Blue Care Network Best Practices
Controlling high blood pressure
Ypsilanti doctor shares his treatment strategy for high blood pressure patients
R. David Brooks, D.O., of Ypsilanti, has developed an approach to treating hypertension in his 43-plus years of family practice. He attributes his success in treating these patients to his prescribing patterns and to aggressive follow up.
First, Dr. Brooks likes to check his patients' blood pressure himself, rather than having other medical personnel perform the task. "I want to be sure it's done accurately," he said.
Dr. Brooks treats systolic readings of 130 mmhg or greater and diastolic readings of 85 mmhg or greater. He is satisfied if systolic readings are between 115 mmhg and 125 mmhg and if diastolic readings are between 70 mmhg and 85 mmhg.
When treating patients, Dr. Brooks uses a combination of prescription drugs. He prefers multiple drugs at low doses rather than drugs at a high dose because he feels the patient will benefit from the effects that the multiple drugs will have on a patient's cardiovascular system with fewer side effects. He also divides the medication so it is taken every 12 hours instead of one daily. "I am willing to sacrifice some compliance for good medication coverage for the full 24 hours each day," he says.
When hypertension is diagnosed and the blood pressure is greater than 150/100, treatment is started and Dr. Brooks sees the patient again in two to three days for medication adjustment. "Once the blood pressure is controlled, I will see the patient monthly for six months and, if it is still controlled, every three months thereafter," he said.
Dr. Brooks recommends that all of his hypertensive patients purchase a blood pressure cuff (preferably an Omron® or Welch Allyn®). He also recommends blood pressure checks three times a week at home.
"If I run into a case that is resistant to treatment, even with four or more medications, then I consider the possibility of primary aldosteronism or anxiety," says Dr. Brooks. "If all my attempts to control a patient's blood pressure fail, I refer that patient to a hypertensive specialist."
Heredity vs. lifestyle
Heredity and lifestyle can contribute to the presence of hypertension. Therefore, Dr. Brooks reviews diet with every overweight patient and makes recommendations for healthier eating. "I recommend a 1,000 to 2,000-calorie diet that is low in fat, sugar and sodium and high in protein. I also recommend a daily two-mile walk or jog, depending on age," he says. Since hypertension can be asymptomatic, Dr. Brooks also recommends a blood pressure check every four months in families with high blood pressure and every six months in families with no hypertension after the age of 40.
In most primary practices, hypertension, type 2 diabetes and dyslipidemia are three of the most common problems. "In my opinion," says Dr. Brooks, "primary doctors should be adept at dealing with all three proficiently."