Evo Terra (Host): Welcome to DocTalk, presented by Montefiore St. Luke's Cornwall. I'm Evo Terra, and with me is Dr. Ahmad B. Hadid, an interventional cardiologist at Montefiore St. Luke's Cornwall, as we talk about hypertension, what it is, why it matters, and how you can take control of your blood pressure. Thanks for joining me, Dr. Hadid.

Ahmad B. Hadid, MD: Thank you for having me.

Host: Can we start with the basics? Like, it sounds silly, but I'm going to ask the question, why is hypertension or high blood pressure bad?

Ahmad B. Hadid, MD: Hypertension is bad because it could be the silent killer. If it's not found early, it can cause a problem, it can affect a lot of vital organs in our body. So, that's why it is called the silent killer. You don't have symptoms initially, and it have to be looked very carefully to detect it if it's there and treat it before it causes any problem. A lot of patients do not experience symptoms initially. If it's left untreated, it can lead to serious health problems such as heart disease, stroke, kidney disease, and vision loss. Good news, the hypertension can be prevented, detected early, and effectively can be treated.

Let's start. What is blood pressure? Simply, the blood pressure is the force of the blood that's pushing against the walls of our arteries. Arteries are those pipes that carry the blood inside our body. It's exactly as the heart pumps the blood through the body. The blood pressure, when you have readings, a lot of my patients, they have their own machine at home, they come to me, "My pressure is 120/80. What does this mean?" The higher number, that's called the systolic pressure. That's the top number. And this is basically the pressure when the heart squeezes the blood, contracts. That's called systolic blood pressure. The lower number is the pressure when the heart relaxes.

Normal blood pressure is supposed to be less than 120/80. When we get a little bit higher than that, we call it elevated blood pressure. So, if it reaches 120 to 129 and the bottom around 80, that's called elevated blood pressure. Anytime the blood pressure reaches above 130/80, that's what we call it hypertension. Stage I hypertension is when the pressure is like 130 to 139 over the bottom number 80 to 89. And stage II, when it gets worse, it will become more than 140/90. Obviously, we're going to try to catch it before it gets there, look at it, and treat it.

Host: For a patient who has been newly diagnosed with maybe it's just that mild hypertension, the low values, how do you as a physician figure out what's better for the patient, just lifestyle changes or when should they start medication?

Ahmad B. Hadid, MD: This is a very individual question. It will come from the relationship between the patient and the doctors. So obviously, somebody, when I get the patient first time, I have to look at the previous record, see what the patient's blood pressures have been before, what's his medical problem. Does he have any other medical issue I'm concerned about? And what's his risk factors for hypertension?

The most common thing that we face, as a risk factor to have high blood pressure, increased age. The older we get, our arteries become more stiff and more chance that we have hypertension. The second risk factor is family history of high blood pressure. So if your parents have high blood pressure, one of them or both, you're at higher risk of having high blood pressure. Usually, also, males are higher risk of having high blood pressure. Some other risk factors include unhealthy diet, eating, a lot of extra salt, excess salt intake, high consumption of processed foods, processed foods have a lot of salt in it, sedentary lifestyle. Patients who don't exercise, they're overweight. Sometimes they don't exercise that much, they start gaining weight. And by gaining the weight, we notice that the blood pressure also starts to creep up.

Those are the patients that we'll tell them, "If you improve your lifestyle, get better to exercise, improve what's called the BMI, your body mass index, your blood pressure can get better." Smoking is a risk factor for that. So, anybody who smokes, we ask them to stop smoking. That definitely will help the blood pressure.

Stress, as somebody going through stressful condition, emotional stress. His blood pressure was good. All of a sudden the pressure start to go up. Most of these patients, if they pass through this, their blood pressure, the pressure can get back to normal. The issue is what we do when the blood pressure is high first time we meet the patient is very dependent on the individual. If the blood pressure is not extremely high and probably in the range of 130, 140 with no symptoms, And we can detect that, as the patient specifically, the first treatment is improve your lifestyle. Cut down on the salt, exercise regularly, less alcohol drinking, lose the weight, walk 15, 20 minutes a day and continue to monitor the blood pressure. And guarantee within a few weeks the blood pressure will improve. This is how we start.

However, if the blood pressure is significantly elevated, sometime I see patient in my office, they never been on blood pressure medication, they come up with some symptoms. They're feeling headache, dizzy, tired, short of breath if they walk, go uphill, climb the stairs, and their blood pressure is in the 160 or 170 range. Those are the patients we do on a week. The lifestyle modification is definitely a must. However, you may start some pharmacological treatment to avoid just further damage to any other vital organ in the body.

Host: Yeah. That sounds very important when you have numbers that high, for sure. Definitely start medication. Let's talk about those medications. I know about statins. Is that still the pharmaceutical of choice?

Ahmad B. Hadid, MD: So, statin is the medication that we use for high cholesterol mainly.

Host: Oh, you're right, cholesterol.

Ahmad B. Hadid, MD: When people have significant blood pressure, the issue with that is most patients who have hypertension, their cholesterol is high. So, they end up to be on statin. But this is not the treatment for the high blood pressure, the treatment for the cholesterol. There are a few groups of medication that we use for that. Most patients, we start them on a simple what's called diuretics, which is just like a water pill, something specifically called hydrochlorothiazide. It's a drug that we take it once a day. It will help the blood pressure to go down. We monitor the kidney function, monitor the electrolyte, the potassium, the sodium when they take it. There's a group of medication called ACE inhibitor, angiotensin inhibitor. Other medication called ARB.

There are a few drugs available that we can use. There's something called beta blockers. There's something called calcium channel blockers. The way we choose this medication is depending on the patient, the profile. Somebody who's diabetic, we love to put them on those drug called ACE inhibitor because this is to protect the kidney and help the blood pressure. So, you're really using this drug for more than one reason. Somebody who had heart disease, have blockages in the heart, we like to use beta blockers more. Somebody had decreased function of the heart, ACE inhibitor is the drug of choice. Some patients who had irregular heartbeat, something common called AFib, we like to use beta blockers or calcium channel blockers. This is how we try to choose the medication to fit each individual separately.

Host: Understood. Thanks for the clarification there. I've done a little bit of research on this topic, and I saw a couple of things called white coat hypertension, masked hypertension. Can you explain what those are?

Ahmad B. Hadid, MD: So, white coat syndrome is a condition that's really it's there. It's definitely available. Those are the patients that they come, they have a machine at their house, and they check their blood pressure, and their blood pressure at home is within normal range. And when they come to the office for some other reason, not because to check their blood pressure, but their blood pressure is elevated. We think it's the emotional stress being in the office. Sometimes it's a concern. It's real. It is real. We confirmed this. Pressure will be elevated in the office. They go home, the blood pressure is normal. We ask this patient just to confirm, make sure they have an accurate machine at home, and the numbers and the readings are really accurate.

There's a few things that we can confirm that really this is the case to make sure we're not missing anything there. Some of those patients kind of mimic this type of stressful condition that they think they're coming to the office. Sometime I put them on a treadmill and see what their blood pressure when they try to start to exercise. I get their previous record from their family health provider before to see really is their blood pressure been elevated every time in the office. It's a little problem because that will mask real hypertension, and just have to work a little bit harder to make sure that we're not missing real hypertension there.

I still advise them, "If your blood pressure is high in the doctor office, that means you have the tendency to become hypertensive in the future." So, this is the patient who I will tell him, "You have to work hard on the risk factors. You have to work harder on your lifestyle. You have to walk more. You have to get your weight to ideal weight. And you have to watch your salt intake, because clearly your pressure under emotional stress or whatever type of stress, it's higher than usual. So, you have the tendency in the future, if you are not hypertensive now, to have hypertension in the future." So, it will require both the provider and patient to work harder to detect the problem and work on the risk factors.

Host: You mentioned at-home blood pressure monitoring, and I think everyone I know over the age of 50 has one of these blood pressure cuffs. They're relatively inexpensive to buy right now. What's the recommendation of how we should use that blood pressure monitoring at home? Like, what should we be doing to make sure we do it the right way?

Ahmad B. Hadid, MD: Every patient who comes to see me, I will tell them I will take at least five minutes of my interview to tell him, "It's good to have a blood pressure machine at home." Blood pressure have to be checked—really, I ask my patient to check it maybe couple of times a week. Have to check couple of hours after they take their blood pressure medication. Sometime they check it early in the morning before they take the blood pressure medication. It's expected to be in the higher side because some of the medication already wore off. I will tell them to check it sometime middle of the day if they can. And the best way of checking the blood pressure is by sitting on the chair. You sit in your chair, your arm should be relaxed on the table. Don't do it while your arm's on the couch, sitting down. The blood pressure machine should be at the level of your heart, sitting at the table. Don't do it while the machine is in your lap. Have your blood pressure checked.

Those machines are good. However, once in a while, especially in patient who have an extra heartbeat or irregular heartbeat, sometimes the machine will have a hard time. It will give you a reading that you think it's very abnormal. So, I tell my patient, "Do not get panic, especially if you have no symptoms. You wait 10 minutes and recheck it one more time." I always recommend to my patients not to keep pushing that button and keep checking the blood pressure, because sometime it starts to become very tight, it will cause a spasm in the arteries, and then will start to give you higher reading. So, I tell my patients, "Relax, take a breath, 10 minutes and recheck it one more time, or try to check it in the other arm." So the recommendation, you will sit in a chair, the machine is next to a table, your arm is relaxed on the table, and the machine should be on this table, not in your lap.

Host: We have these blood pressure devices that we can buy, these cuffs. But now, there's all these digital health tools, right? Our watches are connected and can tell what our blood pressure is, and telemedicine and other sorts of things on our smartphone. What's the role they play in protecting hypertension today?

Ahmad B. Hadid, MD: They are excellent. They have a good role on this, because we start to depend on this. However, the message of those devices, even though they're great, they're not perfect. So, I always tell my patient, "If you get something, you get some notification that really you're feeling well, and you get some abnormal reading or modification, you know what? Listen, call us here. Come, we'll check it out. We'll see what it is."

Once in a while, those readings may not be totally—most of the time, it's accurate, but sometimes may not be accurate. I have a lot of my patients get scared by some readings that have been just because the way the device contact their skin was not accurate, not totally accurate. It's too high, too low. So, I feel just because blood pressures, especially the initial stage of the blood pressure, have really not much symptoms, you know. So, having availability of this machine will detect and sometimes open the conversation. "I've not seen a doctor for years, but now the blood pressure is ranging 140, 150, and I know this is high." So, that will lead you to get a office visit. And from there, the physician will take over.

So, that's a great achievement to discover a patient who may have hypertension. You can help him either with medication or by lifestyle modification. And this way, we can prevent complication in the future. So, they're great. Those tools are here to stay. They're more evolving and invading our life in every way. So, we have to learn how to deal with it.

Host: Well, this has been fascinating information. Any final thoughts on hypertension you'd like to share?

Ahmad B. Hadid, MD: Again, let me summarize. You should know your number. You should know what's your blood pressure. You should know that every patient, especially in their 40s, have to have physical exam once a year, have your blood pressure checked once a year at least. All of us should be on exercise program, walking 20, 30 minutes a day, five days a week, if we can, at least.

Limit the salt, even for patients who don't have high blood pressure, to prevent hypertension in the future. Limit the processed food. And if you experience any symptoms that kind of unusual, severe headache, blurry vision, shortness of breath, just contact your provider. Let's look if it's the blood pressure or something else going on

Host: Very good information. Once again, Dr. Hadid, thank you very much.

Ahmad B. Hadid, MD: Thank you for having me.

Host: Once again, that was Dr. Ahmad B. Hadid, an interventional cardiologist at Montefiore St. Luke's Cornwall. To learn more about our cardiac services, please visit montefioreslc.org. Again, that's montefioreslc.org. And if you enjoyed this episode, please share it on your social channels and check out the entire podcast library for topics of interest to you. I'm Evo Terra. This has been DocTalk, presented by Montefiore St. Luke's Cornwall. Thanks for listening.