Carl Maronich (Host): Meaningful Medicine is a Novant Health Podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today we are fortunate to be joined by Dr. Desiree Dawson, a Cardiologist, and we're going to be talking about blood pressure. I'm your host, Carl Maronich, and we'll get into the topic and doctor, let's first start if we could, by defining what blood pressure actually is.

Dr. Desiree Dawson: Yes. Wonderful. Thank you so much for having me, Carl. So blood pressure is basically when your arteries, they either constrict or they're not as shall we say pliable as they should be because your arteries that open, dilate and constrict, kind of in out and out.

But there are times when your arteries get somewhat hardened, and the blood flow isn't flowing through your arteries like it should. And that can create high blood pressure and that becomes a problem for some people.

Host: Yeah. And the standard you hear is 120 over 80 is kind of the normal. Is that still considered the normal or is there really not a full normal?

Dr. Desiree Dawson: We actually go with 130 over 80, because that gives a little leeway. Because 120 might be a little bit too tight of a control for some people. So we do try 130 over 80. And that gives a benchmark for some people especially as you're older, you don't want to be too tight with your blood pressure control.

 But the 130 over 80 has been somewhat the go-to parameters that we've been using thus far.

Host: Gotcha. Well then let's get into it and, and ask why is controlling blood pressure so important and what are the risks if it's not controlled?

Dr. Desiree Dawson: Blood pressure is important to control because without its control it can be extremely elevated and that causes risks of different issues in your body. Complications like heart attacks, congestive heart failure, strokes. So it's important to control because without its control, you're going to come into issues where your blood pressure is extremely high because your blood vessels are contracted, because of the highness of your blood pressure that does create what we sometimes call atherosclerosis in the arteries, hardening your brain arteries, your heart arteries, even your kidney arteries. So it is important to keep a control of it because if you continue to have blood pressure that's high and not on medication for or not doing anything for, it will lead to issues extremely like where I come into effect is with heart issues. So I see a lot of people that have had blood pressure for a long periods of time where it is been uncontrolled, haven't been on any medications, and they come in with thick muscles of their heart because it's your heart that's pumping against this blood pressure.

If you can imagine, someone that's lifting weights, right? The higher you go, the more your muscles kind of bulk up. Well, that's kind of what your heart is. It's a big old muscle. And if it is trying to pump blood, because that's what your heart does, that's the job of it. And if it is pumping blood against a blood pressure that's so high; it's going to bulk up this muscle. And eventually, when this muscle's so thick, your heart can eventually become weakened. In addition to that, chambers of the heart become extremely dilated or enlarged, like an enlargement of your heart. And that's where heart failure comes in. It weakens your heart muscle, it weakens your overall power of your heart, and then you run into some big complications.

And like I said, not to mention stroke issues because of that blood pressure, those vessels, they don't get strong. They get weak over time. And then with strokes, people come in with high blood pressures and, and hemorrhagic strokes as well as ischemic strokes, blockages, because of the hardening.

Host: Yeah, so obviously very important to control, as you've pointed out, and we've heard about natural kind of lifestyle based ways to manage blood pressure. Are there some strategies you would recommend to patients related to lifestyle?

Dr. Desiree Dawson: Yeah, no, absolutely. I talk about this all the time in my clinic. Natural things that you always can do. So I always start with exercise. Exercise is super important. I understand some people have like arthritic pain, or something or other. So we have other reasons or other things that you can do to help your blood pressure.

But when it comes to exercise, if you can, definitely do it and it's exercise at least 150 minutes a week. So I'd say if it's just walking, because aerobic exercise is fine, or walking, or anything, cardio is always a great thing, right? Swimming, whatever it is, 30 minutes, five days a week. And I always say an hour, three days a week, depending on what your schedule looks like.

So naturally, because exercise one, it helps inflammation, chronic inflammation, it's going to help with that and therefore help that inflammation not to target those arteries and get it hardened and all that. So, exercise is important in addition to weight loss. So that kind of is two things, exercise and weight loss.

But the exercise of course, will help with your weight loss. At least losing a good five to 10% of your weight, your body weight, maybe not eating as much calories in that you're trying to burn out, with your exercise. So that's definitely important things. And then another thing would also be too if you are a smoker, gotta quit. It is a major blood pressure increaser, right? And if have alcohol intake, you gotta reduce your consumption, in the alcohol range and kind of keep it to a couple of glasses of wine or maybe a cocktail or two, a day depending on what you're used to.

But overabundance of alcohol is going to make one weight gain go up and your blood pressure not get any better.

Host: So you've mentioned exercise and, and healthier lifestyle issues, avoiding excess drinking, avoid smoking, diet. Obviously there are many diet, both things you should avoid and probably things you should include your diet that might help.

Dr. Desiree Dawson: Oh, for sure. Yeah, diet is a big thing. Again, that goes with those who can't exercise or burn off that excess calories and everything. But when it comes to diet, super, super important. even if you are like an avid runner, so you're going to have to monitor, what you're eating for sure. So avoiding things that are like processed meats. I'm going to have to deal with that. And that's eating out the red meats. You're going to have to cut back on the bacon, the sausages, the red meats, and when you're going to do meats, it's okay to do lean meats if they're red meats. But it is more like lean, cut steak or lean beef, something like that because it's the fat. You're going to have to watch foods that are in saturated fat, unsaturated are more healthy fats. But the saturated, you're going to have to watch things like the keys, heavy in dairy. You want to more so do low fat dairy, more like legumes, beans, that kind of thing. Almonds, some form of nuts.

Um, don't want to always cook with butter. You want to do like olive oil, everything in moderation though. When it comes to weight gain and diet, I always tell people, sugar is not your friend. It's going to break down into fat, carbs. So you're going to have to watch the added sugars, cereals and the candies.

And I gotta have this ice cream before bedtime, that's going to have to be cut for sure, in moderation, if not any sugar is not your friend when it's coming to weight loss and trying to get that blood pressure down.

Host: One thing, I think by and large people are becoming more aware of mental health issues and stress is something that I think also can play a role in trying to deal with blood pressure. Is that, is that accurate?

Dr. Desiree Dawson: That's accurate because stress brings on the hormones that your blood pressure, will spike up for, like increase cortisol, increase adrenaline. These are hormones that make your blood pressure go sky high. So you always got to, the best you can try to limit your stress, for sure and get the whatever, mental issues, depression, whatever it may be, because when you're depressed, you're not going to eat like you should. You might go back to smoking. Like so many things are going to cause you to go back to bad habits when it's coming to mental things. We gotta have our mental clarity, mental health to be in check. So, definitely when it comes to stress, limit as much stress as you can. Whatever you can do, calm music, definitely exercise helps with stress because that's going to allow endorphins to come in. Hormones that are going to allow you to relax. So when you're exercising, that helps in the long run. Not only just building up endurance and weight loss, but those endorphins are going to come in and have help you feel relaxed, you sleep better.

 Sleep is important. Even going into that, you want to get at least seven to eight hours of sleep if you can at night. I know some of us that work a good bit, like we were like, man, we're happy we get five or six. But sleep is a major, major issue. You want to make sure that you get a good enough sleep so you have energy to do those things.

To, to exercise, to not be so stressed because you're not going to handle a good day's work if you're didn't get enough sleep and you're going to be easily stressed for sure.

Host: Now there may be folks that are doing all these things, they're doing all the right things, yet their blood pressure still stays high. So at some point, medication may be what they need. How is that determined and when you it really important to really look at a medication?

Dr. Desiree Dawson: Yes. I always say, don't wait too long. If you ever hear that, hey, your blood pressure's high, don't take that lightly. If a doctor tells you, Hey, your blood pressure's high, have you checked it at Walmart, or whatever convenience store, you checked it, and your blood pressure's high, that 130 over 80, mark, either the top or bottom number.

Do not take it lightly. You gotta understand what's going on. And what happens is, you know, your first check will be in the clinic, and we know sometimes we talk about white coat syndrome. Some people have that in the clinic. We understand that. But if you're also getting readings at home and they're high in the clinic, that's pretty consistent.

And so basically what you want to do is, hey, talk to your doctor about what can I do to check this? And we're always going to say, we need readings from home because we get it. You see white coats in the clinic, you see everything, blood pressure cuffs, everything in the clinic going on, and you get a little nervous.

So blood pressure can be a high, and we do tend to check it like we give it like five minutes later. See how you're feeling. Check it again, make sure it's not too high still. But we definitely have you check some blood pressures at home, not right after you wake up, not right after you eat, some time in between.

Check them at home with a good arm blood pressure cuff, and get accurate readings and bring it to your next visit. You can even put it on your phone if you want to. Whatever works. But we gotta know if it's been consistent in the clinic high as well as being at home high. And sometimes we do run into discrepancies, but we're more comfortable if blood pressure is high in the clinic short.

But at home it's normal and it's been average normal because honestly, I've had patients that we've gone up on blood pressure in the clinic and at home it's normal and blood pressures are dropping because we've added so much medication when the blood pressure is actually good at home, that's what matters the most.

Host: So there are blood pressure monitors folks can get for their home. And you mentioned an arm cuff as opposed to a wrist cuff. Is that preferred?

Dr. Desiree Dawson: Yes. Arm cuff is definitely more accurate. You're more relaxed. Got your arms down or on a, a table that's heart level and your feet are on the ground. It's just more of an accuracy because that's what we do in the clinic. So you want to give the right accurate measurement how we do in clinic at your home.

And we do a blood pressure cuff that ele, that kind of squeezes your arm. And then will release after a few seconds and give you an accurate reading.

Host: I know from personal experience, I'll say, once you're down this road, you get the home cuff and you're taking it every hour trying to see how am I now, how am I now? Which probably isn't the best practice. If someone is monitoring at home, how often should they be taking their measurement?

Dr. Desiree Dawson: Yeah, you do get very anxious when you like first check it and it's high, I'm going to check it again. That probably makes you more anxious actually. So don't definitely don't do that. I always say at least just once a day, not right after you eat, because whatever you ate, I don't know.

So, give it like, at least like an hour after you ate. Definitely not after you drink coffee or anything with any kind of caffeine for sure. Because your blood pressure's going to spike up so bad. Definitely not right after you wake up, just get yourself relaxed so at least 30 minutes after waking up and give it like an hour if you're going to check it after eating, or even before you know you go to bed, that's fine. You, as long as dinner's been like at least an hour, a couple hours or so check it then. You're relaxed, you're cool, calm and collected, but don't keep checking and checking. Just, it's okay if you want to, like we do in the clinic, check it once. If it's a little high, give yourself a little breather. Check it again in five or 10 minutes, then boom, let it be.

Host: And if you're recording this at a doctor's request, should you do it consistently about the same time every day? Is that something?

Dr. Desiree Dawson: Not necessarily. Only if you find that time to be the best for you, that's fine. But if for some reason you're following what I mentioned as far as not right after you eat, it can be in the middle of the day and maybe the, the next day before you might have checked it at night. No bigee. It doesn't have to be the same time every time.

Now it comes a little tricky if you're taking medication, so we kind of want you to check it a certain time after your medications, in the morning and before you eat breakfast or something like that. Then we might want you to check it at a certain time. But if you're someone that's just learning about blood pressure and it's high, your doctor's like, just check it and we just kind of want to know what it is before we put you on medication, then you don't have to check it at a certain time every day.

Host: Now they call blood pressure the silent killer, which, you know, is extreme, but that's the reality. There probably aren't symptoms that somebody might have, so really it's just diligent when you, when you go to your primary care provider, get the blood pressure and monitor it that way, is that really the best practice?

Dr. Desiree Dawson: Yeah, exactly. If you are not one, because I have patients that will come into clinic and say, I'm too afraid to check it. I'm too anxious to check it. I don't check it at home and I understand. No problem. So we can check it because I do nurse visits, so after a week or two, I, I have you come in and let the nurse check it if you're willing to kind of work with me and come back into clinic.

But some people are sensitive to blood pressures. They actually might have a headache. They actually might have palpitations or chest pain, if it's high enough. You might have some symptoms, but there are people that have blood pressures that are so high, they feel nothing. They actually tell me, I feel better with my blood pressure is higher, and you got me on that medication, I don't feel as good. I'm like. Oh, trust me, we're doing the best thing for you. But we try to meet middle ground to see what else we can talk about to get that blood pressure down. Because getting it down is a must. So that's what we try to do. Talk about it, and see what we can do from a standpoint in the clinic to get everything checked out for you.

Host: Doctor, you've provided a lot of great information, a lot of it, common sense, make healthy choices, be healthy, make sure you're getting your blood pressure checked. If there's an issue, see the right provider and all that. As a cardiologist, let me ask, what drew you to cardiology as practice?

Dr. Desiree Dawson: Oh man, because it was male dominated. No. That was part of it. I grew up with brothers, so I was pretty much, not necessarily a tomboy, but I, I really enjoyed like, kind of like learning different fields that were catered, well not catered, but very fluent with men in the field.

And I thought like, hey, I could really be an advocate for women. So that's kind of what drew me because I'm like, well, this, we talk about heart attacks and men, I'm going through medical school, but I'm like, what about, what about women? I know this is like a, major killer in women as well.

Because we do so many things. We stress ourselves out. We're worried about family. And when I got to learning more about the heart and things that happen as far as, complications, I'm like, women are affected big time. So I was like, well, I want to be an advocate. I want to be someone that can really cater to women and what we go through, whether it be menopause, whether it be stress of family and our symptoms, and knowing when a heart attack's happening and when to get checked out.

I really want to be, I wanted to be someone standing in the gap for women. So that drew me, most overall.

Host: Well, that's great. That's, and we're lucky to have you, and we appreciate and so lucky to have you today. We, we appreciate your time and the great information. And to find a physician, like a great physician like Dr. Dawson, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org. Thanks for listening today.