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Liz Unruh (Host): Hello, listeners, and thanks for tuning in to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Liz Unruh. And joining me today is Liz Deck, who's a certified nurse practitioner and senior advanced practice provider. She's here to discuss blood pressure medication, who needs them, how long they take to work, and warning signs to discuss with your provider. Thanks for joining us today, Liz.

Liz Deck: Thanks for having me.

Host: So, I know this is not your first time on our podcast, but can you give our listeners a quick reminder of your role and background?

Liz Deck: Certainly. I'm senior advanced practice provider for the Riverside Medical Group. Currently, there's approximately 70 of us who are physician assistants, nurse practitioners, clinical nurse specialists. And now, we have two nurse midwives. So, we're real excited for the expanded roles. And I am also practicing internal medicine in Bourbonnais. I'm on the second floor of the Bourbonnais building.

Host: Oh, perfect.

Liz Deck: So, I'm there five days a week, and it's a great place to be.

Host: Yeah. So, you are a great person to talk to us about high blood pressure as an internal medicine provider. You see those patients that are, you know, 18 and above. But what qualifies as, like, a high blood pressure?

Liz Deck: What we consider a high blood pressure, and where we're looking at this is pre-hypertension or high blood pressure, which can be over 120/80. Now, we've known always 120/80 to be a pretty safe place, but higher than that, we're concerned, and particularly have to do something if blood pressure's over 140/90, either number being high, either the 140, the top number, which is the systolic blood pressure or the heart at work, or the diastolic reading over 90, which is the heart at rest, known as the diastolic reading.

Host: Yeah. I know that that's always confusing to me, because, you know, you go in for your appointment and they take your blood pressure, and I'm like, "Okay, great. Can you tell me is that okay?" And, you know, they'll always give an answer. But there are some things that could cause or contribute to high blood pressure. Can you talk to us about those?

Liz Deck: Absolutely. And what we look at as providers are those risk factors. Certainly obesity or somebody whose body mass index is over 30 people who are overweight, and that's a body mass index of 25.0 to 29.99. Even those at normal weight or whose body mass index can be from 19 to 24.9 can have high blood pressure. And the reason is what did they inherit of genetics from family members?

People are not always real happy. It's not just the blonde hair or the blue eyes that get inherited. It can be health issues that can show up later on in life when that genetics turn on. We want to look at people who may have kidney problems. Our kidney physicians in the area want blood pressure under 130 over 80, which I think is very, very significant. And we want to make sure that there's nothing else going on with the patient as far as other issues. Do they have heart issues? Do they have other kidney problems? Do they have breathing problems? What are all their issues that we have to take in account where we really want that blood pressure to be under control?

Host: Yeah. I think that's why some people might think it's weird that they ask for your family history or your health history when you go into the doctor and if there's any changes. Those are why, because they want to know if it's a contributing factor that could cause a health issue for you later on. But that inherited side isn't the only thing. There are some signs and symptoms that can come up. Are there certain ones that people should discuss with their provider?

Liz Deck: Absolutely. We want to know if the patient has diabetes, because we want to protect their kidneys. Many people don't know that blood pressure regulating systems are within the kidneys.

There's two systems, one of them is the renin-angiotensin-aldosterone system, also known as RAAS, R-A-A-S. And also, the renal fluid volume regulation system, which balances fluid and sodium within our systems. So, the body has its way of checks and balances to regulate blood pressure. And if not, that signal goes out that the blood pressure is up and the symptoms that go with high blood pressure.

There's many contributing factors. Those include diabetes, but again, we want to protect the kidneys. Maybe the patient has cholesterol problems. Maybe they have an advanced body mass index, as we talked about before. And then, it makes the heart and the body itself work harder to regulate itself. People with chronic kidney disease, perhaps adrenal gland disorders, hyperparathyroidism, pregnancy can elevate blood pressure, renal artery stenosis, which means the circulation that goes to the kidneys are made smaller, those vessels are smaller. Oral contraceptives can raise high blood pressure, diet pills, cold medicine, migraine medication can all raise blood pressure.

Host: Yeah. You definitely have to watch out for those side effects of medication too and keeping all of that in mind. So, can you talk to us a little bit about the process of diagnosis and finding, you know, the right medication to help balance your blood pressure?

Liz Deck: Absolutely. We want everyone to work with their provider to find the right medication that basically fits them best. We have somewhat of a protocol to use for blood pressure medication, which gives the best outcomes the quickest.

If that's not tolerated, then the patient needs to let us know, and then we will adjust that medication accordingly. We also do lab work to make sure. We want to make sure that patient has a heart healthy diet, which focuses on fiber and potassium. We want them to drink lots of water, 30 minutes of exercise daily to help lower that blood pressure, quit smoking, limit their alcohol consumption, reduce their stress and overall look at their body weight. Even a three to 10-pound weight loss can make a huge difference in blood pressure control.

Host: Yeah. Before we continue our conversation, we're going to pause to discuss the importance of primary care.

At Riverside, our primary care providers are right here in your community offering personalized care for you and your family, close to home and connected to the specialists and services you may need.

Having a primary care provider means having someone who knows you, listens to you, and helps you stay well through every stage of life, from annual checkups and preventative screenings to managing everyday concerns when they pop up, because remarkable care should never be out of reach. Remarkable care right where you live.

To find a primary care provider who's right for you and your family, visit myrhc.net/acceptingnew.

And we're back. So once someone is prescribed a blood pressure medication, how long should it take to begin working?

Liz Deck: Generally within two to six weeks that medicine will work. It's not automatic. Some people expect it to work within two, three or four days. Often we see results within two to six weeks, and that's because of the effectiveness of the medication. So, we're really excited when that blood pressure comes down and the patient can see that at home, they often take their own blood pressures. And when they do that, we encourage them to use a cuff and to sit at a desk or a table to where their heart, their arm, and the cuff are all on the same level, and that's going to give us the most accurate reading for that patient's reassurance at home.

Host: Yeah. I think that's really important, you know, having that same spot that you go and you take your blood pressure so you're getting a very similar ambient, like, reading. Are there any negative health impacts that can be helped by lowering blood pressure?

Liz Deck: We want to make sure that the blood pressure is caught when it's high. Some people have no symptoms at all, so then it's becomes the silent killer, and we don't want that to happen to anybody. Overt symptoms that can occur such as headache, dizziness, shooting pains up the back of the head, they just don't feel well, confusion, nausea, vomiting, nosebleeds, vision changes, all those things can go on. Those are the warning signs. But what we want to do is prevent stroke, heart attack, and heart failure.

Host: Yeah, I think those are the big ones. We want to make sure that we're helping prevent those because sometimes they are completely preventable by managing our symptoms. You know, we talked briefly about different side effects medication can have. Are there medications that can interfere with blood pressure medications?

Liz Deck: Absolutely. And it's important for everybody to know what those are. Basically, the nonsteroidals, that's abbreviated NSAIDs, N-S-A-I-D. And those are nonsteroidal medications like ibuprofen, Advil, Motrin. Prescription ones include Mobic, non-prescriptions such as Aleve. It's not to give them a bad name, but just to understand that those can have potential poor side effects for blood pressure control and can really elevate blood pressure. Nasal decongestants can also do that. Antidepressants such as bupropion, MAO inhibitors, and steroids like prednisone, ADHD medication can increase blood pressure. Energy drinks or high caffeine intake can increase blood pressure.

Host: Okay. Yeah, it definitely goes to show why when you are prescribed a medication to talk to your provider about any type of supplement or medication that you're on, even if it is over the counter, so they can understand the full picture. I think that's a really important takeaway from that question. If someone is concerned about their blood pressure, how should they start getting it addressed?

Liz Deck: Basically, make an appointment with your provider. See your provider, make sure that blood pressure is taken. Often when we have someone in the office, we take their blood pressure. If it's high, we take the blood pressure again at the end of the appointment, and it's much lower because their questions have been answered, we've taken care of a number of issues, and they're feeling good about what's going to happen next, and that blood pressure comes down. So we're able to get that second reading within a normal range, and that's really important.

And if not, we get that blood pressure treated and have them back within four weeks' time, check lab work, make sure the kidneys like the blood pressure medicine, and hopefully get that on the very first time. If not, and we have to adjust the medication, we're happy to do that so the patient better tolerates what they're prescribed.

Host: Yes. So, it's definitely a partnership between your provider and your patient, and it's an individualized approach. I think that's huge. If there's one thing that you want listeners to take away from this episode, what would it be?

Liz Deck: Basically, don't resist what your provider has to tell you. Not everything we come up with is positive, but it's for the patient's benefit. We want them to be healthy. What we practice in internal medicine is preventative issues. We want to prevent the heart attack. We want to prevent stroke. We want to prevent heart failure. And one of the things to do is to get that blood pressure under control. I see many patients during the course of the day. And when they come back to me with their blood pressure in better control, we can then pursue the other issues that they need to talk about.

We want basically to have good health habits for all of our patients to be able to take their blood pressure medicine daily, to not run out of their blood pressure medicine, and to see their provider yearly, if not twice yearly, to review the medications they may be taking.

Host: Yeah. I think those are great takeaways. And definitely contact your primary care provider if you think that high blood pressure could be something that you have or if you have a family history of it. That's really important. Well, thank you so much for joining us today, Liz.

Liz Deck: Thank you for having me.

Host: Yeah. To learn more about primary care at Riverside or to find a new primary care provider, visit myrhc.net/acceptingnew.

Thank you for tuning into the Well Within Reach podcast with our guest, Liz Deck, and your host, Liz Unruh. Be sure to like and subscribe to the Well Within Reach podcast on Apple, Spotify, or wherever you get your podcasts. To learn more about the services at Riverside Healthcare, visit riversidehealthcare.org.