Helen Dandurand (Host): Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand, and today I'm going to be joined by Miranda Sirvinskas, Nurse Practitioner at Riverside Medical Group's Internal Medicine Bourbonnet Office, to talk about blood pressure.

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Helen Dandurand (Host): And we're back with Miranda. Thanks for joining me today.

Miranda Sirvinskas, FNP-C: You're welcome. No problem.

Host: So, you've been on the podcast one time before, but for some, anyone who hasn't, listened to that episode, could you just start by telling us a little about yourself?

Miranda Sirvinskas, FNP-C: Sure. I've been in healthcare for about nine years. I started as a Registered Nurse at Christ Hospital, working multiple areas, but mostly in the ICU. I also worked in Urgent Care for a year before starting here at Riverside with the Internal Medicine Group in January. Still currently taking new patients. I have a pretty wide open schedule, up until August when I go on maternity leave, but then I'll be back in October.

Host: Awesome. Sounds great. Thanks for sharing all that. So, we're going to jump in now to talk about blood pressure. So, the first question is, what is blood pressure and why is it important for overall health? And I know it feels basic, but when I was kind of thinking about it, I was like, you know, I don't actually know specifically what it is, so just dive in.

Miranda Sirvinskas, FNP-C: Yeah. So, I mean, we all need a blood pressure, very important for life, but blood pressure is the measurement of the blood that pushes against the walls of the arteries as your heart pumps blood throughout the body. The systolic blood pressure is the top number and it is the pressure in your arteries when the heart contracts or beats and the diastolic blood pressure is the bottom number and it is the pressure in your arteries when your heart is at rest.

Host: Can you explain what the different categories of blood pressure readings are and what they signify?

Miranda Sirvinskas, FNP-C: Yeah so, there is like low blood pressure and that's anything less than 90 over 60. Low blood pressure is a cause for concern if it's associated with symptoms such as confusion, dizziness, nausea, fatigue, or blurred vision.

Normal blood pressure is anything less than 120 over 80. Elevated blood pressure is anywhere between 120 to 129 over less than 80. You start reaching high blood pressure, hypertension, stage 1 when it's between 130 to 139, over 80, over 89, and then there's hypertension stage 2, which is anything greater than 140 over 90, and then there's a hypertensive crisis, which you don't want, is anything over 180, over 120, definitely warrants an ER visit, or at least a call to your primary emergently, yeah.

Host: Good to know. What would you say are the common risk factors that could lead to high blood pressure?

Miranda Sirvinskas, FNP-C: Some common risk factors would include advancing age, obesity, family history, race, more specifically, our African American patients will have the higher risk factor. A high sodium diet, excessive alcohol consumption, physical inactivity, and insufficient sleep.

There are also several prescription and over the counter medications that can cause high blood pressure, including but not limited to birth control pills, NSAIDs such as ibuprofen or naproxen, antidepressants, steroids, nasal decongestants, weight loss medications, and antacids that contain sodium.

Host: Oh, wow. That's kind of good to know. I didn't necessarily know that some of those things could lead to that. What are some of the common symptoms of high blood pressure and how is it typically detected?

Miranda Sirvinskas, FNP-C: So high blood pressure can be a little scary because some people don't have any symptoms at all when their blood pressure is elevated, hence why they can call it the silent killer.

Those who do have symptoms of high blood pressure might experience a headache, vision changes, chest pain, dizziness, difficulty breathing, nausea, vomiting, confusion, and anxiety. Typically, these symptoms will occur when the blood pressure is near like the hypertensive crisis range, but for some people, they'll experience them more in like the hypertension one or two stage as well, just depending on how sensitive they are.

Host: Okay, so what can people do, what can folks do, to change that for themselves. So what lifestyle changes can someone make to help manage or prevent high blood pressure?

Miranda Sirvinskas, FNP-C: A big one would be weight loss reduction through diet and exercise. Exercise helps lower the blood pressure and decrease the risk of cardiovascular disease overall. Dietary changes and avoiding energy drinks with sugar, caffeine, and all those other stimulants as well. And then avoiding drinking excess alcohol or avoiding it altogether. Um, and then lastly, smoking is also like, smoking cessation is also recommended to reduce high blood pressure.

Host: If someone has high blood pressure, is that just something that is constantly high or sometimes, is it just like spike?

Miranda Sirvinskas, FNP-C: It'sdifferent for everyone. I have had patients where they'll have random spikes, and those patients are a little bit harder to treat because you don't want to give them a blood pressure medication and then they go too low when they're not spiking. But most patients are pretty typical and they will stay within a range pretty much all the time.

Host: Got it. Got it. We're going to take a quick break to talk about finding a primary care provider. Riverside knows that health is your greatest asset and that your primary care provider is your partner in health. Find a primary care provider that fits your needs at riversidehealthcare.org /primary care.

All right, we are back. You kind of touched on this a little bit before, but how does diet influence blood pressure? Are there specific foods that can help lower it?

Miranda Sirvinskas, FNP-C: So, there are many substances that people put into their bodies that are not good for them. You may have heard of the DASH diet before, which stands for the Dietary Approaches to Stop Hypertension Diet, which is a dietary pattern that includes reducing sodium, eating more fruits and vegetables, increasing potassium intake, choosing low fat options, cutting down on sugars, eating whole grains and lean proteins such as fish and chicken, are all good options to help reduce and manage high blood pressure.

Host: Good to know. What types of medications, like if that's not enough, you need medication, what is commonly prescribed for that and how do they work?

Miranda Sirvinskas, FNP-C: Okay, so there are four main classes that we can choose from. The provider will choose the best option for their patient. Some patients will require multiple medications to manage their hypertension, you know, if the one doesn't do the trick.

Thiazide diuretics, um, such as hydrochlorothiazide works by pulling fluid off of the body to decrease the blood pressure. Calcium channel blockers such as amlodipine prevent calcium from entering the cells of the heart and arteries, which allows the blood vessels to relax and open up, reducing the blood pressure. Angiotensin converting enzymes, or ACE inhibitors, such as lisinopril, reduces the activity of ACE, which is an enzyme that controls blood pressure hormones. And then lastly, angiotensin-2 receptor blockers, or ARBs such as losartan, can block the chemical which constricts blood vessels, which allows to decrease the blood pressure.

Host: Got it. Is there, are there reasons why you would prescribe each of those to different patients? Just maybe depending on their history and.

Miranda Sirvinskas, FNP-C: Definitely depends on their history. Sometimes their race, comes into factor. I typically like to start with an ACE inhibitor such as the lisinopril or the calcium channel blocker amlodipine, but it's really all just preference and kind of just evaluating your patient one by one.

Host: Sure. Makes sense. How does stress affect blood pressure? What are some effective stress management techniques?

Miranda Sirvinskas, FNP-C: Stress releases a surge of hormones or endorphins, which can cause the heart to beat faster and blood vessels to narrow, which increases blood pressure for a period of time. When the body is under persistent stress, it can lead to increased blood pressure for greater periods of time, which can then further harm the body. Some effective ways to manage the stress include making adjustments to your day to day schedule, asking others to help reduce your workload, things like that, slow deep breaths along with yoga, meditation, and regular exercise are all physical ways to reduce stress. Ensuring you are getting enough sleep, at least like seven to nine hours for most people, will also help reduce stress levels.

Host: So say, you know, you have high blood pressure, and you've gotten it, kind of checked out, but how often should individuals monitor their blood pressure? And like, what is the best way to do that at home?

Miranda Sirvinskas, FNP-C: So for, a typical patient who doesn't think they have hypertension, you don't really have to monitor it at home. Just following up with your primary, making sure you're doing those annual visits is important. But if you have high blood pressure or you think you do, I definitely recommend my patients to check it three times a day until we can see the pattern of their blood pressure.

Is it elevated all the time? Is it only elevated in the morning? Nighttime? If we're starting a new medication, we definitely want to monitor the response to that medication. So I'll have them take their blood pressure in the morning, then take their medication, and also probably take their blood pressure in the afternoon and nighttime just to make sure it's not going back up. So it kind of just goes within the treatment plan. It may vary a little bit, but usually three times a day.

Host: Yeah. That makes sense. What potential complications could come from uncontrolled high blood pressure?

Miranda Sirvinskas, FNP-C: Some potential but serious complications of uncontrolled hypertension include left ventricular hypertrophy, which is an enlarged heart, heart failure, ischemic and hemorrhagic strokes, ischemic heart disease, and heart attacks, vision problems, and kidney disease that can lead to dialysis. It's crucial to manage your blood pressure effectively and ensure adherence to your blood pressure medications and or the lifestyle modifications to reduce the risks of complications as these complications can be irreversible.

Host: Got it. So it's really important, something to keep an eye on, definitely be going to your primary care, you know, every year, annually, make sure that all is good and if it's not, to take care of it.

Miranda Sirvinskas, FNP-C: Absolutely.

Host: Right away. Is there anything else you'd like to add?

Miranda Sirvinskas, FNP-C: I mean, if you think that you have high blood pressure and need to be checked, I encourage you to reach out to your primary care provider or seek one. It's like you said, important to stay up with your annual checkups and follow up visits, to monitor those health issues including blood pressure, and never run out of your medications. Always ask for refills before you run out to avoid going into that hypertensive crisis level.

Host: Good call. I need to be reminded sometimes. Not for that. But yeah. Well, thank you for joining us today.

Miranda Sirvinskas, FNP-C: Of course. Thank you for having me.

Host: Yes. And thank you listeners for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.