Hypertension is a major public health problem both for Arkansas and the nation. According to the 2017 BRFSS survey, 41.1% of Arkansan adults have self-reported hypertension compared to 32.3% nationally. Approximately 51.5% of Arkansan adults have uncontrolled hypertension, which is the leading cause of both fatal and non-fatal cardiovascular events, such as coronary heart disease, acute myocardial infarction, congestive heart failure, stroke and kidney disease. Arkansas ranks 4th among states for hypertensive disease deaths and the state’s rate of 35.5 deaths per 100,000 is 35.2% higher than the national death rate of 23.0 per 100,000. In 2010, direct medical costs for hypertension and its associated conditions were estimated at $1.5 billion among Arkansans. The medical and public health significance of hypertension control cannot be overstated.

High blood pressure, or hypertension, affects millions of Americans, and some have hypertension that is undiagnosed and untreated, i.e. they are “hiding in plain sight.” One-third of adults with hypertension in Arkansas remained undiagnosed or undetected. In 2014, the ADH began screening all adult clients who receive any service at Local Health Units (LHU) for high blood pressure. ADH LHU nurses were encouraged to record and document two blood pressure readings for all adult patients.  

• ADH Chronic Disease Prevention and Control Branch
• ADH Local Public Health
• ADH IT Support

Million Hearts®, a national effort to prevent 1 million heart attacks and strokes by 2017, has made blood pressure control a priority. Million Hearts® encourages health care providers to take steps to identify patients with potentially undiagnosed hypertension. Blood pressure screening at ADH LHUs has led to increased identification of adults with previously undiagnosed or undetected hypertension.

Strategy 1: Add blood pressure measurements as a standard of practice across all clinical programs at ADH for persons 18 or older.

Strategy 2: Ensure staff is aware of the parameters that constitute high blood pressure and require mandatory trainings.

• Final Recommendation Statement. High Blood Pressure in Adults: Screening. US Preventive Services Task Force, 2017. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening
• Wall HK, Hannan JA, Wright JS. Patients with Undiagnosed Hypertension Hiding in Plain Sight. JAMA. 2014;312(19):1973-1974. Available at: https://jamanetwork.com/journals/jama/fullarticle/1935131
• Undiagnosed Hypertension, Million Hearts®. Available at: https://millionhearts.hhs.gov/tools-protocols/hiding-plain-sight/index.html