Hypertension, or high blood pressure, is called a “silent disease,” with few symptoms. But left untreated, hypertension can lead to heart disease in many forms, including hardening of the arteries, heart attack and stroke. Hypertension can also damage other organs, namely the kidneys.
The good news is that, for most patients, hypertension can be controlled through medications and lifestyle changes.
In the past five years the American Heart Association revised its hypertension guidelines, chiefly to emphasize that even slightly elevated blood pressure should be taken seriously due to the health risks it can raise.
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Controlling High Blood Pressure
Featuring:
Learn mor eabout Derrick Plahn, DO, FACC, FASE, RPVI
Derrick Plahn, DO, FACC, FASE, RPVI
Derrick Plahn, DO, FACC, FASE, RPVI is a Cardiologist at Franciscan Physician Network Indiana Heart Physicians.Learn mor eabout Derrick Plahn, DO, FACC, FASE, RPVI
Transcription:
Scott Webb (Host): One of the ironies about hypertension and high blood pressure is that despite how many people suffer from it, most of us don't know that we're suffering from it. But there is some good news about hypertension which is that it's easily diagnosed and treated and modification of behavior and lifestyle would go a long way to controlling our hypertension and high blood pressure.
And joining me today to help us all understand hypertension and high blood pressure and what we can do to help ourselves is Dr. Derrick Plahn. He's a Cardiologist with Franciscan Physician Network, Indiana Heart Physicians. This is the Franciscan Health Doc Pod. I'm Scott Webb. So Doctor, thanks so much for your time today.
We're going to talk about all things hypertension. So a great topic. One that's probably relevant for many of us, unfortunately. So let's start here. What exactly is hypertension and why is it bad for us?
Derrick Plahn, DO, FACC, FASE, RPVI (Guest): Hypertension is when your blood pressure or the force of the blood pushing against the walls of your blood vessels is consistently too high for too long. And the problem with that is it causes coronary artery disease. It causes and leads to stroke. It leads to chronic kidney disease, and it leads to a host of myriad of chronic medical problems that the blood pressure itself is usually not the problem; it causes other problems in the circulatory system.
Host: Yeah, I see what you mean. And really, as we know, no good can come from having hypertension, especially untreated hypertension. Give us a sense of how many Americans actually suffer from hypertension.
Dr. Plahn: Well, well over a hundred million Americans and upwards of 50%, some estimates believe. So it's incredibly common and it's an incredibly difficult problem.
Host: Yeah, it is common. And fortunately there are medications and we have healthcare providers and so on. And I think the biggest problem is right, just getting people to be aware that they have hypertension, to see their doctors, to be treated and so on. Also, maybe just break down for us, when we think about age, gender, who primarily has hypertension?
Dr. Plahn: Well, everybody has hypertension but it increases with age, for sure. We know that about 10% of 20 year olds have hypertension, that goes up to about 25 to 30% of people in their forties. But amazingly, it goes up to about 75% for people in their eighties. So, it's incredibly common, but it definitely worsens with age.
Host: Yeah, we're going to come back to that about the prevalence or incidence of younger folks having hypertension, which I don't think used to be the case, or maybe it just wasn't diagnosed as readily or as easily as it is now. But before we get there, let's talk about women and hypertension, especially after menopause.
Dr. Plahn: So women after menopause actually have a higher incidence of hypertension than men do, which often goes unnoticed or undertreated, for sure. Upwards of 80% of women in the post-menopausal state can have hypertension, which is a huge health dilemma.
Host: Yeah, it really is. And let's come back now. Let's talk about trends or things that have been developing over the recent past, whether it's in younger patients, certain occupations and so on.
Dr. Plahn: So we've noticed that with the obesity crisis in America, hypertension has worsened and it certainly is affecting younger and younger Americans. And that is a big problem. As we see that happening, we see increasing obstructive sleep apnea, which is very highly correlated with hypertension. Those two patterns have emerged quite clearly.
Host: Yeah, they definitely have. And I think one of the difficult things for us, just the lay people, patients is that we don't really know what's normal, right, when it comes to blood pressure. So, maybe have you go through that AHA guidelines. What's normal in terms of blood pressure, what's not? And at what level would you recommend to people like, say, okay, this is hypertension and we need to do something about it basically.
Dr. Plahn: The American Heart Association defines normal blood pressure as less than 120 systolic blood pressure, the top number and less than 80 diastolic pressure. And anything above that is considered elevated. Stage one, hypertension is considered 130 to 139 systolic or 80 to 89 diastolic and stage two hypertension, which is kind of what has been defined as regular hypertension in the past is greater than 140 over 90. And certainly if your blood pressure's over 140 over 90, we need to be thinking about medical therapy. And if it's between that, we certainly need to be thinking about sodium reduction, weight loss and general health maintenance to try to get our blood pressure under better control.
Host: Yeah, we definitely do. And I know that as much as we would like to, we cannot escape, genetics and family history. Is hypertension, just behavior and lifestyle, or is there a genetic component as well?
Dr. Plahn: There is a genetic component. I cannot point to a gene or a gene locus that shows who's going to have it, or you can't be tested readily, but people tend to be the children of their parents. And they tend to have the same risk factors, obesity. They tend to have the same stress level. They tend to have certain characteristics of their parents. And unfortunately it tends to run in families. It does. But that's a little bit more difficult question to answer. There are very rare forms of genetic hypertension, but for the most part, genetic hypertension does run in families. But it's not genetic per se.
Host: Yeah, I get what you mean. And it's hard to pinpoint exactly what in our family history, our genetics exactly you know, would cause hypertension, but we know that it's a thing. And we also know, as I mentioned, behavior, lifestyle, controllable, modifiable things. So, let's talk about that. You mentioned obesity and the crisis we have in America, but also I'm sure smoking, diet, lack of exercise. There's a lot of factors, right?
Dr. Plahn: Absolutely. So, I would say number one is the increase in weight of the population has been a big issue. Smoking continues to be a problem, especially in the Midwest. That is definitely a leading cause of hypertension, dietary indiscretion with higher saturated fats and especially high sodium diets can lead to or worsen hypertension and the general lack of exercise and overall just poor maintenance of health here in the Midwest has been a major issue that certainly contributes to hypertension.
Host: Yeah, it definitely does. And I hate to say this because I have a couple of cups of coffee every day, but I'm sure that caffeine on top of smoking is just you know, you're just really doubling down. Right. It's just no good can come from excessive caffeine and smoking.
Dr. Plahn: We definitely know that caffeine intake can transiently increase your blood pressure. The good news is though, I think that for people that are listening to this podcast is that it does raise your pressure. But over time that actually mitigates and it's not as quite as bad as before.
I wouldn't recommend taking in caffeine right before you check your blood pressure because it will increase it. But overall, it's not going to be a major contributor. However, smoking is definitely a major contributor and definitely modifiable and should certainly be stopped to help prevent high blood pressure in the future.
Host: Yeah, that's good advice. I made that mistake one time of sipping on a cup of coffee on my way to see my primary. And they were alarmed at how high my blood pressure was. And I said, oh, well, maybe that was the cup of coffee I just drank on the way here. And they, they said, yeah, don't do that Other things I've heard from my primary, about being cautious of and not doing as much or in more in moderation is when it comes to salt. Salt blood pressure, not a good marriage there. So what advice do you have for folks? Because I know that we all like our foods to taste well. I mean, you see people and I do it myself. I'll salt foods before I even taste them. So, from an expert here, why should we go easy on the salt Doctor?
Dr. Plahn: Well, we also know that salt intake increases your volume of water inside your blood vessels which causes high blood pressure. And we know that the more salt you intake, the higher your blood pressure is going to be. It's a difficult thing to wean from, but I think most Americans need to throw the salt shaker away. There's just too much sodium in our food already. And the American College of Cardiology recommended drastic reductions in the amount of sodium that most Americans take in upwards of maybe only a third of what they're currently taking. So it's certainly something that's going to be a long-term problem that we need to work on, but sodium definitely drives up blood pressure and it is a major problem.
Host: Yeah, my wife will get mad at me because she'll be like, you don't even know how I prepared this, of much sodium is in the meal. Why are you salting, at least taste the food first, right?
Dr. Plahn: Absolutely. Absolutely.
Host: Yeah. So let's talk about stress and I know this is a difficult one because stress points, pressure points for, you know, folks may be different, but in general, when we think about high blood pressure, hypertension, how does stress factor in?
Dr. Plahn: Stress can certainly cause transient hypertension and overall can lead to a chronic low level hypertension as well. It is certainly to try to strive for to reduce stress in our lives, the stress in our jobs, stress in our families, we know stress kills, and it's a chronic difficult problem to remove from our lives. But try to just deal with stress with yoga, with exercise, with healthy habits is certainly going to be helpful, but definitely stressful situations can drive up blood pressure, quite dramatically, in fact.
Host: Yeah, they definitely can. And I think we all just probably need to work on that too. As you say, yoga, whatever, it might be ways of keeping our stress levels down. A lot of good benefits, including maybe keeping our blood pressure down along the way. And let's talk then about some things that, you know, we think about medications, the more traditional ways of treating high blood pressure or hypertension. How do you get rolling? I'm actually on blood pressure medicine, myself, and it was a process with my primary of, you know, starting with a low dosage and kind of working up till we found the sweet spot, if you will. So, I'm sure that's true of all primaries, but just in general, can you take us through that? What's the process of okay, you've been diagnosed with hypertension and now here's what we're going to do about.
Dr. Plahn: Well, we typically look for people that have comorbid conditions meaning that you have high blood pressure, and maybe you have something else. Maybe you have a fast heart rate, or maybe you have an enlarged prostate. And we try to generally get you on a low dose medication that affects more than one process, but ultimately we typically need to put patients on a diuretic, a thiazide diuretic, such as hydroclorothiazide or HCTZ. Many people on the listening panel have heard that medication. That's typically what we recommend first-line therapy. And then we build from there and we add on multiple medications until we can get your blood pressure down to a reasonable goal without using too much medication to cause too many side effects. That's kind of the overall over reaching goal.
Host: Yeah, it's always that balance, right? The right amount of medication to treat the thing, in this case, maybe hypertension, but also then limiting the side effects and great that we have experts and doctors to help us sort through all of this. We definitely don't want to do it ourselves. Doctor, really educational stuff today, as we wrap up, what would be your final takeaways? What do you want folks most to know about hypertension and high blood pressure?
Dr. Plahn: I want them to know that it's incredibly prevalent and that there are multiple therapies to treat this and that discussing it with their primary provider is going to be paramount to their overall health and preventing cardiac problems, stroke, et cetera, in the future. And they really need to be open to treatment.
Host: Yeah, that's the great takeaway is that we need to be diagnosed. We need to be treated. That's why we have doctors and experts in medicine and all of that. So Doctor, thanks so much for your time today and you stay well.
Dr. Plahn: Thank you so much. I appreciate it.
Host: And for more information, visit franciscanhealth.org/heartcare. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb (Host): One of the ironies about hypertension and high blood pressure is that despite how many people suffer from it, most of us don't know that we're suffering from it. But there is some good news about hypertension which is that it's easily diagnosed and treated and modification of behavior and lifestyle would go a long way to controlling our hypertension and high blood pressure.
And joining me today to help us all understand hypertension and high blood pressure and what we can do to help ourselves is Dr. Derrick Plahn. He's a Cardiologist with Franciscan Physician Network, Indiana Heart Physicians. This is the Franciscan Health Doc Pod. I'm Scott Webb. So Doctor, thanks so much for your time today.
We're going to talk about all things hypertension. So a great topic. One that's probably relevant for many of us, unfortunately. So let's start here. What exactly is hypertension and why is it bad for us?
Derrick Plahn, DO, FACC, FASE, RPVI (Guest): Hypertension is when your blood pressure or the force of the blood pushing against the walls of your blood vessels is consistently too high for too long. And the problem with that is it causes coronary artery disease. It causes and leads to stroke. It leads to chronic kidney disease, and it leads to a host of myriad of chronic medical problems that the blood pressure itself is usually not the problem; it causes other problems in the circulatory system.
Host: Yeah, I see what you mean. And really, as we know, no good can come from having hypertension, especially untreated hypertension. Give us a sense of how many Americans actually suffer from hypertension.
Dr. Plahn: Well, well over a hundred million Americans and upwards of 50%, some estimates believe. So it's incredibly common and it's an incredibly difficult problem.
Host: Yeah, it is common. And fortunately there are medications and we have healthcare providers and so on. And I think the biggest problem is right, just getting people to be aware that they have hypertension, to see their doctors, to be treated and so on. Also, maybe just break down for us, when we think about age, gender, who primarily has hypertension?
Dr. Plahn: Well, everybody has hypertension but it increases with age, for sure. We know that about 10% of 20 year olds have hypertension, that goes up to about 25 to 30% of people in their forties. But amazingly, it goes up to about 75% for people in their eighties. So, it's incredibly common, but it definitely worsens with age.
Host: Yeah, we're going to come back to that about the prevalence or incidence of younger folks having hypertension, which I don't think used to be the case, or maybe it just wasn't diagnosed as readily or as easily as it is now. But before we get there, let's talk about women and hypertension, especially after menopause.
Dr. Plahn: So women after menopause actually have a higher incidence of hypertension than men do, which often goes unnoticed or undertreated, for sure. Upwards of 80% of women in the post-menopausal state can have hypertension, which is a huge health dilemma.
Host: Yeah, it really is. And let's come back now. Let's talk about trends or things that have been developing over the recent past, whether it's in younger patients, certain occupations and so on.
Dr. Plahn: So we've noticed that with the obesity crisis in America, hypertension has worsened and it certainly is affecting younger and younger Americans. And that is a big problem. As we see that happening, we see increasing obstructive sleep apnea, which is very highly correlated with hypertension. Those two patterns have emerged quite clearly.
Host: Yeah, they definitely have. And I think one of the difficult things for us, just the lay people, patients is that we don't really know what's normal, right, when it comes to blood pressure. So, maybe have you go through that AHA guidelines. What's normal in terms of blood pressure, what's not? And at what level would you recommend to people like, say, okay, this is hypertension and we need to do something about it basically.
Dr. Plahn: The American Heart Association defines normal blood pressure as less than 120 systolic blood pressure, the top number and less than 80 diastolic pressure. And anything above that is considered elevated. Stage one, hypertension is considered 130 to 139 systolic or 80 to 89 diastolic and stage two hypertension, which is kind of what has been defined as regular hypertension in the past is greater than 140 over 90. And certainly if your blood pressure's over 140 over 90, we need to be thinking about medical therapy. And if it's between that, we certainly need to be thinking about sodium reduction, weight loss and general health maintenance to try to get our blood pressure under better control.
Host: Yeah, we definitely do. And I know that as much as we would like to, we cannot escape, genetics and family history. Is hypertension, just behavior and lifestyle, or is there a genetic component as well?
Dr. Plahn: There is a genetic component. I cannot point to a gene or a gene locus that shows who's going to have it, or you can't be tested readily, but people tend to be the children of their parents. And they tend to have the same risk factors, obesity. They tend to have the same stress level. They tend to have certain characteristics of their parents. And unfortunately it tends to run in families. It does. But that's a little bit more difficult question to answer. There are very rare forms of genetic hypertension, but for the most part, genetic hypertension does run in families. But it's not genetic per se.
Host: Yeah, I get what you mean. And it's hard to pinpoint exactly what in our family history, our genetics exactly you know, would cause hypertension, but we know that it's a thing. And we also know, as I mentioned, behavior, lifestyle, controllable, modifiable things. So, let's talk about that. You mentioned obesity and the crisis we have in America, but also I'm sure smoking, diet, lack of exercise. There's a lot of factors, right?
Dr. Plahn: Absolutely. So, I would say number one is the increase in weight of the population has been a big issue. Smoking continues to be a problem, especially in the Midwest. That is definitely a leading cause of hypertension, dietary indiscretion with higher saturated fats and especially high sodium diets can lead to or worsen hypertension and the general lack of exercise and overall just poor maintenance of health here in the Midwest has been a major issue that certainly contributes to hypertension.
Host: Yeah, it definitely does. And I hate to say this because I have a couple of cups of coffee every day, but I'm sure that caffeine on top of smoking is just you know, you're just really doubling down. Right. It's just no good can come from excessive caffeine and smoking.
Dr. Plahn: We definitely know that caffeine intake can transiently increase your blood pressure. The good news is though, I think that for people that are listening to this podcast is that it does raise your pressure. But over time that actually mitigates and it's not as quite as bad as before.
I wouldn't recommend taking in caffeine right before you check your blood pressure because it will increase it. But overall, it's not going to be a major contributor. However, smoking is definitely a major contributor and definitely modifiable and should certainly be stopped to help prevent high blood pressure in the future.
Host: Yeah, that's good advice. I made that mistake one time of sipping on a cup of coffee on my way to see my primary. And they were alarmed at how high my blood pressure was. And I said, oh, well, maybe that was the cup of coffee I just drank on the way here. And they, they said, yeah, don't do that Other things I've heard from my primary, about being cautious of and not doing as much or in more in moderation is when it comes to salt. Salt blood pressure, not a good marriage there. So what advice do you have for folks? Because I know that we all like our foods to taste well. I mean, you see people and I do it myself. I'll salt foods before I even taste them. So, from an expert here, why should we go easy on the salt Doctor?
Dr. Plahn: Well, we also know that salt intake increases your volume of water inside your blood vessels which causes high blood pressure. And we know that the more salt you intake, the higher your blood pressure is going to be. It's a difficult thing to wean from, but I think most Americans need to throw the salt shaker away. There's just too much sodium in our food already. And the American College of Cardiology recommended drastic reductions in the amount of sodium that most Americans take in upwards of maybe only a third of what they're currently taking. So it's certainly something that's going to be a long-term problem that we need to work on, but sodium definitely drives up blood pressure and it is a major problem.
Host: Yeah, my wife will get mad at me because she'll be like, you don't even know how I prepared this, of much sodium is in the meal. Why are you salting, at least taste the food first, right?
Dr. Plahn: Absolutely. Absolutely.
Host: Yeah. So let's talk about stress and I know this is a difficult one because stress points, pressure points for, you know, folks may be different, but in general, when we think about high blood pressure, hypertension, how does stress factor in?
Dr. Plahn: Stress can certainly cause transient hypertension and overall can lead to a chronic low level hypertension as well. It is certainly to try to strive for to reduce stress in our lives, the stress in our jobs, stress in our families, we know stress kills, and it's a chronic difficult problem to remove from our lives. But try to just deal with stress with yoga, with exercise, with healthy habits is certainly going to be helpful, but definitely stressful situations can drive up blood pressure, quite dramatically, in fact.
Host: Yeah, they definitely can. And I think we all just probably need to work on that too. As you say, yoga, whatever, it might be ways of keeping our stress levels down. A lot of good benefits, including maybe keeping our blood pressure down along the way. And let's talk then about some things that, you know, we think about medications, the more traditional ways of treating high blood pressure or hypertension. How do you get rolling? I'm actually on blood pressure medicine, myself, and it was a process with my primary of, you know, starting with a low dosage and kind of working up till we found the sweet spot, if you will. So, I'm sure that's true of all primaries, but just in general, can you take us through that? What's the process of okay, you've been diagnosed with hypertension and now here's what we're going to do about.
Dr. Plahn: Well, we typically look for people that have comorbid conditions meaning that you have high blood pressure, and maybe you have something else. Maybe you have a fast heart rate, or maybe you have an enlarged prostate. And we try to generally get you on a low dose medication that affects more than one process, but ultimately we typically need to put patients on a diuretic, a thiazide diuretic, such as hydroclorothiazide or HCTZ. Many people on the listening panel have heard that medication. That's typically what we recommend first-line therapy. And then we build from there and we add on multiple medications until we can get your blood pressure down to a reasonable goal without using too much medication to cause too many side effects. That's kind of the overall over reaching goal.
Host: Yeah, it's always that balance, right? The right amount of medication to treat the thing, in this case, maybe hypertension, but also then limiting the side effects and great that we have experts and doctors to help us sort through all of this. We definitely don't want to do it ourselves. Doctor, really educational stuff today, as we wrap up, what would be your final takeaways? What do you want folks most to know about hypertension and high blood pressure?
Dr. Plahn: I want them to know that it's incredibly prevalent and that there are multiple therapies to treat this and that discussing it with their primary provider is going to be paramount to their overall health and preventing cardiac problems, stroke, et cetera, in the future. And they really need to be open to treatment.
Host: Yeah, that's the great takeaway is that we need to be diagnosed. We need to be treated. That's why we have doctors and experts in medicine and all of that. So Doctor, thanks so much for your time today and you stay well.
Dr. Plahn: Thank you so much. I appreciate it.
Host: And for more information, visit franciscanhealth.org/heartcare. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.