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Do You Know the Effect of Your Blood Pressure Numbers

Dr. Mosher discusses the effects of blood pressure numbers. 

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Do You Know the Effect of Your Blood Pressure Numbers
Featured Speaker:
Laura Mosher, MD
Dr. Laura Mosher is board certified in interventional cardiology, nuclear cardiology, cardiovascular diseases and adult echocardiography. She has participated in numerous peer groups and written articles on cardiovascular disease. Dr. Mosher’s clinical interests include cardiovascular disease prevention, chronic angina and women’s cardiovascular health. She is a member of the American Heart Association and has served on its board of directors.

Introduction: Here's another edition of the BayCare Health System’s Podcast series, BayCare HealthChat with Melanie Cole.

Melanie Cole: Welcome to BayCare HealthChat. I'm Melanie Cole, and today we're discussing high blood pressure or hypertension. Joining me is Dr. Laura Mosher. She's Board Certified in Interventional Cardiology, Nuclear Cardiology, Cardiovascular Diseases and Adult Echocardiography at BayCare. Dr. Mosher, it's a pleasure to have you join us again. For the listeners, let's have a little physiology lesson. What is blood pressure?

Dr. Mosher: Blood pressure is essentially the force of the blood that exerts on the arterial walls within the body.

Host: Tell us a little bit about how it's measured. What do those numbers mean and what is considered high blood pressure?

Dr. Mosher: So blood pressure is measured by two numbers. The top number is what we call the systolic blood pressure. That is the force of the blood. That's the pressure measurement. When the heart is squeezing, the bottom number is the diastolic number, which is the pressure that's measured when the heart is relaxing. Most of the time we check the blood pressure in one of the upper extremities, either a left or right arm with the blood pressure cuff. What is considered a normal blood pressure is 120 over 80, so 120 for the systolic reading and 80 for the diastolic reading. Elevated blood pressure is considered when the systolic number is 120 to 129 we call that elevated blood pressure or sort of pre hypertension. We don't call it hypertension yet when it's in that range. Currently stage one hypertension is considered when the systolic number is 130 to 139 or the bottom number, the diastolic is 80 to 89 so that's stage one Hypertension. What's classified as stage two hypertension is when the top number, the systolic is above 140 and or the bottom number is above 90.

Host: So that's recently changed, hasn't it? I mean they've lowered those numbers now for indicators of hypertension or you know, baseline. So tell us a little bit about why that happened, do you think?

Dr. Mosher: Right. The blood pressure goal has been a bit of a moving target recently. I think what we're seeing is that people with blood pressure that's not well controlled are starting to have complications from it such as stroke and heart disease or kidney problems and we want to avoid that so we've become more aggressive in treating blood pressure to a more normal level.

Host: So then let's talk about taking blood pressure and when you determine that it's considered high and something that you want to treat, first of all, sometimes people come into the doctor, they get their blood pressure taken and it's high. With this white coat effect, they're nervous, maybe they're a little scared to be there. When do you really determine that it is high and what is the first line of defense Dr. Mosher?

Dr. Mosher: What I would typically do when someone comes into the office and they have elevated blood pressure reading, I recheck it again while they're there sitting in the office because sometimes the first reading is falsely elevated or like you said, people can be stressed and nervous and the blood pressure can be high. I also make sure that when I recheck it, I use one of those old fashioned pump up blood pressure cuff on the upper arm. I make sure that the patient is sitting in a chair where their back is relaxed against the back of the chair. And I make sure that their legs are uncrossed and the feet are on the floor and that the patient is as relaxed as they possibly can be in the office. And that's going to give us the most accurate reading there in the office. So I'll document what that number is and typically what I'll do is, unless the blood pressure is just insanely high and in the danger zone, I really hesitate to call someone or tell someone that they have high blood pressure based on just one reading.

Usually doctors will do a couple of readings and make sure that we are certain that this person has high blood pressure. Oftentimes what I also do is have patients take a log home with them and they write down blood pressure numbers that they take at home. Now this does require that the patient has their own blood pressure cuff or some reliable way of checking it at home when they're in their happy place and the comfort zone and see what those numbers are at home. Because you're right. Sometimes people just always chronically have higher blood pressures when they come to the office, but 99% of the time when they're not at the doctor, the blood pressure is okay.

Host: So then what is the first line of defense? What do you do if you do determine that someone is hypertensive or tending towards a rising blood pressure? Do you start with medications? Do you start with exercise and diet? What do you do for them?

Dr. Mosher: I try to actually start with lifestyle modification and that would be cutting back on some of the risk factors. So I would recommend people stop smoking, moderate weight loss, decrease sodium in their diet, decrease alcohol intake, and decrease stress as much as possible and increase exercise. So some of those lifestyle interventions can be very helpful in bringing the blood pressure down, such to a range that people may not actually need medication. Now. If that doesn't work, then we may start a low dose blood pressure pill and get people back on track if those lifestyle interventions don't work.

Host: So you mentioned a few of the lifestyle changes you would like people to do. Are those really the risk factors for hypertension, for high blood pressure - obesity, smoking, stress? Is that a risk factor? Something that could contribute to high blood pressure? And while you're answering that, Dr. Mosher, can you feel it if you have high blood pressure? I get asked this question all the time. Can you feel it if your blood pressure is high?

Dr. Mosher: What's interesting is a lot of times no and people can go many years with having high blood pressure and not know it because they may not have symptoms at all. That's why routine blood pressure checks in the doctor's office during a routine physical exam are so important because we don't want people to have untreated blood pressure for a long time. Now, if people do have symptoms from high blood pressure, they may experience something like headaches or shortness of breath or a nose bleed, things like that. But usually that doesn't happen until the blood pressure is really, really high and that's what we want to avoid.

Host: So then tell us a little bit about what medications are intended to do. There's a lot of them on the market. We've heard about diuretics and beta blockers and ACE inhibitors and all these things. What are they intended to do, Dr. Mosher?

Dr. Mosher: Really the goal of those medications is to bring the blood pressure back down into a normal range and thereby we feel a decrease of the patient's risk of complications from having high blood pressure such as heart attack, stroke, or kidney damage.

Host: Let's go back to lifestyle for just a second. Salt, it's been demonized and it's part of the contributing factor in diet to hypertension. What advice do you give people about their diet and about how much exercise is really needed to bring that blood pressure down?

Dr. Mosher: In terms of diet to bring blood pressure down, the biggest thing is to reduce the sodium as you mentioned. I typically recommend people intake 2000 milligrams or 2,500 milligrams or less per day to decrease blood pressure levels. Also alcohol can contribute to blood pressure levels as well. And the recommendations currently are for no more than one alcoholic beverage for women per day and no more than two alcoholic beverages for a man each day. Those are the current guidelines. So if people are partaking in more alcohol than that, they should really try to cut back and this could help improve blood pressure as well. In terms of exercise, the recommendation would be exercise five days a week for 30 minutes per day. Now it doesn't have to be super intense exercise even walking would be fine and it can be split up throughout the day. You don't have to do 30 minutes all at once.

Host: This is really important information and really a great segment. You've explained all of this so very well. Wrap it up for us, Dr. Mosher, with what you would like people to know about the importance of knowing our numbers, of having our blood pressure checked regularly – it’s a very important vital sign - and talking to their doctors if they have questions about their blood pressure or they need help to bring it down.

Dr. Mosher: So I want people to realize that everyone over the age of 35 needs to have a routine blood pressure check at least once a year. Go see your doctor once a year, know what your numbers are. If your doctor has a concern, they will follow you up more closely and make sure that the blood pressure is not elevated. If you are diagnosed with high blood pressure, important things to do would be to stop smoking, decrease sodium intake, achieve an ideal body weight, decrease stress as much as possible, decrease alcohol intake and get routine and regular exercise. Those can all be very beneficial and then if you do find yourself needing blood pressure medication, then it is very important to follow up with your doctor on a regular basis to make sure that the blood pressure is well controlled on the medication and that you're not having any side effects from those medications.

Host: Thank you again, Dr. Mosher as always, you're a great guest and so informative. Thank you for joining us today. To learn more about BayCare's Heart and Vascular Services, please visit our website at for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts, and please share this show with your friends and family on social media. I'm sure you know someone who has high blood pressure and they can learn from the experts at BayCare. This is Melanie Cole.