Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilton , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2: 0:18

Hey everybody, it's Dr. David Hilden , and welcome to episode nine of the podcast in which we're gonna talk about high blood pressure, medically known as hypertension. February is heart month, and as hypertension is the most common, preventable cause of stroke and heart disease, we thought it a great time to talk about this important topic. To help me out, I have Dr. Rubish Anu . He is a cardiologist at Hennepin Healthcare, and he was a previous guest on the show to talk about lipids, which I might say it was one of the more popular episodes we've ever done, but today it's high blood pressure. Dr. Anu , welcome back.

Speaker 3: 0:55

Hey , thank you for having me, Ken . So

Speaker 2: 0:56

The term hypertension or high blood pressure, what does that mean?

Speaker 3: 1:00

So if we look at the , uh, term hypertension, it's a combination of a Latin and a Greek word. You know, it takes a root , uh, phrase , uh, from the Latin hyper excess . And then , uh, the tension comes from a Greek , uh, phrase that will mean stretching. So it's excess stretching, and it sort of leads you to see how people are thinking about high blood pressure as a function of the arteries being excessively stretched. And by that probably they're thinking excess blood inside the blood vessel, stretching them. And when you look at it historically, it sort of makes sense as to how bloodletting or application of leches used to be the way they used to try to take care of it, because their thought was the sole cause of it was just excess blood, just too much, too much blood stretching it, causing high blood pressure. But they're the same terms who use them interchangeably with, you know, hypertension, more medically used and high blood pressure in the other situations.

Speaker 2: 1:55

So why do we care about it? Why do we care if you have hypertension?

Speaker 3: 1:58

If the high blood pressure persists for days and days and then your , uh, high blood pressure keeps on bombarding, you know, the vessels inside various organs eventually starts to scar them or starts to sort of put them out of commission. And being that most organs we're talking about the heart, the kidney, the brain, they're counting on always adequate blood flow. If the blood vessels are not applying, you know, the delivery of nutrients to them, then you start to get heart attack and stroke and the kidney failure and all the other consequences that come with it.

Speaker 2: 2:31

So how does it lead to those bad things? And what, what is happening in your body that would lead to a stroke or a kidney problem or a heart problem? Those are all, those are three different parts of your body. Yeah . Your brain, your heart, your kidneys and and other parts. How does, how blood pressure lead to damage in those areas ?

Speaker 3: 2:48

Yeah , you know , uh, in , in different organs, probably differently. You know, if we look at , for instance, the kidneys. The kidneys are full of tiny blood vessels. That's where the filtration process is going on. And those blood vessels, again, count on them being patent or widely open and the bombardment with high blood pressure. And when we talk about high blood pressure, we'll probably eventually get to this, but we're not talking about a one day or two day of it. This we're talking about months and months of persistent high blood pressure that starts to really narrow and scar down the blood vessels. So the whole filter that was counting on a good amount of blood flow is no longer getting that. And that leads to then the kidney not functioning properly. In the case of the kidneys, it gets worse because once you have abnormal kidney function, that actually then leads to even more triggers for high blood pressure. It becomes this , uh, you know, ugly cyclical

Speaker 2: 3:40

'cause your kidneys are a , a , a victim of high blood pressure, but they're also the that feeds back in your, your kidneys help help control it. Yeah. That's a vicious cycle. Now,

Speaker 3: 3:48

To just give another example. If you look at the heart, the heart is pumping into this blood vessels. If you have high blood pressure, you start to overwork the heart. And over a course of time, that's how you can see the heart starts to be overworked, to start to dilate. There we have the heart failure. And then you can see how different organs start to be affected

Speaker 2: 4:08

By this. Yeah . And your heart's just a muscle after all . Well , it's a very complicated muscle. It is,

Speaker 3: 4:11

It is. But uh , you know, it's , it's like lifting heavy weights, but it can only do it so much before it says, I'm tired of it .

Speaker 2: 4:18

I'm tired of it. Okay. Yep . So who, who gets hypertension? I , and, and listeners, just a little teaser, it's probably more common than you think and you might have it and not know about it 'cause you don't get symptoms. But yes . Let's talk a little bit more about the prevalence. Who gets it, who's at risk, that kind of stuff.

Speaker 3: 4:36

Very good. So the most common factor associated with it is age. And with advancing age, we start to see more and more people affected by high blood pressure or hypertension. Just to give you an idea, if people, you look at them in their thirties and their thirties , probably one out of 10 people are affected by high blood pressure. Now you get them into their fifties, three out of 10 people are affected by high blood pressure. But then if you come back and look at these people few decades out in their sixties and seventies, we're talking about seven out of 10 people are gonna be affected by the majority

Speaker 2: 5:07

Of

Speaker 3: 5:08

People. Majority of people are affected by it. So in the US we're looking at 85 million people that are affected by this. And if you look at male female, it's slightly more women than men. And then the more advanced the age gets , you realize women really take , uh, a larger number of the people who are affected by high blood pressure.

Speaker 2: 5:29

I don't think we've talked about any topic in four seasons of this podcast where there were 85 million people who had the condition. That is probably the most common thing we've ever talked about.

Speaker 3: 5:39

Very common. And I don't think it , uh, it gets, its due in our discussion and I don't think we explore it and look at it and engage people adequately because that's why it has become the most common preventable cause. But I'm not sure we're actually applying it and preventing this diseases.

Speaker 2: 5:57

Is it more common in older people because there's something going on in your nervous system or your blood vessels themselves just getting more rigid? Mm-hmm <affirmative> . What happens?

Speaker 3: 6:07

Well, if I apply what my mechanic tells me, everything that goes with my car say it's like too much mileage. There is wear and tear. That's what he say . That's his answer to everything. Just about all

Speaker 2: 6:16

The hoses and tubes are getting a little stiffer.

Speaker 3: 6:18

Yes . So you can imagine the heart, you know, how many years is it gonna pump and then how many years is it gonna pump into these blood vessels? How long are you expecting these blood vessels to remain with their elasticity? All those things come into play . So yes, with advancing age, the blood vessels have done a great job for mm-hmm <affirmative> . Decade after decade after decade, at some point they start to narrow or their stretchability or elasticity Yeah . Starts to get lost. And that's how you end up getting that. I

Speaker 2: 6:45

Think , uh, some people might think your blood vessels are these rigid pipes. They're not like metal pipes, they're, you just said they're elastic. Yes,

Speaker 3: 6:52

Yes. They're rubbery .

Speaker 2: 6:54

Robbery

Speaker 3: 6:54

Tube. Robbery tube is what you see. And then, you know, the younger you are more rubbery , more stretchy. And then , uh, with advancing edge, they kind of, you know, get stiffer and stiffer and then they cannot accommodate whether it's excess fluid or anything applied to them. So that's sort of the , the nature or the course of our blood vessels.

Speaker 2: 7:13

So age is the biggest risk factor, but it must not be the only thing because some people get it younger.

Speaker 3: 7:18

Correct? Correct. So exploring other things, family history, genetics is another big factor. So if you have got parents or if you have got siblings affected by high blood pressure, likely you are at risk for it. And something to watch for. And if there are things you can avoid, excess weight, tobacco use, excess alcohol use, these are the things, if you have a family history, definitely you wanna avoid for reasons that's not always clear to us. We find elevated blood pressure more common in certain ethnic groups. Hmm . For instance, African-American people tend to have higher blood pressure. And you know, we always think about that. So is it the diet? Is it uh , sort of the way of life and you know, is there stress involved with it? And other things we do not know, but we do see it in certain ethnic groups more than um , others. Diet affects it. Diet. And if there's lack of exercise that can lead to excess weight. And we know that excess weight definitely is associated with high blood pressure

Speaker 2: 8:14

Smoking. I bet smoking's good for it. Uh,

Speaker 3: 8:17

I beg not So with with tobacco.

Speaker 2: 8:20

Tobacco, I , I was saying that listeners, I'm kidding. I'm kidding. I'm kidding. Smoking is a good, I hear you .

Speaker 3: 8:25

Anything. No, no. And frankly, that's one of those things we just don't compromise. Right ? So even with alcohol, we say one or two drinks a day, if it relaxes you, it's part of your socializing that's sort of acceptable. That makes sense. Tobacco's one of those where we say, no, none, zero tobacco is a good idea. I know that that's what good tobacco will be. So the only other thing I think, you know, out of the factors that are associated with high blood pressure, I would like to mention in women there are certain factors we do not see in men. Hmm . In younger women, this end up being birth control pills, those are associated with high blood pressure. And then pregnancy actually can be in many situations associated with high blood pressure. And then in women with advanced age, postmenopausal state actually suddenly predisposes women to the risk of high blood pressure. So the factors while being the same in most earlier, when I say to you, out of the 85 million adults in America, probably about there are four to 5 million more women having it. Most of them tend to be in the 65 70 postmenopausal. Yeah . Because that really accelerates it .

Speaker 2: 9:35

Before I'd like to get off these topics. Some of these things you've mentioned are reversible, things you can control. Not always easily, but some things you can control. Some things you can't. Yes. Let's stick to a couple of these things that you can, you mentioned diet. Should I just eat pine nuts and leaves all day long? Or layoff of salt? What general dietary things should people know about?

Speaker 3: 9:58

I think the mention of salt is a big one. No ,

Speaker 2: 10:01

Some people bring up a lot.

Speaker 3: 10:02

Yes, they do. And one thing we have to be clear before we leave this topic is that the sensitivity to salt is not in everyone , but there are certainly some people who are salt sensitive. And when we say salt sensitive, we have to specify it to be sodium is what we're talking about. In fact, when you look at diet, something we're exploring more and more nowadays is low potassium is another risk factor for high blood pressure,

Speaker 2: 10:27

Low potassium, low

Speaker 3: 10:29

Potassium.

Speaker 2: 10:29

Don't eat a banana, everybody.

Speaker 3: 10:30

So if you eat your banana or other food items, tomatoes or you know , dried apricots, all these things that you can get that are rich in potassium, that may actually be protecting you from high blood pressure. So when we say salt, not all salts get thrown out . Potassium

Speaker 2: 10:44

Table salt, sodium,

Speaker 3: 10:46

Sodium is the problem. Potassium is different . And many, many people do not fortify their diet with a good source of , uh, potassium. Usually .

Speaker 2: 10:54

That's, that's a great tip. Now my own wife and I talk about salt a lot mostly 'cause I like the taste of it and she doesn't. So in some sense it's preference, but also the effect on blood pressure. I tell patients all the time who have high blood pressure mm-hmm <affirmative> . And, and it's tough to control that salt isn't gonna be your friend. But could you comment on this for someone who doesn't have high blood pressure, their blood pressure's great and they like a little salt. Is it that bad?

Speaker 3: 11:19

No, no. I think, you know , um, my sense of looking at most of this processes is moderation, right? Mm-hmm <affirmative> . So yes, I mean , uh, not taking a crystal of it and licking it, but sprinkling it here and there. If it's gonna enhance the dining experience,

Speaker 2: 11:35

Why not here and there a little bit

Speaker 3: 11:36

Here and there a little bit. So with everything, moderation is the key. Yes. Just, you know, this morning when I saw somebody in clinic, she likes her salt, blood pressure has become an issue. And we talked about the fact that hey, there is a potassium salt substitute. Why don't you try that? And it's available in the grocery stores, potassium salt substitutes. So instead of the sodium chloride, they are potassium chloride. So if you use that instead of the sodium chloride or the usual table salt, that will probably be helpful. And in her case, her potassium was, you know , getting lower and lower. And my thought was go substitute your salt with that and see how it goes.

Speaker 2: 12:14

We're not gonna get into smoking much. 'cause the message is zero, zero, try to get off of it. There's help available. Yes. Uh , but what about exercise? Does it have an effect on blood pressure?

Speaker 3: 12:25

It sure does. Uh, if you start to exercise regularly, you can drop down your blood pressure by seven to 10 points, how much exercise is gonna be the question, right? So I am not a big advocate of just sticking to those 10,000 steps. The 10,000 steps are, I think , a great idea to motivate people. Mm-hmm <affirmative> . We have promoted it. And if you're just maintaining something, if you are dealing with excess weight and thinking, no, actually I need to work on losing some, I think 10,000 is just your warmup. I think you should start to look at 30 to 45 minutes most days of the week, maybe five days a week, and gauge it by that to see if you have the time for it, if you have the interest for it even more. But definitely exercise allows those arteries that are getting stiffer to kind of gain some of their elasticity. So that's a good one. And with the proper diet, let's say, if you are either curbing the amount of calories or taking away some of the excess carbohydrates and you know, fats that along with exercises you can cut down on your weight. We also , uh, know that for every two pounds of weight you lose, you drop your blood pressure down by one point. So a good 10 pounds of , uh, weight loss can be about five points drop in your systolic blood pressure, which I think is brilliant.

Speaker 2: 13:44

Significant. Yes. So these are all things, not necessarily saying they're easy for everybody, but are known to be effective exercise and maybe a little bit more than you think. Exercise. Take it seriously, maintain a healthy weight, don't smoke. Lay off of sodium and salt. Yes . These are, these are good tips. Yes . Uh , on a sort of related topic, your cholesterol numbers and your cholesterol and your diet. We did a previous episode on cholesterol. Correct . As I said at the top. And I do encourage listeners to go into the archive and listen to Dr. Anu show about cholesterol. It , it's , it literally was one of the most popular episodes we've had. But could you clarify for listeners on this one, hypertension versus cholesterol. Two things people need to

Speaker 3: 14:26

Care about. Yes, absolutely. So yes, high blood pressure, high cholesterol, you're thinking, all right , this not sounding good. And when the two are found in the same body, the problem is one makes the bad effect of the other even worse. So upfront , one thing you need to keep in mind is even though one is a whole, you know, lipid your fat thing, and the other one is, as we talked about how your blood vessels are sort of tense. If you have both factors, it accelerates the stroke risk and , uh, uh, heart disease risk. And what to get out of it is, if you have one, be very careful not to be playing with the other. And you know, if it's , uh, elevated blood pressure, make sure your cholesterol is quite optimally managed. And if you are working with higher cholesterols, you'll be the one who should be very careful about not allowing your , uh, blood pressure to run away.

Speaker 2: 15:16

Sounds good. We have been talking with Dr. Rub, ANU . He is a cardiologist at Hennepin Healthcare in downtown Minneapolis. A colleague and friend I've known for many years. He was actually one of my teachers back in the day. We are talking about hypertension. You may know it as high blood pressure. When we come back, we're gonna talk about what is the definition, what are the numbers, is it possible to be too low? What kind of treatments are available? So stick around, we'll be right back.

Speaker 4: 15:44

When Hennepin Healthcare says, we are here for life. They mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital, HCMC and a network of clinics both downtown and across the West Metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 16:22

And we're back talking with Dr. Anu about high blood pressure. So people don't know you have this, you don't have symptoms. Everybody, even I can tell you that for the majority of the time of your life that you might have high blood pressure, you don't know about it until it leads to some other problems. So you have to measure it in an office or at a clinic or at home or somewhere. So let's talk about that, about how we measure blood pressure. And first of all, when, when you go to the clinic, they always make you shut up. Don't talk so much, sit quietly, uncross your legs. What , what's

Speaker 3: 16:50

That all about? I know that that's a lot to be expecting of, you know , um, our patients. But all these things that they tell you when you come to the clinic, each one of them has a tendency to slightly increase your blood pressure. You know, the crossing leg part, continuing to be engaged with , uh, the nurse or all these things are stimulating you and they are raising your blood pressure. And we do not want to check your stimulated blood pressure. We like to, we're trying to get your baseline blood pressure.

Speaker 2: 17:16

So it goes up and down in a matter of minutes. Minutes.

Speaker 3: 17:19

You and I, if someone was checking us now, we probably have had our blood pressure , uh, very easily by 10 15 points. You know, when I took the stairs to come this way, probably my blood pressure could have worked its way to about 1 50, 1 60, you know? Mm-hmm . When we do stress test and people, it gets to 180, 1 90, but that's just for the moment of reaction. That's not what we're worried about. So I think as we are talking more about it , uh, we'd like to highlight that it's the sustained effect of this high blood pressure. We're worried about not the one minute or two minute flickering of high numbers.

Speaker 2: 17:50

So let me give a little condemnation of the medical field that we're in in the office. We measure blood pressure, maybe not at the ideal time. So people come in, they check in at the desk, they sit in the waiting room, maybe they're having a cup of coffee. We talk to them, we put the cuff on them, they're , they haven't been resting. And so we, we do our best. Yeah. But what is the ideal way for people to know if they have high blood pressure? Is it to go to your doctor's office? Is it to get one of those cuffs that you can buy at the drug store ? How's the best way to diagnose it?

Speaker 3: 18:20

Your is a good point because the current standard of care is , is just that, you know , you come to clinic, come to the

Speaker 2: 18:26

Doctor's

Speaker 3: 18:26

Office, yes, yes. To get it checked. And you know, look at the CSC. The CSC, you cannot make it any beautiful than that. You cannot.

Speaker 2: 18:32

That's our building. That's where we see PA patients. The clinic and specialty center is

Speaker 3: 18:36

Beautiful. It's , it is beautiful and you think that will calm you down. But at the end of the day, if you look at it, there's nothing natural about coming to a clinic. You know, you're being taken out of your own environment. You're wondering, am I gonna get to park at the right time or not? Will there be keeping in line or not? None of this is supposed to keep your blood pressure normal. It's supposed to be stressing you out until you get there. And then you are in a waiting area. At some point someone rushes you into a room and as you're sitting there they're saying , uh, let's go over your medications. Let's talk about this. Have you had any allergies? None of this is helping out. Mind you. And then we check it and at some point we tell you, you know, your blood pressure is not normal and you're thinking, are you kidding me? Of course it's not .

Speaker 2: 19:13

And you're standing there in that white coat, you're terrifying me. You know ? Yes,

Speaker 3: 19:15

Exactly. The white coat, hypertension, you know, all those things come into place . So you're thinking okay, with that understanding maybe that is as good as it gets will be a good screening tool. But to really get to the bottom of did you really have high blood pressure or did we stress you out to get there? My advocacy will be to really do some home monitoring. Now the , we have ways of monitoring blood pressure where we have people wear this gizmo and walk around for 24 hours and we'll check them throughout the 24 hours. But taking that complexity out, what have been really advocating for in the community setting and we have various programs we're working on now, is get them one of this blood pressure monitorings, teach them how to do it the right way. We can talk about, you know, what that right way will be. But to do that and have them gather the data, I think that will be much helpful with diagnosing an ongoing follow-up and management of each individual's high blood

Speaker 2: 20:10

Pressure. That makes a ton of sense. Uh , it really does. So let's get to the very basics. Hypertension 1 0 1. What are the numbers that you're looking for?

Speaker 3: 20:18

Good one. So you know, we have been throwing out this many points higher, this many points lower. Yeah . What are they? So when I talk to people, I tell them that when you check your blood pressure, probably you're gonna see three numbers show up. The top two are gonna be the blood pressures. And we call it systolic over diastolic. Again, it's back to the Greek word systole means during contraction, diastole means relaxation. So the top number, I tell them systole the superior, the top number will be the highest of all the numbers below that diastole down under the systole, that will be the lower number.

Speaker 2: 20:52

Where were you when I was in med school? That would've been helpful. Uh ,

Speaker 3: 20:55

You know , uh, I , I wish, I wish you could have had it <laugh> , but so systole or diastole. And then the monitor spits out a third number, which is your heart rate. And we have to keep in mind they keep those straight because obviously you don't want to confuse the heart rate for the diastolic blood pressure or whatever it is. So that's what you see and the numbers you're looking at mostly is if it's one 20 over 70, so the top numbers theto is one 20, DIA is 70 , you're good. I think you just, yeah . Live

Speaker 2: 21:23

Forever. One twenties over seventies. Good

Speaker 3: 21:25

Forever. You got it. So that is good. Now when you get into the one thirties, over eighties, that's when we start to look at , okay, they start to pay attention to this. But again, it's not really time to be alarmed. It's time to follow you carefully and say, well if there are other overwhelming risk factors, like earlier you said, how about you have high cholesterol at the same time? How about there is kidney disease? How about you have diabetes? Those people will start to pay attention and say, well, and you maybe we should start to talk about doing something to bring it along . If you

Speaker 2: 21:56

Have all these other things or some of these other things in your one thirties over eighties, yes you should pay attention a little more closely,

Speaker 3: 22:02

Pay attention. But then the number I think that's looking at to say, okay, this definitely does not make sense, will be one 40 over nineties when it gets there, by definition, that's where we have actually crossed into the stage one high blood pressure territory. That's the part that we say, yep , this is actually, you know , we gotta do some starting, you know, to get complicated. And then it can go higher and higher where we talk about hypertensive crisis and other things when it gets into the 180, over one 20 and stuff. But again, that's not what we usually see. Those are the numbers where persistently you are sitting there, we usually recommend people start to get attention more urgently. But for the most part those are the numbers you are looking at. Yeah ,

Speaker 2: 22:42

That's helpful. Uh, is there, such as a thing as too low hypotension,

Speaker 3: 22:47

Hypotension? Correct. So the definition for that is the top number 90, the lower number 60, 90 over 60. If it is anything below that, we call that low blood pressure or hypotension. But one thing that's worth clarifying here is as much as high blood pressure is a help hazard , hypotension, actually, if you keep yourself in the 90, over 60 or a hundred over 60 range and you are feeling okay and that's what you live with, that is okay. That's okay . That is good. That is good. Now here are two um, times where I want people to be concerned about it. Let's say you live at a higher number. So let's say your blood pressure usually is one 20 over 80 . Finally one day you find yourself at 90 over 60. That's not your normal. Something does not make sense. You need to recheck, you need to see if you are dehydrated. Something did not make sense there. That is something to be evaluated and followed carefully. The other thing is you have low blood pressure and you have other things not working well. You are dizzy, your vision is blurred, you're feeling fatigued. Uh, you are having fevers, chills, like you're thinking something is not right with me. And you have that low blood pressure. I'll not leave that alone. I think I'll try to seek some uh , clarification .

Speaker 2: 24:00

But if you don't have any of those symptoms and you're just normally 92 over 62, yeah , that could be

Speaker 3: 24:06

Okay. You know, with my uh, mother, I have not seen her blood pressure above 100 ever. And she's , uh, happily living. And I love

Speaker 2: 24:13

That about

Speaker 3: 24:13

Your mom. Okay . Yes, yes. In her eighties, quite healthy. So that's where people live and usually see this in in younger women . Younger women have lower blood pressure. Leave them alone if they're just functioning fine and that's what their baseline is.

Speaker 2: 24:26

When do you recommend people get checked ? So first of all, the person who doesn't have any idea what their blood pressure is, when should they start checking? How often should they keep checking? And then people who do have hypertension, how often should they be checking,

Speaker 3: 24:39

You know, some of the factors we talked about and obviously we talked about the , uh, age issue, we talked about the family history. I think you look at the various risk factors you have. Let's say you are someone in your thirties, maybe you are enjoying more alcohol than that will be recommended. I'll start to monitor it carefully. Uh, let's say you are in your thirties, forties, and then you have a strong family history of it, but you have never been diagnosed. Maybe you're someone who should monitor it. Now how often should you monitor it? Well, to start with, I think trying to get it maybe once a week or once every other week will be reasonable. And if all of them remain the same, you don't need to check it that often. Maybe once every few months will be reasonable. On the other hand, the first thing you check does not look that great. I think I'll monitor it more closely in that setting. But I'll gauge it by, are you one who already has some risk factors? Yes. Well then let's monitor more frequently. You don't have risk factors. You have always been healthy. Your weight is not an issue. No tobacco, no alcohol, no family history. I don't think you need to be that obsessed with it. So that's how I will gauge it.

Speaker 2: 25:46

I have some people that check it two, three times a day, keep it in an Excel spreadsheet and then send me the results of that. And I always said, you know, it's been stable for years. Yes, yes. And I think you're actually raising it by checking it so much. Maybe you need to chill out just a little bit.

Speaker 3: 26:02

Oh, you raise a very good point. Because the moment they see those flick rings, if that's gonna stress them, now actually the monitoring is gonna result in more high blood pressure. So that's where you should know yourself. And the frequency also should be guided by that. If you're somebody who, as soon as you have more data, you actually, instead of feeling better, you're gonna feel worse by thinking, oh my goodness, where is this going? And then now you check it again . Takes over

Speaker 2: 26:25

Your life.

Speaker 3: 26:25

Yeah. Yes. Now, now it's as good as being in the clinic and being rattled by various things. So you're gonna find yourself working higher and higher and higher. So you should know yourself. And if you are that excitable, check it. Rarely. The other times where I think the home blood pressure monitoring becomes very valuable is if you are at the cusp of an intervention. So you , let's say you have senior provider and your provider has said, you know, your blood pressure is kind of at in the gray zone. At some point, maybe we should consider starting you on a medication or you should do something about it. Maybe you should start exercising or something to that effect. If you are in the monitoring phase and now the data you have will be the decider of whether you're gonna be put on a medication or not. Sure do it weekly or whatever your provider has recommended. But if you're not in that realm, you're just minding your business, none of those issues have been raised. The frequent checking can only stress you out more. So

Speaker 2: 27:19

What we shared , how should people check their blood pressure at home to do it correctly?

Speaker 3: 27:23

Okay, this a , this is a very important one and what I recommend to people is, first of all, you need to sit down and just get to your baseline resting state for about five minutes. Now, when I say rest, I don't mean be on your phone listening to the news, talking to your cousin. I mean just rest. Just sometimes they even recommend maybe a darker room, a quiet room. Just bring your blood pressure back to its baseline. You should not have had any coffee. You should not probably have eaten no tobacco an hour from the time you're checking. Put the arm at the level of the heart. So the upper arm should be at the level of the heart. And if people need more information on the proper way of doing it, American heart and other groups have actually , uh, put information for this. On the website

Speaker 2: 28:10

Listeners, we will put a link to those resources to learn how to check your blood pressure at home correctly. We'll put a link to those on the show notes. So I don't need you to get into all of the medications for high blood pressure. Let's just preface it by that. 'cause there are a lot of them . Sure . But let's talk about medications. If your doctor recommends medications for your high blood pressure, what are some of the things people need to know about? So

Speaker 3: 28:31

The medications, yes, they are , there are plenty families of medications, as you can imagine, as we mentioned it at the start, about how this was taught to be from excess blood instead of the bloodletting and the leches. We have come up with medications , uh, what we call water pills or diuretics that actually remove fluid from your system.

Speaker 2: 28:51

It's a leech in a pill,

Speaker 3: 28:52

A lech pill is what they have come up with. So that's one of the more common forms of blood pressure management. But now we know it's not just the excess fluid. Sometimes the elasticity has been lost, so the blood vessels have become a little tight. So we have things to dilate those blood vessels. Medications in the family called the calcium channel blocker,

Speaker 2: 29:11

Amlodipine, nifedipine dose heart . Those people may be known as those . Yes,

Speaker 3: 29:15

Those, those are , uh, uh, medications that might sound familiar. And then because the kidneys are very much involved with managing blood pressure, we have medications that work on the kidneys. Medications we call ace inhibitors. Lisinopril. Ramipril , all the prills the prills are . So yes, a very common one to hear about are beta blockers. And these are ones which sort of , uh, calm the hyperactivity. That's the , uh, sense of the heart, you know, pumping too much blood into these blood vessels and medications like metoprolol, carvedilol

Speaker 2: 29:48

Ol the ols. Yeah, the

Speaker 3: 29:50

Ols. I like, I like that. So if you just hear that ending, most of them fall into that category. And so people should work with their provider to see which choice of medications is gonna be appropriate for them .

Speaker 2: 30:02

What do you say to people who to say, I know it's a little high, I feel fine. You're gonna gimme all these pills. I don't wanna take all these pills.

Speaker 3: 30:09

Yeah. Well, and we hear that a lot, don't We do . Yes,

Speaker 2: 30:12

We do.

Speaker 3: 30:12

Yes. Because , um, I I myself don't wanna take a pill. I

Speaker 2: 30:15

Have to , I wanna take two, three pills to control something that is , that doesn't make me feel bad.

Speaker 3: 30:19

No, and that's the whole thing is that this is really a real silent killer. Right. It's so by the time you notice it, it has gone a little too far. You know, the kidney's not working as well, the heart is not working as well. So I think informing people who are working with to say that, yeah, yeah, this is gonna be silently destroying the brain, the kidney, the heart. And so that's why you need to monitor it. If it's still elevated, we just need to act on it because it's not gonna give you a signal of a headache or this or that before you actually get it. By the time you are having a lot of headache, probably it has gone too far at that

Speaker 2: 30:53

Sense . Exactly. Yeah . You sometimes your first symptom is the heart attack or it's exactly a stroke or something like that . Unfortunately.

Speaker 3: 30:59

Yeah , unfortunately. So this is one of those, the same way, high cholesterol did not give you any symptoms until it was a problem. This one also, you need to monitor it and act on it , uh, before you get there, before we leave medications. David, one thing that's worth reminding, people who have been started on medications says , stick to what has been recommended. Sometimes people try to switch medications around a bit . Maybe they thought their blood pressure was okay one day and they said , I skip it when my blood pressure is normal. And it's worse for people to keep in mind, it takes three to four days for the medication to have action. So once you get started, don't give up in the first two days or so on saying it didn't work. It needs that many days for it to start to work and has to be every day it has to be taken. You cannot skip it.

Speaker 2: 31:44

So when the pill bottle runs out, refill it , you need to keep going,

Speaker 3: 31:48

You need to do that. And final thing to say about that is if you are gonna cut it back or stop it, it has to be done after talking with your doctor. Yeah . Because sometimes actually stopping it can cause a much higher blood pressure you have never seen before than what you started with. So that's another thing to keep in mind.

Speaker 2: 32:06

One last thing about medications. 'cause I I hear this a lot too. When you need to add a second medicine or add a third one, people say, I I never needed that. It was always fine, but as you have told us, it gets worse as you age. So it is also true, correct, that sometimes you need to add medicines.

Speaker 3: 32:21

Yes, yes. This is a gradually progressive disease and as such, with advancing age or whatever other factors come into play, you may need to add a second one, maybe a third one needs to be added. So if that's what's necessary to keep you from having a stroke, from having a heart attack or a kidney disease and you know, needing dialysis, I think that might be a a , a fair trade in that sense.

Speaker 2: 32:45

So if you wanna leave our listeners with a few tips, what would you most want listeners to know about high blood pressure?

Speaker 3: 32:52

Well, of all the things we monitor in patients, I strongly feel like their home monitoring might have a bigger role in addressing this compared to other things like, you know, with diabetes , uh, with cholesterol, maybe we'll say, we'll like to do this, this blood work here, it's not a blood work. This is data we need to collect. I feel like patients should be empowered to say, you know, I think I can get a cleaner, better data in my home setting and they can start to participate in that and use that data to help their

Speaker 2: 33:21

Providers. All monitoring is a really good idea.

Speaker 3: 33:23

Yes, I think give it out as a gift to anyone you come across. So that's gonna be , uh, uh, a reasonable thing to do. Blood pressure monitors are not that expensive. I give them out in many community settings, you know, and I don't think I've spent more than $40 for a good blood pressure monitor. And unless you're gonna get ones with the bells and whistles that can go into the seventies or so, because some of them, they also say they monitor rhythm for you and stuff so you get more, you don't need it . Just get a blood pressure monitor. You are talking about $40 over years, that's gonna save you from a lot of unexpected outcomes. Always remember the lifestyle changes, diet with exercise, maybe cutting back a little bit on the alcohol are key to managing this. And if you go past that and get to medications, stick with what is recommended and work very closely with your provider to make sure you're taking it the way it's prescribed and consistently as you are expected. So those

Speaker 2: 34:20

Are three really good tips. Rubish , thank you for being on the show today.

Speaker 3: 34:23

Hey, thank you you for having me. Again, this

Speaker 2: 34:25

Is Dr. W Inu . He is a cardiologist and a colleague of mine here at Hennepin Healthcare. Okay. So maybe this show was a little longer than our usual episodes, but there are so many things to talk about with high blood pressure. So thanks for tuning in and I hope you'll join us in two weeks time for another great episode. And in the meantime, be healthy and be well.

Speaker 1: 34:45

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At highball Executive producers are Jonathan , CTO and Christine Hill . Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.