Hypertension Prevention and Control Improvement Toolkit

Hypertension Preconception and Preventive Health Teen Pregnancy Prevention Program Title X Family Planning Program
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Welcome to the Toolkit

Almost half of U.S. adults, and approximately four in 10 adult women, have hypertension (blood pressure greater than 130/80). Hypertension is a major contributing risk factor for heart disease, stroke, and kidney disease.1

Hypertension is one of the leading — and most preventable — contributors to maternal death and to disparities in maternal morbidity and mortality.2 Women with hypertension are at higher risk for complications during pregnancy and the postpartum period, including some of the leading causes of maternal morbidity and mortality, such as preeclampsia, eclampsia, placental abruption, stroke, and cardiomyopathy. Pregnant women with hypertension are also at increased risk for intrauterine growth restriction and preterm delivery, and they are more likely to need labor induction and cesarean section.2

Some groups are more likely to have hypertension than others. For example, Black women 20–44 years old have a prevalence of hypertension more than twice that of other racial and ethnic groups. Inequitable access to the social, economic, and environmental conditions needed for health, and the impact of stress, poverty, and racial discrimination, have been linked to hypertension.

High blood pressure — which includes both elevated blood pressure (BP 120–129/less than 80) and hypertension — in youth is linked to health problems in later life. Therefore, efforts to improve maternal health must begin with promoting mental and physical health in young girls and adolescents, and continue throughout the reproductive years.

The goal of this toolkit is to support sexual and reproductive health agencies and service sites in implementing best practices for hypertension prevention, diagnosis, and control practices.

Illustration of a woman meeting with a doctor having her blood pressure taken

This toolkit is not prescriptive. Rather, it is a guide to help your program develop a systematic, comprehensive method to improve care. Use the steps and resources that fit your site’s needs and priorities.

This toolkit recommends the following steps:

  1. Assess your program’s hypertension prevention and control efforts
  2. Train and prepare staff for hypertension prevention and control improvements
  3. Integrate hypertension prevention and screening into all client visits
  4. Strengthen support for clients with or at risk for hypertension
  5. Integrate hypertension into community participation and program promotion activities

This toolkit is informed by the Million Hearts Hypertension Control Change Package and the American Heart Association Target BP Blood Pressure Improvement Program.

Family planning providers can improve general and preconception health outcomes by making hypertension control a priority, implementing evidence-based strategies, and engaging in quality improvement over time. The first step is to assess hypertension prevention- and control-related activities and identify gaps between current and recommended practice.

Action Steps Supportive Resources

Review current professional guidelines.

Providing Quality Family Planning Services (QFP)

U.S. Medical Eligibility Criteria (MEC), 2016

Assess site policies and protocols related to hypertension prevention, detection, and control.

Hypertension Prevention and Control Site Assessment Job Aid

Incorporate hypertension prevention, detection, and control into site policies and procedures.

Sample Policy for Hypertension Prevention and Control Services Job Aid

Select blood pressure improvement metrics.

Hypertension Screening Performance Measure Calculator

Develop an improvement goal.

Aim Statement Worksheet

Identify strategies for improvement.

Plan-Do-Study-Act Worksheet

Focus on Hypertension to Improve Reproductive and Maternal Health Outcomes Plan for Improvement Job Aid

Tackling Hypertension through Reproductive Health Care in Kachemak Bay: A Case Study Video

Before making changes to clinical practice, ensure that the care team has the guidance and resources they need. Make sure that staff understand the rationale for making improvements, the impact and root causes of hypertension, and the evidence-based recommendations and guidelines for hypertension prevention, detection, and control. This foundation will give staff both the motivation and skills to implement changes.

Action Steps Supportive Resources

Train staff, as needed, on foundational concepts, including how hypertension relates to general health, reproductive health, and racial disparities in health.

Integrating Hypertension Prevention and Control into Family Planning Services eLearning

Hypertension: Screen, Start Connect Video

Train the care team, as needed, to consistently and accurately measure, assess, and document blood pressure.

Accurate Measurement of Blood Pressure in a Reproductive Health Setting Video

Train the care team, as needed, to provide education, counseling, and referrals for clients who have or are at risk for hypertension.

Providing Effective Referrals Training Guide

Train providers to align their services with evidence-based best practices to diagnose, manage, and/or refer for non-pharmacologic and pharmacologic hypertension treatment and control.

Addressing Hypertension in Family Planning Settings Clinician Cafe Website

Provide care team training, as needed, to support patients in blood pressure self-monitoring.

Family planning providers can use various approaches to integrate healthy living recommendations into every family planning visit and to increase awareness of these recommendations among clients. Early intervention is important, since hypertension — or the path toward developing hypertension — can begin in childhood or adolescence. Individuals with elevated blood pressure (120-129/less than 80), overweight, obesity, or Black are at increased risk. When counseling a client about healthy behaviors, providers should assess the client’s social needs and provide recommendations for healthy behaviors that are realistic for the client.

Action Steps Supportive Resources

Measure, interpret, and document blood pressure for all clients using evidence-based protocols.

8 Steps to Accurately Measure Blood Pressure (BP) Poster

Integrate hypertension prevention-related healthy living messages into all client visits.

Integrating Blood Pressure Screening and Intervention into Family Planning Visits Job Aid

Ayuda del trabajo: Integración de la evaluación e intervención de presión arterial en las citas de planificación familiar

OARS Model—Essential Communication Skills Job Aid

Assess the client’s reproductive goals and provide preconception-related healthy living messages, as indicated.

Client-Centered Reproductive Goals and Counseling Flow Chart

Integrating Blood Pressure Screening into Preconception Health Services Job Aid

Ayuda del trabajo: Integración de la evaluación de presión arterial en los servicios de salud preconcepcional

Assess and address social needs to support the client’s ability to engage in healthy behaviors.

Neighborhood Navigator Resource Finder

Addressing Social Determinants of Health in Family Planning Care Meeting Package

Provide culturally competent healthy living and risk reduction resources and/or referrals for related services related to healthy weight, diet, physical activity, smoking, alcohol, and sleep.

Local Resource List

Healthy Living Resources to Help Clients Prevent and Control Hypertension

Action Steps Supportive Resources

Identify and diagnose clients with elevated blood pressure and/or hypertension.

How to Diagnose and Manage Hypertension in a Family Planning Setting Job Aid

Identifying and Managing Hypertension in Family Planning Settings: A Title X Prescriber’s Supplement

Act rapidly to engage (or refer) clients with hypertension for non-pharmacologic and/or pharmacologic management.

Contraceptive Counseling for a Client with Hypertension Video

Preconception Services and Hypertension Video

Provide culturally competent client resources and educational materials to support hypertension control.

My Blood Pressure Log

8 Steps to Accurately Measure Blood Pressure (BP) At Home Job Aid

Refer clients with hypertension or hypertension risk factors for additional services or resources, as appropriate.

Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers

Once family planning providers have identified clients as having elevated blood pressure or hypertension, they should engage (or refer) clients for non-pharmacologic or pharmacologic treatment according to evidence-based guidelines. Address the client's social needs and support them in making small lifestyle changes. Use team-based care; non-clinical staff who use a collaborative approach can engage patients in managing and controlling hypertension. Establish networks and systems to refer clients for additional services, when appropriate.

Although improving screening, treatment, and control of hypertension in the clinical setting is important, it is insufficient for ensuring better population health outcomes. Health care accounts for only an estimated 10–20% of the modifiable contributors to health outcomes.4 The other 80–90% are related to the social determinants of health, such as economic, community, social, and environmental factors. Family planning providers are encouraged to engage in diverse collaborative partnerships to identify opportunities for improved general and maternal health outcomes.

Action Steps Supportive Resources

Identify and support local programs and community groups that work toward equity in healthy living.

System Support Mapping

Stakeholder Mapping

Participate in multi-sector partnerships to identify opportunities for hypertension prevention and control at the community level.

Value Proposition Template

Using Virtual and Remote Outreach to Meet CPEP Requirements Job Aid

Engaging Diverse Community Partners Job Aid

Ensure that individuals broadly representative of the community participate in the development of hypertension-related health messages and strategies.

Collaborative Planning and Community Engagement Policy Template

Incorporate hypertension messaging, education, and resources into community outreach and project promotion activities.

Hypertension and Reproductive Health Social Media Toolkit for Family Planning Agencies

Community Participation, Education, and Project Promotion Plan: Objectives, Activities, and Worksheet

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  1. U.S. Department of Health and Human Services. (2020). The Surgeon General’s Call to Action to Improve Maternal Health. https://www.hhs.gov/sites/default/files/call-to-action-maternal-health.pdf
  2. Centers for Disease Control and Prevention. (2020, October). The Surgeon General's Call to Action to Control Hypertension. https://www.cdc.gov/bloodpressure/CTA.htm
  3. Ostchega, Y., Fryar, C.D., Nwankwo, T., Nguyen, D.T. (2020, April). Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief, No. 364. National Center for Health Statistics.
  4. Hood, C. M., K. P. Gennuso, G. R. Swain, and B. B. Catlin. 2016. County health rankings: Relationships between determinant factors and health outcomes. American Journal of Preventive Medicine 50(2):129-135.