Scott Webb (Host): Today, I am joined by Dr. Julie Colvin, a seasoned family medicine physician at St. Joseph's Health. With over 30 years of experience, Dr. Colvin is renowned for her compassionate care and expertise in managing chronic conditions like hypertension. Her commitment to patient education and proactive care led her office to achieve the highest rate of hypertension control among all Trinity Health Hospitals. In this episode, Dr. Colvin will share her insights on understanding and managing blood pressure and offering practical advice to help you take charge of your cardiovascular health.

This is the St. Joseph's Health Medcast from St. Joseph's Health. I'm Scott Webb. Dr. Colvin, it's nice to have you here today we're going to talk about blood pressure control and what does that mean and how do we do it? And I know your office achieved the highest rate of hypertension control among all Trinity Health Hospitals for more than a year, which is pretty awesome. So, what specific strategies or protocols did you implement to reach that milestone?

Dr. Julie Colvin: First, I wanted to say Trinity Health pays very close attention on patient's well-being, especially hypertension and measure accurately, act rapidly and partner with patients. It was first initiated by American Heart Association. And Trinity Health adapted that strategy, and we have very frequent meetings. We have champions to focus on helping people to manage the hypertension from all the way to CMO of Trinity Health, Dan vice versa, and to local ministries. And we, as a whole, not just the St. Joe's physicians, but the entire Trinity, taking patient's hypertension management very seriously. And we want to be national leaders in hypertension control because we know the control of hypertension significantly decrease patients' not just cardiovascular risk, but also decrease stroke and kidney disease and congestive heart failure. And all that by just simply measuring patient's blood pressure and partner with patient to control the blood pressure and, hopefully, make patient's quality of life better.

Host: Yeah, it really sounds like a team effort. You know, top down, bottom up, everybody pulling on the same end, so to speak, with the best interest of patients at heart, of course. So, why is it so important that we take hypertension seriously?

Dr. Julie Colvin: Hypertension is one of the leading causes of cardiovascular disease. High blood pressure can cause enlarged heart, leading to congestive heart failure. High blood pressure untreated can cause a stroke and high blood pressure can also cause chronic kidney disease. Those are very debilitating diseases. For example, like a cardiovascular disease, it's number one killer throughout the entire disease spectrum.

And we talk about cancer, right? For women, a lot of people are worried about having breast cancer. We talked a lot about breast cancer, and there's a lot of movement about that. But if you think about it, the leading cause of death, it's not actually the breast cancer or cancer in general, it is cardiovascular disease. And even during the COVID pandemic, the leading cause of the deaths, it's not COVID, it's still cardiovascular disease. That just tells you how important it is to control patient's blood pressure. Decreasing the chance of the cardiovascular disease can help patients live longer and live better.

Host: Yeah. And as somebody in his 50s, you know, I think about living longer and that sounds like a good plan to me, and I'm sure it does to a lot of patients and providers, of course. So, how do you educate and empower your patients to take an active role in managing their blood pressure?

Dr. Julie Colvin: A lot of patients feel, especially in people in the 50s like you or even younger, they don't go to see the doctor often and they are nervous when they go to see the physicians, or the primary care providers. So, the best way actually to measure blood pressure accurately is not just at the doctor's office, it is at home. And I'm a firm believer everyone should have a blood pressure machine or should have access to home blood pressure machine just to check your blood pressure on a regular basis, to make sure your blood pressure is normal and truly when you are not nervous or even on a daily basis and have a pulse check and your blood pressure so that you know what is best and in terms of your numbers, because a lot of patients, actually more than half of patients in the United States who have hypertension don't know they even have it, just because elevated blood pressure, initially, patients do not have symptoms.

Host: Then, let's talk about like what types of patients should monitor their blood pressure at home?

Dr. Julie Colvin: So, I would say everyone should monitor their blood pressure at home just because hypertension is so underdiagnosed. And for example, I have data that shows the CDC reports that only 22.5% of patients with high blood pressure have their blood pressure condition under control. That just tells you so many people don't know. So, if I would advise anyone, I would say, it doesn't matter, get your blood pressure checked. And it doesn't matter your race, your gender, your age, or your lifestyle, just check your blood pressure.

Host: Yeah, that's great advice from an expert. And along those lines, doctor, how do we do that? How do we take our blood pressure? What's the right way to do it?

Dr. Julie Colvin: There's a lot of home blood pressure machines now that are very good. In the old days, we all thought, you know, we go to doctor's office, they check our blood pressure, right? And, nowadays, just like everything else, the technology of blood pressure machines are so much better now. They're very accurate. If you will say, "Okay, I really wanted a reputable place. I can find a blood pressure machine and I can trust, " there is a website from CDC, it's called validbp.org. So if you go on validbp.org, you can find a list of home blood pressure machines. You can get anywhere between around $50 to a $100 dollars, and a lot of them were even cheaper than $50. And it's a good investment because, you know, nowadays people paying phone bills probably, and every month it's over 50

Host: bucks.

Easily, right? Yeah.

Dr. Julie Colvin: And having a good blood pressure machine, it's so important. I feel that money is really well worth it for anyone. And for some patients who are very-- you know, they have a pretty large arm, right? They said, "Okay, the machine just doesn't fit me. " Those patients, the wrist blood pressure, it's an alternative choice. It's not ideal, not as good as the arm machine, but the blood pressure machine on the wrist, it could be useful as long as when you check the blood pressure, put the wrist right next to your heart, that has the best accuracy.

Host: And I'm assuming you recommend then, just like when we're at the doctor's office, having both feet on the ground back supported, you know, be as relaxed as possible, those kinds of things.

Dr. Julie Colvin: Absolutely. So, checking the blood pressure right away means, yes, first of all, you know, try not to smoke or drink coffee right before you get to the doctor's office. I guarantee that's going to make you blood pressure high. And some patients don't know, even if they have a full bladder and if they hold and, you know, finish the doctor visit, actually a full bladder can elevate blood pressure too. So, make sure you say, "Okay, well if I need to have a blood pressure check, let me go to the bathroom, empty my bladder," and then, yeah, you know, the back supported, feet on the ground, and relax.

We also have other medical office blood pressure monitoring. So, Trinity Health actually has been advocating encouraging all the offices, use that. What we use is a machine calibrated and then patients will be in the examining room. We check the blood pressure for five minutes and three blood pressure over five minutes' span. And then, we'll get the average blood pressure. And that way, it will somewhat eliminate the white coat syndrome.

Host: Right. And sort of take nerves and just walking in and those types of things that might throw the test off, so to take some of that out of it. I've had that done myself where they take the average over five minutes or so, and it seems to be pretty effective. And it's been good stuff today. It's great to learn from you today. Let's just finish up and talk about how you tailor hypertension management plans, you know, specifically to the individual to meet their needs.

Dr. Julie Colvin: Absolutely. So for hypertension control, first of all, we have to measure accurately, right? What confirms patients truly have hypertension. And then, what do we do well at Trinity Health is act rapidly. So when patients really have elevated blood pressure, we don't let a patient just leave without making followup appointment, and have them to get a blood pressure machine at home and then check it a few times before they come back to see us. And then, we will review the blood pressure results with them and provide their education of course. And then, if the blood pressure is truly high, we will start to treat patient's blood pressure right away.

So, how to tell by individual, it really depends on patients. Of course, lifestyle is a big part of it. Low salt diet, active lifestyle, eating more vegetables, those advices we give to everyone. So for different populations, we treat patients slightly different. For example, there's different medication classes. And for patient who have very active lifestyles and they cannot be by the bathroom frequently, we use a different category medication versus diuretics, which initially make patients go to bathroom very frequently. And then, for elderly patients, we use a different medication so that we make sure their kidney function would not be affected, and their legs are not swollen. So really, everyone is different. We have to look at what a patient's lifestyle is, and then we tailor to what is the best individual for those patients. And patient has to be willing to take the medication, and patient has to be able to tolerate the medication. That comes down to treating hypertension really is partnering with patients. Without the patients, we can tell them anything we wanted, but without that partnership, we'll not be successful in hypertension control.

Host: Right. Yeah, that's all good stuff, you know, individual plans, not just a one-size-fits-all. Really partnering with patients, the top-down support you have at Trinity Health hospitals. It's really good stuff. So, thank you so much for your time today.

Dr. Julie Colvin: Absolutely.

Host: And for more information, please visit SJHSYR.org. That's SJHSYR.org. And if you found this podcast helpful, please share it on your social media. I'm Scott Webb. Thanks again for listening to the St. Joseph's Health Medcast from St. Joseph's Health.