Transcription
Do you have high blood pressure? We're going to talk about how to lower your blood pressure and why it matters. Welcome to Talking with Docs. I'm Dr. Bradman. And I'm Dr. Paul Zozal. And I'm Dr. Mike Hefernan. Off the top, Mike. I'm loving the scrubs. Thank you. I doubt I had my game. There we go. Old school. Gone. Little mash, a little hot guy. Yep. Yeah. Little goatee. Yeah. November. November. Dr. Hein is a cardiologist. Has been on here before. A lot of our viewers um have appreciated his content in the past. And today we're going to revisit some blood pressure conversations that we've kind of had before and add a few other things mostly about how what you can do at home to lower your blood pressure to reduce your risk of its many many potentially silent consequences.
Yeah, we made a video about blood pressure. You guys left some great comments uh which kind of inspired us to have a good cardiologist back on the show to discuss lifestyle things you can change in order to lower your blood pressure. Great. because you know the last time we talked it was more kind of what's high blood pressure the medications that we use commonly to reduce the blood pressure. Um, but we can spend a little bit more time talking about the lifestyle things that we can all do at home right to lower our blood pressure. And just to remind everybody um why is high blood pressure bad for you? So high blood pressure is bad because it increases the risk of heart attack, stroke and death, right? And so you can't generally feel your high blood pressure. That's called the silent killer for a reason. Um, and then and we like to have a number for most individuals of about 120 over 80. Okay? And so, and people get confused about those numbers. So, what's the 120? So, the 120 is the driving force of blood pressure. It's like if you've got your garden hose at home and you just open up the faucet, that's the force that just kind of flies out um and and goes in our body to provide blood to all our organs. And the second number, the 80 number is kind of what's the kind of the resting pressure that just kind of sits in the system all the time. And so 120 over 80. And so is that a magic to that number? And and the answer is not really. Um we had large population studies uh that were done primarily in the United States. So uh the Framingham study is from a small little town outside Boston. They've been studying these people for 50 years plus. And they found that patients that had blood pressures of around 120 over 80 tended to do better. Less heart attack, less stroke. Um, in the women's health study, in the nurses study, um, patients that had blood pressures around 120 over 80 did better. Um, and then so those are population studies, but then we like research studies to say, okay, well, what if we get people whose blood pressures are higher than 120 and we lower it? Um, you know, does that provide a benefit? And and the answer was yes. And there was a big study called the sprint study in patients that were, you know, relatively high risk, a high Framingham score or maybe they had some kidney disease or maybe they had some heart disease. And we lowered their pressure and really tried to get it to 120 over 80. And those people did better. They lived longer. Okay.
Yeah. So [clears throat] 120 your systolic blood pressure measured in millimeters of mercury. Then the 80 is your diastolic blood pressure which is also measured in millimeters of mercury. And that's just your blood pressure wave. And those are the two numbers that we focus on. Generally speaking, can we say that lower short of uh passing out having a single episode, lower is always better. So lower is better. And I know I think we talked in the last last article, the last video session that there is a J curve. And so so lower is better, but if you get too low, you know, bad outcomes start to increase. But those tend to be hospitalized patients in the ICU, as you would you would imagine. Sure. Lower is better unless you're a giraffe. lower is better unless you're a drug. Um, but and and actually meaningful reductions in events happen with relatively modest reductions in blood pressure. And so good rules of thumb that we use in the office is if we can lower your systolic blood pressure, the top number by five, even if you were like at 140 and we lower it to 135, um, we reduce your risk of of stroke by 15%. we reduce your risk of heart disease by another 10%. So those are not small numbers when you when you're treating a lot of people. And some people think, "Oh, what the what's the point? I can't I can't get it to that 120. I'm not going to bother." So you're saying it definitely is worth it. Every millimeter kind of counts. Every every millimeter counts. Okay. So big bang for the buck lowering your blood pressure. That's why this video is going to be so important. So let's get into it. Okay. How can I lower my blood pressure?
Yeah. So let's do uh let's do all the lifestyle stuff. All right. Um so exercise. So the current Canadian guidelines and the guidelines for most centers around the world and I know you have international viewers is 150 minutes of vigorous exercise a week right and Rome wasn't one in a day you know you might not be able to start that you know immediately but if you can achieve 150 minutes of vigorous exercise a week you will lower your blood pressure and I think this is something that you like you said it doesn't happen quickly so if you're someone who's sedentary and does not have any exercise capacity start small even if it's 2 minutes or 5 minutes or 10 minutes you can build up. There's so some amazing stories on social media about people that have gone from being, you know, totally sedentary and maybe excessively overweight to super fit and running marathons and things like that. So, just take that first step and do something. Yeah, absolutely. Okay. Awesome. Exercise. Exercise. Let's do salt.
Okay. Cuz salt tends to be a little bit controversial, right? It is controversial. And so, I don't have high blood pressure fortunately right now. I think I can tell you that 80% of individuals at some point in their lifetime if they live long enough will. Wow. Um, so it's almost inevitable for a lot of people. So with that being the case, um, salt intake for me doesn't change my blood pressure very much. It might change it 2 millm of mercury or so. Okay. Um, but if you actually have high blood pressure, excessive salt intake will definitely uh increase your blood pressure. And this is where again on social media people say, "Oh, salt doesn't matter or salt doesn't affect your blood pressure." Right? Dr. Heaven is saying there's a very small percentage of people who don't have high blood pressure where it doesn't matter. And those people, you see them with the shakers and they have salty stuff and nothing happens. But if you already have high blood pressure, if you're prone to it, this can make a big difference. And it's a relatively easy thing to reduce for you. It is a easy thing and it takes a little while because especially if you're used to a salty diet. Some people have misinterpreted an old study and where that comes from is there was an old analysis called in the Cochran database and it was advice to lower salt wasn't effective. But I can remember when my daughter was young, if I advised her to make her bed, it might not have worked, right? But if you actually make the bed, the bed's made. The bed's made. And so the subsequent analyses where people actually didn't just they actually acted on the advice and they lowered their blood pressure, it was effective. Makes sense. Okay. So if I'm at McDonald's, I get my Big Mac and fries. I just say, "Hold the salt." Yeah, that's what you do. God, do not do that. But what we would say, there's two main ways, right? So get rid of the salt shaker if you can. So that's the easy one, the added salt. But the other thing is if you're buying processed foods. So the best way is don't eat processed food. But if you are buying processed foods, look at the salt content because it is very sneaky. And sometimes you can see your entire day's worth of salt in a serving of certain processed foods. And we've talked about this before, restaurants, when you order me at a restaurant, there's a ton of salt usually added to that meal. No question. And and so if just be careful on how much you eat at restaurants, you know what I mean? That's going to increase your salt to take. if you're one of those individuals that is susceptible to the high blood pressure if you take insult.
So, we're talking food. Yes. And so, that's a nice segue into into the DASH diet. Okay. And so, of all the, you know, we don't recommend diets per se, but in terms of a way of eating or a style of eating, eating habits, change your eating habits. The DASH diet is a kind of a western Mediterranean diet. It tends to be the most effective um for lowering blood pressure, right? and the the meat and potatoes of that diet are what? [laughter] Not right. So, reducing the amount of meat that you have. Yeah. Um increasing your fruits and vegetables. Yeah. Legumes. Yeah. Rice. Yeah. Yeah. I've talked about this before. I like the grizzly bear diet. Have you heard of the grizzly bear diet? I have not. Grizzly bear in its natural habitat eats about 80% fruits, vegetables, seeds, 20% fish, meat, the odd camper. But most of it is that fruit, vegetable, seeds, berries, that kind of stuff. And then just a little bit of meat and um fish. I read that on a plaque at a grizzly bear sanctuary. And they don't have hypertension. Is that your point? Last I checked, they don't like to have the cuff on for too long, so it's hard to get the measurement, but yeah. No. Okay. But they live a long time. There you go. That's So that's number three. What's number four?
Uh alcohol consumption. So you know the current guidelines now in the World Health Organization has stated for some time there's no safe amount of alcohol consumption. The Canadian guidelines changed within the last year and said two beverages per week. It used to be for men two beverages per day here. Um so that was a big drop um based on uh the World Health Organization uh criteria and the data that's come out over the last year. Mostly for cancer, right? Like mostly for cancer but but it has other effects to be sure. uh liver and heart often get forgotten. Um so a modest amount of alcohol consumption or a minimal amount will lower your blood pressure. Okay. In addition to calories too, right? Yeah. We should probably release this video after the holidays then. Yeah. With American Thanksgiving, Chris, all the holidays in December and uh we just lost probably 9% of our viewers when we said we should have kept alcohol for the end. Okay. So, so alcohol and empty calories in alcohol lend itself nicely to our number five and that would be maintaining a healthy weight.
Maintaining a healthy weight which yeah and it fits into you know your diet exercising regularly um and and it's just and it is a healthy weight and trying you can go on a on a on a calculator you can kind of Google a BMI you'd like your BMI or your body mass index uh it's not the greatest you know tool but it gives you a good guide and so if your BMI is less than 25 um you're probably in a good range if it's more than 25 or 26 um then you've got you've got some work to do And we do realize that the majority of the population right now is over 25 26. I'm pretty you know that there are different classifications but right now the majority of the American population Canadian population I think is over 25 26 and there [clears throat] is a kind of a real epidemic going on with high BMIs. So that is definitely something that as a whole population we need to work on. Yeah. To be sure. Okay. Number six. Thankfully was a bigger problem in the 70s days becoming less of a problem. What are your thoughts on smoking and high blood pressure, Mike?
Uh, well, [laughter] you know, I think 17% of Canadians right now smoke. So then it's still that shock to hear that. No, it's still it's still that high, but it's going down. You know, the numbers are definitely going down. And um how does it affect high blood pressure? Why why does it matter blood pressure? Uh probably the inflammation. So uh so smoking gives rise to a whole host of different things. Um but it increases the inflammatory response in our body. Anything that increases inflammation can increase kind of vascular tone and squeeze the vessels. So, independent of the nicotine. Independent of the nicotine. Okay. I got a question and we may not have the answer to this. Um, there's going to be viewers out there going, "Oh, good. I'm so glad I switched from smoking to vaping." Any data on blood pressure and vaping yet? Or is that sort of still in the work? Not that I'm aware of. No. [clears throat] Specifically for blood pressure? No. Okay. Okay. So, that's number six. Number seven for me is going to be reducing stress.
And we've talked a lot about this in the last, I'd say, 10 years of medicine. We're starting to recognize having a high level of stress at a constant level is not good for so many measures of our health, including our blood pressure. Like your job. Yeah. Like Yes. Like our job. Like your job. Sure. Um so yeah, and it's hard for us to prescribe, you know, yoga, meditation, mindfulness. Uh right. We're really good at prescribing medications, but those are words 20 years ago as a doctor we wouldn't have mentioned. Nope. Mindfulness. What are you talking about? No, I agree. So um so see, we've come a long way. Yeah. [laughter] Uh probably um so yeah and actually so if you want numbers you know uh it's about 5 millm of mercury um for uh for things like meditation uh mindfulness that um will will help you lower your blood pressure and as I mentioned 5 millm of mercury is a huge benefit in terms of stroke reduction myioardial inffection. And this looks very different for everyone. So you have to find something that that you're willing to do that you feel comfortable doing. Like people get sometimes embarrassed or or confused about it. So there's lots of options to teach you ways to get into a happy kind of safe calm space. Often you have to do it alone in a in a protected environment where you can work on lowering your blood pressure. Yeah, that's a good point. It's different for everybody what your definition of mindfulness and meditation is. So don't poo poo it right off the bat. There may be a form of it that really uh fits into your sort of frame of mind. Yeah. Mine might be building an ice rink on the weekend all by myself. I feel and that's good exercise. You're outside. How'd that go? It's looking fantastic. You just need some cold weather now. Now I [clears throat] need cold weather. Yes. Sorry Canadian viewers. Dr. Heon is asking for colder weather. Okay. So number nine on my list would be would be sleep.
And this just like stress has really come to the forefront of good sleep and the adequate amount of sleep is critical to good health. What do you tell your patients about sleep for blood pressure? Um so it's not something they can control easily, right? Um and and as people get older, sleep becomes a big problem for them. Um and so you would like to have about 8 hours of sleep. That that's a sweet spot. Um in terms of just good for your health. Um being able to achieve eight hours of sleep for a lot of people is a real challenge. Sometimes people need sleep studies. Y they may have unrecognized sleep apnea and they're waking up in the night or coming just above into the wakefulness threshold and don't realize it. They're choking themselves. They're hypoxic. There's not enough blood going to their brain and then they sleep again and they do that all night. We sleep studies are important. We've talked about that this the unrecognized sleep apnea and the consequences and the association with atrial fibrillation and things like that. So definitely if you're feeling like you're not getting that full night's sleep, even though you've tried for eight hours, uh that's something you should get your your sleep. We tried to have a sleep expert on here, but he kept sleeping faster. Yeah. Narcolepsy and those sleep, they're important. I've done one and and it's awkward. You have a bunch of probes all over your body and you're in an unfamiliar environment. You think, "How am I going to get a good night's sleep here?" But you do. You're right. And and then they show you the number of times like your legs and arms are moving and wait. And you're like, "What the heck? I feel like I had a decent night's sleep." And you're not. and it's really dangerous for you. So, if you are concerned about this or particularly if you're concerned about your partner because of the way that they behave and they keep you up, often if the partner says, "Listen, your sleep is weird. We need to get you to the doctor to save your life." Really? Yeah. And there's some things that you can do, some simple things. Um, you know, you're not going to eat after dinner. Yep. You're for sure not going to have a caffeinated beverage after dinner, but most people would say don't have a caffeinated beverage after 12:00 noon cuz caffeine can linger in your body for quite a lengthy period of time. Um, alcohol consumption is not going to lend itself to a good sleep. Yeah, that's what we wrote because you think, you know, if I have a few drinks, I'm going to sleep better. In fact, that's not true. Not true. So, there's there are some good books out there. There's one called Why We Sleep. Uh, it's a really good book, like Sleep Hygiene Habits. Yeah, we have a video about that as well.
Um, the next last one on my list is measuring your blood pressure. Because a lot of people think this doesn't apply to me. I don't have high blood pressure. And they go to the doctor's office and maybe it's really high and they write that off as being, you know, white coat syndrome or having elevated blood pressure because you're in your doctor's office. What do you tell people about the rules of having something to measure your blood pressure at home? Oh, it's gold. Okay. Um, so to be perfectly frank, we don't trust the blood pressures we get in our offices, right? And so the Canadian guidelines actually say um that while we might measure a blood pressure in the office when I when I leave here today and I do that throughout the day um I'm using it as a guide but it is not going to be a target for me in terms of initiating therapy. Okay. So if we use a machine in the office it has to be an automatic machine. It can't be the kind where your doctor is kind of blowing up his uh the cuff and listening with a stethoscope because we know we make rounding errors. We get a little bit lazy when we do that. It's hard. The machines don't lie. Um, and the machines will often do repeated measures. They drop the first number because it's always higher and then they average the other numbers. So, an office automated office reading is fantastic. But the best ones are uh the 24 ambulatory readings. So, patients get a blood pressure cuff. We send them on their way. They wear it for 24 hours and it takes readings all through the day and even when they're sleeping. And it journals it. And it journals it. And so then I I can read that the following day and go, "Okay, here's your average. Here's your day average. is your night average, right? Um and then and then ideally though, if a patient just, you know, often they're about $75 to $100. If a patient purchases her own blood pressure machine for home use, that's fantastic. And and it doesn't have to be there are a lot of sophisticated apps, but it can be just as simple as a calendar. Just print a calendar and just write your blood pressures in the days of the week. Good advice. Do you trust the wrist ones at all or No, I stick with the arm ones. Stick with the arm ones. Yeah. Okay. And it's weird though because like the studies that we based all our blood pressure therapeutics on were office measurements though, weren't they? Or were they home measurements? They were mostly office measurements and but mostly the automated office measurements. So they were they were you know more accurate. It's kind of comparing apples to oranges a little bit if we're if you're thinking of all your home blood pressures and then using that to you know apply to the data we got from those studies that were all office measurements. True. Although the the newer data like the sprint data is more uh is more robust. Yeah. Okay.
Anything else on our list of things that you can do on your own at home to lower your blood pressure in addition to watching this video? Uh oh, a dog. Okay. Do Yeah, dogs lower blood pressure. Interesting. Like just the owning one. What about when they're a puppy? I feel like that raised my blood pressure when we had a puppy. Maybe. So, not everybody. I know dogs are not suited for everybody but [laughter] um but but because they make you walk them so you know and it makes you happy. It's the mindfulness thing. So there's there's a lot of things just about that um you know that uh that that love that uh that you get from maybe not. So you know they're cat lovers I'm sure. So maybe it's a cat. My dog digs the garden sometimes and that does not help that will raise your um last question just about high blood pressure because definitely leave comments about your experience what you've done to lower your blood pressure. Is there any change in the blood pressure guidelines like as we get older cuz a lot of people are like listen I'm 70 do I not need slightly higher blood pressure cuz I kind of earned it cuz I'm a little bit older and there's a lot of controversy and a lot of very strong feelings about this as far as comments that we've received back. What are your thoughts or what does the evidence say about and I don't have to think about it and it's not you know what do you believe Dr. He I don't have to believe anything. Good. And I like that cuz we don't want to believe stuff. We want to know stuff, we need to know stuff, right? And that's why guidelines are set up. Whether you're in Canada, Europe, Australia, you know, England, the United States, we have guidelines for things to stop physicians from believing things, right? Level five evidence. You want good evidence so that when you're doing something for a patient that the rest of the physicians in the country are doing it and sometimes the rest of the physicians in the world are doing it. And so there is no age stratification primarily. Um, so the majority of patients, the guidelines are all still the same, right? So, we're ready to field those comments. People are going to be mad, but this is for your benefit. Yeah. Yes.
Okay. Now, you know everything you need to know about what you can do to control your blood pressure. Obviously, this is something you can discuss with your doctor. If your blood pressure does not respond to these measures over a reasonable period of time, then there are pharmaceutical interventions that can help and are often are required. We've talked about this in other videos, but this is a great start point. Yeah. If you don't like being on medications, I don't like being on medications. If you don't like being on medications, then these are things you can try and are proven to work. There you go. Thanks, Dr. He so much for educating us. If you guys like this video, please like it. Subscribe to our channel. What's that thing around your neck anyway? [laughter] And remember, you are in charge of your own health. We'll see you next time. [music]