**Summary of Recommendations and Ratings of State and Expert Panels as
to Feasibility and Impact on Hypertension Control**

+---+--------------------------------------+--------+--------+-------+
|   | **Recommendation**                   | *      | **     | **E   |
|   |                                      | *State | Expert | xpert |
|   |                                      | Panel  | Panel  | Panel |
|   |                                      | Ra     | Rating | Rat   |
|   |                                      | ting** | for**  | ing** |
|   |                                      |        |        |       |
|   |                                      | **4=   | **4=h  | *     |
|   |                                      | h      | ighest | *4-Hi |
|   |                                      | ighest | f      | ghest |
|   |                                      | f      | easibi | Imp   |
|   |                                      | easibi | lity** | act** |
|   |                                      | lity** |        |       |
+===+======================================+========+========+=======+
|   | **A. Recommendations for State       |        |        |       |
|   | Programs Rated by Both Expert and    |        |        |       |
|   | State Panels as Highest Feasibility  |        |        |       |
|   | and Impact to Prevent and Control    |        |        |       |
|   | Hypertension**                       |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| A | (Health Care Systems) Identify,      | 3.9    | 3.8\*  | 3.5   |
| . | disseminate and promote utilization  |        |        |       |
| 1 | of evidence-based guidelines for     |        |        |       |
|   | hypertension identification,         |        |        |       |
|   | treatment, and management            |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| A | (Health Care Systems) Encourage      | 3.4    | 3.3\*  | 3.8   |
| . | primary care practices to adopt      |        |        |       |
| 2 | team-based care that moves between   |        |        |       |
|   | physicians and non-physicians. This  |        |        |       |
|   | could include nurse case management  |        |        |       |
|   | and pharmacy intervention            |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| A | (Health Care Systems) Identify and   | 3.3    | 3.3\*  | 3.6   |
| . | promote simple information system    |        |        |       |
| 3 | solutions (like registries, reminder |        |        |       |
|   | systems, and identification flags    |        |        |       |
|   | for patients at high risk) to        |        |        |       |
|   | practices that don\'t have the       |        |        |       |
|   | capital or personnel to deal with    |        |        |       |
|   | electronic health record conversion  |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| A | (Health Care Systems) Encourage      | 3.3    | 3.6    | 3.6   |
| . | statewide collaboration and          |        |        |       |
| 4 | coordination with organizations that |        |        |       |
|   | have succeeded in developing         |        |        |       |
|   | community activities to improve      |        |        |       |
|   | hypertension control (Indian Health  |        |        |       |
|   | Service, HRSA, Medicaid programs) to |        |        |       |
|   | find common activities and support   |        |        |       |
|   | disease management programs in       |        |        |       |
|   | Medicaid and HRSA supported health   |        |        |       |
|   | centers                              |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| A | (Worksite -- Health Plans And        | 3.2    | 3.5    | 3.5   |
| . | Employers) Develop programs that     |        |        |       |
| 5 | employers can provide without having |        |        |       |
|   | to hire staff to write and develop   |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| A | (Worksite -- Health Plans And        | 3.0    | 3.2    | 3.4   |
| . | Employers) Provide the cost benefit  |        |        |       |
| 6 | data to demonstrate how hypertension |        |        |       |
|   | prevention and control can reduce    |        |        |       |
|   | health care costs, increase          |        |        |       |
|   | productivity, and showcase worksite  |        |        |       |
|   | benefit programs that have           |        |        |       |
|   | successfully encouraged BP control   |        |        |       |
|   | and made a difference in BP control  |        |        |       |
|   | rates.                               |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| A | (Provider Behavior) Teach patients   | 3.0    | 3.3    | 3.4   |
| . | to ask, \"Why is my BP not less than |        |        |       |
| 7 | 140/90 and how can we get there?\"   |        |        |       |
+---+--------------------------------------+--------+--------+-------+

+---+--------------------------------------+--------+--------+-------+
|   | **Recommendation**                   | *      | **     | **E   |
|   |                                      | *State | Expert | xpert |
|   |                                      | Panel  | Panel  | Panel |
|   |                                      | Ra     | Rating | Rat   |
|   |                                      | ting** | for**  | ing** |
|   |                                      |        |        |       |
|   |                                      | **4=   | **4=h  | *     |
|   |                                      | h      | ighest | *4-Hi |
|   |                                      | ighest | f      | ghest |
|   |                                      | f      | easibi | Imp   |
|   |                                      | easibi | lity** | act** |
|   |                                      | lity** |        |       |
+===+======================================+========+========+=======+
|   | **B. Recommendations for Partner     |        |        |       |
|   | Activities Rated by Both State and   |        |        |       |
|   | Expert Panels as Highest Feasibility |        |        |       |
|   | and Impact to Prevent and Control    |        |        |       |
|   | Hypertension**                       |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| B | (Patient Level Care) Encourage       | 3.5    | 3.6\*  | 3.2   |
| . | effective heart disease and stroke   |        |        |       |
|   | prevention patient education         |        |        |       |
|   | programs that promote messaging      |        |        |       |
|   | around root behaviors rather than    |        |        |       |
|   | specific disease conditions - people |        |        |       |
|   | get \"two-fors\" and such by having  |        |        |       |
|   | better nutrition and activity        |        |        |       |
|   | information to prevent/control       |        |        |       |
|   | multiple risks and behaviors across  |        |        |       |
|   | all CVD risk factors.                |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| B | (Worksite -- Health Plans And        | 3.1    | 3.1    | 3.1   |
| . | Employers) Encourage worksites to    |        |        |       |
| 2 | adopt public health interventions    |        |        |       |
|   | that would benefit hypertensives     |        |        |       |
|   | e.g. physical activity at the        |        |        |       |
|   | worksite and good nutrition choices, |        |        |       |
|   | e.g. use Google as one example       |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| B | (Worksite -- Health Plans and        | 3.1    | 3.1    | 3.2   |
| . | Employers) Create a healthy work     |        |        |       |
| 3 | environment for hypertensive         |        |        |       |
|   | employees, by increasing the visual  |        |        |       |
|   | messages and availability of healthy |        |        |       |
|   | foods (DASH diet menu items, more    |        |        |       |
|   | low salt and other healthy choices)  |        |        |       |
|   | and getting rid of unhealthy choices |        |        |       |
|   | in vending machines, starting with   |        |        |       |
|   | state office buildings.              |        |        |       |
+---+--------------------------------------+--------+--------+-------+

+---+--------------------------------------+--------+--------+-------+
|   | **Recommendation**                   | *      | **     | **E   |
|   |                                      | *State | Expert | xpert |
|   |                                      | Panel  | Panel  | Panel |
|   |                                      | Ra     | Rating | Rat   |
|   |                                      | ting** | for**  | ing** |
|   |                                      |        |        |       |
|   |                                      | **4=   | **4=h  | *     |
|   |                                      | h      | ighest | *4-Hi |
|   |                                      | ighest | f      | ghest |
|   |                                      | f      | easibi | Imp   |
|   |                                      | easibi | lity** | act** |
|   |                                      | lity** |        |       |
+===+======================================+========+========+=======+
|   | **C. Recommendations for State       |        |        |       |
|   | Programs Rated by Experts as Highest |        |        |       |
|   | Impact and Selected Items as High    |        |        |       |
|   | Feasibility, but Rated Lower in      |        |        |       |
|   | Feasibility by States.**             |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Provider Behavior) Provide primary  | 2.9    | \* Not | 3.5   |
| . | care providers with feedback on      |        | in top |       |
| 1 | group hypertension control rates in  |        | r      |       |
|   | their practices/settings             |        | atings |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Patient Level Care) Encourage       | 2.8    | Not in | 3.2   |
| . | patient incentives around            |        | top    |       |
| 2 | self-management and control of       |        | r      |       |
|   | hypertension                         |        | atings |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Patient Level Care) Use local media | 2.7    | 3.5    | 3.3   |
| . | to promote high blood pressure       |        |        |       |
| 3 | awareness, treatment and control     |        |        |       |
|   | messages (e.g., that hypertension    |        |        |       |
|   | can be controlled, nonpharmacologic  |        |        |       |
|   | approaches to control, importance of |        |        |       |
|   | taking blood pressure medications    |        |        |       |
|   | and following up with providers.)    |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Provider Behavior) Increase the     | 2.6    | \* Not | 3.4   |
| . | resources available for providers in |        | in top |       |
| 4 | low-income/medically underserved     |        | r      |       |
|   | communities to help manage their HTN |        | atings |       |
|   | patients (education resources, basic |        |        |       |
|   | infrastructure support for their     |        |        |       |
|   | medical practices)                   |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Health Care Systems) Use electronic | 2.6    | \* Not | 3.6   |
| . | health records to institute          |        | in top |       |
| 5 | hypertension tracking and follow up  |        | r      |       |
|   | in all primary care settings to      |        | atings |       |
|   | increase hypertension control rates  |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Health Care Systems) Evaluate and   | 2.5    | 3.5\*  | 3.5   |
| . | score health systems on hypertension |        |        |       |
| 6 | control rates and encourage public   |        |        |       |
|   | reporting through JCAHO and NCQA on  |        |        |       |
|   | performance                          |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Provider Behavior) Make deployment  | 2.4    | 3.2\*  | 3.5   |
| . | of health information systems at     |        |        |       |
| 7 | provider sites as affordable and     |        |        |       |
|   | administratively easy as possible,   |        |        |       |
|   | e.g. electronic reminders and        |        |        |       |
|   | algorithms for provider use          |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Worksite -- Health Plans and        | 2.3    | \* Not | 3.1   |
| . | Employers) Adopt incentive-based     |        | in top |       |
| 8 | programs that facilitate health and  |        | r      |       |
|   | wellness and provide health          |        | atings |       |
|   | discounts for staying well           |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Patient Level Care) Encourage       | 2.2    | Not in | 3.4   |
| . | Medicaid, health plans and other     |        | top    |       |
| 9 | third-party payers to make home BP   |        | r      |       |
|   | monitors available cheaply, and      |        | atings |       |
|   | encourage all providers\' use of     |        |        |       |
|   | home blood pressure monitoring to    |        |        |       |
|   | asses white-coat hypertension,       |        |        |       |
|   | adherence, and BP control.           |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Health Care Systems) Increase       | 1.9    | \* Not | 3.8   |
| . | access to affordable medications for |        | in top |       |
| 1 | uninsured or inadequately insured    |        | r      |       |
| 0 | patients                             |        | atings |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Health Care Systems) Work with      | 1.8    | 3.4\*  | 3.6   |
| . | Medicaid, health plans and other     |        |        |       |
| 1 | third-party payers to increase       |        |        |       |
| 1 | reimbursement rates for primary care |        |        |       |
|   | practices for hypertension           |        |        |       |
|   | management, including reimbursement  |        |        |       |
|   | for hypertension services provided   |        |        |       |
|   | by nurse practitioners, registered   |        |        |       |
|   | nurses, health educators, social     |        |        |       |
|   | workers and psychiatric care         |        |        |       |
|   | providers                            |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | (Health Care Systems) Create         | 1.8    | 3.6\*  | 3.6   |
| . | incentives within Medicaid for       |        |        |       |
| 1 | health care systems to use thiazides |        |        |       |
| 2 | as first line antihypertensive       |        |        |       |
|   | agents. (Formularies might include   |        |        |       |
|   | pop-up messages for providers.)      |        |        |       |
+---+--------------------------------------+--------+--------+-------+
| C | Patient Level Care) Develop a        | 1.8    | \* Not | 3.5   |
| . | national strategy that can be        |        | in top |       |
| 1 | translated to a state level to       |        | r      |       |
| 3 | decrease sodium content in           |        | atings |       |
|   | commercially prepared food, such as  |        |        |       |
|   | (1) Work with food industry to take  |        |        |       |
|   | out sodium much as they took out     |        |        |       |
|   | Trans fats, (2) Create public demand |        |        |       |
|   | for more lower salt foods, similar   |        |        |       |
|   | to the campaign to reduce fat in     |        |        |       |
|   | foods, (3) Create a public demand    |        |        |       |
|   | for lower salt choices in            |        |        |       |
|   | restaurants, and create programs to  |        |        |       |
|   | teach commercial food preparers to   |        |        |       |
|   | reduce sodium content in foods they  |        |        |       |
|   | are serving                          |        |        |       |
+---+--------------------------------------+--------+--------+-------+