Intro: Duly Noted, a Health and Care Podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners reimagine and better understand an extraordinary health and care experience.

Joey Wahler (Host): The National Institute of Health says it's one of the leading diagnoses made by primary care physicians in the US. So, we're discussing recognizing and treating hypertension or high blood pressure. Our guest, Dr. Michael Forbes, a family medicine physician with Duly Health and Care.

Host: This is Duly Noted, a health and care podcast. Thanks for listening. I'm Joey Wahler. Hi, Dr. Forbes. Thanks for joining us.

Dr. Michael Forbes: Oh, thanks for having me. I appreciate you guys bringing me on today.

Host: Same here. So first, just how common is hypertension in the first place and what exactly is it for those that don't know?

Dr. Michael Forbes: That's a really good question. Hypertension is very common in the United States. Roughly about half the country has hypertension. I think those numbers might be a little bit higher too, given the COVID pandemic over the past three years. And hypertension's a little bit difficult to grasp. But the best analogy I can come up with is imagine turning on your faucet and your sink and having that water come out. Now, you want the water to come out at a good stream. You don't want it to trickle out and be too low and you don't want it to blast out, like a fire hydrant and be too high and cause water damage. So in your body, you do have some blood and that helps deliver oxygen to your organs. And if you don't have enough blood flowing around, it's low blood pressure or hypotension. And if you have too much blood flowing around and it's too strong, then that's hypertension.

Host: So, that's an eye-opening number when you say that at least 50% of Americans have high blood pressure, which makes me think to right away ask you as well, do you think then that many are going undiagnosed?

Dr. Michael Forbes: Oh, easily. And especially seeing that the number of people seeking out medical attention over the past three years has been on the decline. People have avoided doctor's appointments and dental appointments, and so even fewer people are going to the doctor these days.

Host: So, perhaps more people having it and fewer people addressing it, not a good combination, right?

Dr. Michael Forbes: No. It can be pretty scary and pretty dangerous. So, I think probably in the next 10 or 15 years, we're going to see some of the aftermath and effects of untreated hypertension.

Host: Unfortunately. So, how do you typically diagnose hypertension? Is it tested for at an annual checkup or physical, for instance?

Dr. Michael Forbes: Yeah, it is. It's really easy to check for . So a simple blood pressure cuff can measure your blood pressure and blood pressure cuffs are readily available. You can get your own at Walgreens or CVS or at the grocery store. Sometimes certain pharmacies too have blood pressure cuffs there. They have them at the dentist. Sometimes you can get your blood pressure checked at the nurse's station at a school.

Host: So if you're not getting your blood pressure checked exactly either by a doctor or on your own, what high blood pressure symptoms might a patient notice?

Dr. Michael Forbes: That's another good question. So, unfortunately, high blood pressure, you can't really tell if you have it. A lot of people think they might have high blood pressure, but then when they go to check it, their blood pressure is normal. It's when you have low blood pressure that you can tell. That's usually when you feel woozy and you feel like passing out, a little bit dizzy. But if it's dangerously high or just a little bit high, you wouldn't be able to tell without measuring it.

Host: So when we talk about measuring it, I know that obviously being stressed can raise a blood pressure level, albeit temporarily. So, what constitutes high blood pressure in terms of how much of the time do you have to have it in order to have it, and how is that checked? How do you know if someone's blood pressure is high in the doctor's office, that it's something that's pervasive?

Dr. Michael Forbes: Yeah, that's the tricky part. So, the criteria to diagnose someone with hypertension is pretty strict in my opinion. It just takes two high blood pressure readings to count as a diagnosis of hypertension. So, any blood pressure higher than one 30 over 80 on two separate occasions, two different office visits, would constitute a diagnosis of hypertension. But if you go to the doctor's office and your blood pressure happens to be normal, it might rise at other times if you're only going to the doctor once per year, and so you could have undiagnosed hypertension. So, I do recommend home blood pressure monitoring if that's an option for you.

Host: Okay. And so if someone is diagnosed with this, what treatment options are available to manage it?

Dr. Michael Forbes: There's quite a number of treatment options. A lot of people don't like to take pills or medicines, or they're already taking multiple pills and medicines. And so, there are some dietary approaches to stop hypertension. That's the DASH diet, D-A-S-H, Dietary Approaches to Stop hypertension. And so, what that consists of is trying to increase the number of fresh fruits and vegetables, that you're eating real whole foods instead of processed foods. Another attempt might be to decrease the amount of alcohol consumption. And so if you're drinking daily, maybe decreasing the amount of alcohol you consume can help quite a bit with blood pressure, avoiding caffeine, stimulants, energy drinks, decreasing the amount of smoking and nicotine you use. I know a lot of people are using these vape pens now. But I do think that does contribute quite a bit to high blood pressure. Now, if you're not able to make certain lifestyle changes, there are medications available, or say you've already tried multiple lifestyle changes and you can't bring the blood pressure down, then there's medications that we could try.

Host: How about genetics? How much of a role does that play in having high blood pressure?

Dr. Michael Forbes: That's a really common question. If you Google search that, Google will tell you somewhere between 30% and 50% can be attributed to genetics. But in general, I don't think it's very helpful to blame people's health problems on genetics. And I do think people have quite a bit of control and can do certain things in their life to help manage high blood pressure on their own.

Host: So, you mentioned medication, and will medication typically simply control the blood pressure level temporarily? Or can it, in some cases, do the trick for the time being at least permanently?

Dr. Michael Forbes: Medication I don't think will cure your high blood pressure. But it can buy you time so that you have time to make certain lifestyle changes. So say, you're new to going to a gym or starting a new walking routine or, say, you just bought a standing desk and you're trying to get used to standing all day, now the medication in the meantime you can be using and it keeps your blood pressure in a normal healthy range. And then, someday, if you think that you can go without the medication, you and your doctor can talk and see if you can do a trial without the medication.

Host: So if you do have high blood pressure and it's not addressed right away, what are the dangers there?

Dr. Michael Forbes: That's the scary part. So if you have high blood pressure, depending on how high it goes, you can have a number of health problems. So if it's moderately high in the long term, year after year, it can do damage to the heart. It kind of wears away at it, it makes it work a lot harder than it needs to and can lead to something called congestive heart failure. If your blood pressure though spikes way too high on any one particular instance, it could lead to a stroke, it could lead to damage to the kidneys, and these issues can be pretty debilitating.

Host: So, it really could just be the tip of the iceberg for further problems then.

Dr. Michael Forbes: Correct, correct.

Host: Couple of other things. A hypertension diagnosis, as we can imagine can be overwhelming to someone. So, what's the first step we usually recommend patients take when learning of that news?

Dr. Michael Forbes: When I talk with patients, the first thing most people do is they Google as much as they can. They watch a couple YouTube videos, and then they usually call their mom or their best friend or someone that they're close to, and they talk about the diagnosis. And I actually recommend doing both of those things. I recommend learning as much as you can about hypertension and what you can do to treat it. And then, I do recommend that you talk to a friend or family member or a loved one, just so that your blood pressure doesn't go any higher.

Host: How about after an initial diagnosis yields high blood pressure? When would you or another primary care physician typically refer a patient to a specialist to manage it further?

Dr. Michael Forbes: For most people, a primary care physician is able to treat high blood pressure on their own. But if you have a whole bunch of comorbid conditions, say, extensive cardiac history, then at that point they might refer out to a cardiologist or, say, your kidneys, you have chronic kidney disease, then you might be referred to a nephrologist Also, if the primary care physician tries to treat your high blood pressure and you both have come up with multiple different medications that just aren't working, at that point, a primary care physician may refer out.

Host: And so in summary here, doctor, what's your advice to someone diagnosed with hypertension about what they likely have ahead of them?

Dr. Michael Forbes: My advice to them is be persistent, don't give up and just keep trying different things. You know, it might be small changes every day that add up and standing desks I think are some of the best ways to fight some of these chronic issues.

Host: What's that?

Dr. Michael Forbes: A standing desk. So, a lot of people have now started standing a little bit more. People are saying that sitting is the new smoking. So in general, if you can stand as much as possible, even three more hours per day, it can help blood pressure, diabetes, osteoporosis and a whole bunch of other health issues.

Host: All right. I had not heard that. Perhaps I should start hosting some of my podcasts in a standing position then, huh?

Dr. Michael Forbes: Yeah, it would be really good for you. I bought a standing desk for myself and for my wife. I'm trying to get my parents standing, but so far I haven't been able to get them to stand a little bit more.

Host: Gotcha. Well, folks, we trust you are now more familiar with recognizing and treating hypertension. Dr. Michael Forbes, thanks so much again.

Dr. Michael Forbes: And thank you for having me.

Host: Thanks for being here. And for more information, please visit dulyhealthandcare.com. Again, that's dulyhealthandcare.com. Now, if you found this podcast helpful, please share it on your social media. And thanks again for listening to Duly Noted, a Health and Care podcast. Hoping your health is good health. I'm Joey Wahler.