Jamie Lewis (Host): In popular culture, we often hear references to high blood pressure, particularly when someone is under stress. And we can tell it's something to avoid. But why is high blood pressure a health risk? Who commonly deals with it? And how can it be identified and treated? Today, we're speaking with Dr. Robert Schatz, a Board Certified Cardiologist and specialist in cardiovascular disease, internal medicine, and nuclear cardiology.

He's going to answer questions about high blood pressure and give us a better understanding of what it is, how to watch for it. And how to treat it. This is the podcast from Ridgecrest Regional Hospital. I'm your host, Jamie Lewis. Hello, Dr. Schatz. Thank you for being on the podcast.

Robert Schatz, MD: You're welcome. Thank you.

Host: Let me start with a very basic question. What is high blood pressure?

Robert Schatz, MD: Well, going back in history, before they really termed it hypertension, high blood pressure, it was a hard pulse. Back William Harvey, back 1578 to 1657, talked about the circulation and de motu cordis. And the first publication of blood pressure was really in 1733. Then there was a link between kidney disease and blood pressure by Dr. Richard Bright in 1836. And then the invention of the sphygmomanometer in 1896. So, it's interesting that the terminology came about, tension and hyper, so, stress is definitely involved in hypertension, because the sympathetic nervous system, the fight or flight response, if activated or overstimulated cause catecholamines that are poured into the bloodstream, cause constriction of the vessels and, uh, also, worsened by any kidney problems or vasculature issues, and then you get a high blood pressure.

Host: Wow. Okay. Well, thank you. You've obviously done your homework on the history of high blood pressure. Are there any commonalities between people whose blood pressure tends to be high, like genetics or gender, ethnicity, age, something like that?

Robert Schatz, MD: People over 60, I'd say one half of those people have high blood pressure, or a tendency to, so it's very prevalent, and, interestingly, genetic predisposition plays a role. There are 35 loci, and that's called SNPs, or single nucleotide polymorphisms, that are involved.

And then you'll hear family history of stroke or blood pressure, and especially nowadays, we're learning that, family history is a big deal.

Host: What are some of the signs that someone's blood pressure is getting too high, like getting into the danger zone?

Robert Schatz, MD: Hypertension has been deemed the silent killer. Because you can have no symptoms at all, but be running around with a blood pressure of like 180. I've had many patients, their blood pressure is 170, 180, and I ask them, do you feel okay? And they said, well, yeah, I feel fine.

It's really surprising. But manifestation would be blurred vision, headache, and dizziness. You've probably heard of Franklin Roosevelt, right? Interestingly, he was given a clean bill of health by his private physician. His blood pressure was 220 over 120, but yet he was given clean bill, which is amazing.

Host: Wow. Okay, so if somebody has identified that they have high blood pressure, are there ways to prevent that?

Robert Schatz, MD: Well, the first thing that comes to mind is being calm. That's easier said than done. Meditating, like in the morning or two or three times a day where you're just sitting in a quiet place and, reduce your catecholamine levels and stress that'll help. Salt restriction is probably of some help as well, although it's less of a recommendation nowadays.

But, basically, people need to take their blood pressure at home. That's the best way of monitoring.

Host: So that actually leads to my next question, which is, let's say I visit my doctor and they want me to monitor my blood pressure on my own. Why should I do that?

Robert Schatz, MD: So, untreated blood pressure, hypertension can result in end organ damage. We're talking stroke, heart attack, kidney failure, eye damage, and there's also a risk of aneurysm, and cognitive decline because all this hypertension, all this pressure puts strain on the vessels in the body and it's very important. It is a huge item in cardiovascular disease and prevention.

Host: What are some of the common ways that people take their blood pressure on their own?

Robert Schatz, MD: I've had patients who take their blood pressure with a wrist cuff. I do not recommend that because it's not as accurate as above the elbow cuff. These cuffs are not exactly cheap, but you could probably get one for about 50 dollars and it's very easy to use. It's a digital machine.

You don't need to do it like the old school way with a sphygmomanometer. And then I will tell people, don't just necessarily accept the first reading, if it's like high, whatever it is, you can wait 10 minutes. Even another 10 minutes and take it and that kind of average or take the best of the three.

In fact, the blood pressure cuffs now many of them not just take it a once but you could set it to three and they'll take it three times in a succession, a period of a minute or two and then average.

Host: Are there better times than others throughout the day to take my blood pressure?

Robert Schatz, MD: I tell patients they should get a pattern, particularly if they're just starting out with a treatment of blood pressure; to take it basically from morning when they get up until they go to sleep. There are a percentage of patients who have what's called nocturnal hypertension, and the blood pressure goes up while they're sleeping, and they wind up asking me, why doctor, is my blood pressure high in the morning?

And so, unless you take it, in the morning, the afternoon and at nighttime maybe after you eat, then after exercise you won't know when blood pressure is rising the most.

Host: Right. All right. So I'm watching my blood pressure through regular self checks, but my doctor wants to go a step further to start treating it. At what point would they want to introduce treatment and why?

Robert Schatz, MD: There's a National Council of Hypertension. Years back, what the recommendation was if the blood pressure was over 140, 140 over 90 consistently. Now that has dropped to, normal blood pressure is fine is 120 over 80. So if it's 125 or 128, that's not too bad because people get their groceries and they're, check their blood pressure right away or they haven't gone to the bathroom, the blood pressure may be a few points higher, they're under stress. Some doctors may say if it's over 140, the top number, consistently, I say if it's over 130, the top number, the systolic blood pressure consistently, then it's a time to look at treating.

Host: What are the most common forms of treatment for high blood pressure?

Robert Schatz, MD: You talk about lifestyle changes, you know, like low salt diet, exercise, that kind of thing, but medication is a mainstay for most people, uh, a certain age group. What I mentioned before, like 60 up, and there are various medications. There's a lot of medications, but there are a couple of classes that are top tier.

Host: And can you tell me maybe what some of those are?

Robert Schatz, MD: Those drugs that are top tier are what's known as vasodilators. They open up the vessels and make it easier for the heart to work and let the lower blood pressure. So the two major classes are what's called ACE inhibitors and a similar class is the ARBs or the angiotensin receptor blockers.

So that's one of the top drugs. And then the other are the calcium channel blockers like amlodipine, or Norvasc, and then diltiazem or Cardizem, and then less likely to use is verapamil. So those are your top choices.

Host: Well, Dr. Schatz, this has been so helpful and informative. We probably could talk a lot longer about your expertise, but I really thank you for your time.

Robert Schatz, MD: Well, thank you for hosting.

Host: You've been listening to the podcast from Ridgecrest Regional Health, and I'm your host, Jamie Lewis. To learn more about high blood pressure and how Ridgecrest Regional Hospital physicians like Dr. Schatz can help, visit rrh.org/treatment-care/cardiology.