Uncontrolled high blood pressure–or hypertension– is called “the silent killer” because it has no symptoms but can lead to heart attack, heart disease, congestive heart failure, stroke, kidney damage, vision loss and memory loss, among other problems.
Unfortunately, one in every four American adults has hypertension, often related to obesity, diabetes or other conditions.
Heart disease is one of the most serious health problems of modern times.
The nation’s leading cause of death, heart disease claims the lives of nearly 1 million Americans each year.
Dr. Troy Randle is here to discuss hypertension and cardiovascular disease.
Hypertension and Cardiovascular Disease
From the Show: Lourdes Health Talk
Summary:
Air Date: 12/9/15
Duration: 10 Minutes
Transcription:
heartMelanie Cole (Host): Lourdes Health System is one of the largest providers of cardiac services in the entire Delaware Valley. The experience that comes from this also helps to make Lourdes one of the best in the nation. We’re talking today with Dr. Troy Randle. He is a cardiologist with Lourdes Health System. Welcome to the show, Dr. Randle. What is high blood pressure and how does it contribute to cardiovascular disease?
Dr. Troy Randle (Guest): Thanks for having me on the show, Melanie. High blood pressure – we tend to say “hypertension” but when I explain it, I want you to know that high blood pressure is similar to a weight. When we lift weights, our muscles tend to get big and strong and thick. However, the heart is a muscle. Blood pressure is a weight that the heart has to pump against. The problem with the heart pumping against the elevated blood pressure is, the heart then starts to get thick and, unlike our outside muscles which gives us strength, when the heart gets thick it becomes stiff. It then leads to things such as heart failure. We can have stroke. We can have a high risk of heart disease and heart attacks as well. Over time, it can also affect your vision. It can affect your kidney function as well. So, it’s very important to get the blood pressure under control.
Melanie: What are some risk factors for high blood pressure?
Dr. Randle: The biggest risk factor is genetic. When you have a family history, that’s the one thing that you want to try to keep in mind. Other things outside of family history are then the lifestyle changes that you have. Things that you control. I always tell people that there are things that we can control and things that we can’t control. The thing that I can’t control is, I can’t control my genetic make-up. Unfortunately, the genes that my parents passed on to me is kind of what I have. I can’t control my age. Age is a risk factor. As I get older, I’m going to have a higher incidence of having heart disease and high blood pressure and I can’t control that. I can do things to make myself look younger but the age that chronologically I have is always going to be the same. The other thing I can’t control is my gender. Unfortunately, we can do things to make ourself look a different gender but the gender make up that we were born with, those things I can’t change. Those things are the biggest risk factors that you can’t change. In terms of risk factors that you can change become lifestyle activities. So, your diet. Trying to watch your diet—a low salt diet and trying to cut back on foods that have higher cholesterol or higher fat. I think you want to try to limit your sodium, your sweets, trying to limit red meats. That will help you. Smoking is another big risk factor. I try to encourage you to cut down on smoking as well. Hopefully, you avoid it and stop smoking all together. That’s one of the things that we try to emphasize as well. Another one is alcohol. Alcohol definitely is a big risk factor for high blood pressure as well, so trying to limit your alcohol intake. What some people don’t realize is activity level. Your weight, obesity and being inactive is going to put you at a higher risk as well.
Melanie: When does blood pressure require medicational intervention? When do you say, “Okay. You’ve tried changing some of your diet and gotten a little bit active but now we need to put you on some of the medications”? Explain just a little bit briefly about what these medications are intended to do, Dr. Randle, because people do not understand and you see so much in the media and commercials about all of these different medications. What are they intended to do?
Dr. Randle: As to the first part of the question, “When do I start medication?”, when we talk about high blood pressure there are different goals that we have in mind. The numbers are always somewhat controversial in term of what is a big target goal. There are all these different studies that come out but I think that the biggest consensus among everybody is we want to shoot for 120 over 80. That’s ideal. Then, we have different stages. When I say 120 – that top number we call “systolic blood pressure”. The bottom number--the 80--is diastolic. The top number is referring to what the blood pressure is doing when the heart is actually contracting and pushing blood out to the body. The bottom number is the blood pressure in your vessels when the heart is relaxing. When we’re younger, we tend to focus more on the bottom number because that is the better indication of high blood pressure. I definitely want to target that. As we get older we tend to focus a little bit on the top number. Our ideal goal is 120 over 80. I start talking about treatment when I see blood pressure is around 140 over 90. A lot of people are resistant to medications and I understand that. A lot of people want to try lifestyle modifications. I’m willing to be a little liberal and work with you as long as your blood pressure is not over 140 over 90 and give you a chance to modify things. Once you get over 140 over 90, then I want to start talking about medication. There are different medications that we can use. The idea of the medications, again, is to lower the blood pressure so that we don’t have the affects that we talked about before of heart failure, stroke, kidney damage – and that’s our goal. One of the things that I hear when we talk about medications is the side effects of medications. When you hear all of the different medicines on the media, everybody talks about side effects of medication. I would say different medicines have different side effects. But, when we talk about the side effects of medication I think we also need to talk about the side effects of the disease process. I don’t know if many of us think about the side effect of high blood pressure. I understand that there are medications, for example, calcium channel blockers that we use to lower blood pressure and the biggest side effect that we worry about with that is having some edema or swelling. There are medications that may affect the kidneys. There are medications that slow the heart rate down and may make you a little bit tired, fatigued. Those are the things that I think that people tend to focus on but yet I want to say, what are the side effects of hypertension? The biggest side effect of hypertension is, again, do you want to have a stroke? Do you want to have heart failure? Do you want to have a heart attack? To you want to be on dialysis because you have kidney failure?
Melanie: Wow. That is so well put and such important information. How often do you want people keeping track and taking their blood pressure? Do you want people to getting home sphygmomanometers? Do you want them going to their local drug store and checking it there? How often do you want it to be monitored?
Dr. Randle: I ask people to have their own home blood pressure measurement kits especially to keep an eye themselves. One of the precepts that I have is white coat type hypertension. “My blood pressure is only elevated when I come to see you in the office.” What I encourage, then, is you have a blood pressure cuff at home. Bring it with you to the office when you come to visit. Part of the reason is if my number is higher than your cuff, I want to at least correlate to make sure that we’re seeing the same thing. Let’s say, for example, at home you’re getting 120 and in the office I’m getting 140, then we know that the numbers are about the same. One, I like to calibrate what you are measuring at home towards what I am doing in the office. The second part of it is, how frequently? I tend not to try to be too stringent because I find that as I become stringent people are less compliant. I usually ask you if you can measure your blood pressure at least once a day, three to five times a week and kind of give us an idea. Ideally, I would like to have two to three measurements a day but if you can get me at least one, I’m okay with that and different times of the day. The morning blood pressure may be different than the afternoon blood pressure which may be different than the evening blood pressure. I like to see exactly what your blood pressure is, the time of day it is and I ask you to keep a diary of that as well and then bring that to the office visits so we can keep track of your trends and see where you are going with things.
Melanie: Dr. Randle, the systolic, that high number you discussed – that changes. With exercise it can go up and then go down as a result of one bout of exercise. But that lower number - diastolic - should not change. What do you tell someone if they say I saw my lower number changing around a lot?
Dr. Randle: The top number--the systolic--is the blood pressure as the heart is pumping the blood out. The diastolic is when it is relaxes. Generally, as you exercise, you’re correct. Your blood pressure is going to increase--your systolic is going to increase. That’s a natural phenomenon. The diastolic may increase slightly but it’s not going to increase as much as that systolic will. If your diastolic increases by a few points – two to five points – I’m okay with that. But, if there is an increase in ten points, it shouldn’t increase that much with exercise. Especially if you’re younger, I tend to focus a lot more on the diastolic because that’s an indicator of how things are going to be later in life. So, if you diastolic blood pressure is elevated and not controlled when you are younger two things. One, your heart in your arterial vessels are not relaxing as well which is going to lead to stiffness and be a precursor towards maybe having heart failure and things like that when you get older. The other, as well, is it may be a precursor to showing that as you get older your systolic blood pressure is also going to get elevated. That diastolic measurement is a marker to me as well in terms of what your future is going to hold. So, I try to be a little bit aggressive as well in treating that number if that increases.
Melanie: So, in just the last minute, Dr. Randle, give your best advice for people with high blood pressure. What do you tell them every single day that they can do to take care of themselves and even possibly prevent high blood pressure and why they should come to Lourdes Health System for their care.
Dr. Randle: The biggest thing with high blood pressure, I think, is lifestyle. Again, we talked about the things that you can change but the biggest thing that you can change is your diet and activity level. That’s what I try to encourage. I try to encourage you to monitor your sodium intake, cut back on the salt and increase in exercise. Stopping smoking is big. Cutting back on alcohol is big. The biggest thing is going to be weight loss. If you lose about 20 pounds, you can drop your blood pressure 10 to 20 points. I try to encourage everyone to try to increase their activity level, try to lose the weight and that’s one of the biggest markers you’re going to have in terms of decreasing your blood pressure. After the exercise is going to be the diet. Eat more fruits. Eat more vegetables. Cutting back on the salt. Cutting back on the cholesterol. Cutting back on all the fats and red meats. Why should you come to Lourdes? I think at Lourdes, we have top cardiology. I don’t think it matters when you go in medicine, physicians are great. But, in terms of our cardiology, the services that we provide is what puts us apart from everybody else. You can go to any facility and find a cardiologist that does well but in terms of being personable and in terms of what we do for the community, I think that those are the things that set us aside. I think that we are very approachable as well. If you ever have any issues in terms of cardiovascular institute, Lourdes is definitely at the top.
Melanie: Thank you so much, Dr. Randle, for being with us today. You’re listening to Lourdes HealthTalk with Lourdes Health System. For more information you can go to Lourdesnet.org. That’s Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
[END OF RECORDING]
heartMelanie Cole (Host): Lourdes Health System is one of the largest providers of cardiac services in the entire Delaware Valley. The experience that comes from this also helps to make Lourdes one of the best in the nation. We’re talking today with Dr. Troy Randle. He is a cardiologist with Lourdes Health System. Welcome to the show, Dr. Randle. What is high blood pressure and how does it contribute to cardiovascular disease?
Dr. Troy Randle (Guest): Thanks for having me on the show, Melanie. High blood pressure – we tend to say “hypertension” but when I explain it, I want you to know that high blood pressure is similar to a weight. When we lift weights, our muscles tend to get big and strong and thick. However, the heart is a muscle. Blood pressure is a weight that the heart has to pump against. The problem with the heart pumping against the elevated blood pressure is, the heart then starts to get thick and, unlike our outside muscles which gives us strength, when the heart gets thick it becomes stiff. It then leads to things such as heart failure. We can have stroke. We can have a high risk of heart disease and heart attacks as well. Over time, it can also affect your vision. It can affect your kidney function as well. So, it’s very important to get the blood pressure under control.
Melanie: What are some risk factors for high blood pressure?
Dr. Randle: The biggest risk factor is genetic. When you have a family history, that’s the one thing that you want to try to keep in mind. Other things outside of family history are then the lifestyle changes that you have. Things that you control. I always tell people that there are things that we can control and things that we can’t control. The thing that I can’t control is, I can’t control my genetic make-up. Unfortunately, the genes that my parents passed on to me is kind of what I have. I can’t control my age. Age is a risk factor. As I get older, I’m going to have a higher incidence of having heart disease and high blood pressure and I can’t control that. I can do things to make myself look younger but the age that chronologically I have is always going to be the same. The other thing I can’t control is my gender. Unfortunately, we can do things to make ourself look a different gender but the gender make up that we were born with, those things I can’t change. Those things are the biggest risk factors that you can’t change. In terms of risk factors that you can change become lifestyle activities. So, your diet. Trying to watch your diet—a low salt diet and trying to cut back on foods that have higher cholesterol or higher fat. I think you want to try to limit your sodium, your sweets, trying to limit red meats. That will help you. Smoking is another big risk factor. I try to encourage you to cut down on smoking as well. Hopefully, you avoid it and stop smoking all together. That’s one of the things that we try to emphasize as well. Another one is alcohol. Alcohol definitely is a big risk factor for high blood pressure as well, so trying to limit your alcohol intake. What some people don’t realize is activity level. Your weight, obesity and being inactive is going to put you at a higher risk as well.
Melanie: When does blood pressure require medicational intervention? When do you say, “Okay. You’ve tried changing some of your diet and gotten a little bit active but now we need to put you on some of the medications”? Explain just a little bit briefly about what these medications are intended to do, Dr. Randle, because people do not understand and you see so much in the media and commercials about all of these different medications. What are they intended to do?
Dr. Randle: As to the first part of the question, “When do I start medication?”, when we talk about high blood pressure there are different goals that we have in mind. The numbers are always somewhat controversial in term of what is a big target goal. There are all these different studies that come out but I think that the biggest consensus among everybody is we want to shoot for 120 over 80. That’s ideal. Then, we have different stages. When I say 120 – that top number we call “systolic blood pressure”. The bottom number--the 80--is diastolic. The top number is referring to what the blood pressure is doing when the heart is actually contracting and pushing blood out to the body. The bottom number is the blood pressure in your vessels when the heart is relaxing. When we’re younger, we tend to focus more on the bottom number because that is the better indication of high blood pressure. I definitely want to target that. As we get older we tend to focus a little bit on the top number. Our ideal goal is 120 over 80. I start talking about treatment when I see blood pressure is around 140 over 90. A lot of people are resistant to medications and I understand that. A lot of people want to try lifestyle modifications. I’m willing to be a little liberal and work with you as long as your blood pressure is not over 140 over 90 and give you a chance to modify things. Once you get over 140 over 90, then I want to start talking about medication. There are different medications that we can use. The idea of the medications, again, is to lower the blood pressure so that we don’t have the affects that we talked about before of heart failure, stroke, kidney damage – and that’s our goal. One of the things that I hear when we talk about medications is the side effects of medications. When you hear all of the different medicines on the media, everybody talks about side effects of medication. I would say different medicines have different side effects. But, when we talk about the side effects of medication I think we also need to talk about the side effects of the disease process. I don’t know if many of us think about the side effect of high blood pressure. I understand that there are medications, for example, calcium channel blockers that we use to lower blood pressure and the biggest side effect that we worry about with that is having some edema or swelling. There are medications that may affect the kidneys. There are medications that slow the heart rate down and may make you a little bit tired, fatigued. Those are the things that I think that people tend to focus on but yet I want to say, what are the side effects of hypertension? The biggest side effect of hypertension is, again, do you want to have a stroke? Do you want to have heart failure? Do you want to have a heart attack? To you want to be on dialysis because you have kidney failure?
Melanie: Wow. That is so well put and such important information. How often do you want people keeping track and taking their blood pressure? Do you want people to getting home sphygmomanometers? Do you want them going to their local drug store and checking it there? How often do you want it to be monitored?
Dr. Randle: I ask people to have their own home blood pressure measurement kits especially to keep an eye themselves. One of the precepts that I have is white coat type hypertension. “My blood pressure is only elevated when I come to see you in the office.” What I encourage, then, is you have a blood pressure cuff at home. Bring it with you to the office when you come to visit. Part of the reason is if my number is higher than your cuff, I want to at least correlate to make sure that we’re seeing the same thing. Let’s say, for example, at home you’re getting 120 and in the office I’m getting 140, then we know that the numbers are about the same. One, I like to calibrate what you are measuring at home towards what I am doing in the office. The second part of it is, how frequently? I tend not to try to be too stringent because I find that as I become stringent people are less compliant. I usually ask you if you can measure your blood pressure at least once a day, three to five times a week and kind of give us an idea. Ideally, I would like to have two to three measurements a day but if you can get me at least one, I’m okay with that and different times of the day. The morning blood pressure may be different than the afternoon blood pressure which may be different than the evening blood pressure. I like to see exactly what your blood pressure is, the time of day it is and I ask you to keep a diary of that as well and then bring that to the office visits so we can keep track of your trends and see where you are going with things.
Melanie: Dr. Randle, the systolic, that high number you discussed – that changes. With exercise it can go up and then go down as a result of one bout of exercise. But that lower number - diastolic - should not change. What do you tell someone if they say I saw my lower number changing around a lot?
Dr. Randle: The top number--the systolic--is the blood pressure as the heart is pumping the blood out. The diastolic is when it is relaxes. Generally, as you exercise, you’re correct. Your blood pressure is going to increase--your systolic is going to increase. That’s a natural phenomenon. The diastolic may increase slightly but it’s not going to increase as much as that systolic will. If your diastolic increases by a few points – two to five points – I’m okay with that. But, if there is an increase in ten points, it shouldn’t increase that much with exercise. Especially if you’re younger, I tend to focus a lot more on the diastolic because that’s an indicator of how things are going to be later in life. So, if you diastolic blood pressure is elevated and not controlled when you are younger two things. One, your heart in your arterial vessels are not relaxing as well which is going to lead to stiffness and be a precursor towards maybe having heart failure and things like that when you get older. The other, as well, is it may be a precursor to showing that as you get older your systolic blood pressure is also going to get elevated. That diastolic measurement is a marker to me as well in terms of what your future is going to hold. So, I try to be a little bit aggressive as well in treating that number if that increases.
Melanie: So, in just the last minute, Dr. Randle, give your best advice for people with high blood pressure. What do you tell them every single day that they can do to take care of themselves and even possibly prevent high blood pressure and why they should come to Lourdes Health System for their care.
Dr. Randle: The biggest thing with high blood pressure, I think, is lifestyle. Again, we talked about the things that you can change but the biggest thing that you can change is your diet and activity level. That’s what I try to encourage. I try to encourage you to monitor your sodium intake, cut back on the salt and increase in exercise. Stopping smoking is big. Cutting back on alcohol is big. The biggest thing is going to be weight loss. If you lose about 20 pounds, you can drop your blood pressure 10 to 20 points. I try to encourage everyone to try to increase their activity level, try to lose the weight and that’s one of the biggest markers you’re going to have in terms of decreasing your blood pressure. After the exercise is going to be the diet. Eat more fruits. Eat more vegetables. Cutting back on the salt. Cutting back on the cholesterol. Cutting back on all the fats and red meats. Why should you come to Lourdes? I think at Lourdes, we have top cardiology. I don’t think it matters when you go in medicine, physicians are great. But, in terms of our cardiology, the services that we provide is what puts us apart from everybody else. You can go to any facility and find a cardiologist that does well but in terms of being personable and in terms of what we do for the community, I think that those are the things that set us aside. I think that we are very approachable as well. If you ever have any issues in terms of cardiovascular institute, Lourdes is definitely at the top.
Melanie: Thank you so much, Dr. Randle, for being with us today. You’re listening to Lourdes HealthTalk with Lourdes Health System. For more information you can go to Lourdesnet.org. That’s Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
[END OF RECORDING]
