‘Hypertension Guidelines for Bermuda’

Today [Sept.19] the Ministry of Health announced the implementation of the “Hypertension Guidelines for Bermuda 2011”, which seek to ensure that all physicians and other healthcare professionals use the same criteria to screen and diagnose hypertension, and utilize best practice in the treatment of hypertension and screening for complications.

In October 2010, the Minister of Health appointed a ‘Hypertension Task Group’ to develop these Guidelines. The Hypertension Task Group is comprised of 19 representatives from the healthcare community including family physicians; the Directors of Cardiology, Dialysis, Endocrinology, and the Hospitalist Programme at KEMH; and physicians, nurses, dietitians and a pharmacist representing the Bermuda Hospitals Board, the Department of Health, and the Bermuda Heart Foundation.

The Guidelines were released in February 2011 in a ceremony at Camden House where the Minister of Health Zane DeSilva expressed his gratitude to the Task Group members for completing the work initiated by the former Minister. Since then, a number of information sessions have been conducted for physicians and other health care professionals to review the Guidelines in more detail.

The Minister noted that hypertension is a significant problem for Bermuda with one out of four adults (25%) reporting they had high blood pressure in the 2006 Health Survey of Adults and Children in Bermuda.

Diseases of the circulatory system of which high blood pressure is a major contributing factor are the leading cause of death in Bermuda (47% of all deaths in 2008). Hypertension has a major impact on life expectancy and quality of life, especially if it remains undetected or is poorly controlled.

Hypertension is the term used for elevated blood pressure. It is a chronic medical condition in which the blood pressure remains abnormally high (a reading of 140/90 mm mercury (Hg) or greater).

High blood pressure occurs when arteries become too inflexible to allow an ample supply of blood to circulate, especially under periods of exertion or stress, thus causing excess pressure against arterial walls.

Hypertension is often called the “silent killer” because it has no symptoms or warning signs and can go undetected for a long time. Severe or ongoing high blood pressure can lead to stroke and other life-threatening conditions such as chronic kidney disease (requiring dialysis) and heart disease.

The Chief Medical Officer, Dr John Cann, explained that the need to standardize health care for people with hypertension in Bermuda is threefold. Firstly, to try to prevent or delay the onset of hypertension; secondly, to ensure that patients with hypertension get the best care possible to control their hypertension and prevent hypertension complications and improve quality of life; and thirdly, to minimize health care cost attributed to the disease and complications.

The Guidelines’ recommendation is that all persons be screened for hypertension every one to two years and those with hypertension more frequently.

Dr Cann said: “I wish to emphasize to every person in Bermuda, the importance of taking responsibility for their health. Make sure that you get screened for hypertension according to the Guidelines and have your blood pressure measured at your physician’s office or at the free Blood Pressure Clinic at the Department of Health, Hamilton Health Centre, Victoria St, on Wednesdays between 2pm-4pm. Make sure you ask for your blood pressure reading so you ‘Know Your Numbers’.”

An optimal blood pressure level is 120/80. An important classification is that of “pre-hypertension”, when your systolic blood pressure is between 130-139 (mm Hg) and your diastolic blood pressure between 85-95 (mm Hg).

Most importantly for these persons are that it is within their power to delay and even prevent the development of hypertension if they make significant lifestyle changes to adopt a healthier eating plan and increase their physical activity.

Those persons with a blood pressure greater than 140/90 (mmHg) on three or more occasions are diagnosed as being hypertensive and require treatment. Treatment includes lifestyle modification and if this is not successful in reducing the blood pressure, drug therapy will be prescribed. Patients diagnosed with hypertension should also be assessed for both cardiovascular disease and the presence of chronic kidney disease.

Studies indicate that persons with controlled hypertension – with blood pressure below 130/80 – are much less likely to develop hypertension complications such as kidney disease. You want to do everything in your power to maintain control of your hypertension and avoid complications.

The Department of Health will be conducting a Hypertension information campaign over the next several months. Minister DeSilva said “I encourage everyone in Bermuda to have their blood pressure checked on a regular basis and to know their own blood pressure numbers.”

“Everyone should maintain a healthy lifestyle – eat right and move more. If you have hypertension make sure you follow your treatment plan, follow a healthy lifestyle and take your medications as prescribed to keep your blood pressure controlled.”

HYPERTENSION TASK GROUP MEMBERS

• Dr. Femi Bada – Chairman Bermuda Diabetes Association
• Myrian Balitian-Dill, RN – Nurse Specialist, Cardiac Care Programme – KEMH
• Simone Barton – Executive Director, Bermuda Heart Foundation
• Arlene Basden – Director of Hospitalist – KEMH
• Gloria Burgess, RN – Public Health Nurse, Maternal Health – Department of Health
• Dr Annabel Fountain – Director of Endocrinology – KEMH
• Mellonie Furbert, RD – Public Health Nutritionist, Department of Health
• Dr Carl Levick – Director of Cardiology – KEMH
• Tracy Marra, Pharm D – Pharmacist
• Sara McKittrick, RD – Dietitian and Diabetes Educator, Bermuda Diabetes Association
• Dr. Katherine Michelmore – BHB Employee Health Physician – KEMH
• Dr. Fiona Ross – Family Physician representative
• Dr Cathy Siddle – Internal Medicine
• Norma Smith, RN – Vice President – Nursing (Acting), KEMH
• Dr. Jayalakshmi Thamidela – Medical Officer – Department of Health
• Dr Lynette Thomas- Director of Nephrology – KEMH
• Denise Walls, RN – Clinical Manager Nursing, KEMH
• Dr Louise White – Family Physician representative

Task Group Coordinator:

• Betsy Baillie, MPH, RD – Public Health Consultant, Department of Health

#Health

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