Regulating blood pressure

Promise Magazine: Spring/Summer 2015

Patients access innovative care at St. Paul’s’s Hypertension Clinic for a leading cause of heart attack, stroke, heart failure and kidney disease

Phil Reid’s 50th birthday is certain- ly one he’ll never forget. The Vancouverite had plans to celebrate the milestone in Whistler, but instead of hitting the slopes, he ended up in hospital.

“I just wasn’t feeling well,” remembers Reid. “I was really panicky and short of breath.” Little did he realize his blood pres- sure was through the roof.

Reid was immediately referred to Dr. Jane McKay, a hypertension specialist at St. Paul’s’s Hypertension Clinic (HTC), one of the few dedicated clinics of its kind in British Columbia. McKay quickly diagnosed Reid with hypertension (high blood pressure) and high blood cholesterol levels, and he began receiving treatment and lifestyle advice for his condition. Today, thanks in no small measure to both the immediate care and his regular followup visits to the HTC at St. Paul’s, Reid is happy, healthy and well.

Collaborative Approach

The HTC is unique in that it provides com- prehensive care for the hundreds of British Columbians with hypertension referred there from across the province each year. This includes patients with chronic health conditions, such as diabetes and heart or kidney failure. Thanks to the HTC, patients can receive customized care and referrals in one place, gaining access to a multidisciplinary team of medical experts – cardiologists, dietitians, sleep experts, neurologists and bio-chemists.

“What’s also unique about our approach is that we empower our patients using motivational interviewing techniques, so that they have a say in their own health,” says McKay. “We provide a personalized approach to care at the Hypertension Clinic: the right treatment for the right patient at the right time.”

Help for Hypertension

For Eileen Sallis, the HTC proved to be her lifeline. Prior to being referred there, she says she was on a merry-go-round between doc- tors’ offices, emergency wards, hospital visits and home.

The 58-year-old’s medical problems began in 2002 when she was diagnosed with slightly elevated blood pressure. However, over time, her blood pressure started to go up, exacerbated by her Type 2 diabetes and her admittedly poor diet and lack of exercise. In January 2014, she wound up in hospital suffering from kidney failure.

“They took an ultrasound and found that my left kidney wasn’t functioning properly,” says Sallis from her home in Gibsons, BC. “I was put on medication, but my blood pressure kept rising.”

By April 2014, her blood pressure had reached dangerously high levels, signalling a hypertension crisis and, without proper treat- ment, the possibility of organ failure. She was tired, lacked energy and her cognitive abilities had started to decline. Sallis was in trouble. Luckily, in May 2014, she was referred to St. Paul’s HTC where she met Dr. Laura Kuyper, a hypertension specialist and director of the HTC.

“She [Kuyper] was just amazing,” says Sallis. “Not only was she straightforward and open with me about my condition, she was the hub for my total care. Even when I was not at the clinic, she called and checked up on me.”

A few months after her first visit to the clinic, Sallis had a heart attack. She was flown from Sechelt, BC, to St. Paul’s Hospi- tal, where she was admitted to the cardiac critical care unit.

“Dr. Kuyper came in to see me every day,” says Sallis. “She made sure I was treated for my hypertension, put me on different medication and sent me to see an endocrinol- ogist. Then, I was sent to a sleep apnea clinic – all under Dr. Kuyper.”

The strong collaborative approach at St. Paul’s HTC helps ensure that patients’ specific needs are met. For Sallis, it meant that all of her care was coordinated through Kuyper. Whether it was changing her medica- tion or finding the cause of her hypertension using MRI scans, referrals to endocrinology or sleep specialists, she was provided with access and frequent follow-ups when needed.

“When you are sick and afraid, having all your needs met in one place is so important,” says Sallis, who receives ongoing support from the HTC. “I owe the team my life.”

Pervasive Health Problem

There’s no question that the services provid- ed by the HTC are vital to health care in BC. High blood pressure is one of the leading causes of heart attack, stroke, heart failure and kidney disease in Canada, affecting one in five British Columbians.

“High blood pressure accounts for 70 per cent of all strokes and 30 per cent of heart attacks,” says McKay.

Nearly 95 per cent of cases of hyperten- sion are primary, with no obvious underlying medical cause. Secondary hypertension is caused by another medical condition, such as kidney disease, hormonal disorders and sleep apnea.

Although the exact causes of primary hypertension are unknown, several risk fac- tors increase the chances of developing it, including lack of exercise, obesity, excessive salt and/or alcohol intake, smoking and stress, to name just a few.

The warning signs and symptoms of life-threatening hypertension include severe chest pain and/or headache, accompanied by confusion and blurred vision, nausea, vomit- ing, acute anxiety, shortness of breath, seiz- ures and unresponsiveness.

A Leading-Edge Training Centre

Kuyper says that in addition to providing comprehensive care to patients, the HTC is also an important centre for learning and training in hypertension care and treatment for medical students, family practice residents or medical residents.

Resident training fellow Dr. Karen Tran observes that the HTC’s focus on treating hypertension means staff has the luxury of providing more comprehensive and person- alized care to patients at the clinic.

“It’s very rare in hospitals that we get to spend as much valuable time with patients, from counselling them, to offering personal care and – more importantly – behaviour modification care,” says Tran. Each new patient undergoes a battery of tests in order for doctors to complete an assessment, she adds.

The HTC team is also investigating the best evidence-based approaches to detecting and controlling high blood pressure. This includes studying antihypertensive medica- tion-taking behaviors, tracking population trends in severe hypertension across the province and investigating promising new technologies for patients with refractory (per- sistent) hypertension.

Dr. Nadia Khan, research scientist at the Centre for Health Evaluation and Outcome Sciences (CHÉOS) at St. Paul’s, is currently looking at opportunities to introduce ways to better predict hypertension that are not yet available in Canada.

“There are newer ways to measure blood pressure other than using the standard cuff on the arm technique,” she says. “These innov- ative measures, such as looking for harden- ing of the aorta and other blood vessels by measuring aortic stiffness, will allow us to better treat our patients and personalize their care. This is the future of hypertension care and one aspect we want to bring to the Hyper- tension Clinic.”

Thanks to donors to St. Paul’s Foundation, $30,000 was raised to purchase the key equipment and facility upgrades to help the HTC provide specialized care to patients. Later this year, McKay hopes to have the Virtual Patient Learning Centre up and running: “This will be a web-based learn- ing centre here in the clinic where our patients can access information,” she says.

For Reid and Sallis, who are both doing much better thanks to the care they received at St. Paul’s, the HTC has more than proven its worth.

To find out how you can support care, research and teaching at St. Paul’s, please contact St. Paul’s Foundation at 604-682-8206 or visit our Donate page.