efforts to address hypertension primarily through its state heart disease and stroke prevention programs. Many of these efforts are described in Chapter 3 and throughout other chapters. Objectively, however, there are two significant problems with the current status and direction of hypertension prevention and control activities:

  • Hypertension is only one component of a larger cardiovascular disease prevention program that has more of a medical care rather than a population-based prevention focus.

  • The CDC’s cardiovascular disease program in general, and the hypertension program in particular, are dramatically under funded relative to the preventable burden of disease and the strategy and action plan that have been developed. Despite the magnitude of hypertension-associated morbidity and mortality and costs to the health care system ($73 billion annually), the current resources available for hypertension prevention and control at the CDC are surprisingly limited ($54 million for all cardiovascular and stroke activities in 2009).

This current economic reality limiting the absolute amount of resources available to the CDC must drive short-term programmatic priorities towards approaches that are not only cost-effective but also low in absolute cost. Compared with interventions directed toward individuals, interventions directed toward policy, systems, and environmental changes in populations are more likely to be realistic and effective in the current resource-constrained environment. The committee believes that the DHDSP should focus its priorities on approaches that cater to the strength of the public health system—population-based policy and systems approaches rather than individual health care-based approaches. Any investments in the health care sector should be policy- and systems-based and should leverage health care system resources.

The committee has recommended a number of high-priority strategies to prevent and control hypertension to the DHDSP throughout Chapters 4 and 5. The recommendations embody a population-based policy and systems approach grounded in the principles of measurement, system change, and accountability. In brief, the recommendations seek to:

  • Shift the balance of the DHDSP’s hypertension priorities from individual-based strategies to population-based strategies to:

    • strengthen collaboration among CDC units (and their partners) to ensure that hypertension is included as a dimension of other population-based activities around healthy lifestyle improvement, particularly greater consumption of potassium-rich



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