Participants: Christine Salter
Series Code: WM
Program Code: WM000339
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00:01 The following program presents principles
00:03 designed to promote good health and is not 00:04 intended to take the place of 00:05 personalized professional care. 00:08 The opinions and ideas expressed are those of 00:10 the speaker. Viewers are encouraged to draw their 00:13 own conclusions about the information presented. 00:37 Welcome to Wonderfully Made. 00:39 Our topic today is High Blood Pressure. 00:42 My name is Dr. Christine Salter. I'm board certified 00:46 in Family Medicine, and I'm the medical director 00:48 of Vibrant Health Family Medicine in St Louis, 00:50 Missouri. High blood pressure otherwise know 00:54 as hypertension. It affects 15 million people in the 00:59 United States and is known as a silent killer. 01:02 Why a silent killer? Because many people do 01:06 not have any symptoms of high blood pressure, 01:09 but it contributes two of the three major killers 01:14 in the United States. The number 1 is heart 01:18 disease and number 2 is stroke. 01:25 High blood pressure is defined as a systolic 01:29 blood pressure 140/90 or greater. 01:32 What do you mean by systolic blood pressure? 01:36 When the heart pumps it generates a pressure we 01:40 call that systole or systolic pressure when it relaxes. 01:44 There is a resting pressure we call that diastole or 01:48 diastolic pressure. So, when you go to a 01:51 doctor they say your blood pressure is 160/90 01:55 that means that your heart generated a systolic 01:59 pressure of 160 and when it relaxed it had a 02:03 resting pressure of 90. Why do we even care 02:08 about high blood pressure? Well it silent and it will 02:15 kill and people just don't realize that they 02:18 have the problem. So, how is it diagnosed? 02:23 You have to see your doctor or at least visit a 02:26 practitioner that can take your blood pressure. 02:30 They use a cuff around your arm. And they are 02:33 able to pump that cuff up and generate that 02:37 pressure and tell you if your blood pressure is normal. 02:42 And you may ask what is normal? 02:46 Normal is less than 140/90, but that is not 02:51 optimal. What is optimal? We would like to see 02:56 your blood pressure at 110/70 or even 60. 03:05 Now for some people if they have a blood 03:06 pressure of 90/60 they may get disease and so 03:10 that's not normal for them. On the other hand, 03:16 if you have a blood pressure of 90/60, but you 03:19 are exercising and you feel just fine and that 03:21 blood pressure is just fine for you. 03:24 As the blood pressure increases 90/60, 100/70, 03:31 120/80, 130/85, 140/90 that's generating higher 03:40 pressures and that cause the problem with the 03:44 blood vessels in addition with the heart too. 03:48 What does the heart do? The heart gets bigger 03:54 and fatter, what happens to the blood vessels. 03:59 When that pressure is generated damages the 04:03 blood vessels and if you have an addition to high 04:06 blood pressure, high cholesterol also then that 04:11 high cholesterol building up along the vessels, 04:15 along with this high pressure causes damage 04:20 and clots like to form there. Hence high blood 04:25 pressure is the number one risk factor for stroke. 04:32 It also contributes to heart attack 04:35 and congestive heart failure. 04:39 So, what can you do about it, either to prevent 04:43 having high blood pressure or to treat it 04:46 once you have it. Recent guidelines call the JNC 7 04:52 Guidelines have told us that the foundation for the 04:58 treatment of high blood pressure as was for the 05:01 prevention lifestyle factors. 05:05 What all those lifestyle factors? 05:10 Weight reduction, unfortunately 05:14 obesity and overweight is increased in an alarming 05:18 rate not only in the United States, 05:20 but worldwide. By 2030, they estimate that there 05:26 will be 300 million people who have obesity. 05:32 So, obesity and overweight contribute to high blood 05:36 pressure. And so if you have high blood pressure, 05:40 we would like you to work on losing just 10% 05:45 of your weight. So, if you are 200 pounds 05:49 would like you to lose about 20 pounds or just 05:52 a little more. So, weight management that's the 05:56 first lifestyle factor known to prevent and 06:00 treat high blood pressure according to the JNC 7 06:04 Guidelines. What is the second? Physical activity, 06:11 unfortunately in the United States and other 06:14 developed countries, where used to being 06:16 inactive. We sit in front of the TV, we use the 06:20 remote control, we roll around on stools, we take 06:24 the escalators, we take the elevators. 06:28 We need to have a more physically active lifestyle. 06:33 So, park little farther from work and walk, 06:38 take the stairs, instead of the 06:39 elevator or the escalator. Get up and change the 06:44 TV channel or better still go for a walk instead 06:48 of watching the TV. We would like you to 06:52 have physically active lifestyle. 06:55 I would like you to engage in exercise that 07:00 is moderate and intensity, that's about 3 miles per 07:04 hour walking. So, if you can do that for about 07:08 30 minutes at least 30 minutes ideally 07:13 60 minutes that will help lower your blood pressure 07:20 and independently help you lose weight, 07:24 it's all the balance in act. If you are taking more 07:29 calories then you put out you are simply going to 07:32 gain weight. If you are taking the same amounts 07:36 of calories as you put out, your weight is gonna stay 07:39 the same. If you are taking less and put out 07:43 more, it's simple mathematics you will lose weight. 07:47 So, you either decrease your caloric intake or 07:50 increase your physical activity. 07:54 Let's recap, weight reduction, physical activity, 08:00 that's moderate in intensity for at least 30 08:03 minutes a day. What's the third thing? 08:08 Salt restriction, unfortunately again in the 08:13 United States and other developed countries, 08:16 we like to use lot of salt, that salt shaker is used 08:21 while cooking, it's used after cooking and we like 08:25 to go to restaurants that have a lot foods 08:29 that have lot of salt in them. We like to use 08:32 ketchup, we like to get French Fries, we like to 08:34 add salt to the French Fries that will raise the 08:38 blood pressure by increasing amount of sodium and 08:43 where sodium goes water follows. 08:46 And so we have an increase in volume 08:48 resulting in an increased pressure. 08:52 So, we would like you to decrease your salt intake. 08:56 We only need about a teaspoon of salt or 2.5 09:01 or 2.4 grams of sodium a day. So, how you're going 09:06 to know if you are getting too much salt? 09:10 You have to read your labels. When you go to 09:13 the store read your labels and find out how much 09:17 salt is in a serving. Some people are getting 09:23 all the salt they need just at one meal and clearly 09:27 that is a problem. So, we would like you 09:30 to put down the salt shaker and not add salt 09:34 to your cooking and ideally eat foods that are 09:39 not high in salts. Some of the cheeses are very 09:41 high in salt, tomato sauce, tomato ketchup these are 09:45 high in salt. Chinese food in particular is 09:49 fairly high in salt. So, we hope that's not your 09:52 regular fare. And so we said weight reduction 09:57 is one of the lifestyle interventions, 10:00 physical activity, and salt restriction. 10:05 What is the fourth one? The fourth one is referred 10:08 to as the Dash Diet. What is the Dash Diet? 10:14 Dash stands for the dietary approach to stop 10:17 hypertension and is composed 10:20 of several food groups. Whole grains, fruits, 10:24 vegetables, low fat dairy, lean meats, nuts, and 10:29 legumes. Why do we need these food groups? 10:35 They supply fiber. Fibers been shown in 10:39 clinical trials to lower blood pressure. 10:42 They also supply essential fatty acids. 10:47 They decrease the inflammation in the blood 10:50 vessels and also help to lower the blood pressure. 10:55 What about the fruits and the vegetables 10:58 they supply potassium, magnesium, and calcium. 11:04 What did they do? They also lower the 11:08 blood pressure. Now if you are eating a lot of 11:12 salt that might cause an imbalance with the 11:15 potassium because it's the potassium to sodium 11:18 ratio that is really important. 11:21 So, not only do we want you to increase those 11:24 fruits and vegetables, we also want you to 11:27 decrease the sodium as we have said previously. 11:32 Dash might also be used to say Dash to exercise. 11:40 Use just a dash of salt, implement the Dash Diet. 11:47 This will apply whether you eat meat or whether 11:50 you are vegetarian or whether you are vegan. 11:55 What about alcohol? Alcohol is the problem, 12:02 although the JNC 7 Guidelines says for men 12:05 want no more then one to two drinks a day 12:07 and woman no more than one drink a day. 12:10 As in the Adventists and quote to biblical 12:13 principles, alcohol is not good for the heart, 12:17 for the brain. It is one of the number reasons 12:21 for car accidents and so we do not endorsee 12:24 alcohol at all. And so we will talk about a 12:28 modified JNC 7 Guideline that says no 12:32 alcohol, lose weight, increase exercise and 12:38 physical activity, decrease salt and 12:41 implement the Dash Diet. But, there are some other 12:45 factors that affect blood pressure. 12:48 The use of caffeine, tea, coffee, soda. 12:53 Some people drink these beverages 12:55 through out the day. If you have high blood 12:59 pressure, we want you to eliminate those beverages. 13:03 And you may see your blood pressure come down. 13:06 What about nicotine that we find in cigarette smoke? 13:10 That can also raise the blood pressure again if 13:14 you are a smoker and your blood pressure is not 13:17 controlled, we want you to quit smoking and there 13:20 are several other reasons why you 13:22 should quit smoking. High blood pressure 13:25 is just one of them. Medicines can also be 13:30 used to treat high blood pressure, but the all 13:33 medicines that you maybe taking that maybe 13:36 aggravating your blood pressure and what are they? 13:41 I said general class they are called nonsteroidal 13:44 antiinflammatory drugs, nonsteroidal 13:48 antiinflammatory drugs; Motrin, ibuprofen, Aleve, 13:56 Advil, Celebrex, Vioxx these are all nonsteroidals 14:00 and they cause sodium to be retained and as we 14:03 said earlier, where sodium goes were to 14:07 follows we get an increase in blood pressure. 14:12 I have had patients who ordinary have been 14:14 controlled with their blood pressure and then 14:16 all of a sudden that blood pressure has gone up to 14:19 190/100. And it was found that they just 14:26 recently had a root canal done and the 14:30 dentist prescribed ibuprofen and they 14:34 were taking this two or three times a day for 14:37 several days and as result the blood pressure went up. 14:41 If you are using Advil, Motrin or any of the 14:45 nonsteroidal antiinflammatories 14:47 talk to a doctor about changing to another 14:50 pain medicine. But, there are some drugs that 14:55 are used to treat blood pressure and if you 14:58 present to your physician with a blood pressure 15:01 of 160/100 or higher in addition to the lifestyle 15:08 measures, your physician may also start you on 15:11 some antihypertensive medicines. 15:15 We want you to understand that those 15:17 medicines are only a temporary measure to 15:20 get your blood pressure controlled while you are 15:22 implementing those lifestyle measures. 15:28 Again lifestyle is the foundation for the 15:31 treatment of high blood pressure. 15:35 What about stress? How does that implement 15:39 or affect high blood pressure? 15:44 Stress can cause an increase in blood pressure 15:49 and it doesn't mean that you are necessarily an 15:51 anxious person. People who internalize stress 15:55 and on the outside look calm may also have 15:59 high blood pressure or what we call increased 16:02 sympathetic tone. The heart may rise little 16:07 faster instead of resting heart rate of maybe 70 16:12 beats per minute. The heart rate is run about 16:14 90 beats per minute. Clearly not abnormal, but 16:19 really isn't normal either. So, if you are somebody 16:24 who internalizes stress that you are not able to 16:28 cry or verbalize, we will need to do something 16:32 about that. You may need to see a counselor 16:36 to talk about the stressful events that's going on 16:40 in your life. What about the way that we breathe, 16:45 how does that effect blood pressure? 16:50 Most people breathe shallowly. So, as we take 16:56 a deep breath up go the shoulders. 16:59 That's not the way to take a deep breath. 17:02 If you are going to take a deep breath, we wanted 17:03 to be diaphragmatic breathing so that when 17:06 you inhale your diaphragm flattens, the breath is 17:11 taken deep and the chest expands. 17:16 What does that have to do high blood pressure? 17:19 When we breathe deeply it actually decreases the 17:24 sympathetic tone and we have just mentioned that 17:29 an increased sympathetic tone can raise 17:32 the blood pressure. And so as we can see a 17:38 whole lifestyle the way that we eat, the way that 17:43 we move, the toxins that we may take into our 17:47 bodies such as caffeine, alcohol, cigarette smoke, 17:54 the way that we think and the way that we handle 17:56 stress will all affect the blood pressure. 18:01 And so we don't want you to look for that magic 18:04 bullet to treat your high blood pressure. 18:07 Don't think of you are a diuretic or your calcium 18:11 channel blocker that your physician is prescribing 18:14 as the only way to treat your blood pressure. 18:17 You have to look it in an integrated fashion 18:21 looking all the different aspects that will affect 18:25 your blood pressure. Even the way that we sleep 18:29 and getting an adequate amount of sleep will also 18:33 affect our blood pressure. So, we want you to go to 18:37 bed on time at a regular time and also wakeup at 18:44 a regular time. Why is that important? 18:46 Because the body is clearly, fearfully, 18:50 wonderfully made as the Bible says and is 18:53 created to operate on circadian rhythms. 18:57 There are rhythms for us to sleep, there are 19:00 rhythms for us to eat, there are rhythms when 19:03 then hormones are released. If we are doing things 19:07 irregularly going to sleep at irregular times not 19:10 exercising then that hormone release goes into 19:14 a state of dysregulation and that can also affect 19:19 the blood pressure. And so we can see that 19:24 just simply doing some simple 19:26 lifestyle interventions. You will lower blood 19:30 pressure and decrease your chance from 19:35 sudden death, congestive heart failure, and stroke. 19:42 Unfortunately, stroke of course may not kill the 19:47 person right away, but it causes major morbidity. 19:53 What do we mean by morbidity? 19:56 A person who was ordinarily functioning 19:58 well now is not able to walk properly, may not 20:02 be able to speak properly, may not be able to use 20:05 their hand and be able to write all because that 20:11 uncontrolled high blood pressure. 20:16 And so the first step to take is to find out do you 20:23 have high blood pressure. Visit your physician go to 20:27 the mall where they can check your blood pressure. 20:30 And find out do you have high blood pressure, 20:32 if you do go to your physician and follow your 20:36 physician's guidelines. The lifestyle and if 20:40 needed medicines. Let me give you a case study. 20:46 An African-American gentleman who is about 20:48 50 years old who came in for a cold and of course 20:54 as part of our routine evaluation we took his 20:57 blood pressure. It was 170/100. 21:05 What was that to do with this gentleman? 21:07 I treated his cold of course, but he had to stay 21:11 a little longer while I counseled him about high 21:16 blood pressure and the fact that he is 21:18 African-American increases risk even more 21:23 and so we talked about losing weight. 21:30 We talked about exercise, he smiled, he laughed, 21:35 I don't have time to exercise, 21:37 I'm too busy working. I told him he does have 21:42 enough time not to exercise. 21:45 We talked about the Dash Diet. Oh, but he likes 21:50 his pork and he likes his Chinese food and he 21:55 likes his French Fries. Fruits and vegetables, 21:59 oh he doesn't like those. He can't afford not 22:04 to like those. And I counseled him to this effect. 22:10 Hypertension is a killer, it kills by causing 22:16 strokes, it kills by causing heart attacks, 22:21 it kills by causing congestive heart failure. 22:26 In elderly individuals, congestive heart failure is 22:29 one of the commonest reasons for hospitalization. 22:34 And so I have to impress up on him as I now 22:37 impress upon you that if you have high blood 22:41 pressure it is nothing to smile or laugh about, 22:45 it is something very serious. We want you to 22:50 exercise, treat exercise as though it was a medicine. 22:59 I actually write prescriptions for my 23:01 patients as I did for this gentleman. 23:04 30 minute five times a week at least and he is 23:12 given a written prescription. He is given a prescription 23:14 to eat fruits, vegetables, whole grains. 23:19 In fact, I encourage him to become a vegetarian 23:22 if possible because that would be healthier for him. 23:29 By becoming vegetarian, he would decrease the 23:32 salt and increase the potassium and 23:36 magnesium or fiber. Let's keep in mind for 23:39 those vegetarians, who use a lot of the protein 23:42 analogs that they are also high in salt. 23:45 So, be careful read your labels. 23:50 When you go to the store try to stick to the 23:54 parameter of the store. Where you find the fruits 23:58 and the vegetables and the whole grains, try and 24:01 avoid those middle sections where you find 24:04 the canned products that are so high in salt, 24:09 where you find the processed products that 24:12 are so high in salt. Stick to the periphery, 24:16 make a plan as you go to the store this what 24:21 I told this gentleman also. Plan to exercise, plan to 24:26 implement that Dash Diet. And if you drink alcohol 24:30 now is the time to stop, if you smokes now is the 24:36 time to stop. Caffeine, I ask this patient to 24:43 replace the Pepsis that you drinks 12 ounces or 24:49 16 ounce a time by plain water. Water is the best 24:56 beverage for the body. So, what prescriptions did 25:03 he have when he left my office indeed he did have 25:07 a prescription for a diuretic, 25:13 he had a prescription to exercise, he had a 25:16 prescription to implement the Dash Diet, he had 25:20 a prescription to strictly avoid alcohol, he had a 25:24 prescription to strictly avoid caffeine. 25:28 I also asked him to replace the Motrin that 25:33 he was using for his occasional headaches 25:37 with something like Tylenol. 25:42 All these things together will work together to 25:48 lower his blood pressure and indeed after about a 25:51 month of therapy, he came back and his blood 25:54 pressure was down to 150/80. Now what that 26:01 is better then the original blood pressure, 26:04 it's clearly not at goal. And so I can reiterated 26:10 the importance for him to implement those 26:12 prescriptions the same way that he takes the 26:14 diuretic faithfully he is to also implement the 26:18 exercise faithfully. He is also to implement 26:21 the fruits, vegetables and whole grains faithfully. 26:25 He is to replace the caffeinated beverages 26:29 with water or at least diluted juices that are 26:34 non-caffeinated. Again after a month of 26:39 therapy that blood pressure came down 26:42 some more 130/80. That's much better, 26:48 but again we know that it's still not at goal, 26:52 the goal is to get him down to about 115/75 26:58 that's way we need to be because at levels about 27:01 that, that's where we get increased risk for 27:05 cardiovascular events for stroke, heart attack, 27:11 and also kidney failure. So, the blood pressure 27:16 again is not just affecting the brain not just the 27:20 heart, but it also affects the kidneys. 27:23 And so all these lifestyle interventions together in 27:27 addition to carefully chosen medicines is 27:31 what bring his blood pressure down. 27:34 Truly we are fearfully wonderfully made, 27:37 the Lord our creator made the wonderful circulatory 27:39 system to pump blood to the brain, to the heart 27:43 and to the kidneys to supply these vital organs 27:46 and other vital organs not to have high blood 27:50 pressure that can cause rupture of the vessels or 27:53 to cause rupture of the major vessels running 27:56 through the chest and abdomen or to cause 27:59 kidney failure. Truly, he is woven us in our 28:03 innermost being. I wish above all things that 28:06 you will prosper being in health even as your soul 28:10 prospers, the Lord be with you. |
Revised 2014-12-17