In response to the Department
of Health and Human Services’ Million Hearts Initiative, which seeks to prevent 1 million heart attacks
and strokes by 2017, some hospitals
are making efforts to lower high blood pressure among patients.
In September, the HHS recognized A-rated Kaiser Permanente Colorado in Denver as a 2012 Hypertension Control Champion for improving blood pressure control among patients. They owe their efforts
in part to a hypertension registry that helps track how patients are managing their numbers, free blood pressure checks and reminders to refill prescriptions.
Dr. Ann Wells, an internist with Kasier says she and other physicians also encourage patients to monitor their blood pressure at home.
“This has allowed patients ... to e-mail me or call me with their readings, and I can adjust medications without them coming in for
a formal office visit,” she says.
While medication is common for patients with significantly elevated blood pressure, doctors say noncompliance can be an issue.
“They go from having high blood pressure and no symptoms to blood pressure medication with side effects, so they stop taking their medication,” explains highly rated cardiologist Dr. Edward Kasper, director of clinical cardiology at Baltimore’s Johns Hopkins Hospital.
Dr. Sharonne Hayes, a cardiologist and director of highly rated Mayo Women’s Heart Clinic in Rochester, Minn., says patients need to talk with their doctor to find ways to limit side effects that can include dizziness, fatigue, decreased kidney function and erectile dysfunction.
“Medications get a bad rap,” she says, adding the solution is to use two or three drugs in combination. “It’s more effective and you can have lower doses with lower side effects.” If cost is prohibiting a patient from taking their medication, experts recommend talking to your doctor or pharmacist about the possibility of changing to generics, which are likely to be more affordable.
Hypertension medication and office visits generate $37 billion each year, between insurance, medical assistance programs and out-of-pocket expenses, according to a study published by the AHA. Statistics suggest people spend between $5 to $200 on blood
pressure medicine each month.
Some people can control high blood pressure through diet changes alone, depending on a patient’s health habits and history. Rabinowitz, with the University of Rochester Medical Center, says for someone with diabetes, she’d try medication first, because they have a high risk
of heart disease and stroke.
However, her approach would be different for a healthy person with no other risk factors, such as someone who has intermittently slightly elevated blood pressure, is 25 pounds overweight and loves salty snacks. “I might tell them to replace the pretzels with some baby carrots and to see if they can get an exercise routine going,” she says.
Member Carol Mullinax of Columbus, Ohio, works out three times a week with trainer Simon Davis at the highly rated Fasttrack2 Fitness, in the nearby city of Delaware, Ohio. By exercising smarter, Mullinax has lost more than 40 pounds, gotten her diabetes under control, and brought her blood pressure down to normal from 180/100.
“You have an appointment to meet someone who is going to charge you whether you show up or not, and that’s a huge motivator to get your butt out of bed,” she says. “I’m 63 and I’ve never worked out as hard
as I do now.”
Lowering blood pressure through healthy eating is important, too, says Jan Adams-Kaplan, a highly rated registered dietitian at The Portland Clinic in Oregon. She uses the DASH (Dietary Approaches to Stop Hypertension) approach to help her clients. Promoted by the National Institutes of Health, the plan emphasizes superfoods such as barley, berries, leafy vegetables, walnuts and fish. But she warns, “You can’t eat a poor diet and take supplements and think it’s going to solve the problem.” People who lose just 10 percent of their body weight can cause a significant drop in blood pressure, adds Adams-Kaplan: “Often, if they lose between 10 to 20 percent, the issue is gone.”
Experts say if you tend to visit a dentist more often than a primary care physician, ask about receiving a blood pressure check. The American Dental Association recommends against dentists providing treatment, including regular cleanings, if a reading is too elevated. “The teeth are connected to the rest of the body, so we don’t want to treat somebody who’s not healthy,” says Dr. Matthew Messina, a highly rated dentist in the Cleveland suburb of Fairview Park, Ohio, and an ADA spokesman.
Member Thanh Thibodeaux of Houston discovered she had hypertension from her dentist, Dr. Vanida Wongchukit. Thibodeaux knew her parents and grandparents had the problem, but that didn’t prepare the petite non-smoker for a diagnosis last summer at 39.
“I was just in shock,” she recalls. Since then, she has received two medications and has gone from seeing her highly rated cardiologist, Dr. Eric Barrington Davis, twice a week to once every three months. She says she spends between $75 and $100 a month on medical copays and medication, and is also now looking into meditation and yoga as a way to relieve stress.
Simply getting an annual or biannual eye exam can also pinpoint a hypertension problem. “Most people don’t realize there’s a link, but we can actually look into the eye and see that there’s an issue with blood pressure,” says optometrist David Lampariello, clinical director of eye care services at highly rated Fenway Health in Boston.
Using the latest technology, Lampariello dilates pupils to view the back of the eye, which includes the optic nerve, retinal tissue, macula, veins and arteries, all of which can be affected by hypertension. High blood pressure in its early stages typically doesn’t affect sight. More advanced cases can damage the retina, leading to hypertensive retinopathy, when blood vessels without enough circulation begin to narrow. Severe cases can lead to vision loss.
Studies have shown people with changes in their retinal blood vessels from high blood pressure are two to four times more likely to have a stroke. Researchers have also found that people with hypertensive retinopathy have a higher risk for heart failure — and that the link tends to be strongest in women.
If someone other than your primary doctor discovers your blood pressure is high, experts say to make an appointment with your general practitioner. Collaboration is an important aspect of treating hypertension, one that takes quite a bit of cooperation on the part of the public, says AHA spokesman Dr. Vincent Bufalino, senior medical director of cardiology for Advocate Health Care in Chicago.