The benefit to cost ratio of work-site blood pressure control programs

Article Abstract:

Research findings indicate that work-site programs to monitor and/or treat hypertension (high blood pressure) are effective in reducing the mortality and complications associated with this disorder, particularly after such programs have been ongoing for several years. To learn more about this issue, the long-term effects of work-site hypertension control programs on health benefit claims in four large manufacturing plants were studied. Three programs, two of which offered monitoring, counseling, and referral to physicians at regular intervals after identification of a blood-pressure problem, and one of which offered on-site treatment as well, were compared in an earlier study with one control program in which hypertensive employees were screened and referred once only. Results from the first three years of the programs showed that on-site monitoring and counseling, in either type of program, was associated with considerably better blood pressure control. Employees at all four plants had similar rates of health benefit utilization after the third year. The current study evaluates health benefit utilization after another four years. Each hypertensive employee was screened and matched with a non-hypertensive (normotensive) employee of the same age, sex, race, and job classification. The subjects were compared to evaluate differences in work attendance and health benefit utilization. Results showed that employees at the control site had a greater proportion of excess health care claims for cardiovascular causes, and of excess health care claims overall, than employees at the sites with hypertension control programs. Several methods of data analysis indicated clearly that hypertensive employees from the experimental sites had incurred lower costs for health care claims than hypertensive employees at the control site. The benefit-to-cost ratios for the programs ranged from $1.89 to $2.72 per dollar invested in the programs, depending on the site (after adjustment to standard 1982 dollars). Companies that pay a large proportion of their employees' health benefits can save money by establishing work-site blood pressure control programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Evaluation, Economic aspects, Hypertension, Diagnosis, Medical examination, Surveys, Occupational health services, Wellness programs, Workers, Cost (Economics), Costs (Economics)

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Fourth-order blood pressure waves

Article Abstract:

Acase history of a 80-year-old white man with unusually prolonged periods of blood pressure oscillations is described. Traditionally, descriptions of blood pressure waves have been divided into three categories. First-order waves last about one second and correspond with each heart beat. Second-order waves last about five seconds and coincide with variations in breathing. The third-order waves are indicative of problems such as heart disease, shock, or other critical illnesses, and typically last from between 10 to 160 seconds. An elderly male patient was admitted to the emergency room with fever, fatigue and diarrhea. He was on medication to control high blood pressure, he consumed about 10 ounces of alcohol daily, and had recently undergone surgery. He developed increasingly low blood pressure and slow pulse, and he was admitted to the intensive care unit. Oscillations of the patient's blood pressure, heart rate, and oxygen saturation lasted more than 30 minutes. The length of these oscillations exceeded any that have been previously reported and have therefore been termed by the author as "fourth-order" blood pressure waves. After extensive treatment, including cardiac and pulmonary catheterization, and infusion of dopamine hydrochloride, norepinephrine bitartrate, and heparin, the patient improved enough to be discharged. The cause of the long periods of oscillation is unknown and the prevalence of this abnormality also remains to be determined. It may be that this episode was unique, or it may represent a condition that has been experienced by others but has gone undetected. (Consumer Summary produced by Reliance Medical Information, Inc.)

Heart beat, Heart rate, Oscillation, Oscillations

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Ankle/arm blood pressure index: a useful test for clinical practice?

Article Abstract:

The ankle/arm blood pressure index (AAI) may be an effective method for detecting risk factors for different types of cardiovascular disease. Two research studies found an association between a AAI of 0.9 or less and risk factors for coronary heart disease (CHD) and other types of cardiovascular disease. Patients with a low AAI may also have a higher risk of developing cancer. One study examined the use of AAI in healthy women over 65 years old, and the other evaluated its use in elderly patients with high blood pressure. AAI has been used for several years to detect the presence of peripheral arterial disease (PAD) in the lower extremities. Patients with PAD have an increased risk of death from CHD and all other causes. AAI may not be a perfect method for detecting PAD, but it may be an effective screening test for patients at risk for different types of cardiovascular disease.

Editorial, Cardiovascular diseases, Risk factors, Coronary heart disease

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