NATIONAL HIGH BLOOD PRESSURE EDUCATION PROGRAM

The National High Blood Pressure Education Program (NHBPEP) was established in 1972 by the National Institute of Health to translate research results on the health hazards of high blood pressure into clinical and public health practice. Before 1900, high blood pressure, or hypertension, was not generally recognized as a health problem. Only when a practical method of clinical blood pressure measurement emerged in the early 1900s were associations made between hypertension and subsequent morbidity and mortality. Those associations were confirmed by actuarial statistics, correlating blood pressure levels of life insurance policy holders with subsequent death rates. The associations were also confirmed by observation studies such as the National Heart, Lung, and Blood Institute's Framingham Heart Study, which routinely collected information regarding the health status of an entire community. These data showed that as blood pressure rose, deaths from stroke, heart disease, and all causes began to increase. The higher the blood pressure, the greater the chance of dying from a heart attack or stroke.

The first controlled clinical trial to test the efficacy of blood-pressure–lowering drugs was designed to occur during a five-year period. The results were so successful that the study was stopped at eighteen months. Those receiving blood-pressure–lowering drugs had fewer cardiovascular events than those taking a placebo. Lowering blood pressure saved lives.

The goal of the NHBPEP is to reduce death and disability through programs of professional, patient, and public education. The aim is to raise public awareness about hypertension, to urge hypertensive patients to follow their doctor's advice, and to have clinicians use the available scientific information. The strategies include developing and disseminating educational materials and programs that are grounded in a strong science base and developing partnerships among the program participants. Throughout its history, the NHBPEP has worked to mobilize and coordinate the resources of organizations. The NHBPEP is a network of federal agencies, voluntary and professional organizations, all state health departments, and numerous community-based programs. At the hub of the program is the NHBPEP Coordinating committee, composed of representatives from thirty-eight national professional, public, and voluntary health organizations and seven federal agencies. The program follows a consensus-building process to identify major issues of concern among the participants and to develop program activities. Representatives from the member organizations work together to provide guidance to the program and each other, as well as to develop and promote activities to their own constituencies. This multidisciplinary committee also defines national priorities, examines critical issues, explores future opportunities, sponsors national activities, and promotes collaboration among the program partners. The Coordinating Committee agencies encompass a wide distribution network, supporting a mass media campaign and distribution of educational materials and documents. Among their publications are posters, public service announcements, patient education brochures, and clinical guidelines. Additional activities include designing public health interventions to address the excessive stroke mortality in the Southeast United States; publishing reports describing best treatment practices to control hypertension; conducting demonstration projects at the work site and in urban and rural settings; developing reports and intervention programs regarding hypertension among special populations or situations (e.g., African Americans, hypertensive patients with renal disease or diabetes, children and older Americans); and promoting population strategies for the primary prevention of hypertension.

The effectiveness of the NHBPEP can be measured in several ways. In 1972, the year the program began, less than one-fourth of Americans knew of the relationship between hypertension and stroke and heart disease. By 1990, nearly 90 percent of the public knew of that relationship. In 1971, only 51 percent of Americans with hypertension were aware of their condition, only 39 percent were being treated, and only 16 percent had achieved satisfactory control. Two decades later, the corresponding figures were 84, 73, and 55 percent respectively. Since the inception of the NHBPEP, death rates for strokes decreased by nearly 60 percent and heart disease by nearly 50 percent. These improvements are real, are seen in both genders, and in African Americans and whites. The story of efforts to detect, control, and prevent hypertension is one of the great public health successes of the second half of the twentieth century.

Edward J. Roccella

(see also: Blood Pressure; Framingham Study; National Institutes of Health; Stroke )

Bibliography

Chairman, Sheps S. (1997). "The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure." Archives of Internal Medicine 157 (November 24):2413–2446.

The Society of Actuaries and Association of Life Insurance Medical Directors of America (1979). Blood Pressure Study 1979. Chicago.

Veterans Administration Cooperative Study Group on Antihypertensive Agents (1967). "Effects of Treatment on Morbidity in Hypertension I: Results in Patients with Diastolic Blood Pressures Averaging 115 through 129 mmHg." Journal of the American Medical Association 202:1028–1034.

—— (1970). "Effects of Treatment on Morbidity in Hypertension: II. Results in Patients with Diastolic Blood Pressure Averaging 90 through 114 mmHg." Journal of the American Medical Association 213:1143–1152.