- Hypertension is known as the silent killer.

Tonight, a central Illinois cardiologist explains what you need to know to prevent and manage your high blood pressure.

(upbeat music) (upbeat music continues) (upbeat music continues) Good evening and thanks for joining us for WTVP's "Docs On Call."

I'm Mark Welp.

Nearly half of all US adults have hypertension or high blood pressure, and high blood pressure is a primary driver of heart disease, which is the leading cause of death in our country.

Dr.

Surya Chaturvedula is a interventional cardiologist and the medical director of the Structural Heart Program at Carle Health Methodist Hospital.

Doctor, thanks for coming in.

- My pleasure.

- Very important topic that affects, if not half of us like I said, we know someone who has high blood pressure or hypertension, so let's talk about that right off the bat.

What is hypertension?

- Sure, blood pressure, if I have to simply explain, it's the pressure at which the blood which is being pumped from the organ, which is the heart in your chest to everything which is distant from it.

So it needs a pressure to travel and that's the pressure that it generates as the blood streams through the blood vessel.

And, as you can tell, there is two numbers.

One on the top, which we term it as systolic, and the one at the bottom diastolic.

For a normal adult, the convention is to consider 120/80 as the normal blood pressure.

And once we cross that number, then we assign a specific terminology to it.

And I'm glad that the recent guidelines are not called hypertension guidelines, which has been the tradition, but instead they're called an elevated blood pressure guidelines because when the top number is abnormal, but the bottom number is not, we term that as an elevated blood pressure.

But once the top number crosses 140 and the bottom number starts to race, then we categorize that into two stages of hypertension.

And it's very important to understand this spectrum because the risk is very proportionate to the blood pressure that one has.

- So who are we looking at as far as people who have hypertension and maybe some of their habits or genetics?

- Sure, it's a great question.

As you rightly pointed out in our families, there is always someone who has blood pressure.

It's a very prevalent problem, not just in the United States, but all across the world.

About 45% to 50% of adults in the US are feared to be suffering from high blood pressure.

And to just simply state it in the terms of how global a problem it is, there's over a billion patients all over the world that suffer from high blood pressure.

And there is several factors that go into causing high blood pressure, but for the vast majority of patients, we term it as essential hypertension, meaning there's no real cause that they have a high blood pressure.

But about five to 10% of patients could have some alternate causes which are contributing to them having an elevated blood pressure.

That causes could be from problems with their kidneys, those causes would be from imbalances in their hormones and we term those as secondary hypertension.

- Okay, I guess what kind of, when you, everyone I guess can have high blood pressure at some point, but when should you be concerned?

Is it, you know, a certain amount of time that you have that elevated blood pressure?

- Sure, this is a common question that a lot of patients bring about as well because I'm sure that all of us have heard the term white coat hypertension.

So in the traditional sense of white coat hypertension is when your blood pressure is elevated in a provider's office, but it's normal at home.

So the thing to underpin here is that you're checking your blood pressure at home.

So I would encourage everyone to be not just relying on one blood pressure in someone's office, but that's something that you need to keep a track of.

And in white coat hypertension, your blood pressure is absolutely normal at home, and when I say normal, you're looking at an average number.

All of us have emotions so we are not so worried about one blood pressure when we are emotional that is elevated, but where do you typically live at?

That's what's important.

There's actually an opposite entity called a masked hypertension wherein your blood pressure is actually good in a provider's office, but bad at home.

And that's actually worse because your outcomes are as bad as a person with elevated blood pressures.

And when you say who should be worried about, there definitely is a huge context to be placed at socioeconomic factors as well.

Non-Hispanic African Americans are at the highest risk tertile for hypertension, and that's because of several factors.

But simply put, there is a genetic predisposition that they're very sensitive to sodium, so those are the people who have high rates of elevated blood pressure.

Their rates of prevalence are close to 55 to 60% of adults and they suffer the worst outcomes from having high blood pressure.

But high blood pressure is a problem that occurs throughout your life, and as you age, the prevalence of high blood pressure goes up.

Simply explaining that in terms of aging, for adults who are less than 40, the prevalence is somewhere around about one in four or one in five, but once you cross the age of 40 and you're under 60, that that goes up to about three fourths the odds, but once you're over the age of 60, it's close to every other, so it is a proportionate hazard as you age.

- Is there a big discrepancy between hypertension in men and women?

Or is it about the same?

- Sure, so men seem to be more affected with hypertension till the age is around 60 to 65, but once the women cross 65, their prevalence of hypertension catches up.

- Okay, good to know.

Let's talk a little bit about the causes of hypertension.

You know, there's genetics, there's outside factors.

We all know that smoking isn't good for anything and I'm guessing that's one of the things that can exacerbate high blood pressure.

- Sure, definitely.

And also there's other lifestyle factors which play a major role in as there's a pandemic of obesity and being overweight, that's a huge risk factor for hypertension.

One of the main causes for a secondary cause of hypertension is obstructive sleep apnea, wherein a body habitus causes an abnormal pattern during sleep where you stop breathing and then you hyperventilate, and this is shown to be a major risk factor for causing hypertension.

But, as I explained, kidney problems play a major role in the secondary causes of hypertension.

You could be born with a genetic condition where you have several cysts form on the kidney, that could be a problem.

Any sort of a blood vessel or a circulation problem that occurs to the kidney can be associated with elevated blood pressure.

And any form of kidney failure puts you at a higher risk for hypertension.

And not just that.

Hypertension is because of an interplay between several hormones and organ system coordination that occurs in the body.

So a lot of hormonal imbalances like an elevated level of thyroxine from people who have an overactive thyroid, cortisol.

Some people are born with tumors which produce excessive adrenaline or epinephrine, and those are all secondary causes for elevated blood pressure.

- So tell us about the types of hypertension a little bit more so people can kind of distinguish between the different types.

- So the garden variety of hypertension is the primary or essential hypertension.

About 80 to 90% of patients will not have any causes that lead to hypertension.

As a matter of fact of their lifestyles, their body habitus, their genetics, their blood pressure is high.

But the unfortunate part of this story is that they might not have any symptoms, so it might be too late that they're realizing or recognizing the after effects, the aftermath, of having an uncontrolled blood pressure.

The first time in their life they're actually getting to know that they have elevated blood pressure.

Only five to 10% of the patients do have some secondary causes and such patients could be picked up sooner in their life because the secondary causes of hypertension tend to be much severe hypertension cases.

They could occur very young in life, so they might come to attention sooner.

But for the vast majority, this could be just quiet for a very long time.

It's like smoldering kind of situation.

- Sure, so let's talk about symptoms, what people should be on the lookout for and, you know, you gotta pay attention to your body, it talks to you.

So what should people be on the lookout for?

- I wish more patient had symptoms.

I know coming from a doctor, it might sound crazy, but the problem is, as you rightly pointed out, it's a silent killer.

So you could be walking around with an elevated blood pressure with no symptoms.

Some patients do experience headaches, nose bleeds, they could have difficulty breathing or could have symptoms which the secondary causes are causing them.

But per se, hypertension itself might not have many symptoms till it has impacted your organs and those symptoms then bring the hypertension into the picture.

- So let's say you may be having symptoms like a heart attack symptom and, you know, the high blood pressure which could lead to heart disease, could lead to the heart attack.

So it's kind of a, you gotta be on the lookout for a lot of different things, right?

- Sure, so I'm an interventional cardiologist, so I'm on the front lines when patients come in with heart attack, and I can tell you it's not an uncommon thing that someone figures out or finds out that they have a elevated blood pressure the first when they have a heart attack.

But again, how can you be proactive about it is checking your blood pressure.

Blood pressure checking at home shouldn't be just reserved for people who have a problem.

That can be like checking your pulse, you check your blood pressure so you stay ahead of the game, and heart attack, definitely there's an increased risk of heart attack with hypertension, but not merely heart attack.

There's several other problems in the heart which can occur from an uncontrolled blood pressure.

This is a pressure against which the pump, the heart is pumping.

So over a period of time it's the load against which it is pumping, so the heart has to become thicker to build muscle, so to speak.

It might be nice or cute to build a muscle in your biceps or triceps, but not so much with your heart because now when the heart becomes thicker, eventually it will fail, and when it fails, we term it as congestive heart failure.

So in a patient who has an uncontrolled blood pressure, the heart tries to cope with it over a long period of time by becoming thick and ultimately it fails.

So congestive heart failure is a growing problem with an uncontrolled blood pressure.

Atrial fibrillation is irregular heart rhythm can occur with uncontrolled blood pressure too.

And it's not just the heart.

Literally every organ in the body can be impacted.

- Well, I was gonna ask you, besides the heart, what are some of the other dangers that people can face as far as, you know, kidneys and things like that?

- Sure, so let's go from top down.

The brain.

We are learning more and more that uncontrolled hypertension for decades of one's life puts them at risk for dementia.

And not just that.

Strokes, there are two kinds of strokes simply put.

One is a bleeding kind of stroke, which is very closely related to a sudden surge in blood pressure, uncontrolled blood pressure.

And there is a ischemic stroke, meaning cut off of blood flow to the part of the brain because a plaque buildup in your arteries that supply the brain, such processes also promoted by uncontrolled blood pressure.

Your vision, your eyes can get impacted by uncontrolled blood pressure.

We just spoke about the heart.

Kidneys ultimately see and bear the brunt of the hypertension on a day-to-day basis.

It's not uncommon that we see people have a kidney failure and needing dialysis from an uncontrolled blood pressure.

Your blood vessels, which are constantly dealing with this elevated blood pressure over a period of time, yet thicken.

And the process which leads to plaque development, which can affect multiple organs, is also promoted by this constant uncontrolled blood pressure, which is basically instigating an injury on the blood vessel.

- Wow, so when you have a patient and you've determined that they have prolonged high blood pressure, where do you start in terms of treatments and managing that?

- Sure, so the first step when I see a patient like that is it cannot be just me, it has to be the patient as well.

As a team we work because the patients own recognition of a problem exists and I need to do something about it is very, very important because medical therapy and procedures, et cetera, those are second or third layers of tackling the problem.

The first thing is demonstrating discipline in one's own life with respect to lifestyle modifications which form the backbone of any sort of therapy.

So that's where we start.

- And at what point might medications come in?

- Sure, so the American Heart Association in collaboration with several societies had just recently published a guidelines and in those guidelines there is emphasis on categorizing not just the severity of the blood pressure, but the patient as a whole, meaning a patient who has more to lose from having an uncontrolled blood pressure and someone who has already had a stroke, already had a heart attack or a kidney problem or a limb loss, people who are at otherwise higher risks, diabetes.

And there are risks cause which can also help formulate an assessment of the risk status of the patient, also play a role.

So I would say there's the risk of the patient as a total as well as the blood pressure.

If the blood pressure is going to be at very high levels, I think it is unlikely that a healthcare provider will say, "Let's see you back in six weeks and see how your lifestyle modification is changing."

In the earlier phases of blood pressure, and if the patient's risk is low, that would be a reasonable start with just focusing on lifestyle modification.

But no matter what, everyone needs lifestyle modifications.

- Sure, so you start, yeah, start with that.

And then when it comes to medication, when people, again, they're diagnosed, a lot of people are undiagnosed, but when they are diagnosed with high blood pressure, are people typically who take medication, are they on that for the rest of their life, or is there a point where not only is it manageable but it's gonna go down?

- So it depends on how many medications you need, how severe your blood pressure is to begin with, and how well you have done with your lifestyle modifications.

Because lifestyle modifications is also very effective in controlling blood pressure.

Like talking about lifestyle modification, for example, if someone is overweight or obese, now we want to target a body mass index of less than 25.

So if you are overweight your goal should be to begin with at least getting a 5% weight loss.

A meaningful reduction in blood pressure will likely if you lose about 20 pounds of weight.

That's similar or equivalent to taking one medication.

So like you asked, it has to be a combination of thing.

If you are a heavy alcohol user, that's very closely related to having uncontrolled blood pressure so that's an avenue that you can work on.

And if you're currently practicing a sedentary lifestyle, trying to get active, that's one method to tackle blood pressure.

We ask our patients to simply try and be active for at least 30 minutes a day for five days a week to make up 150 minutes of an active time.

And there is no prescription for exercise.

What you like to do is the right thing for you.

And that could be a combination of trying to walk, jog, run, but you could try one or two days of some sort of resistance training for blood pressure control.

Isometric exercises like where you're not changing the length of the muscle, doing planks or wall sits, things like that are really shown to be of a great benefit.

I do see that a lot of patients, especially the patients from the African American descent, they have more sensitivity to sodium and sodium restriction in the diet is a great initiative again to kind of control the blood pressure.

So if you are able to adopt these things, you might not need any escalation of medication.

- I'm curious about the sodium.

What does that actually do to contribute to high blood pressure?

- Sure, so the moment that you consume sodium, there is a mechanism in your body where the body wants to keep the sodium level very tightly regulated.

So when you consume a lot of sodium, then it automatically has to eliminate that sodium, so makes your drink water, and your blood volume expands and this kind of leads to a chain of events which ultimately culminate in excessive blood pressure.

- Okay, I'd like to go over the blood pressure categories again and because these numbers as I was telling you before we started can confuse me at times.

So we wanna put up a graphic so people can follow along and let's talk about these categories.

The normal category, I guess would be ideal.

- [Dr.

Surya] Correct.

- [Mark] For people to have, and then, as we go down, that's when your high blood pressure increases.

So let's talk about elevated.

Is that something to be concerned about if you have an elevated number?

- There's a great emphasis on this kind of category now because I would say that's the greatest opportunity one has to start changing things before things get out of control.

So elevated categories when your bottom number is normal, but the top number is not yet very abnormal.

So if you will, 120 to 129, but once you cross that threshold, 130 to 139, and the bottom number starts increasing, but it's less than 90, we term as stage one hypertension.

In stage two the top number has gone beyond 140 and the bottom number is starting to go beyond 90.

And then severe forms of hypertension occur when the top number is over 180 and the bottom number is over 120.

Now a lot of patients ask me, "Is it really 138 versus 141?

Is it that kind of a big deal?"

I answer that question saying what we have demonstrated in a huge body of science and over a long period of time from all over the world is we see a pretty graduated kind of risk worsening with uncontrolled blood pressure.

So you want to look at this as a continuum.

So if I am a patient today with a stage two hypertension and I have modified a lot of my lifestyle and I'm taking my medication, I'm coming down from this stage to a better stage, I am doing a lot better with my both quantity and quality of life.

- Sure.

As we go down the list, I mean, the final one is hypertensive emergency and those numbers are very, very high and I'm guessing you should be getting to a hospital very quickly if you have those kind of numbers.

- Yeah, depends on if you are symptomatic or you're not and whether you've had high blood pressure for a long time or not.

But if hypertensive emergency can be associated with some catastrophic health events like having a stroke in the head, like having a bleed in the eye and they're based on what other problems you have on top of the uncontrolled blood pressure, there might be an urgent need to drop those numbers and that might require intravenous therapies, et cetera.

So I would say that's something that you should not definitely take it easy on.

- We talked earlier about testing at home, you know, you could get a blood pressure, you know, a battery powered one at your supermarket or wherever, Target, for fairly cheap.

How often should a typical person be checking it?

I mean, we don't wanna alarm people and say you should be checking it five times a day.

But what, in your opinion, how often should people be checking?

- Sure, so first of all, you want to make sure that the blood pressure machine that you're checking is validated.

So you can go on a FDA website, a CDC website, validate.bp.org where you can make sure that the cuff, the machine that you're using, and I recommend using the one that goes around the elbow.

You want the right size cuff, you want the bottom of it going across the elbow.

And there are certain prerequisites to check blood pressure.

I tell my patients to check two blood pressures in the morning and two in the night.

After you wake up, don't do anything for about 30 minutes, meaning no exercise, no smoking, don't get aggravated or agitated.

You want to be relaxed, empty your bladder, sit down on a comfortable chair, you want to rest your back, you want your feet uncrossed and all the way planted to the ground.

And then you want your arm to be rested on a table with the blood pressure machine at the level of your heart.

And this has been shown to give you the best blood pressure.

You get two numbers one minute apart.

You can do one set in the morning and one set in the evening.

Try doing it at least three times a week, if not every day of the week.

But more numbers are better when you go to your healthcare provider, rather than just focusing on one number, we can look at the mean blood pressure, which is what should be driving our decisions.

- All right, well, we talked about lifestyle changes, which are always difficult for people, but something that's good for people to know about.

Any other preventative things people can do, or things they could do at home to try and manage their high blood pressure?

- I would say taking the medications is the most important thing in addition to the lifestyle modifications.

Unfortunately as a country and as a society, we are very poor at controlling blood pressure.

Less than half the patients, actually some numbers show 40% or less patients with high blood pressure, are able to keep their blood pressures under control.

And large barrier to that is non-adherence to medication, especially the patients who have more severe forms of blood pressure hypertension and who need to take multiple medications fail to take the medication.

So uncontrolled blood pressure is a definite problem from non-compliance with medication.

So in addition to the lifestyle modification, taking your medications regularly would be one advice that I would definitely give.

- Yeah, I've never understood that.

Is it the people are forgetting or they just hate taking pills or what is your thought on that?

- I guess it's a complex interplay of factors.

We need to understand that patients just don't have high blood pressure.

They have other health issues too, so there might be medications that they're taking for several other things.

There are various patterns of why patients don't take medications that could be not having faith or belief in the medication or in healthcare, so to speak, being unable to afford those medications.

But that being said, most of the blood pressure medications have been there for long.

They're generic and they're not very expensive.

But taking several pills, what we do not have is combination therapy.

There's several poly pills in other parts of the world that have shown to improve compliance.

Rather than taking four different pills, if I have one pill with all four medications in one, that increases the odds of me taking it.

- Doctor, is there anything new in treating high blood pressure?

- Sure, there is a procedure called renal denervation.

We reserve this for patients who are unable to control their blood pressure despite taking three or more medications.

And this is FDA-approved after it's been tested.

Simply put, this is a catheter-based therapy where we take a special catheter through one of the arteries and deliver some energy to the kidneys because kidneys have a large amount of nerves which surround these arteries, and those nerves play a major role in the crosstalk with the mediation of hormones between the kidney and the brain, and that leads to regulation of blood pressure.

And the beauty of this procedure is unlike a medication, you're taking the compliance aspect out of the mix.

And when patients take pills, it appears that the early morning hours are the times where the blood pressure is poorly controlled.

And we see a lot of events happening in those hours like heart attacks and strokes.

But with a procedure like this, there's always on effect.

So once you've done it, you've dealt with the problem.

But not everyone is a candidate for it so you need to make sure that you talk to your healthcare provider to see if you qualify for it.

- Well, we hope everyone has learned a lot from this segment, I know I have.

We appreciate you coming on.

Thank you very much.

Dr.

Surya Chaturvedula is with Carle Health Methodist Hospital and you can watch the show again or you can share it with someone who you love or maybe are concerned about.

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