Clinic's Technique Cuts Blacks' Blood Pressure : Medicine: Spending more now will save money later, say doctors of team effort on patient medication.

By MALCOLM RITTER

Sept. 4, 1994 12 AM PT

ASSOCIATED PRESS

NEW YORK — Graham Stroude figures he might be dead today if his fiancee hadn’t taken a second look into her garbage can last year.

There she spotted a newspaper article that described a Brooklyn clinic with unusual success in treating persistent cases of high blood pressure, like Stroude’s.

He had seen doctors about it, but “I wasn’t disciplined enough to religiously follow the medication,” he said. “Sometimes I would take the medication and sometimes I would not.”

That changed after a meeting with clinic director Dr. Samuel Spitalewitz.

“I sincerely believed I was on the threshold of a stroke,” said Stroude, 61. “That caused me to check up on myself and realize the danger I was facing. . . . I could have been dead today.”

Spitalewitz says he told Stroude the facts about high blood pressure and emphasized how medications would reduce the danger.

The incident tells part of the story of how the clinic does its job.

The clinic, which serves a largely black inner-city population, is at Brookdale Hospital Medical Center, which has a more diverse patient mix. Black people run higher rates of high blood pressure and tend to have more severe cases than whites do, so doctors started the clinic in 1981 to deal with the problem, said Dr. Jerome Porush, chief of the medical center’s division of nephrology and hypertension.

It treats only patients whose problem persists despite standard medical care. And it works: a 1991 study found that blood pressure was brought under control in 86 of 105 randomly chosen patients, and substantially improved in 10 others.

Those results are remarkable, said Dr. Elijah Saunders, co-founder of the International Society on Hypertension in Blacks. Hypertension is high blood pressure.

The clinic’s intensive approach to treating high blood pressure in the inner city is not widely used, mostly because of cost, Saunders said. But money spent on controlling high blood pressure will save higher costs later on, he said.

Without that preventive approach, patients “will come back with a stroke in a few years, or a heart attack, or their kidney’s going to go bad and they’re going to go on dialysis. And it’s going to cost you thousands of dollars per patient,” Saunders said.

People at the Brookdale clinic “deserve a lot of credit for what they are doing,” he said.

What are they doing? Apart from the specialized expertise in the disease, Porush said, one important ingredient is that doctors, the nurse and even the clinic clerk take time to stress the medical consequences of ignoring medicines or appointments.

That is key because high blood pressure usually causes no symptoms, which makes it easy for a patient to forget or ignore medication.

So patients hear repeatedly about the importance of taking medicines and keeping appointments even while feeling healthy. It sounds basic, but not all doctors elsewhere take so much time, especially at the busy general medical clinic where most of the patients come from, Porush said.

Stroude, who had gotten medications from several doctors elsewhere, said that in those offices the danger of uncontrolled high blood pressure “was never discussed in any great measure.”

The clinic takes other steps to encourage compliance. Patients who miss an appointment get a call asking, “What happened today?” nurse Alba Correa said. If a patient has moved, the clinic clerk may start calling relatives to locate him. “We track those patients down.”

When patients do appear for an appointment, they usually are seen by a doctor within a half hour, Spitalewitz said.

Saunders, the hypertension expert, called that “incredible.”

“You don’t see that in most clinic systems,” he said. “If you get seen within two or three hours, you’re doing good.”

Since salt can contribute to high blood pressure, Correa keeps a collection of nutrition labels from high-salt foods to show patients. A dietitian familiar with the ethnic foods popular in the neighborhood also consults with patients.

Correa also emphasizes losing weight, because obesity contributes to high blood pressure. When the clinic scale shows a victory, “we’re all very glad and we clap,” she said.

On the other hand, when a portly man was reluctant to agree to a medical test, Correa was blunt. “This is no good,” she told him. “You’ve already had a stroke.”

Among the clinic’s other features: Each patient is assigned a single doctor, family members are recruited to encourage medicine-taking and are taught about low-salt meals, and patients get Correa’s phone number to call with questions.

Stroude says he is impressed by the level of commitment and the overall atmosphere of empathy. “This is the first time I have encountered an environment that is so conducive to healing,” he said. “When you come into this little place, you feel yourself at home and you feel yourself as a participant.”

The clinic has treated about 1,000 patients since it began and handles about 300 at any one time. Once the blood pressure is brought under control, most patients return to getting care from the hospital’s general clinic.

But Stroude would rather not leave.

“I cannot think about that,” he said. “I have a few more years to live and I want to live it in health.”