Appropriate medical or allied health professional trained in measurement of blood pressure, referral protocols, and delivering educational messages to participants conduct blood pressure programs. These programs are required to follow national guidelines.

National guidelines for blood pressure protocols:

• Calibration of blood pressure measuring equipment should be done at least annually.



• Two or more measurements of participant's blood pressure should be taken.



• Referral of participants with high blood pressure readings to personal physician for further evaluation.

Systolic/Diastolic Follow-Up:

Normal: < 130 / < 85
Action: Recheck in 2 years

High Normal: 130-139 / 85-90
Action: Recheck in 1 year

Hypertension:

Stage 1 (Mild): 140-159 / 90-99
Action: Confirm within 2 Months

Stage 2 (Moderate): 160-179 / 100-109
Action: Refer to source of care within 1 month

Stage 3 (Severe): 180-209 / 110-119
Action: Refer to source of care within 1 week

Stage 4 (Very Severe): > 210 / > 120
Action: Refer to source of care immediately

Appropriate educational messages:

Normal: < 130 systolic and < 85 diastolic
Action: No referral. If on treatment, then inform participant that blood pressure is under good control today and should continue seeing and following treatment program.

High Normal: 130-139 systolic and/or 85-89 diastolic
Action: Recommend that participant have blood pressure rechecked within 1 year unless under treatment. Advise participant that the readings are in a high normal range that needs rechecking. In the interim, suggest that one of the most effective means to lower blood pressure is to bring weight into normal range and to exercise.

High: > 140 systolic and/or > 90 diastolic
Action: Refer to physician for further evaluation within 2 months unless the level is within urgent, emergency, or isolated systolic hypertension levels. If already on treatment, advise participant of readings and need to get blood pressure to a goal of 140/90 or less.

Isolated Systolic Hypertension: 140-159 systolic and < 90 diastolic in a participant 65 years of age or older
Action: Advise participant to inform physician of readings at next visit and consider advice regarding weight loss and exercise if appropriate

Urgent: 180-209 systolic and/or 110-119 diastolic
Action: Recommend obtaining medical evaluation within 1 week

Emergency: > 210 systolic and/or > 120 diastolic
Action: Obtain immediate medical attention.

Provides the following:

• Written results, referral instructions, and an explanation of blood pressure levels given to each participant with individualized counseling, including advice about the interval of time recommended when the participant should be checked again.



• Utilizes the recommendations in The Fifth Report Of The Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure, March 1994.



• Written and audiovisual materials that are informative, easy to understand, and useful while containing scientifically accurate information.



• Relationship of high blood pressure and other risk factors, such as family history, smoking, alcohol consumption, high fat and unhealthy diet, lack of exercise, and stress, in the development of cardiovascular disease, including stroke, kidney disease, heart attack, and other diseases.



• Definition and causes of high blood pressure.



• Importance of following prescribed treatment.