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Hypertension: What You Need to Know About Blood Pressure
In this podcast, cardiologist on the medical staff of Baylor Scott & White Heart and Vascular Hospital - Dallas, Dr. Drew Chalkley, discusses hypertension and the importance of managing high blood pressure.
Featured Speaker:
R. Andrew "Drew" Chalkley, MD
Dr. Chalkley is board-certified and specializes in general cardiology. The scope of his practice includes preventive cardiology, coronary artery disease, the management of heart failure, valvular heart disease and arrhythmias. In addition, Dr. Chalkley has a professional interest in advanced cardiac imaging, including CT angiography and echocardiography. Transcription:
Hypertension: What You Need to Know About Blood Pressure
Caitlin Whyte: This is HeartSpeak, the podcast from Baylor Scott & White Heart and Vascular Hospital in Dallas and Fort Worth. Today, we welcome cardiologist, Dr. Drew Chalkley to the show. He's here to tell us the importance of understanding hypertension and the risks associated with having high blood pressure, especially in this pandemic environment.
Dr. Chalkley, my first question, we'll start off pretty simple. What is hypertension?
Dr. Drew Chalkley: So hypertension is elevated blood pressure. It goes into a few categories. There's normal blood pressure, then there's stage 1 hypertension and stage 2 hypertension. Normal blood pressures tends to be the systolic blood pressure is 120 or less and the diastolic blood pressure is 70 or less. The systolic blood pressure is the top number and the bottom number is the diastolic blood pressure.
Stage 1 hypertension has recently, in the last few years, been redefined as a systolic blood pressure greater than 130 over 80, so systolic blood pressure of 130 and a diastolic blood pressure of 80. So if it's greater than that, it's stage 1 hypertension. If it's between normal blood pressure, that is called pre-hypertension. And then stage 2 hypertension is 140 over 90 or greater.
Caitlin Whyte: So let's dig into those two different types a bit more. What is the difference between the systolic and the diastolic pressures?
Dr. Drew Chalkley: The systolic blood pressure is when the heart is squeezing. So that's when the aortic valve is open and the heart is squeezing and you're getting the pressure from the left ventricle. The diastolic blood pressure is when the aortic valve is closed and the heart isn't actively squeezing anymore. And at that point, that's the diastolic blood pressure. The pressure there is coming from the elastin inside the arteries, which hold the pressure from systole. So the elasticity of the arteries as well creates the diastolic blood pressure.
Caitlin Whyte: Now, the American College of Cardiology and the American Heart Association recently revised their blood pressure guidelines. So tell us a bit more about what are they and how we should interpret them.
Dr. Drew Chalkley: They've changed them a little bit, but essentially they've come down with what they define as hypertension. It previously was thought the systolic of 130 to 140 was considered pre-hypertension and now that's considered hypertension and these changes were made to elicit more aggressive hypertension management.
So under the new guidelines again, normal blood pressure is defined as 120 over 70 or less. Pre-hypertension is between 120 over 70 to 130 over 80; 130 over 80 or greater, stage 1 hypertension and 140 over 90 is stage 2 hypertension.
Caitlin Whyte: So now that we have some of those basics under our belt, let's start with some of the causes and risk factors for high blood pressure. What can we do to try our best to stay away from it?
Dr. Drew Chalkley: Most hypertension falls into essential hypertension, and that's the vast majority of hypertension. There can be a few secondary causes of hypertension, which can be from different medical conditions. But for this talk, we'll focus on kind of what normal high blood pressure is, and that tends to come from lack of exercise, poor diet, being overweight or obese, high salt in the diet. And essentially over time, as one gets older, the blood pressure ends up raising. Some people have genetic predispositions to have higher blood pressure earlier ages, even if they have good diet and good exercise.
But risk factors like a poor diet, high in sodium that's also low in potassium, a high salt diet tends to cause high blood pressure. Potassium-rich foods tend to decrease blood pressure. So those are fruits and vegetables. And as anybody gets heavier and goes into overweight and obese, you tend to raise the blood pressure as the weight goes up and the blood pressure tends to go down as the weight goes down.
A normal weight is considered something called body mass index. And for the most part, there are a few exceptions to this, but a normal body mass index is 18.5 to 25. You can figure that out by using a calculator online. So if the BMI is greater than 25 and there's high blood pressure, you can try to lose weight. And a lot of times that will decrease blood pressure significantly. As I mentioned, there's diet, there can be certain medications that can raise your blood pressure and then a lot of times the genetic predisposition to higher blood pressure. .
Caitlin Whyte: Now you mentioned a lot of these things being overweight, a high salt diet. And I imagine those contribute to some other health issues along with that hypertension. What are some other health threads that kind of coincide with, you know, this high blood pressure?
Dr. Drew Chalkley: So the associated diagnoses with high blood pressure, there are many. It can accelerate coronary artery disease. So the blockages inside the coronary arteries that can cause heart attacks. It can cause heart failure. It can cause strokes. It can accelerate kidney disease significantly along with a myriad of other conditions. But those kind of being the major ones, being coronary artery disease, stroke, heart failure, and kidney disease.
Caitlin Whyte: My next question is kind of a two-parter. It's how is hypertension treated? And then, what is the timing? Is there a vast difference between, you know, catching high blood pressure early, as opposed to maybe when it's been around for awhile and you didn't know about it?
Dr. Drew Chalkley: Yeah. So in my practice, I tend to treat younger people more aggressively because obviously as time goes on, they'll be at increased risk for problems down the road. I would always discuss change in diet, discuss people being overweight or obese and encourage them to lose weight if that's necessary.
As people get older and if they've been living with high blood pressure for a long time, I tend not to be quite as aggressive because a lot of those folks don't do well as you bring the blood pressure down swiftly. They do benefit from lower blood pressure and the very elderly often don't tolerate lower blood pressures as much, but that's much more on a case by case basis.
Caitlin Whyte: And, you know, with people at home more than ever, do you have any tips for monitoring blood pressure at home?
Dr. Drew Chalkley: Yeah. So home monitoring actually is a good thing to do. The wrist cuffs that you can get aren't quite as good as those that go over your arm. I find that home monitoring blood pressure cuffs tend to be fairly accurate with the systolic blood pressure, but they don't tend to be as accurate with the diastolic blood pressure.
Essentially to test your blood pressure, you need to sit down, try to be calm for about three to five minutes before taking your blood pressure. And that actually in the literature I've read seems to have a more accurate blood pressure for the patient than the blood pressure that you would get in the clinic. So a lot of times people are stressed out, they've gone upstairs, they're concerned about seeing the doctor and their blood pressure tends to go up from those factors.
So in general, the home monitoring tends to be good, particularly if you do it at the same time every day or once or twice a day and log that. It can be very, very helpful to your healthcare provider in helping manage high blood pressure and also diagnosing it.
Caitlin Whyte: Great. Well, Dr. Chalkley, is there anything else you'd like to add to this conversation about hypertension?
Dr. Drew Chalkley: I think hypertension tends to be an important topic. And a lot of patients are a bit hesitant to start on medications when they first get the diagnosis. I think while lifestyle modifications are very important, it's also really important to keep in mind we need to get that blood pressure low. If that blood pressure remains high, it'll increase the patient's risk for stroke, for heart failure, for coronary artery disease, for chronic kidney disease. So people don't need to be living a long period of time with their blood pressure out of control, needs to be aggressively managed and brought down if at all possible within normal blood pressure ranges.
Caitlin Whyte: Well, thank you doctor for joining us today. That was Dr. Drew Chalkley, a cardiologist on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas. And thank you for checking out this episode of HeartSpeak.
To find a specialist on the medical staff, please call 1-844-279-3627 or visit BaylorHeartHospital.com. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk again soon.
Baylor Scott and White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.
Hypertension: What You Need to Know About Blood Pressure
Caitlin Whyte: This is HeartSpeak, the podcast from Baylor Scott & White Heart and Vascular Hospital in Dallas and Fort Worth. Today, we welcome cardiologist, Dr. Drew Chalkley to the show. He's here to tell us the importance of understanding hypertension and the risks associated with having high blood pressure, especially in this pandemic environment.
Dr. Chalkley, my first question, we'll start off pretty simple. What is hypertension?
Dr. Drew Chalkley: So hypertension is elevated blood pressure. It goes into a few categories. There's normal blood pressure, then there's stage 1 hypertension and stage 2 hypertension. Normal blood pressures tends to be the systolic blood pressure is 120 or less and the diastolic blood pressure is 70 or less. The systolic blood pressure is the top number and the bottom number is the diastolic blood pressure.
Stage 1 hypertension has recently, in the last few years, been redefined as a systolic blood pressure greater than 130 over 80, so systolic blood pressure of 130 and a diastolic blood pressure of 80. So if it's greater than that, it's stage 1 hypertension. If it's between normal blood pressure, that is called pre-hypertension. And then stage 2 hypertension is 140 over 90 or greater.
Caitlin Whyte: So let's dig into those two different types a bit more. What is the difference between the systolic and the diastolic pressures?
Dr. Drew Chalkley: The systolic blood pressure is when the heart is squeezing. So that's when the aortic valve is open and the heart is squeezing and you're getting the pressure from the left ventricle. The diastolic blood pressure is when the aortic valve is closed and the heart isn't actively squeezing anymore. And at that point, that's the diastolic blood pressure. The pressure there is coming from the elastin inside the arteries, which hold the pressure from systole. So the elasticity of the arteries as well creates the diastolic blood pressure.
Caitlin Whyte: Now, the American College of Cardiology and the American Heart Association recently revised their blood pressure guidelines. So tell us a bit more about what are they and how we should interpret them.
Dr. Drew Chalkley: They've changed them a little bit, but essentially they've come down with what they define as hypertension. It previously was thought the systolic of 130 to 140 was considered pre-hypertension and now that's considered hypertension and these changes were made to elicit more aggressive hypertension management.
So under the new guidelines again, normal blood pressure is defined as 120 over 70 or less. Pre-hypertension is between 120 over 70 to 130 over 80; 130 over 80 or greater, stage 1 hypertension and 140 over 90 is stage 2 hypertension.
Caitlin Whyte: So now that we have some of those basics under our belt, let's start with some of the causes and risk factors for high blood pressure. What can we do to try our best to stay away from it?
Dr. Drew Chalkley: Most hypertension falls into essential hypertension, and that's the vast majority of hypertension. There can be a few secondary causes of hypertension, which can be from different medical conditions. But for this talk, we'll focus on kind of what normal high blood pressure is, and that tends to come from lack of exercise, poor diet, being overweight or obese, high salt in the diet. And essentially over time, as one gets older, the blood pressure ends up raising. Some people have genetic predispositions to have higher blood pressure earlier ages, even if they have good diet and good exercise.
But risk factors like a poor diet, high in sodium that's also low in potassium, a high salt diet tends to cause high blood pressure. Potassium-rich foods tend to decrease blood pressure. So those are fruits and vegetables. And as anybody gets heavier and goes into overweight and obese, you tend to raise the blood pressure as the weight goes up and the blood pressure tends to go down as the weight goes down.
A normal weight is considered something called body mass index. And for the most part, there are a few exceptions to this, but a normal body mass index is 18.5 to 25. You can figure that out by using a calculator online. So if the BMI is greater than 25 and there's high blood pressure, you can try to lose weight. And a lot of times that will decrease blood pressure significantly. As I mentioned, there's diet, there can be certain medications that can raise your blood pressure and then a lot of times the genetic predisposition to higher blood pressure. .
Caitlin Whyte: Now you mentioned a lot of these things being overweight, a high salt diet. And I imagine those contribute to some other health issues along with that hypertension. What are some other health threads that kind of coincide with, you know, this high blood pressure?
Dr. Drew Chalkley: So the associated diagnoses with high blood pressure, there are many. It can accelerate coronary artery disease. So the blockages inside the coronary arteries that can cause heart attacks. It can cause heart failure. It can cause strokes. It can accelerate kidney disease significantly along with a myriad of other conditions. But those kind of being the major ones, being coronary artery disease, stroke, heart failure, and kidney disease.
Caitlin Whyte: My next question is kind of a two-parter. It's how is hypertension treated? And then, what is the timing? Is there a vast difference between, you know, catching high blood pressure early, as opposed to maybe when it's been around for awhile and you didn't know about it?
Dr. Drew Chalkley: Yeah. So in my practice, I tend to treat younger people more aggressively because obviously as time goes on, they'll be at increased risk for problems down the road. I would always discuss change in diet, discuss people being overweight or obese and encourage them to lose weight if that's necessary.
As people get older and if they've been living with high blood pressure for a long time, I tend not to be quite as aggressive because a lot of those folks don't do well as you bring the blood pressure down swiftly. They do benefit from lower blood pressure and the very elderly often don't tolerate lower blood pressures as much, but that's much more on a case by case basis.
Caitlin Whyte: And, you know, with people at home more than ever, do you have any tips for monitoring blood pressure at home?
Dr. Drew Chalkley: Yeah. So home monitoring actually is a good thing to do. The wrist cuffs that you can get aren't quite as good as those that go over your arm. I find that home monitoring blood pressure cuffs tend to be fairly accurate with the systolic blood pressure, but they don't tend to be as accurate with the diastolic blood pressure.
Essentially to test your blood pressure, you need to sit down, try to be calm for about three to five minutes before taking your blood pressure. And that actually in the literature I've read seems to have a more accurate blood pressure for the patient than the blood pressure that you would get in the clinic. So a lot of times people are stressed out, they've gone upstairs, they're concerned about seeing the doctor and their blood pressure tends to go up from those factors.
So in general, the home monitoring tends to be good, particularly if you do it at the same time every day or once or twice a day and log that. It can be very, very helpful to your healthcare provider in helping manage high blood pressure and also diagnosing it.
Caitlin Whyte: Great. Well, Dr. Chalkley, is there anything else you'd like to add to this conversation about hypertension?
Dr. Drew Chalkley: I think hypertension tends to be an important topic. And a lot of patients are a bit hesitant to start on medications when they first get the diagnosis. I think while lifestyle modifications are very important, it's also really important to keep in mind we need to get that blood pressure low. If that blood pressure remains high, it'll increase the patient's risk for stroke, for heart failure, for coronary artery disease, for chronic kidney disease. So people don't need to be living a long period of time with their blood pressure out of control, needs to be aggressively managed and brought down if at all possible within normal blood pressure ranges.
Caitlin Whyte: Well, thank you doctor for joining us today. That was Dr. Drew Chalkley, a cardiologist on the medical staff at Baylor Scott and White Heart and Vascular Hospital Dallas. And thank you for checking out this episode of HeartSpeak.
To find a specialist on the medical staff, please call 1-844-279-3627 or visit BaylorHeartHospital.com. And if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk again soon.
Baylor Scott and White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians.