High Blood Pressure: Know Your Numbers

Did you know it's a myth that high blood pressure mostly affects people over the age of 60?

Nearly half of American adults may have high blood pressure, or hypertension, but many of them don’t realize it. Not only can high blood pressure affect people of all ages, if left untreated, it can cause harm to many organs in the body. It’s a leading cause of strokes as well as heart failure, kidney failure and heart disease.

Find out why hypertension is called the “silent killer” with host, Dr. Jonathan Fialkow and his guest Ian Del Conde, M.D. a Board certified cardiology and vascular medicine specialist with Miami Cardiac & Vascular Institute.

Transcript

Announcer:

At Baptist Health, South Florida. It's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.

Dr. Jonathan Fialkow:

Hello Baptist Health Talk podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a practicing preventative cardiologist and lipidologist at the Miami Cardiac and Vascular Institute at Baptist Health, South Florida, as well as Chief Population Health Officer at Baptist Health. While much attention has deservedly been given to the coronavirus and COVID-19 biomedical organizations over the past few months, we all want to be sure we continue the message the importance of general medical care. In recent podcasts we've discussed immunizations, heart failure, mental health issues.

Dr. Jonathan Fialkow:

Today we'll discuss hypertension. Nearly half of American adults may have high blood pressure or hypertension, and many of them don't realize it. There are a lot of misconceptions out there, like the myth that high blood pressure mostly affects people over the age of 60. Not only can high blood pressure affect people of all ages, but if left untreated, it can cause harm to many organs in the body. It's a leading cause of strokes, as well as heart failure, kidney failure and heart disease in general. Today, we'll talk about why hypertension is called the silent killer and discuss what can be done to prevent and treat it. We'll also talk about a unique hypertension program out of Miami Cardiac and Vascular Institute Cardiology Group for hypertension evaluation and treatment.

Dr. Jonathan Fialkow:

For today's discussion. I'm pleased to welcome back my colleague, Dr. Ian Del Conde. Dr. Del Conde is a board certified cardiologist and vascular medicine specialist who holds several leadership roles at Miami Cardiac and Vascular Institute, including the Medical Director of the Resistant Hypertension Program. Thanks for joining us Ian.

Dr. Ian Del Conde:

Thank you, Jon. My pleasure.

Dr. Jonathan Fialkow:

So let's start with some of the basics, but I think very important, especially to the average person out there. We talk about high blood pressure, it's easy to ask what is high blood pressure? But maybe approach it by not what is high blood pressure, but what's happening in our bodies when we're hypertensive or have high blood pressure?

Dr. Ian Del Conde:

Yeah, that's the fundamental question here. Just so our audience is clear, blood pressure is the pressure that exists within our arteries, which are the pipes in the body. And our bodies were designed and built, if you will, to operate at a certain sweet spot. You don't want it too low, but you also don't want it too high. And we've known after a multitude of different studies that different organs end up getting damaged if you expose them to elevated blood pressures. And this includes the brain, the eyes, the kidneys. And for example, one of the most recent findings and numerous studies is that even the risk of dementia starts going up if you live your life with elevated blood pressures.

Dr. Jonathan Fialkow:

So it definitely seems that people tend to be more afraid of certain things than others. And strokes and dementia would be two of the big ones. And as you're mentioning hypertension at a younger age is clearly implicated in that risk, as one gets older. So another of the many reasons to evaluate and control your hypertension. So we know hypertension is important, it affects the organs. We call it the silent killer. Why are there no obvious symptoms? And what symptoms would make someone concerned that they might be hypertensive?

Dr. Ian Del Conde:

Yeah, this is a really important point, Jon. There are no symptoms of hypertension. And I'm sure that many folks in the audience have at some point heard about the frog in the boiling pot of water experiments. You place a frog and you slowly started boiling the water.,The frog never jumps out and it boils to death basically. But if you put it in boiling water, it'll immediately jump out. Well, that's similar to what happens with hypertension. If you slowly develop hypertension throughout life, your body slowly starts adapting. And most people, the vast majority of people will not experience any symptoms of that elevated blood pressure. And the only way of making that diagnosis is by actually measuring your blood pressure. And that's the reason self-monitoring is absolutely paramount in this condition.

Dr. Jonathan Fialkow:

How often and what population would you say should be measuring their blood pressure? Again, you're not feeling anything, it's a slow occurrence. You don't go to sleep normal tensive, or at least with normal blood pressure, wake up the next day with all these blood pressure related organ damage. Is there an age when you might say start checking your blood pressure? And then at that age, how often should they be doing their blood pressure?

Dr. Ian Del Conde:

So people will have periodic blood pressure measurements when they go to their health screenings with their pediatricians when they're kids and doctors, but certainly after the age of 25 and even 30, I would say that most people, and perhaps I'm biased. Look, this is what I do all day, but I really think that it's so prevalent in the community, as you mentioned in your opening statements, Jon, up to 40 to 50% of the general population in the United States and other Western countries will develop hypertension. So just statistically there's a good chance that every one of us, no matter how thin and healthy and active you are, there's a good chance that any one of us will develop hypertension. So I personally think that after the age of 25 or 30, you should just check your blood pressure every now and then. And if you notice that it's elevated, that's the time to seek further attention. Blood pressure monitors are cheap and widely available. You can buy them in many stores online.

Dr. Jonathan Fialkow:

How accurate are the blood pressure machines that they may have in the pharmacies or in some of the supermarkets?

Dr. Ian Del Conde:

So great question. Maybe 10, 15 years ago.

Dr. Jonathan Fialkow:

Ian, I love you man, but all my questions are great.

Dr. Ian Del Conde:

Maybe 15 years ago, I would have said that you should stick to certain specific brands that are very well validated. The reality is that nowadays the vast majority of the devices that you can buy have in some way or another been vetted, and the technology is sound. It's been tested and improved over the last 10, 15 years. And I would say that the vast majority of the devices that you buy in a regular drug store, they're good, they're working. And if you go to the hospital, you will notice that almost all of the blood pressure machines we use nowadays, they're electronic. We rarely use the manual method nowadays. They're good. That's the bottom line.

Dr. Jonathan Fialkow:

You can obviously get your blood pressure checked that your doctor through a regular visit, or just saying, I want my blood pressure checked. There are health fairs that are done at community centers or various places where blood pressures can get checked. And then those that are the most motivated, which we do recommend would be, even for the family, buy a good quality, relatively low priced home blood pressure machine, which you can use periodically check every few weeks at home. Those would be, I guess, viable recommendations.

Dr. Ian Del Conde:

Absolutely.

Dr. Jonathan Fialkow:

So when should someone be concerned now? So now I'm checking my blood pressure every two to three weeks. First question, is there a time of day I should check? Should I do it randomly? And then when would I say, "Wait a minute, maybe I should get further help."

Dr. Ian Del Conde:

Right. So people have to be aware what the numbers are. You have to know your number. A normal blood pressure, an ideal blood pressure I should say, is 120 over 80 or less. However, if most of your blood pressures are in the 120 to 130s range over 70 to 80s, you're probably fine. Remember blood pressure is not static. It's not as if you're always going to have the absolute same blood pressure. Blood pressure is influenced by your degree of hydration, your emotional state, level of activity, a number of different features. So blood pressure fluctuates a little bit, similar to the stock market. It goes up and down, up and down, but it always should stay within a certain range. And that's the 120 to 130 that we're shooting for. Hey, if you're a lucky 110, great. Now, when should you get worried? When you consistently see numbers that are in the 130s, 140s, or even above, that's when you should know these measurements are high, let me seek attention.

Dr. Jonathan Fialkow:

So talk about what one should do if they find their blood pressure readings a little consistently high. And I think the word consistent is important. What circumstances may someone find that blood pressure to be elevated during, but it's not hypertension. Are there other things that may raise a blood pressure, but you're not necessarily hypertension with that risk of organ damage?

Dr. Ian Del Conde:

Oh, definitely. And I think that we have identified a few things that are pretty common in life. For example, if somebody injures, for example, their knee or their back, and they're taking anti-inflammatories, NSAIDs, ibuprofen, that sort of medication, and they're taking it consistently everyday for few days, that can increase your blood pressure. Alcohol can also increase your blood pressure if you're taking it at elevated quantities over several days. And also emotional stress. This is something that we see in clinical practice. People who've been well controlled and they suddenly go through a period in life that is particularly stressful. And these do exist, unfortunately, but you can pinpoint that there is a correlation between emotional stress that can be prolonged and elevated blood pressures. So those sorts of things can lead to elevated blood pressures without you necessarily being hypertensive.

Dr. Jonathan Fialkow:

So speak if you would, those are great points. If you're angry and you're infuriated and yelling at someone, if you're in pain, you mentioned the anti-inflammatories, but being in pain itself can raise your blood pressure. So going back to that word consistently. So again, I have an argument with someone, the veins are bulging in my head, I feel flushed, I check my blood pressure was high. What would make me determine that, that's not hypertension? Speak a little bit to the consistency, the recurrent readings that one needs.

Dr. Ian Del Conde:

Right. So the best way to answer that situation is by getting additional data points. In other words, get additional measurements. And if you notice that most of your measurements are fine, but every now and then in a particular situation, it's elevated, in a way that can be normal. Again, blood pressures is a reflection of what's going on in our bodies, emotional state, et cetera, similar to the pulse, so the heart rate. If you make a number of measurements and regardless of your emotional state and hydration and activity, so on and so forth, they're elevated, well that puts you in a different category.

Dr. Jonathan Fialkow:

So again, great points. I think it's helpful for people to understand what is hypertension, how we identify it, not to scare people that every time they may be exposed to a reading that's elevated it means it's going to be a negative consequence. Take the time to get more data points, determine if you're really hypertensive. So now let's say someone is hypertensive. Young, middle aged, older. Let's talk about some of the more common things one can do to improve their blood pressure before we then get to medications and other things.

Dr. Ian Del Conde:

Yeah, so this is the most important question that I try to answer. When I see particularly a youngish person coming in with elevated blood pressures, you try to answer why has this person developed persistently elevated blood pressure? So you try to look for those reversible factors that can save the person from going on potentially lifelong drug therapies, which of course nobody wants. And certainly I, as a doctor, don't want to prescribe drug therapies for people necessarily. Sometimes it's necessary. But if you can find a reversible factor that explains it, that's the target then.

Dr. Ian Del Conde:

So you look for changes in weight. For example, in this COVID a pandemic, I have seen a fair number of people who have gained a significant amount of weight. And along with that, they have now developed high blood pressure. Well, their treatment, and so long as the blood pressure is not dangerously high, the treatment is not drug therapy, it's weight reduction. And that absolutely works in many, not all, but in many, most cases weight reduction will help. If somebody has developed sleep apnea, you treat the sleep apnea, not the hypertension, the hypertension will resolve. Also dietary changes. People are eating out, perhaps food delivery services, greater content of salt. You change your diet, you avoid that excess salt and people improve.

Dr. Jonathan Fialkow:

A lot of times people, when we identify they're hypertensive, they say, "I don't believe it. I've never been hypertensive before." Which of course it has to start at some point. So sometimes as you're saying you can identify something's that's changed in that person's life or experience that's now making them hypertensive. And age could be one of them, which of course we can't change. Talk a little bit about salt. If someone has a normal blood pressure and they're otherwise healthy and they eat a lot of salt, will they become hypertensive or is salt a target of something to lower if you are hypertensive? Another words, can it cause hypertension, or is it just one thing we look at in someone who needs to control hypertension?

Dr. Ian Del Conde:

So just be based on the way that the kidneys work, most people will experience an elevation in blood pressures if they increase their salt consumption. That's just physiology. And it's not necessarily a bad thing. But in some people who have developed hypertension, just high blood pressures, a reduction in the amount of salt that they consume can be very effective in reducing their blood pressure. We unfortunately are exposed to high salt foods. Salt is used as a preservative. So if you eat processed foods, things that you buy in the supermarket, perhaps restaurants, and it's already prepared, there's a good chance that it has a high salt content. And yeah, you should avoid them.

Dr. Jonathan Fialkow:

Is there such thing as too little salt in your diet?

Dr. Ian Del Conde:

Perhaps in very rare cases where your sodium levels are low. But that will not be an issue for the vast majority of people who are listening to this today.

Dr. Jonathan Fialkow:

Good. Fair enough. I want to take on medications a little bit, but before we do, is there any proof, is there any data there's genetic component to hypertension?

Dr. Ian Del Conde:

Yeah, I'm sorry, but this is also a great question. So why is hypertension so prevalent in the world? 30, 40 up to 50% of adults. Well, this is really interesting. And when you look at evolution of humans. Throughout civilization, humans have been exposed to drought. And many humans in the past, many people have died because of drought. During migrations, from Africa up to Europe and subsequently to America and Asia, it turns out that during that time, if you carried certain mutations that made you retain salt better, you were more resistant to that drought, more likely to survive the drought and therefore certain genes that encourage salt retention, sodium retention have been conserved in our modern populations. And it is believed that this is one of the reasons why we are hypertensive as a civilization. We have high levels of hypertension that is particularly salt sensitive. So I think that, that's where the genetics component comes into play.

Dr. Jonathan Fialkow:

It's a fascinating concept, the whole too much of a good thing. So you're saying that evolutionarily those that were able to retain salt, to maintain a blood pressure in a drought environment had a protective benefit. So it was something that was inherited, but now in our environment where-

Dr. Ian Del Conde:

Exactly. It's harmful.

Dr. Jonathan Fialkow:

Right. Same thing with, with calories, there's a consideration of anxiety and the stress response, and even clotting might be too much of a good thing. You're gored by the saber tooth tiger, you clotted, you survived to pass that gene down, but we're not really exposed the saber tooth tigers as much.

Dr. Ian Del Conde:

Exactly.

Dr. Jonathan Fialkow:

But it's fascinating. So medications. Don't want to talk about specific medications. I have a couple of general thoughts that I think might be worthwhile for the listeners. So the first thing is you're dealing with a medical problem, which produces no symptoms, telling the person that if they don't do something, whether it be a lifestyle change or take a medication, they may wind up with something. Talk about how difficult that is, if you will, as a doctor to get someone to take a medication for something that they don't feel to prevent something they may have?

Dr. Ian Del Conde:

I think that the problem is that we doctors don't spend enough time explaining to patients why is it that we're starting a certain medication. But the way that I do it is number one, I'm extremely sensitive and respectful with medications, especially in younger people. I don't want to take medications unnecessarily, and I don't want to prescribe medications unnecessarily, I always explain to patients that they need to change their mindset. They will be taking medications, not to treat an illness, but to stay healthy. And I think that the focus has to be that. Let's talk about health. Let's not talk about disease. Let's talk about health and how we can stay healthy.

Dr. Ian Del Conde:

The way that we both, Jon and I, we grew up, people took medications when they were sick. I think that things have changed. It is okay nowadays, there's enough data nowadays for you to be perfectly healthy and still there's a role for drug therapies to make sure that you continue being healthy. And that's the point that I make with patients. You're healthy, but your blood pressure is high, if we don't change course, it is expected that in the next 10 to 15 years, you may have damage to the heart, the eyes, the brain, the kidneys, et cetera. There's something we can do today, the best treatment is starting a medication.

Dr. Jonathan Fialkow:

That's well said. It's thru prevention, you want to do something now to avoid something down the road that's preventable. Do you ever take people off blood pressure medications? And if so, under what circumstances?

Dr. Ian Del Conde:

Yeah. I would like this to be much more common than it is, but I've certainly seen a lot of patients, many patients who manage to, for example, reduce a substantial amount of weight and their blood pressure, their hypertension completely disappears. So for some patients, a real bold change in their lifestyles will be large enough for them to be able to come off entirely drug therapy. And that's what I would wish for most patients, for all patients. But obviously that's not the case for all of them.

Dr. Jonathan Fialkow:

So the statement that, "Well, doc, I don't want to go on the medicine because I don't want to be on with the rest of my life." The argument is unless you change something to not be hypertensive, you will be on the medication. But then the consequences of that, if you want to talk about is the medications we use and maybe talk about the longterm safety profiles.

Dr. Ian Del Conde:

Correct. Especially when I see people with milder levels of hypertension, I usually like to explain what the deal is to them and give them a chance, four to six months, to really change their lifestyles. There is no urgency to starting these medications and the reality is that once they start them, they will probably stay on them for a long, long time. So it pays off to be gentle and to be gradual.

Dr. Jonathan Fialkow:

Fair enough. Can you then address the concept of saying you put them on, they're on the medications indefinitely. That doesn't mean if they feel something on a medication, there aren't options, they still should still discuss with the doctor, maybe this isn't the right medication for me. So it's not like you're on this and there's no room for conversation.

Dr. Ian Del Conde:

Absolutely. And the good thing about this is that we have so many different drug options available to us that we can find the right medication to the right person with essentially no side effects.

Dr. Jonathan Fialkow:

Before I get to the last topic, which is our resistant hypertension program, I just want to, again, elaborate on a point you did make, this is not an emergency. So the person who feels well, they get a checkup or they check the blood pressure, its elevated, they shouldn't walk in and they shouldn't walk out with a pill. It should be multiple readings over period of time, give them an opportunity to change their lifestyle. I think we do see a lot of anxiety related to the people who check the blood pressure and see a reading thinking, "Oh my God, it's high today. I'm going to have a bad outcome." Speak a little bit, this is a chronic process.

Dr. Ian Del Conde:

Yeah. It's a chronic process. And yet it's true. There's a lot of anxiety related to seeing that number. People play so much emphasis on that number. Which it's okay, but it also has its risks and anxiety is one of them. So tagging this conversation to the hypertension clinic that you were just about to start, that's the reason we, in the Hypertension Clinic at the Miami Cardiac and Vascular Institute, we have an open line of communication for patients to send their blood pressures, we review them and we provide almost immediate feedback to the patient. This is okay, continue what you're doing, or now it's time to make some adjustment to your regimen. But that constant loop of information is critical for the successful management of hypertension.

Dr. Jonathan Fialkow:

So talk about the program. So what are the kinds of people... Let me rephrase that. What are the patient criteria that would make you say, this is an appropriate person to be referred to a higher level of hypertension evaluation? What's done in the program that makes it unique?

Dr. Ian Del Conde:

So the reason we started the Hypertension Clinic at Baptist or Miami Cardiac and Vascular Institute is because of the knowledge that approximately half of all hypertensive patients are not well controlled despite them seeing their doctor on a regular basis and despite the fact that they're taking medications for blood pressure. So we realized that we needed to provide a service to patients with a goal of controlling their blood pressure. So the way that the program is structured is patients need to have a blood pressure monitor at home, they keep a blood pressure diary, and there was a specific way we want them to check their blood pressure. Once a day at completely random times, using an upper arm cuff, not the wrist cuff, upper arm, an electronic automated machine. They keep a blood pressure diary and they send us their measurements, their logs, and we review them.

Dr. Ian Del Conde:

And when it's time, we pull the trigger, and occasionally we started drug therapies. Of course, everyone with elevated blood pressure is also under goes counseling on lifestyle changes, on dietary changes, weight reduction, and some people we pursue further evaluation for other conditions, such as obstructive sleep apnea or for more uncommon conditions that can cause high blood pressure. But the goal is to really get patients checking their blood pressure, sending us the readings, and we make quick assessments and changes to their regimen with the goal of having them well controlled on a drug therapy that is working for them within the first couple of months or so. That's the goal, certainly. It's a comprehensive service. And it started initially for patients with resistant hypertension, which are patients that are more difficult to control, but we have been expanding the service to patients who are simply not well controlled for whatever reason. We can take care of them.

Dr. Jonathan Fialkow:

And I think again, to clarify your original introduction statements about the program, that's not an indictment of the community or the physicians to say that most people aren't controlled, these are national trends having to do with whether we're not recognizing their hypertensive or the followup is not a robust or in depth or the patient may have a bad reaction to medication and say, "I give up." So I think it's a higher level of service to get those patients on the control. So again, it's great. It's very innovative. I think the patient satisfaction is great. You've given us tons of information, Ian, and it's always a pleasure having you as a guest. We talked about what is hypertension, why it's important. And we talked about how to identify it, medications, and again, resistant hypertension, the Hypertension Program at Miami Cardiac and Vascular Institute. So any final comments you'd like to mention to the listeners or anything you want to reiterate?

Dr. Ian Del Conde:

The only thing that I would say is the same way that you know exactly how much money you have in your bank account, or how much gas you have in your car, you need to know what your numbers are. Your blood pressure, your glucose or cholesterol. But because today we're talking about hypertension, I'll reiterate it, know your blood pressure numbers, get a device, check your blood pressure at home.

Dr. Jonathan Fialkow:

Thanks again. A little bit lengthier than our usual podcast but the information is so cogent and so helpful. Ian, really appreciate the time. Go back to work.

Dr. Ian Del Conde:

My pleasure. Thank you.

Dr. Jonathan Fialkow:

And to listeners as usual, if you have any comments, thoughts, ideas for future topics, for our Baptist Health Talk, please email us at baptisthealthtalk@baptisthealth.net. Stay safe, mask up.

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