Transcription:
Know Your Numbers

Scott Webb (Host):  Knowing your blood pressure and cholesterol numbers and understanding what they mean could help you live a longer and healthier life. Let’s talk to Dr. Robert Hopkins, a UAMS Professor of Medicine and Pediatrics and the Director of the Division of General Internal Medicine. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Scott Webb. Dr. Hopkins, thanks for joining me today. Why is it so important that people know their numbers and maybe more importantly, know what those numbers mean?

Robert Hopkins, MD (Guest):  The challenge we have in life is oftentimes we kind of skate our way on through and we don’t think about taking care of ourselves. It’s really easy to take care of other folks. But we don’t necessarily think about our own health. Blood pressure is a real determinant of what our risk is for cardiovascular disease down the road. We don’t want people to have heart attacks. We don’t want people to have strokes. We don’t want people to have blockages in their major arteries. And so, if we can control people’s blood pressure effectively; we can help reduce the risk of those things.

Now, what are those numbers that we need to think about and what do they mean? Well in general, we’re looking to try to keep people’s blood pressure at close to a number of 120/80 or less on a regular basis. It used to be that the standard we set was we wanted everyone’s blood pressure below 140/90 and some more recent studies have shown even being satisfied with that set of numbers may put some people at higher risk than they ought to be.

Now, it doesn’t mean that you necessarily need to be on medicine if you see that reading every once in a while, because our blood pressure does vary throughout our lives. But knowing that number from the doctor’s office and making sure that we ask questions, am I doing the things to get a good measurement is important. I think it’s helpful for people to check their own blood pressures at home. No one reading by itself is a be all and end all. But following that over time, can help us to better manage our cardiovascular health.

And so, knowing that blood pressure number is important. The second issue is cholesterol. Many of us have had cholesterol measured over the years and we think about my cholesterol is 200 or my cholesterol is 100 or my cholesterol is 300. That number is often a measure of total cholesterol. Total cholesterol can change a bit as we age through life. In men, it tends to kind of gradually increase and in women, it tends to stay relatively stable unless you have other changes in your life like a big change in weight or a big change in activity but tends to jump up more around the time of the menopause.

But having that cholesterol number measured on a regular basis can help us to put that into a calculator and figure out what your risk is for cardiovascular disease down the road and make a decision whether we need to continue to work on exercise, we need to do something with diet, we need to focus on weight, or we potentially need to start a medication to lower cholesterol. So, that’s the cardiovascular numbers that are important.

Host:  So much great information Dr. Hopkins. How are those critical numbers monitored?

Dr. Hopkins:  Well cholesterol or a lipid panel should be checked in most of us intermittently, probably every three to five years is plenty as long as you don’t have a big change in weight or a big change in activity or other change in your health status. If you have those changes that are happening; then it may need to be checked more frequently than that. Blood pressure probably ought to be checked in all adults at least all of us 35 and older at least once a year. But I think it’s helpful to – if you have the opportunity to spot check it either at home or in your local pharmacy or grocery store, spot checking that on a intermittent basis through the year to allow your doctor to have some data to go on can also be very helpful in monitoring your health.

Host:  That’s interesting that you mentioned that. I saw one of those chairs the other day and I’ve seen the home versions, the portable versions. Would it just be best if we leave blood pressure monitoring to the professionals?

Dr. Hopkins:  Those of us that do this everyday realize that the more data you have, the more actual numbers you have to look at; you can really better assess what the trends are. I think it’s okay for folks to just use the numbers that come out of a doctor’s office, but I think if we are proactive and we are more involved with out own health and looking at things over time; while those numbers may not be perfect, if we are measuring it the right way, and I’ll give you a couple of tips on that in just a minute. But if we are measuring it the right way; then that can be very helpful.

What is the right way? Generally, we want people to be sitting comfortably in a chair with their feet flat on the floor. The cuff that you are using to measure blood pressure should be directly on the skin of your upper arm and you need to be calm and relaxed. Not a good time to measure your blood pressure when you’ve just had an argument with your next door neighbor or if you’ve just eaten a big meal. So, you want to be at a kind of an even keel, relaxed state.

Host:  Yeah, so I know when I go into a doctor and I sit down, I sort of feel like maybe we shouldn’t take my blood pressure right away. Should we maybe wait a couple of minutes, let things kind of calm down? Is it better than to kind of let things calm down a little bit before you check that?

Dr. Hopkins:  Absolutely. You’re right on target there in fact that’s what I instruct my staff is, it’s best for us to go talk through some of the additional history information we need to know, what’s been going on since the last time you were in the office, what medications you are taking, if there are any other screening questionnaires; let’s do all of those things first, then let’s check blood pressure after you have had a chance to relax a few minutes.

Host:  And I know you mentioned this earlier, but how does blood pressure change as we get older and if it happens to rise, is that necessarily a bad thing, or do we need to consider all the factors?

Dr. Hopkins:  All of the factors are important is the short answer Scott. As we age, out blood vessels tend to get a little stiffer and so blood pressure particularly the top number tends to rise a little bit. We still have the same targets that we aim for but in consultation with your doctor, we may as an individual set slightly different targets than what we talk about as our national goals because some people have symptoms when you aim for a set number. And so having that discussion with your doctor, with your healthcare professional is really important to make sure that we’re treating you as an individual and not just throwing you in the pot with everybody else.

Host:  So, let’s talk about glucose. How do we measure that? How do we monitor that? What does that mean exactly? What is glucose?

Dr. Hopkins:  Glucose is basically a simple sugar that is in many of the things that we eat, and our body uses that as an energy source. And people that are – that either have high blood pressure or people that are overweight or people that we’re concerned about diabetes; checking blood sugar, checking glucose is an important thing to do. Generally, it’s most accurate if you measure it a fasting state meaning somebody hasn’t eaten for at least a couple of hours. But glucose can be measured through either a fingerstick or a blood draw. It can be measured fasting. It can be measured over time. But generally when we are talking about glucose measurements, we are talking about a one time spot check of what your sugar is at that moment in time.

If you have diabetes, having that measured on a regular basis is helpful. If you are on certain medications that can cause that sugar to go up and down, but for most of us, having that checked once every year or two or three in relation to their health status is a good thing.

Host:  Let’s talk about cholesterol. Let’s move there. Let’s talk about the difference between good and bad cholesterol. How do we maintain correct range of each?

Dr. Hopkins:  That can be a bit of a challenge. There are lots of factors that go into the different components of cholesterol. When I think about cholesterol, I think of basically four components. I think about the total cholesterol, that’s all the cholesterol added up together. I think about triglycerides. Triglycerides are the true fats, the fats that come from what your body makes as well as from the foods you eat. I think about HDL or good cholesterol and I think about LDL or bad cholesterol. Each of those components can go up and down through your life depending on what your overall health is, depending on what the status of your liver is, depending on what your weight and exercise are.

So, each of those components tell us slightly different information and may imply that we need to think about other health conditions. Most of the time, when I’m thinking about cholesterol and those lipid fractions or components these days; I use those numbers and put them into a calculating tool to calculate someone’s cardiovascular risk rather than spending a whole lot of focus on the absolute lipid numbers themselves. So, we try to put that in the context of the whole person.

And really that leads to the point of when I think about numbers in medicine, I try to help my patients remember and I try to keep myself focused on the fact that a number is a number unless you put that in the context of the human being sitting in front of you. And a number of blood sugar of 110 in me might mean something very different than a blood sugar of 110 in a patient that I’m taking care of who has got diabetes on insulin. So, context is at least as important as the number itself.

Host:  Absolutely. Context. And I love your patient centered approach Dr. Hopkins. What else do people need to know about their numbers, what they mean, treatment options, anything else we can share with listeners.

Dr. Hopkins:  Really the big thought that I think we need to put around numbers is that really anytime that we have a situation where we’re getting blood work done or we’re in a healthcare setting; having a conversation with the healthcare provider that you are seeing about what we’re checking, why we are checking it and how that’s important in you as an individual is really as important as what any one individual result is. We also have to remember that all of us as individuals are slightly different. And for most test results that you see done in a clinic or in the hospital; there’s going to be a range that’s listed as a normal range. Well that range is normal across a population, but it doesn’t mean that any particular individual is going to be abnormal if they sit slightly above or outside of that range.

So, having a conversation about what the numbers are and what their implications are in you as an individual is really the most important piece.

Host:  That’s awesome. You are such a wealth of information Dr. Hopkins. Thanks so much for your time today. for more information on Dr. Hopkins and the importance of knowing your numbers visit www.uamshealth.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is UAMS Health Talk. Thanks for listening.