February 26, 2025 • 35 mins
02/16/25
The Healthy Matters Podcast
S04_E09 - Hypertension: Avoiding the Silent Killer
High Blood Pressure, or hypertension, is often called The Silent Killer because it can wreak havoc on our bodies, oftentimes without us even knowing. It's estimated that 85 million people in the U.S. alone have high blood pressure, which is an alarming stat, especially given that it can be a major contributor to a whole host of bad stuff - like stroke, heart attacks and kidney disease, to name just a few. But what causes hypertension? Why is it so damaging to our bodies? Who's most at risk, and what can be done to keep it in check?
From Hypertension to Hypotension, on Episode 9 of our show, we're talking all things blood pressure with a repeat guest, Dr. Woubeshet Ayanew (MD). Dr. Ayenew is a cardiologist at Hennepin Healtcare and currently holds the record for most downloads of a single episode of our show (S3: Episode 09 - "Cholesterol: The Good, The Bad, and the Triglycerides...)! He'll break down the condition for us and explain the causes and effects of high blood pressure, best practices to stay ahead of it, the importance of home monitoring (and what those numbers actually mean), and what can be done for those looking to get things under control. This is a great chance to learn all about hypertension and get some useful tips on how to manage your blood pressure from a true expert. Join us!
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Home Blood Pressure Monitoring
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilden , and welcome
to episode nine of the podcastin which we're gonna talk about
high blood pressure, medicallyknown as hypertension. February
is heart month, and ashypertension is the most
common, preventable cause ofstroke and heart disease, we
thought it a great time to talkabout this important topic. To
(00:39):
help me out, I have Dr. RubishAnu . He is a cardiologist at
Hennepin Healthcare, and he wasa previous guest on the show to
talk about lipids, which Imight say it was one of the
more popular episodes we'veever done, but today it's high
blood pressure. Dr. Anu ,welcome back.
Speaker 3 (00:55):
Hey , thank you for having me, Ken . So
Speaker 2 (00:56):
The term hypertension or high blood
pressure, what does that mean?
Speaker 3 (01:00):
So if we look at the , uh, term hypertension, it's a
combination of a Latin and aGreek word. You know, it takes
a root , uh, phrase , uh, fromthe Latin hyper excess . And
then , uh, the tension comesfrom a Greek , uh, phrase that
will mean stretching. So it'sexcess stretching, and it sort
of leads you to see how peopleare thinking about high blood
(01:22):
pressure as a function of thearteries being excessively
stretched. And by that probablythey're thinking excess blood
inside the blood vessel,stretching them. And when you
look at it historically, itsort of makes sense as to how
bloodletting or application ofleches used to be the way they
used to try to take care of it,because their thought was the
(01:42):
sole cause of it was justexcess blood, just too much,
too much blood stretching it,causing high blood pressure.
But they're the same terms whouse them interchangeably with,
you know, hypertension, moremedically used and high blood
pressure in the othersituations.
Speaker 2 (01:55):
So why do we care about it? Why do we care if you
have hypertension?
Speaker 3 (01:58):
If the high blood pressure persists for days and
days and then your , uh, highblood pressure keeps on
bombarding, you know, thevessels inside various organs
eventually starts to scar themor starts to sort of put them
out of commission. And beingthat most organs we're talking
about the heart, the kidney,the brain, they're counting on
(02:18):
always adequate blood flow. Ifthe blood vessels are not
applying, you know, thedelivery of nutrients to them,
then you start to get heartattack and stroke and the
kidney failure and all theother consequences that come
with it.
Speaker 2 (02:31):
So how does it lead to those bad things? And what,
what is happening in your bodythat would lead to a stroke or
a kidney problem or a heartproblem? Those are all, those
are three different parts ofyour body. Yeah . Your brain,
your heart, your kidneys andand other parts. How does, how
blood pressure lead to damagein those areas ?
Speaker 3 (02:48):
Yeah , you know , uh, in , in different organs,
probably differently. You know,if we look at , for instance,
the kidneys. The kidneys arefull of tiny blood vessels.
That's where the filtrationprocess is going on. And those
blood vessels, again, count onthem being patent or widely
open and the bombardment withhigh blood pressure. And when
we talk about high bloodpressure, we'll probably
(03:09):
eventually get to this, butwe're not talking about a one
day or two day of it. Thiswe're talking about months and
months of persistent high bloodpressure that starts to really
narrow and scar down the bloodvessels. So the whole filter
that was counting on a goodamount of blood flow is no
longer getting that. And thatleads to then the kidney not
functioning properly. In thecase of the kidneys, it gets
(03:31):
worse because once you haveabnormal kidney function, that
actually then leads to evenmore triggers for high blood
pressure. It becomes this , uh,you know, ugly cyclical
Speaker 2 (03:40):
'cause your kidneys are a , a , a victim of high
blood pressure, but they'realso the that feeds back in
your, your kidneys help helpcontrol it. Yeah. That's a
vicious cycle. Now,
Speaker 3 (03:48):
To just give another example. If you look at the
heart, the heart is pumpinginto this blood vessels. If you
have high blood pressure, youstart 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. Andthen you can see how different
organs start to be affected
Speaker 2 (04:08):
By this. Yeah . And your heart's just a muscle
after all . Well , it's a verycomplicated muscle. It is,
Speaker 3 (04:11):
It is. But uh , you know, it's , it's like lifting
heavy weights, but it can onlydo it so much before it says,
I'm tired of it .
Speaker 2 (04:18):
I'm tired of it.
Okay. Yep . So who, who getshypertension? I , and, and
listeners, just a littleteaser, it's probably more
common than you think and youmight have it and not know
about it 'cause you don't getsymptoms. But yes . Let's talk
a little bit more about theprevalence. Who gets it, who's
at risk, that kind of stuff.
Speaker 3 (04:36):
Very good. So the most common factor associated
with it is age. And withadvancing age, we start to see
more and more people affectedby high blood pressure or
hypertension. Just to give youan idea, if people, you look at
them in their thirties andtheir thirties , probably one
out of 10 people are affectedby high blood pressure. Now you
get them into their fifties,three out of 10 people are
(04:58):
affected by high bloodpressure. But then if you come
back and look at these peoplefew decades out in their
sixties and seventies, we'retalking about seven out of 10
people are gonna be affected bythe majority
Speaker 2 (05:07):
Of
Speaker 3 (05:08):
People. Majority of people are affected by it. So
in the US we're looking at 85million people that are
affected by this. And if youlook at male female, it's
slightly more women than men.
And then the more advanced theage gets , you realize women
really take , uh, a largernumber of the people who are
affected by high bloodpressure.
Speaker 2 (05:29):
I don't think we've talked about any topic in four
seasons of this podcast wherethere were 85 million people
who had the condition. That isprobably the most common thing
we've ever talked about.
Speaker 3 (05:39):
Very common. And I don't think it , uh, it gets,
its due in our discussion and Idon't think we explore it and
look at it and engage peopleadequately because that's why
it has become the most commonpreventable cause. But I'm not
sure we're actually applying itand preventing this diseases.
Speaker 2 (05:57):
Is it more common in older people because there's
something going on in yournervous system or your blood
vessels themselves just gettingmore rigid? Mm-hmm
. What happens?
Speaker 3 (06:07):
Well, if I apply what my mechanic tells me,
everything that goes with mycar say it's like too much
mileage. There is wear andtear. That's what he say .
That's his answer toeverything. Just about all
Speaker 2 (06:16):
The hoses and tubes are getting a little stiffer.
Speaker 3 (06:18):
Yes . So you can imagine the heart, you know,
how many years is it gonna pumpand then how many years is it
gonna pump into these bloodvessels? How long are you
expecting these blood vesselsto remain with their
elasticity? All those thingscome into play . So yes, with
advancing age, the bloodvessels have done a great job
for mm-hmm .
Decade after decade afterdecade, at some point they
start to narrow or theirstretchability or elasticity
(06:41):
Yeah . Starts to get lost. Andthat's how you end up getting
that. I
Speaker 2 (06:45):
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 (06:52):
Yes. They're rubbery .
Speaker 2 (06:54):
Robbery
Speaker 3 (06:54):
Tube. Robbery tube is what you see. And then, you
know, the younger you are morerubbery , more stretchy. And
then , uh, with advancing edge,they kind of, you know, get
stiffer and stiffer and thenthey cannot accommodate whether
it's excess fluid or anythingapplied to them. So that's sort
of the , the nature or thecourse of our blood vessels.
Speaker 2 (07:13):
So age is the biggest risk factor, but it
must not be the only thingbecause some people get it
younger.
Speaker 3 (07:18):
Correct? Correct. So exploring other things, family
history, genetics is anotherbig factor. So if you have got
parents or if you have gotsiblings affected by high blood
pressure, likely you are atrisk for it. And something to
watch for. And if there arethings you can avoid, excess
weight, tobacco use, excessalcohol use, these are the
things, if you have a familyhistory, definitely you wanna
(07:39):
avoid for reasons that's notalways clear to us. We find
elevated blood pressure morecommon in certain ethnic
groups. Hmm . For instance,African-American people tend to
have higher blood pressure. Andyou know, we always think about
that. So is it the diet? Is ituh , sort of the way of life
and you know, is there stressinvolved with it? And other
(07:59):
things we do not know, but wedo see it in certain ethnic
groups more than um , others.
Diet affects it. Diet. And ifthere's lack of exercise that
can lead to excess weight. Andwe know that excess weight
definitely is associated withhigh blood pressure
Speaker 2 (08:14):
Smoking. I bet smoking's good for it. Uh,
Speaker 3 (08:17):
I beg not So with with tobacco.
Speaker 2 (08:20):
Tobacco, I , I was saying that listeners, I'm
kidding. I'm kidding. I'mkidding. Smoking is a good, I
hear you .
Speaker 3 (08:25):
Anything. No, no.
And frankly, that's one ofthose things we just don't
compromise. Right ? So evenwith alcohol, we say one or two
drinks a day, if it relaxesyou, it's part of your
socializing that's sort ofacceptable. That makes sense.
Tobacco's one of those where wesay, no, none, zero tobacco is
a good idea. I know that that'swhat good tobacco will be. So
(08:47):
the only other thing I think,you know, out of the factors
that are associated with highblood pressure, I would like to
mention in women there arecertain factors we do not see
in men. Hmm . In younger women,this end up being birth control
pills, those are associatedwith high blood pressure. And
then pregnancy actually can bein many situations associated
(09:08):
with high blood pressure. Andthen in women with advanced
age, postmenopausal stateactually suddenly predisposes
women to the risk of high bloodpressure. 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 havingit. Most of them tend to be in
(09:30):
the 65 70 postmenopausal. Yeah. Because that really
accelerates it .
Speaker 2 (09:35):
Before I'd like to get off these topics. Some of
these things you've mentionedare reversible, things you can
control. Not always easily, butsome things you can control.
Some things you can't. Yes.
Let's stick to a couple ofthese things that you can, you
mentioned diet. Should I justeat pine nuts and leaves all
day long? Or layoff of salt?
What general dietary thingsshould people know about?
Speaker 3 (09:58):
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 isthat the sensitivity to salt is
not in everyone , but there arecertainly some people who are
salt sensitive. And when we saysalt sensitive, we have to
specify it to be sodium is whatwe're talking about. In fact,
when you look at diet,something we're exploring more
and more nowadays is lowpotassium is another risk
(10:25):
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 , driedapricots, all these things that
you can get that are rich inpotassium, that may actually be
protecting you from high bloodpressure. 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 notfortify 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 somesense it's preference, but also
the effect on blood pressure. Itell patients all the time who
have high blood pressure mm-hmm . And, and it's
tough to control that saltisn't gonna be your friend. But
could you comment on this forsomeone who doesn't have high
blood pressure, their bloodpressure's great and they like
(11:16):
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 ismoderation, right? Mm-hmm
. So yes, I mean, uh, not taking a crystal of
it and licking it, butsprinkling it here and there.
If it's gonna enhance thedining 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 morningwhen I saw somebody in clinic,
she likes her salt, bloodpressure has become an issue.
And we talked about the factthat hey, there is a potassium
salt substitute. Why don't youtry that? And it's available in
the grocery stores, potassiumsalt substitutes. So instead of
(11:57):
the sodium chloride, they arepotassium chloride. So if you
use that instead of the sodiumchloride or the usual table
salt, that will probably behelpful. And in her case, her
potassium was, you know ,getting lower and lower. And my
thought was go substitute yoursalt 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 toget off of it. There's help
available. Yes. Uh , but whatabout 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 downyour blood pressure by seven to
10 points, how much exercise isgonna be the question, right?
So I am not a big advocate ofjust sticking to those 10,000
steps. The 10,000 steps are, Ithink , a great idea to
motivate people. Mm-hmm . We have
promoted it. And if you're justmaintaining something, if you
(12:48):
are dealing with excess weightand thinking, no, actually I
need to work on losing some, Ithink 10,000 is just your
warmup. I think you shouldstart 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 youhave the time for it, if you
have the interest for it evenmore. But definitely exercise
allows those arteries that aregetting stiffer to kind of gain
(13:12):
some of their elasticity. Sothat's a good one. And with the
proper diet, let's say, if youare either curbing the amount
of calories or taking away someof the excess carbohydrates and
you know, fats that along withexercises you can cut down on
your weight. We also , uh, knowthat for every two pounds of
(13:32):
weight you lose, you drop yourblood pressure down by one
point. So a good 10 pounds of ,uh, weight loss can be about
five points drop in yoursystolic blood pressure, which
I think is brilliant.
Speaker 2 (13:44):
Significant. Yes. So these are all things, not
necessarily saying they're easyfor everybody, but are known to
be effective exercise and maybea little bit more than you
think. Exercise. Take itseriously, maintain a healthy
weight, don't smoke. Lay off ofsodium and salt. Yes . These
are, these are good tips. Yes .
Uh , on a sort of relatedtopic, your cholesterol numbers
(14:06):
and your cholesterol and yourdiet. We did a previous episode
on cholesterol. Correct . As Isaid at the top. And I do
encourage listeners to go intothe archive and listen to Dr.
Anu show about cholesterol. It, it's , it literally was one
of the most popular episodeswe've had. But could you
clarify for listeners on thisone, hypertension versus
cholesterol. Two things peopleneed 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. Andwhen the two are found in the
same body, the problem is onemakes the bad effect of the
other even worse. So upfront ,one thing you need to keep in
mind is even though one is awhole, you know, lipid your fat
thing, and the other one is, aswe talked about how your blood
(14:49):
vessels are sort of tense. Ifyou 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 withthe other. And you know, if
it's , uh, elevated bloodpressure, make sure your
cholesterol is quite optimallymanaged. And if you are working
(15:10):
with higher cholesterols,you'll be the one who should be
very careful about not allowingyour , uh, blood pressure to
run away.
Speaker 2 (15:16):
Sounds good. We have been talking with Dr. Rub, ANU
. He is a cardiologist atHennepin Healthcare in downtown
Minneapolis. A colleague andfriend I've known for many
years. He was actually one ofmy teachers back in the day. We
are talking about hypertension.
You may know it as high bloodpressure. When we come back,
we're gonna talk about what isthe definition, what are the
numbers, is it possible to betoo low? What kind of
(15:38):
treatments are available? Sostick around, we'll be right
back.
Speaker 4 (15:44):
When Hennepin Healthcare says, we are here
for life. They mean here foryou, your life and all that it
brings. Hennepin Healthcare hasa hospital, HCMC and a network
of clinics both downtown andacross the West Metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(16:06):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (16:22):
And we're back talking with Dr. Anu about high
blood pressure. So people don'tknow you have this, you don't
have symptoms. Everybody, evenI can tell you that for the
majority of the time of yourlife that you might have high
blood pressure, you don't knowabout it until it leads to some
other problems. So you have tomeasure it in an office or at a
clinic or at home or somewhere.
So let's talk about that, abouthow we measure blood pressure.
(16:43):
And first of all, when, whenyou go to the clinic, they
always make you shut up. Don'ttalk 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 whenyou come to the clinic, each
one of them has a tendency toslightly increase your blood
pressure. You know, thecrossing leg part, continuing
to be engaged with , uh, thenurse or all these things are
stimulating you and they areraising your blood pressure.
And we do not want to checkyour stimulated blood pressure.
(17:13):
We like to, we're trying to getyour 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 bloodpressure , uh, very easily by
10 15 points. You know, when Itook the stairs to come this
way, probably my blood pressurecould have worked its way to
about 1 50, 1 60, you know?
Mm-hmm . When we do stress testand people, it gets to 180, 1
90, but that's just for themoment of reaction. That's not
what we're worried about. So Ithink as we are talking more
(17:41):
about it , uh, we'd like tohighlight that it's the
sustained effect of this highblood pressure. We're worried
about not the one minute or twominute flickering of high
numbers.
Speaker 2 (17:50):
So let me give a little condemnation of the
medical field that we're in inthe office. We measure blood
pressure, maybe not at theideal time. So people come in,
they check in at the desk, theysit in the waiting room, maybe
they're having a cup of coffee.
We talk to them, we put thecuff on them, they're , they
haven't been resting. And sowe, we do our best. Yeah. But
what is the ideal way forpeople to know if they have
(18:13):
high blood pressure? Is it togo to your doctor's office? Is
it to get one of those cuffsthat you can buy at the drug
store ? How's the best way todiagnose it?
Speaker 3 (18:20):
Your is a good point because the current standard of
care is , is just that, youknow , 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, youcannot make it any beautiful
than that. You cannot.
Speaker 2 (18:32):
That's our building.
That's where we see PApatients. 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 theend of the day, if you look at
it, there's nothing naturalabout coming to a clinic. You
know, you're being taken out ofyour own environment. You're
wondering, am I gonna get topark at the right time or not?
Will there be keeping in lineor not? None of this is
supposed to keep your bloodpressure normal. It's supposed
to be stressing you out untilyou get there. And then you are
(18:57):
in a waiting area. At somepoint someone rushes you into a
room and as you're sittingthere they're saying , uh,
let's go over your medications.
Let's talk about this. Have youhad any allergies? None of this
is helping out. Mind you. Andthen we check it and at some
point we tell you, you know,your blood pressure is not
normal and you're thinking, areyou 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 intoplace . So you're thinking
okay, with that understandingmaybe that is as good as it
gets will be a good screeningtool. But to really get to the
bottom of did you really havehigh blood pressure or did we
stress you out to get there? Myadvocacy will be to really do
some home monitoring. Now the ,we have ways of monitoring
(19:39):
blood pressure where we havepeople wear this gizmo and walk
around for 24 hours and we'llcheck them throughout the 24
hours. But taking thatcomplexity out, what have been
really advocating for in thecommunity setting and we have
various programs we're workingon 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
(20:01):
will be. But to do that andhave them gather the data, I
think that will be much helpfulwith diagnosing an ongoing
follow-up and management ofeach 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 verybasics. Hypertension 1 0 1.
What are the numbers thatyou're looking for?
Speaker 3 (20:18):
Good one. So you know, we have been throwing out
this many points higher, thismany points lower. Yeah . What
are they? So when I talk topeople, I tell them that when
you check your blood pressure,probably you're gonna see three
numbers show up. The top twoare gonna be the blood
pressures. And we call itsystolic over diastolic. Again,
it's back to the Greek wordsystole means during
(20:39):
contraction, diastole meansrelaxation. So the top number,
I tell them systole thesuperior, the top number will
be the highest of all thenumbers below that diastole
down under the systole, thatwill 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 , but so systole ordiastole. And then the monitor
spits out a third number, whichis your heart rate. And we have
to keep in mind they keep thosestraight because obviously you
don't want to confuse the heartrate for the diastolic blood
pressure or whatever it is. Sothat's what you see and the
numbers you're looking atmostly is if it's one 20 over
(21:17):
70, so the top numbers theto isone 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 youget into the one thirties, over
eighties, that's when we startto look at , okay, they start
to pay attention to this. Butagain, it's not really time to
be alarmed. It's time to followyou carefully and say, well if
there are other overwhelmingrisk factors, like earlier you
said, how about you have highcholesterol at the same time?
(21:46):
How about there is kidneydisease? How about you have
diabetes? Those people willstart to pay attention and say,
well, and you maybe we shouldstart 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 thirtiesover eighties, yes you should
pay attention a little moreclosely,
Speaker 3 (22:02):
Pay attention. But then the number I think that's
looking at to say, okay, thisdefinitely does not make sense,
will be one 40 over ninetieswhen it gets there, by
definition, that's where wehave actually crossed into the
stage one high blood pressureterritory. That's the part that
we say, yep , this is actually,you know , we gotta do some
starting, you know, to getcomplicated. And then it can go
(22:22):
higher and higher where we talkabout hypertensive crisis and
other things when it gets intothe 180, over one 20 and stuff.
But again, that's not what weusually see. Those are the
numbers where persistently youare sitting there, we usually
recommend people start to getattention more urgently. But
for the most part those are thenumbers 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 forthat is the top number 90, the
lower number 60, 90 over 60. Ifit is anything below that, we
call that low blood pressure orhypotension. But one thing
that's worth clarifying here isas much as high blood pressure
is a help hazard , hypotension,actually, if you keep yourself
(23:09):
in the 90, over 60 or a hundredover 60 range and you are
feeling okay and that's whatyou live with, that is okay.
That's okay . That is good.
That is good. Now here are twoum, times where I want people
to be concerned about it. Let'ssay you live at a higher
number. So let's say your bloodpressure usually is one 20 over
80 . Finally one day you findyourself at 90 over 60. That's
(23:30):
not your normal. Something doesnot make sense. You need to
recheck, you need to see if youare dehydrated. Something did
not make sense there. That issomething to be evaluated and
followed carefully. The otherthing is you have low blood
pressure and you have otherthings not working well. You
are dizzy, your vision isblurred, you're feeling
fatigued. Uh, you are havingfevers, chills, like you're
(23:52):
thinking something is not rightwith me. And you have that low
blood pressure. I'll not leavethat 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 over62, yeah , that could be
Speaker 3 (24:06):
Okay. You know, with my uh, mother, I have not seen
her blood pressure above 100ever. 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 seethis in in younger women .
Younger women have lower bloodpressure. Leave them alone if
they're just functioning fineand that's what their baseline
is.
Speaker 2 (24:26):
When do you recommend people get checked ?
So first of all, the person whodoesn't have any idea what
their blood pressure is, whenshould they start checking? How
often should they keepchecking? And then people who
do have hypertension, how oftenshould 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 youlook at the various risk
factors you have. Let's say youare someone in your thirties,
maybe you are enjoying morealcohol than that will be
recommended. I'll start tomonitor it carefully. Uh, let's
say you are in your thirties,forties, and then you have a
(25:00):
strong family history of it,but you have never been
diagnosed. Maybe you're someonewho should monitor it. Now how
often should you monitor it?
Well, to start with, I thinktrying to get it maybe once a
week or once every other weekwill be reasonable. And if all
of them remain the same, youdon't need to check it that
often. Maybe once every fewmonths will be reasonable. On
the other hand, the first thingyou check does not look that
(25:23):
great. I think I'll monitor itmore closely in that setting.
But I'll gauge it by, are youone who already has some risk
factors? Yes. Well then let'smonitor more frequently. You
don't have risk factors. Youhave always been healthy. Your
weight is not an issue. Notobacco, no alcohol, no family
history. I don't think you needto be that obsessed with it. So
(25:44):
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 Excelspreadsheet and then send me
the results of that. And Ialways said, you know, it's
been stable for years. Yes,yes. And I think you're
actually raising it by checkingit 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, ifthat's gonna stress them, now
actually the monitoring isgonna result in more high blood
pressure. So that's where youshould know yourself. And the
frequency also should be guidedby that. If you're somebody
who, as soon as you have moredata, you actually, instead of
feeling better, you're gonnafeel worse by thinking, oh my
(26:22):
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 byvarious things. So you're gonna
find yourself working higherand higher and higher. So you
should know yourself. And ifyou are that excitable, check
it. Rarely. The other timeswhere I think the home blood
pressure monitoring becomesvery valuable is if you are at
the cusp of an intervention. Soyou , let's say you have senior
(26:46):
provider and your provider hassaid, you know, your blood
pressure is kind of at in thegray zone. At some point, maybe
we should consider starting youon a medication or you should
do something about it. Maybeyou should start exercising or
something to that effect. Ifyou are in the monitoring phase
and now the data you have willbe the decider of whether
you're gonna be put on amedication or not. Sure do it
(27:08):
weekly or whatever yourprovider has recommended. But
if you're not in that realm,you're just minding your
business, none of those issueshave been raised. The frequent
checking can only stress youout more. So
Speaker 2 (27:19):
What we shared , how should people check their blood
pressure at home to do itcorrectly?
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 yourbaseline resting state for
about five minutes. Now, when Isay rest, I don't mean be on
your phone listening to thenews, talking to your cousin. I
mean just rest. Just sometimesthey even recommend maybe a
(27:44):
darker room, a quiet room. Justbring your blood pressure back
to its baseline. You should nothave had any coffee. You should
not probably have eaten notobacco an hour from the time
you're checking. Put the arm atthe level of the heart. So the
upper arm should be at thelevel of the heart. And if
people need more information onthe proper way of doing it,
(28:05):
American heart and other groupshave actually , uh, put
information for this. On thewebsite
Speaker 2 (28:10):
Listeners, we will put a link to those resources
to learn how to check yourblood pressure at home
correctly. We'll put a link tothose on the show notes. So I
don't need you to get into allof the medications for high
blood pressure. Let's justpreface it by that. 'cause
there are a lot of them . Sure. But let's talk about
medications. If your doctorrecommends medications for your
high blood pressure, what aresome of the things people need
(28:30):
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 ofthe bloodletting and the
leches. We have come up withmedications , uh, what we call
water pills or diuretics thatactually 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 commonforms of blood pressure
management. But now we knowit's not just the excess fluid.
Sometimes the elasticity hasbeen lost, so the blood vessels
have become a little tight. Sowe have things to dilate those
blood vessels. Medications inthe 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 thenbecause the kidneys are very
much involved with managingblood pressure, we have
medications that work on thekidneys. Medications we call
ace inhibitors. Lisinopril.
Ramipril , all the prills theprills are . So yes, a very
common one to hear about arebeta blockers. And these are
(29:36):
ones which sort of , uh, calmthe hyperactivity. That's the ,
uh, sense of the heart, youknow, pumping too much blood
into these blood vessels andmedications 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 intothat category. And so people
should work with their providerto see which choice of
medications is gonna beappropriate 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 thesepills. 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 younotice it, it has gone a little
too far. You know, the kidney'snot working as well, the heart
is not working as well. So Ithink informing people who are
working with to say that, yeah,yeah, this is gonna be silently
destroying the brain, thekidney, the heart. And so
(30:39):
that's why you need to monitorit. If it's still elevated, we
just need to act on it becauseit's not gonna give you a
signal of a headache or this orthat before you actually get
it. By the time you are havinga lot of headache, probably it
has gone too far at that
Speaker 2 (30:53):
Sense . Exactly.
Yeah . You sometimes your firstsymptom is the heart attack or
it's exactly a stroke orsomething like that .
Unfortunately.
Speaker 3 (30:59):
Yeah , unfortunately. So this is one
of those, the same way, highcholesterol did not give you
any symptoms until it was aproblem. This one also, you
need to monitor it and act onit , uh, before you get there,
before we leave medications.
David, one thing that's worthreminding, people who have been
started on medications says ,stick to what has been
recommended. Sometimes peopletry to switch medications
(31:21):
around a bit . Maybe theythought their blood pressure
was okay one day and they said, I skip it when my blood
pressure is normal. And it'sworse for people to keep in
mind, it takes three to fourdays for the medication to have
action. So once you getstarted, don't give up in the
first two days or so on sayingit didn't work. It needs that
many days for it to start towork and has to be every day it
(31:43):
has to be taken. You cannotskip 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 aboutthat is if you are gonna cut it
back or stop it, it has to bedone after talking with your
doctor. Yeah . Becausesometimes actually stopping it
can cause a much higher bloodpressure you have never seen
before than what you startedwith. 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 needto add a second medicine or add
a third one, people say, I Inever needed that. It was
always fine, but as you havetold 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 ageor whatever other factors come
into play, you may need to adda second one, maybe a third one
needs to be added. So if that'swhat's necessary to keep you
from having a stroke, fromhaving a heart attack or a
kidney disease and you know,needing dialysis, I think that
(32:41):
might be a a , a fair trade inthat sense.
Speaker 2 (32:45):
So if you wanna leave our listeners with a few
tips, what would you most wantlisteners to know about high
blood pressure?
Speaker 3 (32:52):
Well, of all the things we monitor in patients,
I strongly feel like their homemonitoring might have a bigger
role in addressing thiscompared 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 weneed to collect. I feel like
patients should be empowered tosay, you know, I think I can
(33:13):
get a cleaner, better data inmy home setting and they can
start to participate in thatand 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 arenot that expensive. I give them
out in many community settings,you know, and I don't think
I've spent more than $40 for agood blood pressure monitor.
And unless you're gonna getones with the bells and
(33:43):
whistles that can go into theseventies or so, because some
of them, they also say theymonitor rhythm for you and
stuff so you get more, youdon't need it . Just get a
blood pressure monitor. You aretalking about $40 over years,
that's gonna save you from alot of unexpected outcomes.
Always remember the lifestylechanges, diet with exercise,
maybe cutting back a little biton the alcohol are key to
(34:06):
managing this. And if you gopast that and get to
medications, stick with what isrecommended and work very
closely with your provider tomake sure you're taking it the
way it's prescribed andconsistently 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 HennepinHealthcare. Okay. So maybe this
show was a little longer thanour usual episodes, but there
are so many things to talkabout with high blood pressure.
So thanks for tuning in and Ihope you'll join us in two
weeks time for another greatepisode. 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 findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(35:07):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(35:29):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilden .
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilden , and welcome
to episode nine of the podcastin which we're gonna talk about
high blood pressure, medicallyknown as hypertension. February
is heart month, and ashypertension is the most
common, preventable cause ofstroke and heart disease, we
thought it a great time to talkabout this important topic. To
(00:39):
help me out, I have Dr. RubishAnu . He is a cardiologist at
Hennepin Healthcare, and he wasa previous guest on the show to
talk about lipids, which Imight say it was one of the
more popular episodes we'veever done, but today it's high
blood pressure. Dr. Anu ,welcome back.
Speaker 3 (00:55):
Hey , thank you for having me, Ken . So
Speaker 2 (00:56):
The term hypertension or high blood
pressure, what does that mean?
Speaker 3 (01:00):
So if we look at the , uh, term hypertension, it's a
combination of a Latin and aGreek word. You know, it takes
a root , uh, phrase , uh, fromthe Latin hyper excess . And
then , uh, the tension comesfrom a Greek , uh, phrase that
will mean stretching. So it'sexcess stretching, and it sort
of leads you to see how peopleare thinking about high blood
(01:22):
pressure as a function of thearteries being excessively
stretched. And by that probablythey're thinking excess blood
inside the blood vessel,stretching them. And when you
look at it historically, itsort of makes sense as to how
bloodletting or application ofleches used to be the way they
used to try to take care of it,because their thought was the
(01:42):
sole cause of it was justexcess blood, just too much,
too much blood stretching it,causing high blood pressure.
But they're the same terms whouse them interchangeably with,
you know, hypertension, moremedically used and high blood
pressure in the othersituations.
Speaker 2 (01:55):
So why do we care about it? Why do we care if you
have hypertension?
Speaker 3 (01:58):
If the high blood pressure persists for days and
days and then your , uh, highblood pressure keeps on
bombarding, you know, thevessels inside various organs
eventually starts to scar themor starts to sort of put them
out of commission. And beingthat most organs we're talking
about the heart, the kidney,the brain, they're counting on
(02:18):
always adequate blood flow. Ifthe blood vessels are not
applying, you know, thedelivery of nutrients to them,
then you start to get heartattack and stroke and the
kidney failure and all theother consequences that come
with it.
Speaker 2 (02:31):
So how does it lead to those bad things? And what,
what is happening in your bodythat would lead to a stroke or
a kidney problem or a heartproblem? Those are all, those
are three different parts ofyour body. Yeah . Your brain,
your heart, your kidneys andand other parts. How does, how
blood pressure lead to damagein those areas ?
Speaker 3 (02:48):
Yeah , you know , uh, in , in different organs,
probably differently. You know,if we look at , for instance,
the kidneys. The kidneys arefull of tiny blood vessels.
That's where the filtrationprocess is going on. And those
blood vessels, again, count onthem being patent or widely
open and the bombardment withhigh blood pressure. And when
we talk about high bloodpressure, we'll probably
(03:09):
eventually get to this, butwe're not talking about a one
day or two day of it. Thiswe're talking about months and
months of persistent high bloodpressure that starts to really
narrow and scar down the bloodvessels. So the whole filter
that was counting on a goodamount of blood flow is no
longer getting that. And thatleads to then the kidney not
functioning properly. In thecase of the kidneys, it gets
(03:31):
worse because once you haveabnormal kidney function, that
actually then leads to evenmore triggers for high blood
pressure. It becomes this , uh,you know, ugly cyclical
Speaker 2 (03:40):
'cause your kidneys are a , a , a victim of high
blood pressure, but they'realso the that feeds back in
your, your kidneys help helpcontrol it. Yeah. That's a
vicious cycle. Now,
Speaker 3 (03:48):
To just give another example. If you look at the
heart, the heart is pumpinginto this blood vessels. If you
have high blood pressure, youstart 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. Andthen you can see how different
organs start to be affected
Speaker 2 (04:08):
By this. Yeah . And your heart's just a muscle
after all . Well , it's a verycomplicated muscle. It is,
Speaker 3 (04:11):
It is. But uh , you know, it's , it's like lifting
heavy weights, but it can onlydo it so much before it says,
I'm tired of it .
Speaker 2 (04:18):
I'm tired of it.
Okay. Yep . So who, who getshypertension? I , and, and
listeners, just a littleteaser, it's probably more
common than you think and youmight have it and not know
about it 'cause you don't getsymptoms. But yes . Let's talk
a little bit more about theprevalence. Who gets it, who's
at risk, that kind of stuff.
Speaker 3 (04:36):
Very good. So the most common factor associated
with it is age. And withadvancing age, we start to see
more and more people affectedby high blood pressure or
hypertension. Just to give youan idea, if people, you look at
them in their thirties andtheir thirties , probably one
out of 10 people are affectedby high blood pressure. Now you
get them into their fifties,three out of 10 people are
(04:58):
affected by high bloodpressure. But then if you come
back and look at these peoplefew decades out in their
sixties and seventies, we'retalking about seven out of 10
people are gonna be affected bythe majority
Speaker 2 (05:07):
Of
Speaker 3 (05:08):
People. Majority of people are affected by it. So
in the US we're looking at 85million people that are
affected by this. And if youlook at male female, it's
slightly more women than men.
And then the more advanced theage gets , you realize women
really take , uh, a largernumber of the people who are
affected by high bloodpressure.
Speaker 2 (05:29):
I don't think we've talked about any topic in four
seasons of this podcast wherethere were 85 million people
who had the condition. That isprobably the most common thing
we've ever talked about.
Speaker 3 (05:39):
Very common. And I don't think it , uh, it gets,
its due in our discussion and Idon't think we explore it and
look at it and engage peopleadequately because that's why
it has become the most commonpreventable cause. But I'm not
sure we're actually applying itand preventing this diseases.
Speaker 2 (05:57):
Is it more common in older people because there's
something going on in yournervous system or your blood
vessels themselves just gettingmore rigid? Mm-hmm
Speaker 3 (06:07):
Well, if I apply what my mechanic tells me,
everything that goes with mycar say it's like too much
mileage. There is wear andtear. That's what he say .
That's his answer toeverything. Just about all
Speaker 2 (06:16):
The hoses and tubes are getting a little stiffer.
Speaker 3 (06:18):
Yes . So you can imagine the heart, you know,
how many years is it gonna pumpand then how many years is it
gonna pump into these bloodvessels? How long are you
expecting these blood vesselsto remain with their
elasticity? All those thingscome into play . So yes, with
advancing age, the bloodvessels have done a great job
for mm-hmm
Decade after decade afterdecade, at some point they
start to narrow or theirstretchability or elasticity
(06:41):
Yeah . Starts to get lost. Andthat's how you end up getting
that. I
Speaker 2 (06:45):
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 (06:52):
Yes. They're rubbery .
Speaker 2 (06:54):
Robbery
Speaker 3 (06:54):
Tube. Robbery tube is what you see. And then, you
know, the younger you are morerubbery , more stretchy. And
then , uh, with advancing edge,they kind of, you know, get
stiffer and stiffer and thenthey cannot accommodate whether
it's excess fluid or anythingapplied to them. So that's sort
of the , the nature or thecourse of our blood vessels.
Speaker 2 (07:13):
So age is the biggest risk factor, but it
must not be the only thingbecause some people get it
younger.
Speaker 3 (07:18):
Correct? Correct. So exploring other things, family
history, genetics is anotherbig factor. So if you have got
parents or if you have gotsiblings affected by high blood
pressure, likely you are atrisk for it. And something to
watch for. And if there arethings you can avoid, excess
weight, tobacco use, excessalcohol use, these are the
things, if you have a familyhistory, definitely you wanna
(07:39):
avoid for reasons that's notalways clear to us. We find
elevated blood pressure morecommon in certain ethnic
groups. Hmm . For instance,African-American people tend to
have higher blood pressure. Andyou know, we always think about
that. So is it the diet? Is ituh , sort of the way of life
and you know, is there stressinvolved with it? And other
(07:59):
things we do not know, but wedo see it in certain ethnic
groups more than um , others.
Diet affects it. Diet. And ifthere's lack of exercise that
can lead to excess weight. Andwe know that excess weight
definitely is associated withhigh blood pressure
Speaker 2 (08:14):
Smoking. I bet smoking's good for it. Uh,
Speaker 3 (08:17):
I beg not So with with tobacco.
Speaker 2 (08:20):
Tobacco, I , I was saying that listeners, I'm
kidding. I'm kidding. I'mkidding. Smoking is a good, I
hear you .
Speaker 3 (08:25):
Anything. No, no.
And frankly, that's one ofthose things we just don't
compromise. Right ? So evenwith alcohol, we say one or two
drinks a day, if it relaxesyou, it's part of your
socializing that's sort ofacceptable. That makes sense.
Tobacco's one of those where wesay, no, none, zero tobacco is
a good idea. I know that that'swhat good tobacco will be. So
(08:47):
the only other thing I think,you know, out of the factors
that are associated with highblood pressure, I would like to
mention in women there arecertain factors we do not see
in men. Hmm . In younger women,this end up being birth control
pills, those are associatedwith high blood pressure. And
then pregnancy actually can bein many situations associated
(09:08):
with high blood pressure. Andthen in women with advanced
age, postmenopausal stateactually suddenly predisposes
women to the risk of high bloodpressure. 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 havingit. Most of them tend to be in
(09:30):
the 65 70 postmenopausal. Yeah. Because that really
accelerates it .
Speaker 2 (09:35):
Before I'd like to get off these topics. Some of
these things you've mentionedare reversible, things you can
control. Not always easily, butsome things you can control.
Some things you can't. Yes.
Let's stick to a couple ofthese things that you can, you
mentioned diet. Should I justeat pine nuts and leaves all
day long? Or layoff of salt?
What general dietary thingsshould people know about?
Speaker 3 (09:58):
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 isthat the sensitivity to salt is
not in everyone , but there arecertainly some people who are
salt sensitive. And when we saysalt sensitive, we have to
specify it to be sodium is whatwe're talking about. In fact,
when you look at diet,something we're exploring more
and more nowadays is lowpotassium is another risk
(10:25):
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 , driedapricots, all these things that
you can get that are rich inpotassium, that may actually be
protecting you from high bloodpressure. 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 notfortify 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 somesense it's preference, but also
the effect on blood pressure. Itell patients all the time who
have high blood pressure mm-hmm
tough to control that saltisn't gonna be your friend. But
could you comment on this forsomeone who doesn't have high
blood pressure, their bloodpressure's great and they like
(11:16):
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 ismoderation, right? Mm-hmm
it and licking it, butsprinkling it here and there.
If it's gonna enhance thedining 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 morningwhen I saw somebody in clinic,
she likes her salt, bloodpressure has become an issue.
And we talked about the factthat hey, there is a potassium
salt substitute. Why don't youtry that? And it's available in
the grocery stores, potassiumsalt substitutes. So instead of
(11:57):
the sodium chloride, they arepotassium chloride. So if you
use that instead of the sodiumchloride or the usual table
salt, that will probably behelpful. And in her case, her
potassium was, you know ,getting lower and lower. And my
thought was go substitute yoursalt 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 toget off of it. There's help
available. Yes. Uh , but whatabout 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 downyour blood pressure by seven to
10 points, how much exercise isgonna be the question, right?
So I am not a big advocate ofjust sticking to those 10,000
steps. The 10,000 steps are, Ithink , a great idea to
motivate people. Mm-hmm
promoted it. And if you're justmaintaining something, if you
(12:48):
are dealing with excess weightand thinking, no, actually I
need to work on losing some, Ithink 10,000 is just your
warmup. I think you shouldstart 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 youhave the time for it, if you
have the interest for it evenmore. But definitely exercise
allows those arteries that aregetting stiffer to kind of gain
(13:12):
some of their elasticity. Sothat's a good one. And with the
proper diet, let's say, if youare either curbing the amount
of calories or taking away someof the excess carbohydrates and
you know, fats that along withexercises you can cut down on
your weight. We also , uh, knowthat for every two pounds of
(13:32):
weight you lose, you drop yourblood pressure down by one
point. So a good 10 pounds of ,uh, weight loss can be about
five points drop in yoursystolic blood pressure, which
I think is brilliant.
Speaker 2 (13:44):
Significant. Yes. So these are all things, not
necessarily saying they're easyfor everybody, but are known to
be effective exercise and maybea little bit more than you
think. Exercise. Take itseriously, maintain a healthy
weight, don't smoke. Lay off ofsodium and salt. Yes . These
are, these are good tips. Yes .
Uh , on a sort of relatedtopic, your cholesterol numbers
(14:06):
and your cholesterol and yourdiet. We did a previous episode
on cholesterol. Correct . As Isaid at the top. And I do
encourage listeners to go intothe archive and listen to Dr.
Anu show about cholesterol. It, it's , it literally was one
of the most popular episodeswe've had. But could you
clarify for listeners on thisone, hypertension versus
cholesterol. Two things peopleneed 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. Andwhen the two are found in the
same body, the problem is onemakes the bad effect of the
other even worse. So upfront ,one thing you need to keep in
mind is even though one is awhole, you know, lipid your fat
thing, and the other one is, aswe talked about how your blood
(14:49):
vessels are sort of tense. Ifyou 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 withthe other. And you know, if
it's , uh, elevated bloodpressure, make sure your
cholesterol is quite optimallymanaged. And if you are working
(15:10):
with higher cholesterols,you'll be the one who should be
very careful about not allowingyour , uh, blood pressure to
run away.
Speaker 2 (15:16):
Sounds good. We have been talking with Dr. Rub, ANU
. He is a cardiologist atHennepin Healthcare in downtown
Minneapolis. A colleague andfriend I've known for many
years. He was actually one ofmy teachers back in the day. We
are talking about hypertension.
You may know it as high bloodpressure. When we come back,
we're gonna talk about what isthe definition, what are the
numbers, is it possible to betoo low? What kind of
(15:38):
treatments are available? Sostick around, we'll be right
back.
Speaker 4 (15:44):
When Hennepin Healthcare says, we are here
for life. They mean here foryou, your life and all that it
brings. Hennepin Healthcare hasa hospital, HCMC and a network
of clinics both downtown andacross the West Metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(16:06):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (16:22):
And we're back talking with Dr. Anu about high
blood pressure. So people don'tknow you have this, you don't
have symptoms. Everybody, evenI can tell you that for the
majority of the time of yourlife that you might have high
blood pressure, you don't knowabout it until it leads to some
other problems. So you have tomeasure it in an office or at a
clinic or at home or somewhere.
So let's talk about that, abouthow we measure blood pressure.
(16:43):
And first of all, when, whenyou go to the clinic, they
always make you shut up. Don'ttalk 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 whenyou come to the clinic, each
one of them has a tendency toslightly increase your blood
pressure. You know, thecrossing leg part, continuing
to be engaged with , uh, thenurse or all these things are
stimulating you and they areraising your blood pressure.
And we do not want to checkyour stimulated blood pressure.
(17:13):
We like to, we're trying to getyour 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 bloodpressure , uh, very easily by
10 15 points. You know, when Itook the stairs to come this
way, probably my blood pressurecould have worked its way to
about 1 50, 1 60, you know?
Mm-hmm . When we do stress testand people, it gets to 180, 1
90, but that's just for themoment of reaction. That's not
what we're worried about. So Ithink as we are talking more
(17:41):
about it , uh, we'd like tohighlight that it's the
sustained effect of this highblood pressure. We're worried
about not the one minute or twominute flickering of high
numbers.
Speaker 2 (17:50):
So let me give a little condemnation of the
medical field that we're in inthe office. We measure blood
pressure, maybe not at theideal time. So people come in,
they check in at the desk, theysit in the waiting room, maybe
they're having a cup of coffee.
We talk to them, we put thecuff on them, they're , they
haven't been resting. And sowe, we do our best. Yeah. But
what is the ideal way forpeople to know if they have
(18:13):
high blood pressure? Is it togo to your doctor's office? Is
it to get one of those cuffsthat you can buy at the drug
store ? How's the best way todiagnose it?
Speaker 3 (18:20):
Your is a good point because the current standard of
care is , is just that, youknow , 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, youcannot make it any beautiful
than that. You cannot.
Speaker 2 (18:32):
That's our building.
That's where we see PApatients. 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 theend of the day, if you look at
it, there's nothing naturalabout coming to a clinic. You
know, you're being taken out ofyour own environment. You're
wondering, am I gonna get topark at the right time or not?
Will there be keeping in lineor not? None of this is
supposed to keep your bloodpressure normal. It's supposed
to be stressing you out untilyou get there. And then you are
(18:57):
in a waiting area. At somepoint someone rushes you into a
room and as you're sittingthere they're saying , uh,
let's go over your medications.
Let's talk about this. Have youhad any allergies? None of this
is helping out. Mind you. Andthen we check it and at some
point we tell you, you know,your blood pressure is not
normal and you're thinking, areyou 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 intoplace . So you're thinking
okay, with that understandingmaybe that is as good as it
gets will be a good screeningtool. But to really get to the
bottom of did you really havehigh blood pressure or did we
stress you out to get there? Myadvocacy will be to really do
some home monitoring. Now the ,we have ways of monitoring
(19:39):
blood pressure where we havepeople wear this gizmo and walk
around for 24 hours and we'llcheck them throughout the 24
hours. But taking thatcomplexity out, what have been
really advocating for in thecommunity setting and we have
various programs we're workingon 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
(20:01):
will be. But to do that andhave them gather the data, I
think that will be much helpfulwith diagnosing an ongoing
follow-up and management ofeach 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 verybasics. Hypertension 1 0 1.
What are the numbers thatyou're looking for?
Speaker 3 (20:18):
Good one. So you know, we have been throwing out
this many points higher, thismany points lower. Yeah . What
are they? So when I talk topeople, I tell them that when
you check your blood pressure,probably you're gonna see three
numbers show up. The top twoare gonna be the blood
pressures. And we call itsystolic over diastolic. Again,
it's back to the Greek wordsystole means during
(20:39):
contraction, diastole meansrelaxation. So the top number,
I tell them systole thesuperior, the top number will
be the highest of all thenumbers below that diastole
down under the systole, thatwill 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
spits out a third number, whichis your heart rate. And we have
to keep in mind they keep thosestraight because obviously you
don't want to confuse the heartrate for the diastolic blood
pressure or whatever it is. Sothat's what you see and the
numbers you're looking atmostly is if it's one 20 over
(21:17):
70, so the top numbers theto isone 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 youget into the one thirties, over
eighties, that's when we startto look at , okay, they start
to pay attention to this. Butagain, it's not really time to
be alarmed. It's time to followyou carefully and say, well if
there are other overwhelmingrisk factors, like earlier you
said, how about you have highcholesterol at the same time?
(21:46):
How about there is kidneydisease? How about you have
diabetes? Those people willstart to pay attention and say,
well, and you maybe we shouldstart 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 thirtiesover eighties, yes you should
pay attention a little moreclosely,
Speaker 3 (22:02):
Pay attention. But then the number I think that's
looking at to say, okay, thisdefinitely does not make sense,
will be one 40 over ninetieswhen it gets there, by
definition, that's where wehave actually crossed into the
stage one high blood pressureterritory. That's the part that
we say, yep , this is actually,you know , we gotta do some
starting, you know, to getcomplicated. And then it can go
(22:22):
higher and higher where we talkabout hypertensive crisis and
other things when it gets intothe 180, over one 20 and stuff.
But again, that's not what weusually see. Those are the
numbers where persistently youare sitting there, we usually
recommend people start to getattention more urgently. But
for the most part those are thenumbers 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 forthat is the top number 90, the
lower number 60, 90 over 60. Ifit is anything below that, we
call that low blood pressure orhypotension. But one thing
that's worth clarifying here isas much as high blood pressure
is a help hazard , hypotension,actually, if you keep yourself
(23:09):
in the 90, over 60 or a hundredover 60 range and you are
feeling okay and that's whatyou live with, that is okay.
That's okay . That is good.
That is good. Now here are twoum, times where I want people
to be concerned about it. Let'ssay you live at a higher
number. So let's say your bloodpressure usually is one 20 over
80 . Finally one day you findyourself at 90 over 60. That's
(23:30):
not your normal. Something doesnot make sense. You need to
recheck, you need to see if youare dehydrated. Something did
not make sense there. That issomething to be evaluated and
followed carefully. The otherthing is you have low blood
pressure and you have otherthings not working well. You
are dizzy, your vision isblurred, you're feeling
fatigued. Uh, you are havingfevers, chills, like you're
(23:52):
thinking something is not rightwith me. And you have that low
blood pressure. I'll not leavethat 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 over62, yeah , that could be
Speaker 3 (24:06):
Okay. You know, with my uh, mother, I have not seen
her blood pressure above 100ever. 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 seethis in in younger women .
Younger women have lower bloodpressure. Leave them alone if
they're just functioning fineand that's what their baseline
is.
Speaker 2 (24:26):
When do you recommend people get checked ?
So first of all, the person whodoesn't have any idea what
their blood pressure is, whenshould they start checking? How
often should they keepchecking? And then people who
do have hypertension, how oftenshould 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 youlook at the various risk
factors you have. Let's say youare someone in your thirties,
maybe you are enjoying morealcohol than that will be
recommended. I'll start tomonitor it carefully. Uh, let's
say you are in your thirties,forties, and then you have a
(25:00):
strong family history of it,but you have never been
diagnosed. Maybe you're someonewho should monitor it. Now how
often should you monitor it?
Well, to start with, I thinktrying to get it maybe once a
week or once every other weekwill be reasonable. And if all
of them remain the same, youdon't need to check it that
often. Maybe once every fewmonths will be reasonable. On
the other hand, the first thingyou check does not look that
(25:23):
great. I think I'll monitor itmore closely in that setting.
But I'll gauge it by, are youone who already has some risk
factors? Yes. Well then let'smonitor more frequently. You
don't have risk factors. Youhave always been healthy. Your
weight is not an issue. Notobacco, no alcohol, no family
history. I don't think you needto be that obsessed with it. So
(25:44):
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 Excelspreadsheet and then send me
the results of that. And Ialways said, you know, it's
been stable for years. Yes,yes. And I think you're
actually raising it by checkingit 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, ifthat's gonna stress them, now
actually the monitoring isgonna result in more high blood
pressure. So that's where youshould know yourself. And the
frequency also should be guidedby that. If you're somebody
who, as soon as you have moredata, you actually, instead of
feeling better, you're gonnafeel worse by thinking, oh my
(26:22):
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 byvarious things. So you're gonna
find yourself working higherand higher and higher. So you
should know yourself. And ifyou are that excitable, check
it. Rarely. The other timeswhere I think the home blood
pressure monitoring becomesvery valuable is if you are at
the cusp of an intervention. Soyou , let's say you have senior
(26:46):
provider and your provider hassaid, you know, your blood
pressure is kind of at in thegray zone. At some point, maybe
we should consider starting youon a medication or you should
do something about it. Maybeyou should start exercising or
something to that effect. Ifyou are in the monitoring phase
and now the data you have willbe the decider of whether
you're gonna be put on amedication or not. Sure do it
(27:08):
weekly or whatever yourprovider has recommended. But
if you're not in that realm,you're just minding your
business, none of those issueshave been raised. The frequent
checking can only stress youout more. So
Speaker 2 (27:19):
What we shared , how should people check their blood
pressure at home to do itcorrectly?
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 yourbaseline resting state for
about five minutes. Now, when Isay rest, I don't mean be on
your phone listening to thenews, talking to your cousin. I
mean just rest. Just sometimesthey even recommend maybe a
(27:44):
darker room, a quiet room. Justbring your blood pressure back
to its baseline. You should nothave had any coffee. You should
not probably have eaten notobacco an hour from the time
you're checking. Put the arm atthe level of the heart. So the
upper arm should be at thelevel of the heart. And if
people need more information onthe proper way of doing it,
(28:05):
American heart and other groupshave actually , uh, put
information for this. On thewebsite
Speaker 2 (28:10):
Listeners, we will put a link to those resources
to learn how to check yourblood pressure at home
correctly. We'll put a link tothose on the show notes. So I
don't need you to get into allof the medications for high
blood pressure. Let's justpreface it by that. 'cause
there are a lot of them . Sure. But let's talk about
medications. If your doctorrecommends medications for your
high blood pressure, what aresome of the things people need
(28:30):
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 ofthe bloodletting and the
leches. We have come up withmedications , uh, what we call
water pills or diuretics thatactually 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 commonforms of blood pressure
management. But now we knowit's not just the excess fluid.
Sometimes the elasticity hasbeen lost, so the blood vessels
have become a little tight. Sowe have things to dilate those
blood vessels. Medications inthe 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 thenbecause the kidneys are very
much involved with managingblood pressure, we have
medications that work on thekidneys. Medications we call
ace inhibitors. Lisinopril.
Ramipril , all the prills theprills are . So yes, a very
common one to hear about arebeta blockers. And these are
(29:36):
ones which sort of , uh, calmthe hyperactivity. That's the ,
uh, sense of the heart, youknow, pumping too much blood
into these blood vessels andmedications 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 intothat category. And so people
should work with their providerto see which choice of
medications is gonna beappropriate 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 thesepills. 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 younotice it, it has gone a little
too far. You know, the kidney'snot working as well, the heart
is not working as well. So Ithink informing people who are
working with to say that, yeah,yeah, this is gonna be silently
destroying the brain, thekidney, the heart. And so
(30:39):
that's why you need to monitorit. If it's still elevated, we
just need to act on it becauseit's not gonna give you a
signal of a headache or this orthat before you actually get
it. By the time you are havinga lot of headache, probably it
has gone too far at that
Speaker 2 (30:53):
Sense . Exactly.
Yeah . You sometimes your firstsymptom is the heart attack or
it's exactly a stroke orsomething like that .
Unfortunately.
Speaker 3 (30:59):
Yeah , unfortunately. So this is one
of those, the same way, highcholesterol did not give you
any symptoms until it was aproblem. This one also, you
need to monitor it and act onit , uh, before you get there,
before we leave medications.
David, one thing that's worthreminding, people who have been
started on medications says ,stick to what has been
recommended. Sometimes peopletry to switch medications
(31:21):
around a bit . Maybe theythought their blood pressure
was okay one day and they said, I skip it when my blood
pressure is normal. And it'sworse for people to keep in
mind, it takes three to fourdays for the medication to have
action. So once you getstarted, don't give up in the
first two days or so on sayingit didn't work. It needs that
many days for it to start towork and has to be every day it
(31:43):
has to be taken. You cannotskip 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 aboutthat is if you are gonna cut it
back or stop it, it has to bedone after talking with your
doctor. Yeah . Becausesometimes actually stopping it
can cause a much higher bloodpressure you have never seen
before than what you startedwith. 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 needto add a second medicine or add
a third one, people say, I Inever needed that. It was
always fine, but as you havetold 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 ageor whatever other factors come
into play, you may need to adda second one, maybe a third one
needs to be added. So if that'swhat's necessary to keep you
from having a stroke, fromhaving a heart attack or a
kidney disease and you know,needing dialysis, I think that
(32:41):
might be a a , a fair trade inthat sense.
Speaker 2 (32:45):
So if you wanna leave our listeners with a few
tips, what would you most wantlisteners to know about high
blood pressure?
Speaker 3 (32:52):
Well, of all the things we monitor in patients,
I strongly feel like their homemonitoring might have a bigger
role in addressing thiscompared 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 weneed to collect. I feel like
patients should be empowered tosay, you know, I think I can
(33:13):
get a cleaner, better data inmy home setting and they can
start to participate in thatand 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 arenot that expensive. I give them
out in many community settings,you know, and I don't think
I've spent more than $40 for agood blood pressure monitor.
And unless you're gonna getones with the bells and
(33:43):
whistles that can go into theseventies or so, because some
of them, they also say theymonitor rhythm for you and
stuff so you get more, youdon't need it . Just get a
blood pressure monitor. You aretalking about $40 over years,
that's gonna save you from alot of unexpected outcomes.
Always remember the lifestylechanges, diet with exercise,
maybe cutting back a little biton the alcohol are key to
(34:06):
managing this. And if you gopast that and get to
medications, stick with what isrecommended and work very
closely with your provider tomake sure you're taking it the
way it's prescribed andconsistently 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 HennepinHealthcare. Okay. So maybe this
show was a little longer thanour usual episodes, but there
are so many things to talkabout with high blood pressure.
So thanks for tuning in and Ihope you'll join us in two
weeks time for another greatepisode. 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 findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(35:07):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota, andengineered and produced by John
Lucas At highball Executiveproducers are Jonathan , CTO
and Christine Hill . Pleaseremember, we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(35:29):
time, be healthy and be well.
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