Scott Webb (Host): Most of us know that having high blood pressure is bad, right? But what should our blood pressure be, and what do we do when it's too high? And joining me today to answer these questions and more, is Dr. Swapna Ahern. She's a cardiologist at The Elliot.

This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. 

Doctor, it's so nice to have you here today. We're gonna talk about blood pressure and what does blood pressure mean, and I was mentioning to you that you know we go in, they put the cuff on, they pump the thing and then they give us the numbers and you know we sort of have a sense of what's good and what's bad and maybe what they mean and what they don't and all of that. But it's really great to have an expert on. I feel like these are the kinds of podcasts that that listeners really benefit from. So, let's just start there- simple terms. What is blood pressure and why is it important to keep an eye on it?

Swapna Ahern, MD: So, blood pressure is basically the force of blood pushing outwards against the walls of your blood vessels or your arteries. And when it gets too high, we call this hypertension or high blood pressure.

Host: Okay.

Swapna Ahern, MD: Now if it's really high, we know of our numbers in blood pressure and are familar with it and monitor it over time, because ultimately if you have high blood pressure over a long period of time, it can cause damage. And you may have heard that hypertension or high blood pressure is a silent killer which is different than a lot of other medical conditions where we you feel pain or distress. Hypertension you don't feel. It just causes damage over time until we feel it much later.

Host: Yeah, I've done a few podcasts about that those so-called silent killers and that's the hardest thing for patients and perhaps for providers as well, is you know there are no signs and symptoms and unless somebody comes in to get their blood pressure checked, how would you know, right.

Swapna Ahern, MD: Absolutely. You know sometimes we get referrals from people who have vision issues or kidney issues and it started to see the end organ damage that blood pressure can cause.

Host: So, as I mentioned there, you know we go in, we get blood pressure taken, and they give us those numbers- one something over hopefully you know one twenty over eighty hopefully, right. But maybe you could break that down. What do those numbers mean and what are they actually measuring?

Swapna Ahern, MD: The top number or the first number is called the systolic blood pressure, and this is the force of the, the pressure of the blood pushing against your artery walls while the heart is beating. And then the second number or the lower number is called the diastolic blood pressure, and that's the pressure of blood against the artery walls while the heart is resting in between heartbeats.

Host: Okay.

Swapna Ahern, MD: And both of those together give you a sense of how much pressure is in those vessels beating against the walls. Now as we get older, our arteries just tend to get stiffer with more plaque and cholesterol, and so that blood pressure can tend to rise, and that's why we run into issues.

Host: Yeah and just wondering maybe just sort of broadly for the average adult, like what is the recommendation, the, the recommended blood pressure or the recommended range? I never know so you know if I go in and they say well you're one thirty over ninety something or whatever I think well that sounds pretty good. You know it's not one fifty it's not one sixty. What's a ballpark where you'd like to see most healthy adults?

Swapna Ahern, MD: Most healthy adults, I would like to see a blood pressure of one twenty over eighty or less. And so, when you get that top number, that systolic over one twenty, that's where I call it elevated blood pressure. It is not necessarily hypertension but its elevated. Now when you hit a systolic blood pressure of one thirty to one thirty nine, or a diastolic blood pressure of eighty to eighty nine, now you're into the stages of hypertension. So, most people, one twenty over eighty.

Host: Yeah that's the number I had in my head was one twenty over eighty and my blood pressure is definitely not one twenty over eighty. But we're not here to talk about me today per se. So when we think about the health risks and you say that there no signs and symptoms, and it's kind of a silent killer so specifically you mentioned there as well sort of the end result. So, if somebody has high blood pressure for a long period of time and it's unchecked, undiagnosed, untreated then you know what can that mean in terms of health risks?

Swapna Ahern, MD: Right, no over time is you have the high pressure in your blood vessels, it causes these small tears in the arterial walls. Our arteries are delicate, and these small tears then trigger a cascade of inflammation in the body, and we all know inflammation is bad for many reasons. But that inflammation then triggers cholesterol build up and plaque build up and now you've got narrowing of your arteries.

Host: Right.

Swapna Ahern, MD: And when you get narrowing and stiffness of the arteries, it can cause blockages and lead to heart attack and stroke risk. And whenever you have stiffening of the arteries like that and an increased risk of the heart working harder, you are at risk of heart failure or your heart's struggling to pump adequately. And like I mentioned, stiffening of your arteries not only affects your heart, but it affects your organs, your kidneys, the delicate vessels that go to your eyes and can lead to vision loss and then you know even your brain having a high blood pressure over a long period of time can increase your risk of dementia. 

Host: Yeah you used the word inflammation there, and I've never had an expert on that said inflammation was good.

Swapna Ahern, MD: Right.

Host: You know in any realm, in any conversation, inflammation almost always bad especially when comes to medical things, medical conditions. Wondering if you have any practical suggestions for staying mindful of our blood pressure while still enjoying those tempting treats and other meals especially around the holidays for folks you know there are lots of lots of tempting treats, pumpkin pie whatever it is. 

Swapna Ahern, MD: So, this is very timely. These are the conversations I'm having on a daily basis right now, and overall what I'm telling patients is moderation is key when it comes to the holidays and otherwise. I would recommend limiting salty foods when you can, taking one spoon of stuffing instead of two- just moderation.

If you do consume alcoholic beverages, use moderation in that because we know that salty foods and alcohol can both raise your blood pressure quite a bit. Just being mindful of what you're putting in your body, what processed foods like ham or you know really fatty foods and sugary beverages and desserts. All of those are going to have a negative effect on your health, and you know what I stress with my patients is I want them to be healthy and I want them to make good choices, but I also want them to be happy. So if you make choices where you compromise a little bit here and there you're going to sustain those decisions and, and those small choices are going to make a big impact in your health.

Host: Yeah couldn't agree more. I had an expert tell me recently we were talking about let's say pumpkin pie, and he was talking about the psychology of eating, and he was basically saying you know the first bite is amazing, the second bite still pretty good, but he's like you know by the time you get to the third bite of pumpkin pie, you know it kind of levels off a little bit and he's like if folks could just stop there and not go on and finish the whole thing or as you say one spoon full of stuffing not two right.

Swapna Ahern, MD: Absolutely. It's all those little compromises.

Host: Sure, so let's finish up here and just talk about for those managing high blood pressure, and I'm one of those folks, are there any simple habits or strategies you suggest to help us stay on track?

Swapna Ahern, MD: When you're in home, I tell folks to try and take the salt shaker off the table, so you're not tempted to add salt to your foods. And then when you're out in the store, I love to see the folks who are pausing and reading the labels and really getting a sense of how much sodium is in the products that they're purchasing. Limit your alcohol consumption. And if you're if you're one of those folks who is smoking try to quit. Your cardiologist or your primary care provider, we have a lot of resources we can help you with if you need help with that and try to get some regular exercise. Losing weight can lower your blood pressure tremendously, and then lastly, please please take your medications as prescribed, and if you're having any issues with that in anyway, you know, call us, and we're here to help you.

Host: Yeah that's perfect. Anytime I speak with a doctor, speak with an expert I feel like I have to be totally honest, and I do take my do pressure pill every single night, you know regularly because I know how important it is. I try to do the other things you mentioned there.

A little exercise, one piece of pumpkin pie not three you know and so forth, but you know the truth is we have to help ourselves. So, lowering or limiting our risks, making sure that we see our doctors, that we understand what these numbers mean all good stuff, so thank you so much.

Swapna Ahern, MD: Of course. Of course. Thank you for having me.

Host: And for more information, go to elliothospital.org/cardiology. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.