MITLER STRAIVERT
LAW OFIICES
Slephen M. Willbnu
Scth V. Bingham
Jamcs B. ColliN
Timo$y R Briggs
BBdley D. Tepper
Kirk R. Allen
H. Brook laskey
virsinia A'dcnnrn
PauL O. Maynes
M. Dylan O'Reilly
Jemifcr D. Hall
Todd A. Schwaz
Roben H. Clark
Thomrs R Mack
Jafts J. Widland
Richald L Alvidltz
Matth.w S. Rappapod
Rudolph Lxcem
D€borah A. Solov.
T€rri Saucr Bcach
Nate A. Cobb
Robcrt A. Coi:hil!.
SLplEn B. wallcr
Joshua L Smilh
Dan A. Akcnhcad
500 Maquette
Ry8nM. Walter6*
Albuqu€rque,
Willian T. Deming
William
K
Tom Bunting
Luke A. Salganek
Erica B. Scotr
Cody R. Rog.6
Codon
S.
RaluE B.
Miller
Stratverl
Littl.
rAdmitted only in Texas
Nw, Suite
NM
I 100
87102
Mailing Address:
P.O. Box 2568?
Albuquerque, NM
E
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l2546E
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Telephone:
(s05) E42-1950
(800) 424-7585
Facsimile: (505) 243-4408
February 5, 2013
Via Email [email protected]
Randv Marshall
Via Email [email protected]
Annie Juns
Dear Randy and Annie:
Thanks for giving us some support to develop a hypertension clinical guideline in
accordance with the American Heart Association. Attached please find both the protocol that I
would like office personnel to sign offon as well as the letter that we would like to see given to
patients. Hopefully, this will help our mernbers comply with current AHA guidelines. Thanks in
advance.
Sincerely,
Deborah A. Solove
DAS:m2
Enclosure
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A PROf BSSIONAL ASSOCIATION
AI.BUQUERQUE
TARMINGTON
r,\s cRUcEs
SANTA FE
(505) 842"r950
(505) 326152r
(5751 523-2481
(505) 989-96r4
Patient Name
Patient Address
Dear Patient:
ITYPERTENSION WARNING
Your blood pressure readings today were:
and, the second blood
pressure reading, taken five minutes later continued to be elevated at
.At
least one of these readings indicates that you could possibly suffer from Stage 3 hypertension as
defined by the American Heart Association. This hypertensive reading requires immediate
follow up and care by your primary care physician.
[We do not provide evaluation and treatment for hypertension. Therefore, you MUST follow up
with your primary care physician IMMEDIATELY to determine whether you will
need
medication and/or treatment for your high blood pressure. We want you to seek immediate
treatment because your blood pressure readings may indicate a hypertension crisis. If that is
true, you will require intervention immediately. Therefore, if you are unable to make an
appointrnent with your primary care provider within 24 hours of this clinic visit, we want you to
present to a local emergency room for further treatment.]
HYPERTENSION EDUCATION
WHAT IS BLOOD PRESSURE?
Blood pressure is the force of blood against the walls of the arteries. Blood pressure is
recorded as two numbers, the systolic pressure (as the heart beats) over the diastolic pressure (as
the heart relaxes between beats). The measurement is written one above the other, with the
systolic number on top (or first) and the diastolic number on the bottom (or last). For example, a
blood pressure measurement of 120/80 mmHg (millimeters of mercury) is expressed verbally as
"120 over 80". Normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg
diastolic.
WARNING SIGNS OF HYPERTENSIVE URGENCY
You may be experiencing hypertensive urgency
symptoms:
1.
2.
J.
Severe headache
Shortness ofbreath
Nose bleeds
if
you have any of the following
4.
Severe anxiety.
Any of these symptoms together with the blood pressure readings that you had in our
office, indicate the need for an immediate response.
HIGH BLOOD PRESSURE RISKS
l.
High blood pressure (HBP) increases your chances (or risk) for getting heart
disease and/or kidney disease, and for having a stroke. It is especially dangerous because it often
has no waming signs or symptoms, Regardless ofrace, age or gender, anyone can develop HBP.
It is estimated that one in every four American adults has HBP. Once HBP develops, it usually
lasts a lifetime. You can prevent and control HBP by a change in lifestyle.
2.
HBP is dangerous because it makes the heart work too hard. It also makes the
walls of the arteries hard. HBP increases the risk for heart disease and stroke, the I't and 3'd
leading causes of death for Americans. HBP can also cause other problems, such as heart
disease, kidney failure and blindness.
3.
HBP is the most important risk factor for stroke. Very high blood pressure can
cause a break in a weakened blood vessel, which then bleeds into the brain. This can cause a
stroke. If a blood clot blocks one of the narrowed arteries. it can also cause a stroke.
4.
HBP can eventually cause blood vessels in the eye to burse or bleed. Vision may
become blurred or otherwise impaired and can result in blindness.
5.
As people get older, arteries throughout the body "harden," especially those in the
heart, brain, and kidneys. HBP is associated with these "stiffer" arteries. This, in tum, causes
the heart and kidneys to work harder.
6.
The kidneys act as filter to rid the body of wastes. Over time, HBP can narrow
and thicken the blood vessels of the kidneys. The kidneys then filter less fluid and waste builds
up in the blood. The kidneys may fail altogether. When this happens, medical treatment
(dialysis) or a kidney transplant may be needed.
7.
HBP is the number one risk factor for congestive heart failure (CHF). CHF is a
serious condition in which the heart is unable to pump enough blood to supply the body's needs.
8.
The causes for HBP vary. Causes may include narrowing of the arteries, a greater
than normal volume of blood or the heart beating faster or more forcefully than it should. Any of
these conditions will cause an increased pressure against the artery walls. HBP might be caused
by another medical condition. Most of the time the cause is unknown. Although high blood
pressure usually cannot be cured, in most cases it can be prevented and controlled.
9.
High blood pressure is a common problan. About 65 million American adults,
nearly 1 in 3, have HBP. It is very cofirmon in African Americans who may get it earlier in life
and more often than whites. Many Americans tend to develop HBP as they get older, but this is
not a part of healthy aging. Middle-aged Americans face a 90Yo change of developing HBP
during their live. Others at risk for developing HBP are the overweight, those with a family
history ofHBP and those with prehypertension (120-139/80-89mmHg).
You can find out if you have HBP by having your blood pressure checked regularly.
Most doctors will diagnose a person with HBP on the basis of two or more readings, taken on
several occasions. A consistent blood pressure reading of 140/90 mmHg of higher is considered
hypertension, another
word for HBP. Further information is available at
http://www. nhlbi.nih. eov,/hbo.
OUR PRACTICE EXPECTATION
We expect you to go to your primary care provider and/or a local hospital emergency
room immediately. After you obtain this initial evaluation, it is our expectation that you will
have your blood pressure checked on a regular basis. A consistent blood pressure reading of
140190 or higher is considered hypertension, another word for HBP. Remernber, HBP often has
no signs or symptoms. Therefore it is important that you get periodic readings in addition to
your initial work up. Our expectation is that in order to continue to be a patient in our practice,
you will be obtaining regular treatment for your high blood pressure.
If
you have any questions with regard to this sheet, please ask to speak to one of our
clinical providers. Your signture below notes that you were given a copy of this letter in order
for you to follow up. Thank you for being a responsible member of our practice.
Sincerelv.
Patient Signature
\\Abo-tamarack\Pro Data\000365{06649\2
Date
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27659.docx
PROTOCOL FOR STAGE 3 HYPERTENSION CLINICAL GUIDELINES
Your signature noted below will indicate that you have read the guideline and agree to its
implernentation for all of our patients.
I.
Hypertension Definition
A systolic reading
greater than 179 or diastolic reading greater than 109
need for further assessment and treatment.
[.
will result in the
Clinical Response Required For Such Readings
1.
Wait 5 minutes then take a second reading on the opposite arm. Records both
readings in PrimeSuite and/or the patient's medical record.
2. Pint the patient
hypertension education correspondence attached to this
guideline, highlighting the 2 blood pressure readings. A copy of the patient
hypertension education letter should be given to the patient with the patient
acknowledgrnent of such letter on the last page.
3.
Chart that you gave the patient the hypertension education handout by
indicating same in the patient's record.
4.
Add hypertension to the patient's active problem list.
5. Inform the clinical
practioner that the patient presents with Stage
hypertension and provide the practioner with both blood pressure readings.
6.
Record any additional instruction given the patient in the instruction section
the plan within the patient's chart.
7. Ifthe clinical
3
of
practioner is not the patient's primary care provider, send a copy
of the correspondence section of the plan to the patient's primary care
provider as a cc. In addition, send the primary care provider the hypertension
patient education document that was given to the patient.
I acknowledge that I have read
to implement it for all or our patients.
Signature
\,Abo-larnaracl\ProDala\000365406649V I 27525 docx
and understand the above-referenced protocol and agree
Date