Eduardo Sanchez, MD, MPH, FAHAChief Medical Officer for Prevention, American Heart Association 2021 New York State Hypertension Summit

October 29, 2021

Science Resources Action

Blood Pressure Control Is A Team Sport that Requires

Playing the Long Game

Every person deserves the opportunity for a full, healthy life.

As champions for health equity*, by 2024, the American Heart

Association will advance cardiovascular health for all, including

identifying and removing barriers to health care access and quality.

Addressing the drivers of health disparities, including the social determinants of health, structural racism, and rural health inequities, is the

only way to truly achieve equitable health and well-being for all.

CHAMPIONS FOR HEALTH EQUITY

Rank Cause Number Percent

Total – all causes 3,358,814 100%

1 Heart diseases 690,882 20.6%

2 Cancer 598,932 17.8%

3 COVID-19 345,323 10.3%

4 Unintentional injury 192,176 5.7%

5 Stroke 159,050 4.7%

6 Chronic lower resp. disease 151,637 4.5%

7 Alzheimer’s disease 133,382 4.0%

8 Diabetes mellitus 101,106 3.0%

9 Kidney disease 53,495 1.6%

10 Influenza/pneumonia 52,260 1.6%

Causes of Death: USA (2020) Provisional

Source: Ahmad, MMWR, Vol 70, #14, 2021; cdc.gov/nchs/deaths

Deaths from Hypertension

Source: Ahmad FB, Cisewski JA. Quarterly provisional estimates for selected indicators of mortality, 2018-Quarter 4, 2020. National Center for Health Statistics. National Vital Statistics System, Vital Statistics Rapid Release Program. 2021.. 2020.

Q4 2019 Mortality Rate Q4 2020 Mortality Rate

12 months (crude) 11.1 12.7

12 months (age-adjusted) 8.9 10.0

The death rates for "12 months ending with quarter" (also called moving average rate) are the average rates for the 12 months that end with the indicated quarter. Estimates for the 12-month period ending with a specific quarter include all seasons of the year and, thus, are insensitive to the seasonality.

14.4% increase in crude mortality rate and 12.4% increase in age-adjusted mortality rate.

Location Percent(<140/90)

National (2020) 30.7%

New York State (2019) 29.6%

Sources: CDC – NCHS Data Brief, Hypertension Prevalence, 2020CDC – BRFSS Prevalence and Trends Data, New York, 2019

Hypertension Prevalence

Source: https://www.health.ny.gov/prevention/prevention_agenda/2019-2024/docs/ship/overview.pdf

The New York State Prevention Agenda 2019-2024: An Overview

• PRIORITY AREA 1 – Prevent Chronic Diseases

• Focus Area 1: Healthy Eating and Food Security• Goal 1.1: Increase access to healthy and affordable foods and beverages, skills and knowledge to support healthy food and beverage

choices, food security

• Focus Area 2: Physical Activity• Goal 2.1: Improve community environments that support active transportation and recreational physical activity for people of all ages and

abilities; Promote school, child care, and worksite environments that support physical activity for people of all ages and abilities; Increase access, for people of all ages and abilities, to safe indoor and/or outdoor places for physical activity

• Focus Area 3: Tobacco Prevention • Goal 3.1: Prevent initiation of tobacco use, including combustible tobacco and electronic vaping products (electronic cigarettes and similar

devices) by youth and young adults; Promote tobacco use cessation, especially among populations disproportionately affected by tobacco use including: low SES; frequent mental distress/substance use disorder; LGBT; and disability; Eliminate exposure to secondhand smoke and exposure to secondhand aerosol/emissions from electronic vapor products

• Focus Area 4: Preventive Care and Management • Goal 4.1: Increase cancer screening rates for breast, cervical, and colorectal cancer

• Goal 4.2: Increase early detection of cardiovascular disease, diabetes, prediabetes and obesity

• Goal 4.3: Promote the use of evidence-based care to manage chronic diseases

• Goal 4.4: Improve self-management skills for individuals with chronic conditions

62.39%62.71%

63.20%

64.62%

57.98%

54.00%

56.00%

58.00%

60.00%

62.00%

64.00%

66.00%

2016 2017 2018 2019 2020

High Blood Pressure Control in HRSA-Sponsored Health Centers

Source: https://data.hrsa.gov

Controlled BP defined as SBP <140 mm Hg and DBP <90 mm Hg. Treatment defined by self-reported antihypertensive medication use

JAMA. doi:10.1001/jama.2020.14545 Published online September 9, 2020

10Source: Muntner, JAMA, 2020.Hypertension defined as BP ≥ 140/90

Blood Pressure Control among Adults with Hypertension* in the US

Characteristic Prevalence (%)

45 – 64 years old 49.7

64-74 years old 51.7

≥ 75 years old 37.3

Female 48.5

Male 45.0

Non-Hispanic White 48.2

Non-Hispanic Black 41.5

Non-Hispanic Asian 41.1

Hispanic 40.5

11Source: Muntner, JAMA, 2020.Hypertension defined as BP ≥ 140/90

Blood Pressure Control among Adults with Hypertension* in the US

Characteristic Prevalence (%)

Less than high school graduation 40.5

High school and some college 46.2

College graduation 48.0

< $20,000 annual household income 39.4

$20,000 - $44,999 annual household income 45.1

$45,000 - $74,999 annual household income 49.2

> $75,000 annual household income 50.2

Private health insurance 48.2

Medicare 53.4

Medicaid 41.1

Uninsured 24.1

Usual/no usual health care facility 48.4/26.5

No health care in past 12 months 8.0

Ecological Model of Hypertension Control

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Source: Adapted from CDC

Environment/ Policy

Community

Organizational

Interpersonal

Individual

FDA Salt Guidance

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Source: FDA

Goal

• Reduce average US sodium

consumption from 3,400

mg/day to 3,000 mg/day over

the next 2.5 years.

• The Dietary Guidelines for

Americans recommend 2,300

mg/day.

Impact

• reductions in average intake (modeled down to an average level of 2,200 mg/day) have been estimated to result in tens of thousands fewer cases of heart disease and stroke each year, as well as billions of dollars in health care savings over time.

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Source: https://www.thecommunityguide.org/

The Community Guide – Findings for Cardiovascular Disease

Intervention CPSTF Finding

Team-based Care To Improve BP Control Recommended (strong evidence – 2012)

Clinical Decision-making Support Systems Recommended (sufficient evidence – 2013)

Interactive Digital Interventions For BP Self-

managementRecommended (sufficient evidence – 2017)

Interventions Engaging Community Health Workers Recommended (strong evidence – 2015)

Mhealth Interventions For Treatment Adherence

Among Newly Diagnosed Patients

Recommended (sufficient evidence – 2017)

Reducing Out-of-pocket Costs For CVD Preventive

Services For Patients With High BP And Cholesterol

Recommended (strong evidence – 2012)

Tailored Pharmacy-based Intervention To Improve

Medication Adherence

Recommended (strong evidence – 2019)

SMBP – When Used Alone Recommended (sufficient evidence – 2015)

SMBP – When Combined With Additional Support Recommended (strong evidence – 2015)

Community Settings: A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops

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Population

• Black male patrons with SBP >140 mm Hg

Setting

• 52 Black-owned barbershops

Intervention

• Barbers encouraged meetings in barbershops with specialty-trained pharmacists who prescribed drug therapy under a collaborative practice agreement with the participants’ doctors

Results at 6 months

• SBP decreased by an average of 27 mm Hg in the intervention group

• SBP decreased by an average of 9.3 mm Hg in the active control group

• 63% of participants achieved blood pressure <130/80 mm Hg

• 95% cohort retention rate

Source: Victor et al. 2018, NEJM

Measure Accurately every time to obtain

accurate, representative BPs, reducing clinical

uncertainty

Act Rapidly to diagnose and treat hypertension,

reducing diagnostic and therapeutic inertia

Partner with patients to activate patients to self-

manage and promote adherence to treatment

M

A

P

MeasureAccurately

ActRapidly

Partner withPatients

Therapeutic

inertia

Diagnostic

uncertainty

Treatment

nonadherence

CONTROL

Clinical Care Settings:M.A.P. Framework

All 3 are critical for control

Award Criteria 2017 2018 2019 2020 2021 2022

HTN Pop 3.4M 8.8M 8.2M 8.9M 7.9M

TOTAL HCOs 330 802 1183 1081 1167

ParticipantSubmit data

Achieve < 70% BP control rate145 455 644 577 203

Only first-time

participants

Silver Submit data

Complete 4 of 6 criteria- - - - 567 Continue

Gold Submit data

Achieve ≥ 70% BP control rate 185 347 539 504 125 Continue

Gold+

Submit data

Achieve ≥ 70% BP control rate

Complete 4 of 6 criteria

- - - - 272 Continue

Target; BP Award Summary: Past, Present, and Future

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Office of Minority Health (OMH) funds:

• Community Outreach and Integration

• Program Evaluation and Management

• Patient and Public Education (Community Events, Outreach and Messaging)

Health Resources and Services Administration (HRSA) funds:

• Health Organizations and Health Provider and Clinician Training

• Patient and Public Education (PSA Campaign)

PLUS

• $60 million in separate funding for the 350 HRSA-funded Health Centers

• And $30 million funding for an additional 146 HRSA-funded Health Centers

U.S. Department of Health and Human Services (DHHS) Dual Funding Streams (3 years) $32 million to AHA

National Hypertension Control Initiative (NHCI)

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National Hypertension Control Initiative

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Community

ClinicalCare

Person

Leadership and Evaluation

Health Equity

Training & Technical Assistance Support Plan

• Didactic format & structured curriculum

• Led by national subject matter experts

• Live & on-demand

• Featuring practice tools & resources

• Supplemented with literature & learning essential library

National Webinar Series (monthly, 1 hour)

• Collaborative format & responsive curriculum

• Dynamic challenge & success strategy sharing

• Reflection on self-assessments and EHR audits

• Focus on applying practice tools & resources

Associated Workshops

(monthly, 90minutes - 2 hours)

• Reinforce webinar and workshop content

• Follow-up on assessment or response gaps

• Group troubleshooting

Office Hours (monthly, 2 hours)

• Individual trouble-shooting

• 1:1 Q&A

1:1 Technical Assistance (as needed)

NHCI Training & Technical Assistance - Core Curriculum

12080

Act Rapidly: Treatment

Intensification8/18/21 Webinar

8/31/21 Repeat Webinars

Act Rapidly:

Diagnosis & Treatment

Algorithms

9/15/21 Webinar

09/28/21 Workshop

TBD Office Hours

Partner with Patients:

SMBP II: Work and Data flow

7/14/21 Webinar7/27/21 Workshop (Passcode: AHA)

8/10/21 and 8/11/21 Office Hours

Partner with Patients:

SMBP I: Evidence & Patient Education

6/16/21 Webinar*

Use EHR Data for

Patient & Performance

Monitoring

4/21/21 Webinar*

Measure Accurately

& Team-based Care

5/12/21 Webinar*

6/2/21 Workshop*

6/29/21 Office Hours*

Partner with Patients:

Lifestyle Modification with

Nutrition & Physical Activity

10/13/21 Webinar

10/26/21 Workshop

TBD Office Hours

Partner with Communities:

Social Determinants of Health and

Center Community Linkages

11/10/21 Webinar

11/23/21 Workshop

TBD Office Hours

Note: The following webinars will take place from 12pm-1pm CST / 1pm-2pm EST and Subject to Change* See recordings

Celebrity statistician; Gapfinder co-developer

“I’m not an optimist. I’m a very serious possibilist.”

No soy optimista.Soy un posibilista muy serio.

Hans Rosling (1948-2017)

Thank you

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