Scott Webb (Host): Hypertension or high blood pressure is often referred to as the silent killer because most of us don't experience symptoms when our blood pressure is high. And my guest today is here to discuss the risk factors for hypertension and how he and the experts at Salinas Valley Health can help. I'm joined today by Dr. Jiwan Toor. He's a Family Medicine Doctor at Salinas Valley Health Prime Care, North Salinas.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, it's nice to have you here today we're going to talk about hypertension, high blood pressure, that sort of thing. And I want to have you start by just sort of telling us, explain to us what is hypertension and why is it often called the silent killer?

Jiwan Toor, DO: Let's start off by discussing what hypertension is or what's commonly called high blood pressure. It's essentially when you have, as the name would imply, a little bit of a higher pressure in the blood vessels of your body. So what that entails is typically having a blood pressure reading of 140 over 90, and any number greater than the two of those.

So the top number and the bottom number. And that's how you can define high blood pressure, also known as hypertension. Now it's called the silent killer because you don't really typically feel hypertension or high blood pressure because this is a chronic condition and we can sit on it for many, many years, and the body is magnificent at kind of getting used to having this high blood pressure sit around and cook for a long time.

And so we can not feel it until it's too late, until we get that chest pain and that shortness of breath, or that headache or that slurred speech. And in those cases, we get concerned about something like a heart attack or a stroke.

Host: Yeah, so I see what you're saying, Doctor, that there's not always symptoms or we might dismiss those symptoms. Right. And then sometimes it becomes too late. And so if we don't really experience or feel high blood pressure or hypertension per se, then maybe we should talk about the risk factors, like what puts someone at higher risk for developing high blood pressure, hypertension, and then as you say, possibility of stroke, heart attack, that sort of thing.

Jiwan Toor, DO: So the things that put people at risk of having hypertension or high blood pressure, are things that we commonly associate. So things like a family history. So if your mom or your dad or even your grandparents had high blood pressure, that puts you at a slightly higher risk as well.

There have been some large scale studies suggesting that there might be some geographical differences as well. But those studies haven't been necessarily sussed out, completely or thoroughly. More well known risk factors include things like having a history of diabetes, having a history of high cholesterol and one of the more significant ones that we classically associate as well as a risk factor for high blood pressure is going to be obesity. And so as we may know, there is what we call the obesity epidemic in the western world that now we're, we're seeing outside of America as well.

Host: Right.

Jiwan Toor, DO: And other common ones include alcohol use and cigarette use as well.

Host: Yeah, so possibility of some family history, but, you know, besides genetics and family history, behavior, lifestyle, things we do to ourselves, not eating right, you know, not working out, smoking, all the, the great, the greatest hits, if you will, but not in a good way. So then, you know, I know more and more folks, I see them all the time, Doctor, these blood pressure cuffs and things at the store, I see folks sitting in the chair at, at the, you know, the local drugstore checking their blood pressure. So more and more people seem to be aware of this, seem to be checking their blood pressure. So how do they know then, when it's time? Like what signs would there be? You said you gave us a range there, but is it okay to be a couple over? Is it okay to be 145 over? Like, give us a sense of when we need to really speak with our providers and get serious about things.

Jiwan Toor, DO: Let's put some context to this, right? So if you have your blood pressure cuff, you're at a state fair, or you're at the local grocery store and put your arm through that sleeve and you get some readings. When do you get concerned? Okay, so the American Association of Family Physicians has come out with some good recommendations stating that if your systolic blood pressure, again, that's the blood pressure, that's the top number, over your diastolic, which is the number on the bottom, if it's 140 over 90, and so anything over 140 or anything over 90, that's considered high blood pressure. Now, if it's just a little incy pincy bit over, like two or three or four, well, you know, I would recommend checking again. Maybe just take a few deep breaths and check again.

And if it's consistently elevated, so having multiple readings above 140, then I would classify that as having hypertension. I like to sometimes ensure that we're not dealing with really, really high blood pressures as well. So if you're putting your arm in there and it's 180 over 110. That's never normal.

Host: Straight to the emergency room then if, if we're, if we're 180 over 110, probably time to be seen, right?

Jiwan Toor, DO: I would agree. Definitely, you know, have someone with you, and ask yourself if you're having any headaches, having any chest pain or shortness of breath. Those are going to be the big ones, if you're having any blurry vision when you're experiencing really high blood pressures like that.

And you know, the right thing to do would be to get in contact with a healthcare provider.

Host: Yeah. You know, I'm just thinking, Doctor, you know, we're, as I was mentioning, it seems like a lot of folks are checking their blood pressure at home. Because we listen to our providers, so we listen to the experts, right. Ask the experts, so to speak. So, I'm wondering when should we check it? Like, is it best to check our blood pressure when we're really not doing anything, when we're just hanging around watching Stranger Things on Netflix? Is that a good time? I, you know, like, I'm trying to understand, you know, because obviously if we're, if we're doing something, if we're doing yard work or whatever it might be, well then our blood pressure, we would expect it to be a little elevated. So when's the best time to check our blood pressure to know whether or not, you know, some of these risk factors are getting to us?

Jiwan Toor, DO: The fact that we're even thinking about checking our blood pressure is a victory in and of itself. And the fact that you have even decided to proceed and check your blood pressure at home is a huge victory. So maybe that's just a family doctor in me speaking because I have the privilege of really following these patients, and the community you know, over decades. For some people, just getting a blood pressure cuff, or getting into the habit of even checking their blood pressure anytime of the day, is to me a semblance of a victory.

 It's a start. Typically, I like to kind of think about it as like two best windows. I like to check in the morning. That can kind of be like your true baseline, typically within one hour of waking up. Preferably before your cup of Joe in the morning.

Host: Or my case three. My third cup of Joe. Yeah, I'm with you.

Jiwan Toor, DO: Absolutely. And then, I like to recommend my patients when we're really trying to hone in and get control of our blood pressure to go ahead and check that evening blood pressure as well. Typically before you go to bed or before dinner, just pick one of the two. And you know, the key thing is to try to time it roughly 12 hours after you checked that first morning blood pressure.

So it can sometimes be a little difficult to get exact, but again, we're looking at trends here. Because when you bring these blood pressure recordings to the doctor's office, we're looking at swaths of trends rather than any particular one number.

Host: Yeah, I could envision in my head Doctor folks just checking their blood pressure constantly. Like once you have the cuff at home, folks just constantly checking their blood pressure. But as you say, again, from an expert, you know, every 12 hours when you wake up, either before dinner, before bed, that kind of thing.

And you talked earlier about behavior, lifestyle, and so yes, we all need to lose weight. Of course and quit smoking if that's what we do, and drink in moderation and all of those things. Right. But just in general, what are, what's your best advice for how we can help ourselves?

Jiwan Toor, DO: Let's just kind of go to like Easy Pickens here. You know, if you're smoking cigarettes, we need to think about how we can help you quit that. Because, you know, that's a really strong risk factor for having high blood pressure and it, it adds to your total life long, mortality risk.

The second one be being, if you're drinking alcohol, alcohol use is a very common association that we see with high blood pressure. So Easy Pickens there, at least for the doctor to discuss. We understand that it can be quite difficult though for patients to quit those if they are farther along down that path.

But we have great tools to help you and we'd be happy to help you there as well. And then the other one being weight loss. If we can try to improve our metabolic health, from top to bottom, and that's a passion point for me specifically, is how do we optimize your cellular health? We're starting to now figure out that obesity really does take a toll on our metabolic cellular health.

And it can definitely be a point of improvement in a lot of patients who have high blood pressure because we often see when people drop 10 pounds or 20 pounds, we'll often notice that their blood pressure improves, and then we can start actually having discussions about taking some medications off that they were previously on for blood pressure.

I think those are probably like the big three that come to mind. And then the other one too is there's a plethora of evidence suggesting that there's something called the DASH diet and the DASH diet can be employed to help kind of decrease your blood pressure actually rather significantly as well.

Host: Yeah, as you say, that's kind of the low hanging fruit, but those are the things that are within our control, right? We could all get a little more exercise and eat better and lose some weight and quit smoking, you know, maybe it takes some time, but we could get there if we're really focused on it. If we understand that that's a risk factor, we know that our blood pressure is high because we're smoking and so on.

Good stuff today. Again, I love having the experts on, picking their brains. Let's finish up and talk about, you talked about potentially getting folks off of medication, but let's talk about the ones that need to get on the medication. So when medication is necessary to control, to get a handle on hypertension and high blood pressure, how do you choose the right one for patients?

Jiwan Toor, DO: That's the million dollar question. You know, I, really like to take a personalized kind of structured holistic approach to my blood pressure management. There's a lot to sift through there in that question. There are some guidelines and there's been some, you know, large studies to help support doctors in this decision.

And again, I like to always say to my patients, when we're deciding to start any medication, especially a blood pressure medication, that you're the captain of the ship and I'm just merely the wind in the sails. And I won't let you make a wrong decision, but I'll give you options.

So often, you know, we have to take into consideration comorbidities. If you're somebody with high blood pressure, but you also have diabetes; there's a set of medications that we think about, commonly prescribed medications include the ACE inhibitors and the angiotensin receptor blockers that come to mind.

Those are really commonly prescribed medications in that population. And then there's other medications as well. Oftentimes individuals have high blood pressure and heart failure, and we have to think about certain separate classes of different blood pressure medications as well. So really sitting down with your family medicine doctor, sitting down with your cardiologist and really taking a thorough, holistic view of where you are in your health journey and what comorbidities you have or lack thereof, and then making the decision to then start a blood pressure medication. That's probably the best way to go.

Host: Yeah, as you say, it's not one size fits all. Right? So those conversations of patient history, maybe including family, you know, getting the team of experts, right, together to figure out what's best for a particular patient based on their family history, lifestyle, behavior, all that good stuff.

So, I appreciate your time and your expertise today, Doctor. This has been really helpful. Thanks so much.

Jiwan Toor, DO: Absolutely.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.