patients how to chart their progress toward reaching and maintaining goal blood pressure. • Teach selected patients to measure their own blood pres- Sure at home. • Teach patients to keep a diary on how they maintain their drug and/or dietary therapy. • Work with patients to devise individualized low-calorie di- ets, and/or encourage low-sodium food preparation. • Help patients form an exercise group to assist with weight Control. • Help hypertensive patients organize their own support group. Suggested Organizations Private practitioners' offices, hospitals, health maintenance organizations, health departments, medical centers, clinics, neighborhood health centers, and worksettings. Public Awareness National High Blood Pressure Month provides an ideal op- portunity to encourage people to have their blood pressure checked regularly and to educate the general public. Be sure to tell people where in your community they can go for regular blood pressure measurement or further information. Most importantly, a public awareness effort is an opportunity to remind those who have high blood pressure to stay on their treatment. The general public seems aware that high blood pressure is an easily detected disease that is widespread and has serious consequences. But, the public doesn't know that: • It is possible to lower the risk of developing specific diseases by controlling high blood pressure. • Most high blood pressure has no symptoms. There is no cure, only control, for most high blood pressure. Medication can help lower high blood pressure. Weight loss can help lower high blood pressure. Low-salt diet can help lower high blood pressure. Treatment must be continued daily for control of high blood pressure. There are programs in the community where people can go for regular blood pressure measurement. May is a good month to remind people to get their blood pressure checked, to stay on treatment if they have high blood pressure, and to educate the general public. Suggested Activities • Distribute posters and flyers about high blood pressure. • Place feature stories on local high blood pressure control programs in newspapers; talk with health and food editors. • Issue a proclamation that calls attention to May as National High Blood Pressure Month. • Coordinate the production of special programs or public service announcements on local radio and television Stations. • Place articles on high blood pressure in your organization's newsletter or journal. • Arrange in advance education programs for members of the media to alert them about National High Blood Pressure Month. • Acknowledge the contributions of volunteers who have worked on behalf of high blood pressure control throughout the year. Suggested Organizations Insurance companies, hospitals and clinics, voluntary health agencies, civic and fraternal groups, newspapers, radio and television stations, hypertension control programs, li- braries, Parent-Teacher Associations, restaurants, food stores, churches, Cooperative Extension Services, area health education centers, and health planning agencies. Group or Membership Education National High Blood Pressure Month can be used to begin special or ongoing education programs directed to your orga- nization's members. This is an important activity because some members or people in their families may have high blood pressure. Education programs will help reach these people and can encourage them to treat the condition for a healthier life. Suggested Activities • Arrange for a special speaker or film on hypertension to be presented to the group during your May meeting. • Organize an ongoing high blood pressure detection, re- ferral, and followup program for members. • Distribute educational literature to members or COnStituentS. • Place articles on high blood pressure in your May newsletter. • Put up posters in your building or meeting place. • Present special awards to members or citizens for outstand- ing service in controlling high blood pressure in your com- munity. • Participate in community-wide high blood pressure control activities. • Raise funds for local high blood pressure clinics and pro- grams. • Assist in other special hypertension detection programs by helping to set up tables and chairs, maintain order as people arrive, fill out forms, hand out literature, and trans- port people to screening sites. • Schedule classwork related to high blood pressure. • Involve youth in local community efforts through poster contests and distribution of brochures. Suggested Organizations Libraries, insurance companies, employers, unions, civic groups, Parent-Teacher Associations, students in primary and secondary schools, fraternal orders, women's groups, fire and police department members, YMCA's and YWCA's, senior citizen clubs, community centers, cultural groups, and honor SOCieties. Detection, Referral, and Followup Efforts Planned detection activities are a way of identifying people with undiagnosed, uncontrolled, and/or untreated hyperten- sion. Because detection is the initial step in the series of related activities for high blood pressure control, many orga- nizations often organize detection activities first. An effective detection program involves several steps beyond simple blood pressure measurement. Detection—without referral to a specific source of medical care followup—is of little value. It is the referral and followup that guide the detected hypertensive to the next steps in the high blood pressure control process. Although drawing hypertensives into the health care system is the primary purpose of detection, re- ferral, and followup activities, detection efforts can also: • increase community awareness by making the activities part of a public education/information component; and • serve as a starting point for developing a more comprehen- sive community high blood pressure program. If your group does not ordinarily engage in detection activi- ties, it would be best to work with and support organizations that already have year-round programs. Suggested Activities • Publicize the ongoing detection, referral, and followup programs in your community. • Organize publicity for special detection campaigns. Conduct or participate in detection programs. • Schedule the showing of a film, filmstrip, or slide show on high blood pressure at the detection site. • Give every screener a fact sheet on high blood pressure that describes what it is and the importance of an annual checkup. • Tell those who are screened their blood pressures and explain what the numbers mean. Suggested Organizations Health departments, hospitals, medical centers, clinics, neighborhood health centers, health maintenance organi- zations, nursing homes, worksettings, churches, fire and police departments, unions, schools, and community centers. Resources for Your Activities Your activities may be more effective if you team up with another group to pool resources and talents. Some groups or organizations that might serve as resources include local American Heart Association affiliates, American Red Cross chapters, National Kidney Foundation affiliates, professional societies, high blood pressure control clinics, and state health department programs. These groups may offer training, edu- cational materials, and technical assistance for the activities you plan. The National High Blood Pressure Education Program has produced a variety of educational materials for your use dur- ing National High Blood Pressure Month. These materials are just the beginning. The most important ingredients in Na- tional High Blood Pressure Month are you, your organization, your community, and an ongoing commitment to high blood pressure control in May and all year long. How To Use This Kit The 1984 High Blood Pressure Month kit is a do-it-yourself guide to high blood pressure (HBP) control activities. It is designed to help you de- velop and expand approaches to improving high blood pressure control. The kit contains support- ing materials, but each one asks additional ac- tion from you. For example, a number of kit materials are re- producible. By reprinting these materials yourself, you will have a ready, immediate supply of easy-to-use professional, patient, and con- sumer publications to let you get started on ac- tivities right away. These materials are just the beginning. The most important ingredients in High Blood Pressure Month are you, your com- munity, and an ongoing commitment to high blood pressure control in May and all year long. Contents of the kit include: Activity Guide, with new ideas for HBP control activities and suggestions for working with health professionals, patients, and the general public. It will help you plan high blood pressure control efforts for May and throughout the year. Feature Sheets include a variety of reproducible items that can be shared with health profession- als and patients: a bibliography, tips for health professionals, handbills, “filler” articles, a High Blood Pressure Month Proclamation, a recogni- tion certificate, and a patient wallet diary. In- structions for reproducing these materials are also included in the kit. Prepared articles with an option for your organi- zation to add additional information and retype on your own letterhead. Two large posters to publicize high blood pres- sure control and your own activities. Two pamphlets about HBP that you can repro- duce in quantity for patients and consumers. High Blood Pressure Information Center Month Order Form, listing core materials avail- able in quantity free from the High Blood Pres- Sure Information Center (HBPIC). v Available Materials Sheet, listing other sources of patient and consumer materials (some free in quantity, some reproducible, some at nominal charge). - How to Reprint Materials Many programs don't have the resources to develop their own educational materials. Free pamphlets with the information your patients or clients need are not always available in the right quantity, at the right time. How can you get the materials you need at a price you can afford? For many local programs, reprinting booklets and flyers other groups have produced is the answer. Duplicating publications is easy. You don't need special skills, experience, or materials to do it. And it's economical, with enough options to match almost any program need and budget. In fact, reprinting pamphlets is almost always cheaper than buying them. Here is a simple guide to reprinting that an- swers some common questions and suggests some possibilities. What are the ways materials can be duplicated? For most programs two simple options are available for reprinting materials: photocopying and printing. Here are some general guidelines to consider in choosing between them. Will I need the original artwork and type to reproduce a brochure? No. A printed pamphlet or flyer is all that you need for photocopying or printing. But if you can get the original pasteup of art and type (called the “mechanical”), the reprints will be sharper in quality. Many producers of materials will loan mechanicals for reproduction for a small han- dling charge. If you need to reprint the publica- tion more than once, you can have the mechan- ical itself duplicated (called “making a stat”) and keep the copy on hand. This is not expensive to do. What factors affect printing costs? Five variables are involved: 1. Quantity. The greatest expense in printing is making the printing plates. Thus unlike photocopying costs, which remain constant per item, printing costs per unit go down as quantities go up. And up to 50,000 copies, the more you print, the more you save. For example, a one-sided, black and white flyer would cost about: • $40 for 1,000 copies (S.04 per copy) • $53 for 2,000 copies ($.026 per copy) • $85 for 4,000 copies (S.021 per copy) 2. Printer. Every printer prices work differently, and a single printer's prices for similar work may vary depending on arrangements made. Always get several cost estimates if budget is a concern, and find out about delivery times and any special requirements. Printing qual- ity can also vary. To find a reputable printer, ask others in your organization or those in other health-related groups for their recom- mendations. Look at samples of different printers' work. 3. Paper Quality. Once you've chosen a printer, he or she will show you paper samples in different weights, colors, and finishes. There are papers for all budgets. If the initial esti- mate seems high, ask about using a more modest paper stock. 4. Ink Color. Materials that use only one ink color will be the most economical. For quan- tities under 10,000, black ink will be the cheaper choice. Prices also increase with each different color ink you add. But even if the brochure you're duplicating has four ink colors, you can have it reprinted in black ink on white paper if cost is a concern. 5. Artwork. Printers charge more for materials with drawings or photographs than they do for materials with type alone, but these fees are small. Can I “customize” or adapt reprinted materials? Yes, with a little help from a graphic artist. For example, you can: • Add your organization's name, contact information, and logo to a pamphlet you reprint to identify your group as a local source of high blood pressure materials. • Combine parts of two brochures to make one new publication. A graphic artist can do a professional “cut and paste” for printing or photocopying. OUer • Add a new section to an existing brochure and reprint it. In this case, the graphic artist would have the new material typeset in the same style and would paste it up in a similar format for reproduction. • Save on design fees when developing new materials by adapting artwork from an existing publication. A graphic specialist will still need to lay out and paste up the pages, but you will eliminate illustration costs. What about copyright restrictions? You will need express permission before re- printing most publications and artwork to avoid copyright infringement. Many groups will be will- ing to give permission; commercial firms prob- ably will not. In most cases you will need to give credit (e.g., “reprinted with permission from...") to the original publisher. U.S. Government pamphlets and flyers pro- duced by the National High Blood Pressure Edu- cation Program are not copyrighted and may be reproduced without restriction or written per- mission. And the government only requests that a credit line appear on reprinted copies. How do programs defray the costs of reprinting materials? Lots of ways. Some ideas include: • Finding a printer who donates full or partial Services as a charitable contribution. • Coordinating with other high blood pressure programs who are reproducing materials. If two programs put their reprint orders for the same materials together, their unit costs will go down. • Getting financial support from local mer- chants or industries. Some programs make this more attractive by giving credit to donators on the back of the brochure. Method When to Use Advantages Disadvantages Photocopying When reproducing Economical in Small Unit cost stays the small quantities (in quantities same regardless of general, under 500 quantity and will be sheets) higher for smaller copying machines. Convenient Quality of reprint image may be rough “Instant” turnaround Materials will need to be cut to size and bound by hand Printing When reproducing Increasing quantity Work must be sched- large quantities (more than 500 sheets) decreases price per item Sharper reprint quality More professional ap- pearance with ma- chine binding, cutting, and folding uled in advance; lead times vary for different printers Expensive for small quantities National High Blood Pressure Education Program National High Blood Pressure Month 1984 Evaluation and Order Form High Blood Pressure Information Center 120/80 National Institutes of Health Bethesda, Maryland 20205 (301) 496-1809 (All Items Are Free, Allow Six Weeks For Delivery) Name Organization Street City State Zip Telephone No. (Include Area Code) Please complete this section and return even if you are not ordering additional materials. 1. What type of organization best describes your program setting? (check the appropriate response) [] Health Department [] Voluntary Health Agency D Business or Industry [] Hospital [] Neighborhood Health Center [] Civic or Service Group [] Nursing Home [] Insurance Company [] Other (specify) [] Solo or Group Practice D Professional Association 2. Does your organization target its high blood pressure control activities toward any of the following special populations? (check all that apply) [] Elderly [T] Minorities D. None of the above [] Rural S D Employees [] Other (specify) 3. How many years has your organization participated in National HBP Month? (check the appropriate response) [] This is Our first time [] 4–6 years [] 1-3 years [] 7-9 years 4. In which high blood pressure activities is your organization involved? (check all that apply) D Professional Education D. Public Education [l Referral and Followup D Patient Education [] Detection [] Other (specify) 5. Do you conduct these activities year-round or only during May? (check appropriate response) [] All Year [T] Part Of Year [] May Only 6. How useful are the items in the kit to your organization? (circle one response for each type of mate- rial) Extremely Very Somewhat Not at all Type of Material Useful Useful Useful Useful Useful a. Activity Guide 1 2 3 4 b. Reproducible Pamphlets 2 3 4 5 C. Feature Sheets 1 2 3 4 5 d. Posters 1 2 3 4 5 7. Will your organization place a special emphasis on any of the following issues in HBP control for your National HBP Month activities? (check all that apply) D Nondrug Therapy [] Patient Adherence D Interdisciplinary Cooperation [] Mild High Blood Pressure 8. Do you have any suggestions for ways we could further improve the National HBP Month Kit? Materials for Professionals These materials are designed for use by health professionals in conjunction with professional educa- tion programs or as program planning resources. Quantity Ordered Audiovisual Aids for High Blood Pressure Education (195 pages) Lists films, filmstrips, videocassettes, audiocassettes, and slides pro- duced by a variety of resource organizations. Includes aids for professional, patient, and consumer audiences. Collaboration in High Blood Pressure Con- trol: Among Professionals and with the Pa- tient (4 pages) Position statement by the Coor- dinating Committee of the NHBPEP discusses the benefits of collaboration between health professionals and patients. Community Guide to High Blood Pressure Control (137 pages) The guide summarizes ap- proaches to program development, examines components of a HBP program such as public education and patient teaching, and discusses funding. High Blood Pressure Control: Information and Education Strategies for Messages to Public and Patient Audiences (20 pages) NHBPEP communications strategy statement for public and patient information and educa- tion messages. Quantity Ordered Patient Behavior for Blood Pressure Control (article reprint, Journal of the American Medi- cal Association, June 1979) Report of the Work- ing Group to Define Critical Patient Behaviors in High Blood Pressure Control. Patient Tracking for High Blood Pressure Control (66 pages) A manual for planning and operating a patient tracking system for im- proved control of high blood pressure in a variety of health care settings. Printed Aids for High Blood Pressure Educa- tion: A Guide to Evaluated Materials (98 pages) Description of materials from a variety of sources categorized by overall quality and read- ing level. 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (24 pages) Presents the latest consensus recommendations for diag- nostic tests, stepped-care approaches, and long-term maintenance. Quantity Ordered Materials for Patients and Consumers Report of the Working Group on Critical Pa- tient Behaviors in the Dietary Management of High Blood Pressure (44 pages) A ten-step def- inition of patient and professional behavior and skills for controlling sodium intake and weight. The State Legislature and High Blood Pres- sure Program Funding (6 pages) Explains how to work with State and Federal legislators to promote HBP funding and support. Quantity Ordered Statement on Hypertension in the Elderly (8 pages) Presents consensus statement of the NHBPEP Coordinating Committee on elevated blood pressures, diastolic and systolic eleva- tion, and treatment of “mild” hypertension in the elderly. Based on findings of the Hyperten- sion Detection and Follow-up Program. Statement on the Role of Dietary Manage- ment in Hypertension Control (4 pages) Pre- sents consensus statement of the NHBPEP Coordinating Committee on dietary factors in the pathogenesis of hypertension, factors in dietary management, and recommended action steps for weight control and sodium intake reduction. A Note on Selecting Patient and Consumer Materials An asterisk (*) placed next to some listings indicates that the publication was specifically designed for a certain minority audience. Reading level indications for consumer pamphlets were calculated using the SMOG Readability For- mula. The levels roughly correspond to these school grade levels: Very Easy, grades 6-7: Easy, grade 8; Average, grades 9-10; Fairly Difficult, grades 11-13. Quantity Ordered Pamphlets *Blacks and High Blood Pressure (brown and grey pamphlet, 8 pages) Describes high blood pressure, its importance to blacks, the need for treatment, and the role of the patient's family. “Very Easy" reading level. High Blood Pressure Facts and Fiction (black, white, and blue leaflet, 4 pages) Ideal handout to anyone getting a blood pressure measure- ment. Contains basic facts about high blood pressure and corrects some commonly held misconceptions. “Easy" reading level. guestions About Weight, Salt, and High Blood Pressure (black, white, and pink pamphlet, 8 pages) Describes what is known about the rela- tionship between certain diet changes and high blood pressure. “Average" reading level. *Verdad y Ficcion Sobre la Presion Arterial Alta (black, white, and green leaflet, 4 pages) Version of High Blood Pressure Facts and Fic- tion for a Spanish-language audience. “Easy" reading level. Quantity Ordered Posters High Blood Pressure Messages (16" x 20") National High Blood Pressure Month poster with “blank space" to write in announcements of your activities. Life Savers (16" x 20") Full-color poster describes a variety of actions needed to main- tain one's high blood pressure treatment regimen. Some Hints for People Who Take High Blood Pressure Medicine (12” x 18") Magenta, blue, and black poster reminds patients to develop medication-taking skills and to talk with their doctor, nurse, or pharmacist when questions arise. *Their Future Is in Your Hands. Treat Your High Blood Pressure Every Day (16" x 20") Five different full-color posters depicting chil- dren representing various ethnic and geo- graphic groups. Poster may be ordered with children representing the following groups: Blacks Hispanic origin (copy in Spanish) Native Americans Rural dwellers U.S. Asian and Pacific Island populations ſº eºs PU6 R t? &rºx. r: 3 ; 4- ** Other Materials || N. |% Quantity | | Zºº / Ordered H54. Down with High Blood Pressure (lapel stick-on | Q 8 4– badge, 2" diameter) Red and white badge with § message and high blood pressure symbol. Useful for screenings, patient education, meet- ings, etc. Á i # For More Information... In addition to distributing materials listed here, the High Blood Pressure Information Center serves as a central national clearinghouse for information on various aspects of hypertension control and can assist in locating speakers and other sources of educational materials and audiovisual aids. High Blood Pressure Information Center 120/80 National Institutes of Health Bethesda, Maryland 20205 Materials Available from Other Sources Patient and Consumer Pamphlets Watch Your Blood Pressure (blue booklet, 28 pages) This booklet outlines the nature and physical characteristics of blood pressure, both normal and high, with a description of various types of hypertension. For diagnosed hypertensives. Availability: Public Affairs Pamphlets 381 Park Avenue South New York, NY 10016 (212) 683–4331 Cost: $1.00 each; discount available for quantities. The Sodium Content of Popular Prepared Food Items (blue pamphlet, 11 pages) This pamphlet provides a handy reference guide to meal planning for individuals who have an interest in the sodium content of foods. Contains charts that list the sodium values of commonly eaten, prepared foods. Availability: Attention: Consumer Affairs Morton Salt Division Morton Norwich Products 110 North Wacker Drive Chicago, IL 60606 (312) 621-5582 Cost: Free in limited quantities. Straight Talk About Salt (brown pamphlet, 21 pages) This pamphlet cites the function of sodium in the body, the capabilities of healthy bodies to eliminate excess sodium, and the possible effects of excess sodium on persons who have lost that capability. Contains tables of the sodium content of some 300 foods. Availability: The Salt Institute 206 N. Washington Street, Dept. E Alexandria, VA 22314 (703) 549-4648 Cost: $0.25 each or free with a stamped, self-addressed #10 envelope; discount available for quantities. AGE PAGE: High Blood Pressure A Common but Controllable Disorder (flyer, 1 page) This flyer defines high blood pressure, discusses its asymptomatic nature, and the recommended treatment. Includes prevalence statistics for the elderly and a brief discussion of mild high blood pressure. Availability: NIA/Age Page 9000 ROCkville Pike Bldg. 31, Room 5C36 Bethesda, MD 20205 Cost: Free, up to 50 copies. Note: This is a government publication and very easy to reprint additional copies. Please send a postcard when ordering. Sodium Sense (green and white pamphlet, 8 pages) This brochure discusses the role sodium plays in the diet and how to find sodium on the food label. Includes suggestions on how to reduce Sodium in food preparation and a list of the Sodium and potassium content of a number of everyday foods. Availability: Consumer Affairs Department Food Marketing Institute 1750 K Street, N.W. Washington, DC 20006 Cost: 1-5 copies free; 6-9 copies $0.10 each; 100 or more copies $8.00 per hundred; 1,000 or more copies $70.00 per thousand. Reproducible artwork $25.00 per set. Cross Roads to Health: Your Choice (green and white pamphlet, 6 pages) This pamphlet provides a succinct outline of recommended foods and problems to be aware of when controlling weight and high blood pressure. Availability: Illinois State Council on Nutrition Lincoln Tower Plaza Suite 405-CR 524 S. Second Street Springfield, IL 62706 Cost: Free single copies with a stamped, self-addressed #10 envelope. 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Every day.º. Rain or 7 Shine. I Use a salt substitute like lemons or herbs. When you cook. And at every meal. Control your weight. If the pounds creep up, so will your blood preSSure. Take your high blood pressure pills. Used as directed, every day, they're just what the doctor ordered. Blood Pressure. Theatitforlife. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute, National High Blood Pressure Education Program sº- American Academy of Family Physicians American Academy of Ophthalmology American Academy of Physician Assistants American Association of Occupational Health Nurses American College of Cardiology American College of Chest Physicians American College of Physicians American College of Preventive Medicine American Dental Association American Dietetic Association American Heart ASSOciation American Hospital Association American Medical Association American Nurses' Association American Occupational Medical Association American Optometric Association American Osteopathic Association American Pharmaceutical Association American Podiatry Association American Public Health Association American Red CrOSS American Society of Hospital Pharmacists Association of Life Insurance Medical Directors of America Citizens for the Treatment of High Blood Pressure Committee on Hypertension in Minority Populations National Black Nurses' Association National Heart, Lung, and Blood Institute National Kidney Foundation National Medical Association National Optometric Association Society for Nutrition Education IIII THE UNIVERSITY of MICHIGAN F. .-- -" - . . . . . . . w - - - - - -- . . ." - z . - - g” -- *