The American Heart Association and the American College of Cardiology on Nov. 13 each adjusted their guidelines on high blood pressure, from 140/90 to 130/80. This means about half of the U.S. adult population is living with hypertension and at an increased risk of heart disease and stroke. A day later, the Centers for Disease Control and Prevention announced WellOne Primary Medical and Dental Care as the winner of the 2017 Million Hearts Hypertension Control Challenge.
Providence Business News reached out to Dr. Joanna Brown, associate medical director at WellOne, to ask about the company’s success in helping patients manage high blood pressure. Brown is board certified in family medicine and holds a certificate of added qualification in adolescent medicine. Brown is also a clinical assistant professor in the Department of Family Medicine at Brown University, where she teaches residents about the patient-centered medical home. She received her undergraduate degree from Harvard and medical degree from the Albert Einstein College of Medicine.
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PBN: WellOne is among 24 providers to have won recognition from the CDC for achieving high rates of blood pressure control. How did you accomplish that?
Brown: WellOne is proud to be recognized as a national leader. We have been focusing on improving blood pressure control for many years and the results achieved are a demonstration of our commitment to reducing the poor health outcomes associated with high blood pressure.
There is no one single way that we accomplished this, however much of our success can be attributed to our team approach, with all members of our medical care team, including primary care providers, medical assistants, nurses, leadership, quality improvement and others invested in helping our patients achieve their goals. With our patients, we focus on lifestyle changes, taking medications as prescribed and involving them in setting their own goals for their health and helping them make plans to achieve those goals.
PBN: The ACC and American Heart Association have moved the hypertension and pre-hypertension goal posts on Americans. Does it help the rest of us to look at those numbers more critically?
Brown: Many times, recognizing that a health problem exists is the first step in making important changes. These new guidelines are fresh off the press and derive from the knowledge that blood pressures previously not classified as hypertension carry with them extra risk of stroke, heart attack and other adverse outcomes. We are now directed to classify blood pressures from 130/80 to 139/89 as Stage I hypertension.
An important message underscored by this change – which puts almost half of adults in the U.S. in the “hypertensive” category – is that we should be counseling all our patients as to the importance of a healthy diet and lifestyle, and providing extra emphasis for a large subset of people. Likely these new classifications will lead to more people being prescribed blood pressure medications as well.
PBN: Please explain the physiological risk associated with high blood pressure.
Brown: High blood pressure is related to the elasticity or stiffness of our bodies’ blood vessels and the work our hearts have to do to maintain blood flow with that extra resistance. Hypertension can lead to thickening of the left ventricle, a chamber in our heart, due to the increased demand placed on the heart muscle. The extra stress on the heart puts people at risk for heart attacks and heart failure. Hypertension can put extra stress on the blood vessel system in the brain – it is the main risk factor for stroke. And, given the kidneys’ role in filtering our blood, it makes sense that high blood pressure would put a strain on them and increase risk for kidney disease.
PBN: What’s the most effective thing someone can do to lower their blood pressure?
Brown: Fortunately, there are many things we can do for ourselves to improve our blood pressure readings. Eating a healthy diet, getting regular aerobic exercise, limiting alcohol consumption and decreasing weight/body mass index are all important not only for controlling our blood pressure but improving our overall health and well-being. In addition to lifestyle changes, medications, such as diuretics or calcium channel blockers, may be needed to control blood pressure. Help is available in many different forms to achieve these goals.
PBN: Please explain the blood pressure reading numbers.
Brown: The systolic blood pressure, or top number, describes the amount of pressure in your arteries during contraction of the heart. The diastolic blood pressure, the bottom number, refers to the pressure in the arteries when the heart muscle is between beats. So, for example, if someone had a blood pressure of 120/80, the top number 120 would describe pressure when the heart’s beating and the number 80 would refer to the pressure when the heart is resting.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
