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To achieve and maintain successfully healthy well-being  to ensure a good quality of life to increase an individual's life expectancy.

Maintaining and sustaining normal blood pressures is one of many steps to achieve healthy living.

Nearly half of adults in the United States (108 million, or 45%) have hypertension defined as a systolic blood pressure ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg or are taking medication for hypertension (CDC, 2020).

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High blood pressure (hypertension, HTN, HBP) is a modifiable risk factor
Uncontrolled blood pressure is one of the most prevalent risk factor that can attribute to other disease conditions i.e. high risk for (HRF) cardiac and non-cardiac episodes.

In 2017, nearly half a million deaths in the United States included hypertension as a primary or contributing cause (CDC, 2020).

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Hypertension Control Change Package (HCCP)

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Setting daily sodium limits

Individuals with NBP - 2300 mg/day

Individuals with HTN - no more than 1500mg/day

Healthcare providers must educate through demonstration how to manage their daily sodium  intake.

Food Diary apps allow for clinicians and individuals to work together to set and determine successful progress

Click the link below to understand more about salt to sodium equivalents:
"Shaking the Salt Habit to Lower High Blood Pressure"

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Do you know the most common sources of sodium?

Many Americans have acquired a taste for a high salt diet. One way to cut back is to skip the table salt. However, most of the sodium in our diets comes from packaged, processed foods. Eating these foods less often can help reduce your sodium intake, lower your blood pressure and/or prevent high blood pressure (HBP or hypertension) from developing in the first place.

The American Heart Association recommends no more than 2,300 milligrams (mgs) a day and an ideal limit of no more than 1,500 mg per day for most adults, especially for those with high blood pressure. Even cutting back by 1,000 mg a day can improve blood pressure and heart health.

Salt vs. sodium equivalents

Sodium chloride or table salt is approximately 40 percent sodium. It's important to understand just how much sodium is in salt so you can take measures to control your intake. These amounts are approximate.

1/4 teaspoon salt = 575 mg sodium

1/2 teaspoon salt = 1,150 mg sodium

3/4 teaspoon salt = 1,725 mg sodium

1 teaspoon salt = 2,300 mg sodium

Sodium sources

Sodium can be sneaky! Taking control of your sodium means checking labels and reducing preservatives. Other foods to be aware of include:

Learn about the Salty Six.

Shopping and cooking

From the grocery aisles to your dinner table, here are some tips for reducing the amount of sodium that finds its way into your body.

Shop smart, cook smart

Choose lower-sodium foods or low-sodium versions of your favorites. Although it may take some time for your taste buds to adjust to a lower sodium diet, there are delicious options for very flavorful low-sodium meals. Once the adjustment to healthier dining is made, many people report they would not choose to go back to the highly processed, sodium-rich foods.

When buying prepared and prepackaged foods, read the labels. Americans consume up to 75 percent of their sodium from processed foods like soups, tomato sauce, condiments and canned goods. Watch for the words "soda" and "sodium" and the symbol "Na" on labels, which warn you that these products contain sodium compounds. Many canned and frozen food labels help the consumer by printing "low salt" or "low sodium" boldly on the packaging.

Eat more fruits and vegetables. When buying canned or frozen varieties, be sure to choose the no-salt added versions, and look for the choices without added sauces.

Use fruit and raw vegetables as snacks.

Select unsalted nuts or seeds, dried beans, peas and lentils.

Select unsalted or low-sodium fat-free broths, bouillons or soups.

Avoid adding salt and canned vegetables with added salt to homemade dishes.

Don't use salt during cooking and remove the salt shaker from your table. Certain salt substitutes contain a large amount of potassium and very little sodium. They are not expensive and may be used freely by most people, except those with kidney disease. Talk with your healthcare professional about whether a salt substitute is right for you.

Learn to use spices and herbs to enhance the natural flavor of food. Ditch salt for healthier, delicious salt-free seasoning alternatives.

Don't salt food before you taste it; enjoy the natural taste of food.

Follow the DASH eating plan.

Reduce sodium when dining out

Americans eat more restaurant-prepared meals now than ever, and restaurant food is often high in sodium. But controlling your sodium intake doesn't have to spoil the pleasure of dining out. It just means adopting new habits into your current lifestyle. So if you love dining out, follow these tips.

When dining out:

Be familiar with low-sodium foods and look for them on the menu.

When ordering, be specific about what you want and how you want it prepared. Request that your dish be prepared without salt.

Don't use the salt shaker. Instead, use the pepper shaker or mill.

Add fresh lemon juice instead of salt to season fish and vegetables.

Seasoning alternatives - spice it up!

There is a rich world of creative and flavorful alternatives to salt. Get started with this guide to spices, herbs and flavorings and the food items with which they are a particularly good flavor match. Then get creative and experiment! Here are some seasonings to add variety:

Allspice: Lean meats, stews, tomatoes, peaches, applesauce, cranberry sauce, gravies, lean meat

Almond extract: Puddings, fruits

Basil: Fish, lamb, lean ground meats, stews, salads, soups, sauces, fish cocktails

Bay leaves: Lean meats, stews, poultry, soups, tomatoes

Caraway seeds: Lean meats, stews, soups, salads, breads, cabbage, asparagus, noodles

Chives: Salads, sauces, soups, lean meat dishes, vegetables

Cider vinegar: Salads, vegetables, sauces

Cinnamon: Fruits (especially apples), breads

Curry powder: Lean meats (especially lamb), veal, chicken, fish, tomatoes, tomato soup

Dill: Fish sauces, soups, tomatoes, cabbages, carrots, cauliflower, green beans, cucumbers, potatoes, salads, macaroni, lean beef, lamb, chicken, fish

Garlic (not garlic salt): Lean meats, fish, soups, salads, vegetables, tomatoes, potatoes

Ginger: Chicken, fruits

Lemon juice: Lean meats, fish, poultry, salads, vegetables

Mace: Hot breads, apples, fruit salads, carrots, cauliflower, squash, potatoes, veal, lamb

Mustard (dry): Lean meats, chicken, fish, salads, asparagus, broccoli, Brussels sprouts, cabbage, sauces

Nutmeg: Fruits, potatoes, chicken, fish, lean meat loaf, toast, veal, pudding

Onion powder (not onion salt): Lean meats, stews, vegetables, salads, soups

Paprika: Lean meats, fish, soups, salads, sauces, vegetables

Parsley: Lean meats, fish, soups, salads, sauces, vegetables

Peppermint extract: Puddings, fruits

Pimiento: Salads, vegetables, casserole dishes

Rosemary: Chicken, veal, lean meat loaf, lean beef, lean pork, sauces, stuffings, potatoes, peas, lima beans

Sage: Lean meats, stews, biscuits, tomatoes, green beans, fish, lima beans, onions, lean pork

Savory: Salads, lean pork, lean ground meats, soups, green beans, squash, tomatoes, lima beans, peas

Thyme: Lean meats (especially veal and lean pork), sauces, soups, onions, peas, tomatoes, salads

Turmeric: Lean meats, fish, sauces, rice

Learn more:

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Shaking the Salt Habit to Lower High Blood Pressure

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Many Americans have acquired a taste for a high salt diet. One way to cut back is to skip the table salt. However, most of the sodium in our diets comes from packaged, processed foods. Eating these foods less often can help reduce your sodium intake, lower your blood pressure and/or prevent high blood pressure (HBP or hypertension) from developing in the first place.

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Systolic vs Diastolic

The top number (systolic) is when the heart is working

The bottom number (diastolic) is when the heart is  at rest

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Allows clinicians to see the incidence rates in their area.

Clinicians can join the Millions Hearts Hypertension Control Challenge.

Holds the provider accountability in assisting patients reach healthy goals

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Secondary Conditions to High Blood Pressure

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Secondary Conditions to High Blood Pressure

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Uncontrolled blood pressure can have a serious and irreversible effects on your brain, eyes, heart, kidneys, and the sexual organs (low libido in females and erectile dysfunction in males).

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Million Challenge Champions

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Centers for Disease Control and Prevention

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The Million Hearts ® Hypertension Control Champions are clinicians, practices, and health systems that have successfully completed the Million Hearts ® Hypertension Control Challenge.

The Challenge is an opportunity for clinicians, practices, and health systems to demonstrate excellence in hypertension control. Hypertension Control Champions must reach 80% control rates among their hypertensive patients.

Learn more about the Hypertension Control Challenge.

All these Hypertension Control Champions made blood pressure control a priority. They achieved improved performance by implementing health information technology, home blood pressure monitoring, and medication adherence.

Congratulations, 2019 Champions!

Million Hearts ® has recognized 17 solo practitioners, large health systems, community health centers, and specialty groups as 2019 Hypertension Control Champions. In their work, these Champions were able to achieve blood pressure control for at least 80% of their adult patients with hypertension.

Together, the 2019 Champions cared for nearly 360,000 adults. Read a recent Morbidity and Mortality Weekly Report about the 2019 champions.

Alexander Valley Healthcare, Cloverdale, California*

Burstein Medical Associates, Philadelphia, Pennsylvania

Charles City Regional Health Services, Inc., Charles City, Virginia*

Community Health Centers of Southeastern Iowa, Inc., West Burlington, Iowa*

Esperanza Health Centers, Chicago, Illinois*

Gilman Family Practice, Spokane Valley, Washington

Larry S. Hahn, DO, Pinnacle Physicians Group, Feasterville-Trevose, Pennsylvania

Hunterdon Cardiovascular Associates, PA, Flemington, New Jersey

Intermountain Moroni Clinic, Moroni, Utah

Nusrat Khan, MD, MBA, CMQ, Medpeds Medical Clinic, PA, Weatherford, Texas

Paul Mantia, MD, Elmhurst, New York

Marshfield Clinic Health System, Marshfield, Wisconsin*

Mercy Health Clinics, LLC (Mercy Health-Irvine Primary Care, Mercy Health-Powell County Primary Care, Mercy Health-Lee County Primary Care), Irvine, Kentucky

Mid-Florida Primary Care, Leesburg, Florida

Edward Rippel, MD, Quinnipiac Internal Medicine, PC, Hamden, Connecticut

University Internal Medicine, Inc., Pawtucket, Rhode Island

Gonzalo Urbano, MD, Brooklyn, New York

* Denotes a health care organization that is or includes a health center funded by the Health Resources and Services Administration (HRSA).

2012-2018 Hypertension Control Champions

Ellsworth Medical Clinic, Ellsworth, Wisconsin

Kaiser Permanente, Denver, Colorado

Page last reviewed:

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Million Hearts® Hypertension Control Champions

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The Million Hearts ® Hypertension Control Champions are clinicians, practices, and health systems that have successfully completed the Million Hearts ® Hypertension Control Challenge. The Challenge is an opportunity for clinicians, practices, and health systems to demonstrate excellence in hypertension control. Hypertension Control Champions must reach 80% control rates among their hypertensive patients.

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Patients and their families, respectively, are able to purchase a blood pressure machine or even receive one from their insurance company for free to self-monitoring and management of their blood pressure.

use of blood pressure app to record their BP

use of patient portals to record their BP which their doctors can monitor

smart watches constantly monitors heart rate (HR)

Self-Monitoring of blood pressure (SMBP) requires a cohesive partnership between the physician and the patient.

Emergency visits are decreased and the risk for secondary disease conditions are decreased (American Journal of Preventative Medicine, 2017).

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MedISAFE-BP smartapp
- Medication adherence Improvement Support App For Engagement—Blood Pressure

Improve blood pressure control

Improve adherence to  prescribed therapies

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There are many conditions that can cause secondary hypertension, if it is not controlled (Mayo Clinic, 2020)

Obstructive sleep apnea

Kidney problems

Adrenal gland tumors

Thyroid problems

Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs

Illegal drugs, such as cocaine and amphetamines

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Nutrition plays an important role in the maintenance of our BP, specifically, sodium (salt) levels in the foods we eat.

There is a strong, direct association between higher sodium excretion and higher blood pressure:

People with higher estimated usual sodium intake had higher blood pressure

This association was similar for men and women, for people 20–44 and 45–69 years old, and across racial and ethnic groups (CDC, 2018)

Know Your Sodium Quiz

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Sodium 101: Put Your Sodium Smarts to the Test

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Healthcare providers/clinicians need to better understand nutritional labels to be able to provide health teaching to their patients

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“Behind the Label” With FDA: Helping Health Educators Understand the New Nutrition Facts Label

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Maintaining blood pressure levels reduces/eliminates risk for secondary disease conditions.

Reduce in sodium (salt) intake reduces the risk for HTN.

Self-monitoring and accurate self-reporting on BP and food intake gives providers and clearer picture of how the patient is progressing beyond just blood results. It allows for providers to work with the patient to tweak diet habits and holds the patient accountability and have them remain active in their care.

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Patients between visits monitor and record accurately their BP and at regular visits review with provider if any changes to medical regimen

Each visit represents an opportunity to measure blood pressure and intensify treatment. Physicians make management decisions based on BP measurements obtained during office visits (Journal of General Internal Medicine, 2015).

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American Heart Association. (2020). High Blood Pressure. Retrieved from American Heart Association: https://www.heart.org/en/health-topics/high-blood-pressure

Centers for Disease Control and Prevention. (2018). Sodium Research Reviews. Retrieved from National Center for Chronic Disease Prevention and Health Promotion and the Division for Heart Disease and Stroke Prevention: https://www.cdc.gov/salt/research_reviews/sodium_potassium_blood_pressure.htm

Centers for Disease Control and Prevention. (2020). Heart Disease and Stroke Maps and Data. Retrieved from National Center for Chronic Disease Prevention and Health Promotion and the Division for Heart Disease and Stroke Prevention: https://www.cdc.gov/dhdsp/maps/dtm/index.html

Fontil, V., Bibbins-Domingo, K., Kazi, D., Sidney, S., Coxson, P., Khanna, R., . . . Pletcher, M. (2015). Simulating Strategies for Improving Control of Hypertension Among Patients with Usual Source of Care in the United States: The Blood Pressure Control Model. Journal of General Internal Medicine, 30, 1147–1155. doi:10.1007/s11606-015-3231-8

Jacobs, V., Chattopadhyay, S., Proia, K., Hopkins, D., Reynolds, J., Thota, A., . . . Goetzel, R. (2017). Economics of Self-Measured Blood Pressure Monitoring: A Community Guide Systematic Review. American Journal of Preventative Medicine, 53(3), e105-e113. doi:10.1016/j.amepre.2017.03.002

Mayo Clinic. (2020). High Blood Pressure. Retrieved from Mayo Foundation for Medical Education and Research: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

Million Hearts. (2020). Potential Future Burden of Cardiovascular Events Targeted for Prevention by Million Hearts 2022. Retrieved from Division for Heart Disease and Stroke Prevention: https://millionhearts.hhs.gov/data-reports/data.html

Morawski, K., Ghazinouri, R., Krumme, A., Lauffenburger, J., Lu, Z., Durfee, E., . . . Choudhry, N. (2018). Association of a Smartphone Application With Medication Adherence and Blood Pressure Control. JAMA Internal Medicine, 178(6), 802-809. doi:10.1001/jamainternmed.2018.0447

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Symptom Checker and Next Steps

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If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.

If your symptoms aren't related to those organs, you can choose the gender you identify with.

If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.

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If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms. If your symptoms aren't related to those organs, you can choose the gender you identify with.