Joey Wahler (Host): It's extremely common in Americans and must be properly managed. So, we're discussing hypertension, also known of course as high blood pressure. Our guest is Dr. Andrew Foy, a general cardiologist with Beebe Healthcare.

This is the Beebe Healthcare Podcast. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Foy. Welcome.

Andrew Foy, MD: Hi. Thanks for having me.

Host: Great to have you aboard. We appreciate the time. So first, what would you say initially sparked your interest in Cardiology and dealing with areas like hypertension?

Andrew Foy, MD: I always had an interest in Cardiology from the time I was in college. I was an endurance athlete. I did track and cross country. And so, I was interested in cardiorespiratory physiology. And as I was in med school, I just enjoyed my Cardiology courses, the different learning blocks. And then, I had a very good experience. When I was a third year student, my first rotation was actually on a Cardiology block, and I liked all the people I worked with, had an enjoyable experience.

And so, it all sort of flowed. I always felt like I wanted to be a cardiologist from the time I started med school, but I mean, there was no really big reason for that. I mean, I didn't see a family member get saved from a massive heart attack or anything like that, the things that you sometimes hear. It was just something that I naturally gravitated towards.

Host: Gotcha. Where did you run track in college?

Andrew Foy, MD: A small school called Ursinus in Pennsylvania.

Host: And what do you think it was about that athletic career that piqued your interest in this?

Andrew Foy, MD: I mean, I don't know if it was anything in particular. It was just as an endurance athlete. I was often thinking about cardiorespiratory fitness, thinking about the different kind of training programs I was engaged in and the workouts and how they were benefiting me and could help me achieve what my goals were. And so, I think it just was all kind of naturally tied in with cardiorespiratory physiology.

Host: Interesting. Interesting that you would look at that and kind of look into the future as an offshoot of that for your career. So, hypertension is, of course, often referred to as the silent killer. What's meant by that and why is it so important for people to understand their blood pressure?

Andrew Foy, MD: Yeah. So, I think first off, what's meant by that is that, generally speaking, people don't feel their blood pressure. Even when the blood pressure is significantly elevated, it's unusual for people to feel that. And so, I think that's why, you know, it's referred to as silent. And then, the why it's referred to as killer, which I mean, I've always found a little bit of dramatic language there, but the reality is that high blood pressure is a significant risk factor for contributing to cardiovascular disease. And just for some perspective, it really represents twice the risk of high cholesterol, which we often think of as being like the most proximal thing that causes and contributes to cardiovascular disease.

Blood pressure is actually much more strongly linked to it than cholesterol. It's more strongly linked than smoking, believe it or not, which is strongly linked. Don't get me wrong. But nobody would really be surprised to hear us this day and age talk about smoking and the risk of cardiovascular disease. High blood pressure, significant high blood pressure, is much more strongly linked even than having diabetes, which is also known as a significant cardiovascular disease risk factor. So, I just think the strength of the association between high blood pressure, especially significantly elevated blood pressure and cardiovascular diseases, one, it's very strong and, two, it's very modifiable if treated correctly and with due diligence on the part of patients as well as their providers.

Host: And we'll talk a little bit more about that in a moment or two. But first, what are some of the biggest risk factors you see in patients? Because unfortunately, there are many of the same ones that bring on a wide array of other conditions that are very common, right?

Andrew Foy, MD: Yeah, I think the biggest risk factors for developing hypertension are things that most people would appreciate, which is poor diet, sedentary lifestyle, and obesity.

Host: And so when we talk about those things, obviously, it's easier said than done to make changes to those, especially as we get older and are more set in our ways. But let's talk a little bit first about diet. What are one or two things from your experience that anyone can do on their own to change it for the better to help control that blood pressure?

Andrew Foy, MD: I think the first thing is just trying to reduce calories in general. And usually, the easiest way for most people that I see to do that is to reduce consumption of highly processed foods, reduce consumption of fast foods, and also reduce consumption of sugar-sweetened beverages like soda, sweetened iced tea, things of that nature.

Host: How about regarding exercise or increasing activity on a regular basis? What are some of the minimums that people should look for in terms of doing something? Because it's better than nothing, right? Whether it be walking or whatever, to get the blood flowing and again, maintain a proper blood pressure, hopefully.

Andrew Foy, MD: Yeah. Well, you mentioned walking. That's a great exercise. I recommend that whatever the exercise is that people do from an aerobic standpoint. And it should be pointed out that aerobic exercise definitely has the most data supporting it in terms of its relationship with blood pressure. And it also has the most evidence to support that it can lower blood pressure by engaging in sustained aerobic exercise.

And what that can mean is something as simple as walking. I do encourage that when people are doing anything that they consider to be exercise, that they're doing it at an intensity that's more than simply what they would do to walk around their house. I often ask people, do you feel like you have to huff and puff a little bit? Do you work up a sweat? And that's for something like walking, it could just simply be a case of increasing your pace a little bit. A lot of people, I find, consider like walking pets exercise. I mean, don't get me wrong, it's better than sitting down, but it usually doesn't rise to the level of exercise. I mean, when people walk their dogs, they're constantly stopping. They're sort of doing what the dogs want to do. So, not to say that there's not people that can have an exercise type walk when they're walking a pet. It's just not. It tends to be more difficult than people think. So, I tell them to try to plan some formal exercise time for themselves, which means doing something where you're engaging in a pace and an effort that feels like work.

So, a lot of people when they walk may need to put some effort into that. I say, you know, if you go for a walk, you should feel like if you're engaging in exercise in that walk, it should be more like the effort of going up steps, for example, which is hard because of the effects of gravity

Host: Absolutely. Well, you make a great point. And to that point, hence, the term working out, right?

Andrew Foy, MD: And again, just moving is better than nothing. But if we want to get the benefits of exercise, I mean, there does need to be a slight, at least some increase in effort there.

Host: Got it. So in other words, you're saying take it up a notch or two from the energy you'd use to, as you said, walk the dog or walk across the living room to grab the remote. It's got to be a little more than that, right?

Andrew Foy, MD: Right, right.

Host: So, any common misconceptions, Doctor, from your experience about high blood pressure? This is the place to clear them up right here.

Andrew Foy, MD: Well, I mean, I don't know if it's a misconception, but one thing that I see managing patients in the office that I feel pretty strongly about, and I've published a lot about this, is making determinations of blood pressure solely based on office readings. And I do think that that's something where awareness has improved over the past five to 10 years, but it's still very common to see people who are being managed for blood pressure almost solely based on office readings. Even if the patients have been encouraged to get monitors where they can measure blood pressure in their home, they're not really provided proper education on how to use them correctly to make inferences about what is called the ambulatory blood pressure load.

So when it comes to managing blood pressure for the lifetime, we don't really care that much about individual readings. We don't care that much about readings that are taken sporadically or willy-nilly when patients are under conditions of stress or exertion. I mean, there's a very specific way that we seek to assess somebody's ambulatory blood pressure load. And it requires systematic monitoring of blood pressure throughout the day. It can be as easy as morning and night, but things like the patient's posture when they do this, the conditions under which they do it all make a significant difference in terms of like what that number's going to be and then, how we manage them based on that number.

So, the biggest problem and challenge that I see is just trying to manage blood pressure based on office visits and office readings.

Host: Regarding treatment, how do the lifestyle changes that we've discussed already plus medication work together to manage hypertension?

Andrew Foy, MD: Yeah, they work together synergistically. We can lower blood pressure through one of those means or the other individually. But certainly, you get the greatest bang for your buck when you do them both together. I would say that people that are younger and have more mild high blood pressure, it's generally recommended to start with recommendations about diet and lifestyle and to see if that in and of itself is enough to bring the blood pressure into a range where we wouldn't recommend medical treatment. The reality is that most people though do require both or at least medical treatment. I mean, if you're only going to do one, the reality is it's easier to take a pill than change your lifestyle. Not that I encourage that, but that's the reality.

Host: I have to ask you about Beebe Healthcare's new Cardiovascular Institute. How would you say it's changing how patients of the community are cared for in terms of the way it's bringing together specialists and also services in a way that makes things more seamless for patients.

Andrew Foy, MD: Yeah, I think that's the key, is making things easier for patients. Having the different providers and care teams under one umbrella and in a close proximity location-wise, it really does facilitate care to a significant extent. And just in terms of like communications with providers in the service line, but in other specialties makes it much easier, much more seamless. And, yeah, I just think in general probably provides like a more expeditious process and a more efficient process. And it's easier all around.

Host: All about that ease, right? That's a big part of the picture. Couple of other things before we let you go. For someone that is living with or at risk for hypertension, what kind of support and resources can they expect at Beebe Healthcare? For instance, if someone joining us right now is thinking, "Okay, this all sounds great. I want to try and do some of these things, but I'm going to need help."

Andrew Foy, MD: The first thing, you know, that I would say that I offer and that I make a point of doing is actually helping to train people to monitor their blood pressure at home and providing sort of routine and constant feedback for that, which I think is very important. So, it's common for me when I manage patients with high blood pressure, perhaps even before making any recommendations about medicines, I'll ask them to do home monitoring and I'll provide instructions on that for usually a month. And then, I'll say, "Come back and we're going to review your home readings, and then we're going to come up with a plan." And until we sort of get things leveled out or to a point where we want them in terms of your home blood pressure, we're going to keep doing that every four to six weeks.

And I think, I mean, that's not something that A lot of people do, to be quite frank, especially not cardiologists. And it's very hard for primary care providers to do it because they have a lot more things that they need to do when they see a patient in the office. They have a lot more systems, bodily systems that they may need to be concerned about. There's a lot more when it comes to regulatory guidelines and best practices that they need to be concerned about. It's not really feasible, I think, to dedicate that level of care. And hopefully, we can do that and we'll do it as we continue.

Host: Absolutely. And finally, Doctor, in summary here, you've done a great job covering a lot of ground for us. To sum it up, if someone joining us right now is to take just one step toward better heart health, what would it be?

Andrew Foy, MD: I would say exercise. Aerobic exercise, if you can only do one thing. And if you can do more aerobic exercise and resistance training would make a tremendous difference. Other things will as well. But if you only did one thing, that's what I would advise.

Host: And as you said earlier, Doc, if you're going to include walking the dog as exercise, at least make it a brisk walk, right?

Andrew Foy, MD: That's right. Yeah. And make it sustained. I mean, so yeah, you want to do at least 20 to 30 minutes or more.

Host: Yeah, just because the dog sniffs around a little bit and does his or her business, just keep going, right?

Andrew Foy, MD: That's right. And maybe if the dog does all that and gets it over, gets it out of their system and that takes 15 or 20 minutes, then consider that you still need to go 20 or 30 minutes longer.

Host: Gotcha. Great advice indeed. Well, folks, we trust you are now more familiar with hypertension, a.k.a. high blood pressure. Dr. Foy, great information. Thanks so much again.

Andrew Foy, MD: Thank you.

Host: For more information, please do visit beebehealthcare.org. Now. If you found this podcast helpful, please share it on your social media. And thanks so much again for being part of the Beebe Healthcare podcast.