Transcription:
What is Hypertension and What Risks Does it Present

Bill Klaproth (Host): You may have heard the term "know your numbers." Well, one of those numbers is your blood pressure, and when it gets really high, you're said to have hypertension. What are the risks of hypertension? Let's find out with Dr. Nadeem Goraya, a Family Practice Physician with Dignity Health. Dr. Goraya, thanks for your time. Let's start with this: what is hypertension?

Dr. Nadeem Goraya (Guest): Hypertension is really — like most guidelines, a blood pressure reading of greater than or equal to 140, which is the top number, or 90, the bottom number. The top number is your systolic blood pressure, and the bottom number is your diastolic blood pressure. We really don't diagnose this unless we have greater than two blood pressure reading consistent with an elevated blood pressure reading. For instance, if somebody comes into our clinic, and it's an isolated event, and I look at the records, and they're usually well controlled, I don't necessarily diagnose them with hypertension. Other things could be at play in that visit that might have caused their blood pressure to go up, a recent stressor, or they might have been running late to the appointment, and they're huffing and puffing on their way in. We don't always diagnose based on one reading. We have to get consistency in that, and that's when we officially diagnose it.

Host: Well, that makes sense. It's good to know that you establish consistency before treating. I know I'll go in for a yearly physical and it will be one number, and say I go in three months later, if I have a cold or something, and it's a higher number. It's good to understand how you do that for treating. Dr. Goraya, what factors put someone at risk for hypertension?

Dr. Goraya: The most common diagnosis of hypertension — there are multiple different types, but the most common for the general public is called primary essential hypertension. What puts somebody at risk, unfortunately, is obesity, which is a big risk factor in our current population in the American culture. We have a lot of individuals with obesity, and it's a growing epidemic. That's one of the leading causes.

Unfortunately, just age — as you age, your arteries sometimes harden over time, and we notice the blood pressure goes up accordingly. Family history can play a role as well as race. We note that in African American individuals, we have a higher incidence of hypertension. Individuals with high sodium in their diet, high alcohol intake, and low physical activity, which brings back to the obesity issue and diet issue, where those are all key factors that are driving people to get hypertension.

As far as secondary and other contributing causes that I also encourage everybody to look out for are, for instance, nonsteroidal anti-inflammatory drugs. Those would be drugs like Motrin, Advil, ibuprofen as a core component of those drugs. That is known sometimes to cause increased blood pressure. In addition, oral contraceptive pills are known to increase blood pressure. Decongestants that you take for a cold can sometimes increase your blood pressure. Obstructive sleep apnea — that's also seen a lot in obesity that can drive hypertension. Stimulants, illicit drugs such as cocaine, amphetamine, obviously, are very detrimental in many regards, but blood pressure is one of the issues that is affected there.

Host: Hm, I never knew that about Motrin, and Advil, and ibuprofen. Very interesting. Dr. Goraya, why does a patient with hypertension need to control their blood pressure, and what are the consequences of neglecting high blood pressure?

Dr. Goraya: The importance of controlling your blood pressure is very important. Blood flow that goes to all your vital organs is affected in some way, so if your blood pressure is not controlled, your incidence of coronary artery disease or heart attack go up because the high pressure puts a strain on the vessel walls, the heart, and really everywhere in the body. If we focus on the heart, it really increases the chances of plaque buildup and plaque rupture, causing a heart attack, which is dangerous.

In addition, by the same mechanism, a stroke can also be a higher incidence in these patients who have uncontrolled blood pressure, as well as a ruptured aneurysm. If somebody is known to have an aneurysm — sometimes they run in families — we all hear about aneurysms in peoples' brains, such as Berry Aneurysms and other aneurysms in other parts of the body. It's very vital — a vital component of treating those aneurysms is just to control the blood pressure.

In addition, kidneys are affected, which can lead to renal disease and dialysis we often hear of. Those patients get worse with time with poorly controlled blood pressure. Just vision, in general — we have something called hypertensive retinopathy. If somebody doesn't control their blood pressure adequately, their vision will get affected. All real, vital components of the body are affected in some way.

Host: If we're trying to decrease our risk for heart attack, or stroke, or renal disease, or vision problems, make sure you pay attention to your blood pressure. Dr. Goraya, how do doctors treat hypertension? What can someone do on their own to lower blood pressure?  

Dr. Goraya: The thing that we always try to emphasize with patents before we go to medications is weight loss. That's the most important thing. Often, if you lose 10 pounds, you sometimes lose 10 points on the systolic blood pressure. Exercise. If somebody exercises 30 minutes a day or an hour every other day, they can lower their blood pressure that way. A low sodium diet to less than two grams per day, and also decreasing alcohol intake, and even stop smoking. Some of these are very controllable aspects, and that's a good thing. These things are under your control as an individual.

Sometimes, for instance, when I mention risk factors like age, family history, you don't really have too much control over that. As far as these what we call modifiable risk factors, such as sodium, alcohol, and smoking, those are very much controlled by the individual, albeit difficult at times, especially with smoking, but it is very important for the patient to realize the importance of stopping and how that can prevent worsening disease in other places.

If we go away from those modifiable ones and let's say we've already tried all that, we usually go to medications. We have various degrees of different types of medications that work in different parts of the body to lower the blood pressure. We try to lower the blood volume, which lowers the blood pressure. We try to get medications that will relax the arteries to make them wider, and as such, drop the blood pressure. There are various mechanisms that they work by, and the end goal is to try to lower them. Usually, we can effectively lower them with blood pressure medications.

Host: That's really interesting. How do you monitor hypertension? Say someone tries to change the modifiable risk factors as you say. They try to lose weight, the exercise, go on the low sodium diet, decrease their alcohol, stop smoking. Or if somebody is on medications, how do you monitor that person?

Dr. Goraya: What I like to tell patients to do is to get a blood pressure machine and keep a home blood pressure log. At the minimum checking once to twice a day, maybe once when they wake up and once in the evening before they go to sleep and see where they land. As far as the physician goes, we monitor it in the clinic. This is a vital component for patients to understand is that when they're on a lot of the medications for high blood pressure we have to monitor electrolytes, such as sodium, potassium, magnesium, the creatinine, which tells us how the kidney is doing because some of these medications act on the kidney in good and bad ways. We have to monitor every so often.

Often times, when we start a new medication, we have a patient follow up pretty frequently, and then as time goes on, we spread out the appointments if we realized that okay, this patient has been tolerating this medication for a solid year, they've had no problems on their electrolytes that we discussed. So yeah, we can push out those appointments to every year or even more if the patient has been stable on that medication for quite a while. It's very important, especially up front, for us to be monitoring those electrolytes.

Host: As far as the blood pressure machine goes, I don't want to scare anybody off — you know, I'm going to go get a blood pressure machine. You can readily find these on Amazon and other places, is that right?

Dr. Goraya: Yes. Yes, indeed. Actually, Amazon, any local drug store, grocery store, a lot of places carry them. They usually go from $20 to $40 depending on the type you get. Very accessible. They're usually automated, so you don't really require another person to be there. You can do it yourself.  

Host: I think that's a really good idea. If you're worried about your blood pressure, get a monitor, and understand where it's at. I think that's very helpful. What are the side effects of medications needed to treat hypertension?

Dr. Goraya: One common side effect that we see a lot is dizziness. That is especially seen in a lot of our medications that are called Beta-Blockers because they're affecting the heart rate, which helps in lowering the blood pressure, but at the same time, patients can oftentimes complain of dizziness, even sometimes fainting, so you really have to follow up closely on those side effects and inform your physician. If these are happening, we can easily change you to another medication, which may not have those side effects.

The other one is dehydration. Especially in the class of antihypertensive drugs called diuretics, the fact that we decrease your blood volume by helping you urinate a lot of your volume out, often leads to low blood volume, which can then lead to dehydration, which is dangerous. We monitor for that with our lab tests, but if you have symptoms that are pretty overt and frank, we need to notify your physician so we can adjust your medications accordingly.

Host: Just to wrap up here, Dr. Goraya, we're shooting for under 140/90. If someone buys a blood pressure machine and it's always in the 130s, that's probably a trip to the doctor too, is that right?

Dr. Goraya: Yes, and it's also important to note that if a patient has another disease process, such as diabetes, chronic kidney disease, history of a heart attack or stroke we sometimes shoot for lower than that even. As a general rule for the lay public to know, less than 140/90 is the best goal to keep at the very minimum, and in some cases, we shoot for even lower than that.

Host: Know your numbers. So important. Thank you, Dr. Goraya. For more information about hypertension, or to get hooked up with one of our providers, please visit DignityHealth.org/Bakersfield, that's DignityHealth.org/Bakersfield. And if you like what you've heard, please share it on your social channel. That would do our blood pressure some good. Be sure to check out our full Podcast library for topics of interest to you. This is Hello Healthy, a Dignity Health Podcast. I'm Bill Klaproth. Thanks for listening.