Margaret Enright, MPH, CDE
Quality Improvement Specialist
Oklahoma Foundation for Medical Quality

Nearly one-third of adults in the U.S. have hypertension, and people with diabetes are at even greater risk of developing hypertension and cardiovascular disease. Because of the combined significant risk factors associated with poorly controlled diabetes and hypertension, the target blood pressure for patients with diabetes is <130/80 mmHg. However, achieving and maintaining this target range requires frequent monitoring and aggressive management of blood pressure, standardization of blood pressure measurement, and educating patients on the importance of optimal blood pressure control.

Warren Clinic in Tulsa was recently selected as one of twelve sites in the country to participate in the International Diabetes Center (IDC) National Hypertension and Diabetes Initiative to address this important healthcare challenge. Warren Clinic’s Internal Medicine, Family Practice and Endocrinology practitioners are engaged in education and implementation of evidence-based best practices to aggressively control blood pressure among patients with diabetes.

The national project aims to “…use the same focused energy which clinicians have recently applied to blood glucose control and apply it to aggressively controlling blood pressure,” said Dr. Robert Cuddihy, Endocrinologist and Medical Director of the IDC, speaking to nearly 200 Warren Clinic physicians and staff at a kick-off seminar in Tulsa. Dr. Cuddihy cited several research studies that underline the importance of optimal control of both glucose and blood pressure to significantly improve clinical outcomes for people with diabetes. “Warren Clinic, by actively participating in this initiative, will be well poised to meet the challenge of the coming epidemic of diabetes head on,” he said.

The seminar, led by Cuddihy along with Pam Tompos, MS, RD, LD, both co-Project Coordinators for the IDC Initiative, focused on identifying common sources of blood pressure measurement inaccuracies, promoting improved measurement processes, applying national guidelines for diagnosis and aggressive treatment of hypertension, and using resources to help patients develop self-management skills.

Presenters at the seminar emphasized the goal of achieving systolic blood pressure (SBP) of 130 or below. Focus on the systolic measure is a reasonable strategy because SBP continues to rise as a person ages, while diastolic blood pressure first tends to increase through middle age, but then starts to decrease as the patient gets older. Dr. Stan Schwartz, Medical Director of the Warren Clinic, told attendees that, “Below 130 gives our patients an extra margin of safety from the risk of strokes and heart attacks.”

Using multiple anti-hypertensive medications along with “lifestyle” therapies was recommended to achieve the target SBP result. “Many patients do not take multiple blood pressure medications, yet it’s known that this is what is required to control blood pressure optimally,” Schwartz said. He assured physicians and their staff members that Warren Clinic fully supports the effort it will take to achieve the goals of this project.

Prior to the official project kick-off, Warren Clinic formed a Hypertension/Diabetes Project Planning Committee comprised of three lead physicians from the Internal Medicine, Family Practice, and Endocrinology divisions, along with several members of the executive, practice management, and quality departments. The three medical team leaders sought and received enthusiastic project support within each of their respective divisions. Dr. Joe Schlecht, one of the project leaders from the Family Practice department, discussed his enthusiasm for this project saying, “This is evidence-based medicine emphasizing improved clinical outcomes for our patients. It’s a win for all concerned, including the patients who receive optimal care, the payors who have lower costs associated with better preventive medicine, employers who have healthier personnel with less time away from work, and physicians who have the satisfaction of providing best practices care for their patients.”

Andrea Lytle, RN, project coordinator for the Hypertension/Diabetes project at Warren Clinic emphasized that support staff, particularly Clinical Assistants (CA) who take blood pressure readings, are key players in the success of this project. At the seminar, MAs were taught standardized methods of getting the most accurate blood pressure readings, and simple messages to educate patients on the importance of good blood pressure control. For example, CAs should teach patients that for every ten points the SBP drops, the risk of diabetes-related complications drops 15 percent.

Oklahoma Foundation for Medical Quality (OFMQ) congratulates Warren Clinic for their participation in this proactive diabetes quality improvement initiative and encourages all physicians in our state to work steadfastly to achieve both optimal blood glucose and blood pressure control for their patients with diabetes.

Margaret Enright, MPH, CDE is a Quality Improvement Specialist with OFMQ and supports Oklahoma health care providers in quality improvement projects including prevention and chronic disease management and using health information technology to improve care. She serves on the planning committee for the Warren Clinic Hypertension/Diabetes project.