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Physician approach to controversial issues in hypertension
456
ABSTRACTS: HIGH BLOOD PRESSURE CONTROL
Hypertension screening and follow-up services have traditionally been provided by highly trained and skilled nurses and physicians. In the recent past, representatives of government as well as those from the organized medical and nursing community have suggested that specially trained paraprofessionals may effectively carry out blood pressure screening, education, and monitoring services. The use of paraprofessionals, it is believed, may also decrease individual and general health care costs. This paper will examine two distinct hypertension service delivery models that were funded by the Massachusetts Department of Public Health in FY 1979. In the first model, the nurse professional provided blood pressure screening and monitoring services, and in the second model, the paraprofessional functioned in the same role. One measure of program effectiveness is the extent to which individuals, identified initially as having elevated pressures, return for rescreening and monitoring. In this paper, the effectiveness of the two service delivery models will be compared. Client population demographics within each of the models will be examined. Program costs, including personnel time, and training time of the paraprofessionals will be analyzed. Finally, policy implications are addressed which suggest future directions for the design and funding of service delivery model programs.
A-90 Salient Characteristics Risk for Hypertension.
of Varying Community
Hypertension
Programs in Reaching Individuals
at
Massachusetts Department of Public Health, 600 Washington Street, Room 705, Boston, Massachusetts 02111; SHARONSPAIGHT. SUSAN TOBER,
Individual and aggregate risk for developing hypertension can be predicted by reference to demographic data. Numerous research studies have found correlations between elevated blood pressure and certain demographic characteristics such as sex, race, age, and educational levels. The data suggest that programs specifically targeted to men, blacks, the elderly, and those with fewer years of formal education may yield larger numbers of individuals with elevated blood pressures. Currently, blood pressure screening takes place in a variety of settings, including churches, health centers, and work sites. Each site type may attract a significantly different portion of an at-risk population. This paper examines client demographic data and blood pressure distributions from different settings in which Massachusetts Department of Public Health Hypertension programs were implemented. The data analysis focuses on the identification of the characteristics of sites which are most likely to yield larger rates of at-risk individuals as compared to an expected rate of yield predicted by general demographic data from the geographic areas included in this analysis. The paper then discusses implications for funding and future directions for community blood pressure programs. A-91 Ej$ct of Hydrochlorothiazide
on Cerebral Blood Flow of Elderly Patients with Systolic Hypertension.
YEHUDA M. TRAUB, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261; MANUEL DUJOVNY; DEBBIE NELSON; ALAN BARNETT; BRIGID A. SHERIDAN. Blood pressure (BP), cerebral blood flow (CBF), plasma renin activity (PRA), blood counts, urinary, and serum electrolytes, and other blood chemistries were measured in 10 elderly patients (age 61-76) with systolic hypertension (SH). CBF was calculated from clearance curves of inhaled xenon-133. All measurements were done while the patients were off antihypertensive therapy for at least 3 weeks as well as during chronic management with hydrochlorothiazide (HCT). Average BP fell during treatment with HCT from 188.4/89.7 mm Hg supine and 183.4193.7upright to 162.7/83.2 and 158.4/85.1 mm Hg, respectively. Average CBF remained practically unchanged (36.9 ml/l00 g brain tissue on no therapy and 34.1 during HCT). Individual changes in CBF did not correlate with changes in BP, PRA, electrolytes, or other chemistries. The present data do not support certain fears expressed in the literature about antihypertensive therapy decreasing cerebral perfusion in elderly patients with SH. A-92 to Controversial Issues in Hypertension. YEHUDA M. TRAUB, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261; ROBERTH. MCDONALD, JR.; ALVIN P. SHAPIRO.
Physician Approach
ABSTRACTS: HIGH BLOOD PRESSURE CONTROL
Hypertension screening and follow-up services have traditionally been provided by highly trained and skilled nurses and physicians. In the recent past, representatives of government as well as those from the organized medical and nursing community have suggested that specially trained paraprofessionals may effectively carry out blood pressure screening, education, and monitoring services. The use of paraprofessionals, it is believed, may also decrease individual and general health care costs. This paper will examine two distinct hypertension service delivery models that were funded by the Massachusetts Department of Public Health in FY 1979. In the first model, the nurse professional provided blood pressure screening and monitoring services, and in the second model, the paraprofessional functioned in the same role. One measure of program effectiveness is the extent to which individuals, identified initially as having elevated pressures, return for rescreening and monitoring. In this paper, the effectiveness of the two service delivery models will be compared. Client population demographics within each of the models will be examined. Program costs, including personnel time, and training time of the paraprofessionals will be analyzed. Finally, policy implications are addressed which suggest future directions for the design and funding of service delivery model programs.
A-90 Salient Characteristics Risk for Hypertension.
of Varying Community
Hypertension
Programs in Reaching Individuals
at
Massachusetts Department of Public Health, 600 Washington Street, Room 705, Boston, Massachusetts 02111; SHARONSPAIGHT. SUSAN TOBER,
Individual and aggregate risk for developing hypertension can be predicted by reference to demographic data. Numerous research studies have found correlations between elevated blood pressure and certain demographic characteristics such as sex, race, age, and educational levels. The data suggest that programs specifically targeted to men, blacks, the elderly, and those with fewer years of formal education may yield larger numbers of individuals with elevated blood pressures. Currently, blood pressure screening takes place in a variety of settings, including churches, health centers, and work sites. Each site type may attract a significantly different portion of an at-risk population. This paper examines client demographic data and blood pressure distributions from different settings in which Massachusetts Department of Public Health Hypertension programs were implemented. The data analysis focuses on the identification of the characteristics of sites which are most likely to yield larger rates of at-risk individuals as compared to an expected rate of yield predicted by general demographic data from the geographic areas included in this analysis. The paper then discusses implications for funding and future directions for community blood pressure programs. A-91 Ej$ct of Hydrochlorothiazide
on Cerebral Blood Flow of Elderly Patients with Systolic Hypertension.
YEHUDA M. TRAUB, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261; MANUEL DUJOVNY; DEBBIE NELSON; ALAN BARNETT; BRIGID A. SHERIDAN. Blood pressure (BP), cerebral blood flow (CBF), plasma renin activity (PRA), blood counts, urinary, and serum electrolytes, and other blood chemistries were measured in 10 elderly patients (age 61-76) with systolic hypertension (SH). CBF was calculated from clearance curves of inhaled xenon-133. All measurements were done while the patients were off antihypertensive therapy for at least 3 weeks as well as during chronic management with hydrochlorothiazide (HCT). Average BP fell during treatment with HCT from 188.4/89.7 mm Hg supine and 183.4193.7upright to 162.7/83.2 and 158.4/85.1 mm Hg, respectively. Average CBF remained practically unchanged (36.9 ml/l00 g brain tissue on no therapy and 34.1 during HCT). Individual changes in CBF did not correlate with changes in BP, PRA, electrolytes, or other chemistries. The present data do not support certain fears expressed in the literature about antihypertensive therapy decreasing cerebral perfusion in elderly patients with SH. A-92 to Controversial Issues in Hypertension. YEHUDA M. TRAUB, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261; ROBERTH. MCDONALD, JR.; ALVIN P. SHAPIRO.
Physician Approach