CEO Healthcare Column

CEO Mary Ellen Pratt is extremely knowledgeable about the issues facing healthcare today. Visit this page monthly to keep up with her popular healthcare column which is featured in local newspapers. 

SENIORS AND THE SILENT KILLER.
The statistics are scary when it comes to hypertension (high blood pressure), but the symptoms are usually not. Because, they often don’t exist. 

If you’ve had several higher than normal readings or don’t get your blood pressure checked because you assume you will feel when it is bad, “you are taking a dangerous chance with your life,” says the American Heart Association (AHA). If someone warned you about a killer coming into your home you would take action. Hypertension “the silent killer” is even more dangerous and heart disease is the number one killer of both men and women. 

A leading cause of preventable death, experts warn that hypertension may also be under-recognized as a major contributor to conditions—such as stroke—that cause premature disability. In addition, controlling hypertension and other cardiovascular disease risk factors ranked as one of the top recommendations by the Institute of Medicine for keeping the brain healthy.

The historically grim statistics for people with hypertension lead scientists and medical experts to recommend new, lower targets in 2017. In an effort to diagnose and begin interventions sooner, the American Heart Association considers measurements of 130+—down from 140—for the top number (systolic) or 80+ for the bottom number (diastolic) high blood pressure. 

High blood pressure and aging... It's complicated.  
When it comes to treatment for blood pressure, doctors often follow the “different strokes for different folks” principle based on each patient’s demographics and medical history. Especially tricky, is the treatment of seniors. Since it is common for blood pressure to increase with age, more people at older ages have hypertension. According to the AHA, the treatment standard for people 65 and older was typically higher. However, there has recently been much debate in the medical community about the benefit of lowering blood pressure targets for seniors.

Many doctors worried that lower blood pressures could be unsafe and lead to increased falls for seniors, but a new wave of studies suggests that seniors who are mobile and live at home could benefit greatly from a much lower than typical target.  According to Dr. Jeff Williamson, Chief of Geriatric Medicine and Gerontology at Wake Forest University and a committee member who helped create the latest blood pressure guidelines, “You shouldn’t base your therapeutic decisions on age. It should be based on where your patient is [medically]. We shouldn’t deny them evidence-based care just because of their age.” 

The study.
The new thinking led to a clinical trial sponsored by the National Institutes of Health which studied people 50 and older with high blood pressure and at least one other risk factor for heart disease. The study found that using medication to reduce systolic blood pressure (the top number) to near 120 reduced the combined rate of having a heart attack, acute coronary syndrome, heart failure, stroke and death from cardiovascular disease by nearly one-third. In addition, it reduced deaths from any cause by nearly one-quarter compared to reducing blood pressure to 140 or less. The results of the clinical trial for seniors 75 and older also led to significantly lower rates of death and cardiovascular-related events.

The guidelines do not recommend a specific blood pressure goal for seniors in nursing homes, with advanced illnesses or diseases such as Alzheimer’s.

The challenge.
Both new studies and guidelines acknowledge that treating seniors with high blood pressure is complicated and sometimes risky—especially when this group of adults may have other health issues and be on different medications. This, though, is where the importance of relationships come into play. The challenge makes the “partnership between the clinician, the provider and the patient all the more important, that there’s communication, so that they can achieve the lowest risk,” said Williamson.  

Healthy Relationships
One way we are making sure to nurture the relationships between our clinicians and patients is by promoting wellness visits. We offer traditional wellness visits and Medicare Wellness Visits in our primary care clinics. These visits help our physicians and Care Coordinators screen you for issues like hypertension, monitor changes in your blood pressure over time and come up with a personalized plan based on all of the “complicated” factors that make medicine NOT a one-size-fits all plan.   

We are also helping to facilitate relationships through education. This month, we hosted a free Heart Health Breakfast with our newest cardiologist. We invite you to learn more about the cardiologists on staff and all of the heart health services available at your hometown hospital by visiting sjph.org/hearthealth.