As guideline controversy continues, Dallas practice focuses on lifestyle changes to help patients control blood pressure

Doctor checking patient's blood pressure
In the midst of a controversy over blood pressure guidelines, a Dallas practice first focuses on lifestyle changes for patients. (Getty/AndreyPopov)

When it comes to getting patients to better control their high blood pressure, it’s not just about medication.

A Dallas physician practice also focuses on lifestyle changes, offering patients everything from cooking lessons to fitness classes.

Foremost Family Health Clinic focuses on lifestyle measures, such as encouraging patients to follow the healthy DASH diet, lose weight and exercise, according to a report on AMA Wire.

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“It’s really only after the patient has given a full effort on those lifestyle measures that we have to talk about medication,” said Lindsay Martin-Engel, M.D., a family physician and the clinic’s associate medical director.

Engel said the hypertension guideline released last fall strongly emphasizes lifestyle measures to manage the condition rather than solely relying on medication. That guideline, from the American Heart Association, the American College of Cardiology and nine other health professional organizations, was controversial, however. It advised that high blood pressure should be treated at 130/80 rather than 140/90. That placed almost half of all Americans (46%) in the high blood pressure category.

The Dallas clinic received Gold Status recognition from the American Heart Association and AMA Target: BP Recognition Program last year, a designation awarded to practices in which 70% or more of adult patients have controlled high blood pressure.

The clinic provides monthly healthy lifestyle activities, which kicked off last August with a grocery store shopping trip led by a dietician who taught patients how to read food labels and rewarded them with a gift card.

But the battle goes on between specialists and primary care physicians over just what is the right barometer to measure high blood pressure. After the heart specialist groups released their guideline last November, which redefined high blood pressure for the first time in 14 years, the American Academy of Family Physicians (AAFP) decided not to endorse the guideline.  

AAFP continues to endorse a 2014 guideline developed by panel members appointed to the Eighth Joint National Committee. The AAFP cited a number of reasons for its decision, including that the bulk of the AHA/ACC guideline wasn’t based on a systematic evidence review.

Earlier in 2017, the AAFP and American College of Physicians also published their own clinical practice guideline for hypertension in adults older than 60 that recommended physicians initiate treatment for that population with blood pressure at or above 150.

The blood pressure guideline battle is a real one, according to a Forbes commentary. “The war over the new blood pressure guideline is not a fake war or a childish dispute. It is a real war over genuine differences in how we should think about health and disease and prevention,” wrote contributor Larry Husten. He suggested the focus should be on broad public health measures to create a culture that encourages and steers people toward healthy lifestyles.