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High Blood Pressure - What Patients and Providers Need to Know · Bryan Health Podcasts

• 0:03
  Melanie Cole, MS (Host): Welcome to Bryan Health Podcast.
• 0:05
  I'm Melanie Cole.
• 0:06
  And today, we are learning about high blood pressure or
• 0:09
  hypertension and what patients and providers really need to know.
• 0:14
  Joining me is Dr.
• 0:15
  Kevin Hall.
• 0:15
  He's an interventional cardiologist at the Platte Valley Cardiology Clinic.
• 0:20
  Melanie Cole, MS: Dr.
• 0:20
  Hall,
• 0:21
  Melanie Cole, MS (Host): thank you so much for joining us today.
• 0:23
  I'd like you to tell us really what blood pressure is.
• 0:26
  What is blood pressure?
• 0:28
  And then, what is high blood pressure or hypertension?
• 0:32
  Dr. Kevin Hall:
• 0:32
  Well, you know, one of the most dangerous things about high blood pressure
• 0:37
  is that it doesn't feel dangerous.
• 0:40
  And people typically expect serious medical problems to
• 0:43
  come with warning signs, right?
• 0:46
  So for instance, pain, shortness of breath, a symptom that
• 0:50
  tells you something is wrong.
• 0:52
  Well, in fact, high blood pressure just doesn't work that way.
• 0:56
  And I've had patients walk into my office and say, "You know, Doc,
• 1:00
  I actually feel pretty great."
• 1:02
  Meanwhile, their systolic blood pressure is 180.
• 1:06
  So, they're feeling fine, but their blood vessels aren't, their heart
• 1:11
  isn't, their kidneys aren't, their brain isn't, and that's why we call
• 1:17
  high blood pressure the silent killer.
• 1:19
  Because sometimes the first sign of high blood pressure is a
• 1:23
  complication itself, a heart attack, a stroke, or even heart failure.
• 1:30
  So when I explain blood pressure to patients, I tell them that
• 1:33
  the top number does the damage.
• 1:35
  And when the top number stays above 140 for years, it's quietly
• 1:41
  damaging what I call the big three.
• 1:43
  So, what are the big three?
• 1:45
  The heart, the brain, the kidneys.
• 1:49
  And while many people think high blood pressure is affecting one part
• 1:52
  of their body, it's really attacking the organs that you need the most.
• 1:56
  So again, the heart, the brain, the kidneys.
• 2:00
  Because a stroke can take away your ability to walk, to talk, to work, to
• 2:04
  recognize the people that you love.
• 2:06
  Heart failure can leave you exhausted just simply walking across your living room.
• 2:11
  And kidney failure can lead to dialysis several times a week just to stay alive.
• 2:16
  And here's the part that sticks with me the most, Melanie, is
• 2:20
  I've never had a patient come into my office asking for dialysis.
• 2:24
  I've never had a patient tell me they'd like to have a stroke.
• 2:27
  But every day, I meet people who are unknowingly on that path because their
• 2:32
  blood pressure went untreated for years.
• 2:36
  The tragedy is that so much of this is preventable.
• 2:40
  You know, when people ask why their blood pressure so uncontrolled,
• 2:43
  I think it's important to start with a little bit of compassion.
• 2:47
  Managing high blood pressure isn't always as simple as taking a pill and moving on.
• 2:52
  People are balancing work, family, finances, stress, poor
• 2:56
  sleep, other medical conditions.
• 2:59
  In my experience, most patients care very deeply about their health.
• 3:05
  The challenge is that high blood pressure rarely causes symptoms.
• 3:09
  So, life often wins their attention before their blood pressure does.
• 3:14
  And most people feel completely normal.
• 3:16
  And because they feel normal, high blood pressure can sometimes be easy to ignore.
• 3:21
  Melanie Cole, MS: Doctor, tell us about blood pressure readings and
• 3:24
  what we need to know about them.
• 3:26
  Dr. Kevin Hall:
• 3:26
  One of the biggest mistakes people make is assuming blood
• 3:29
  pressure reading is accurate.
• 3:31
  Blood pressure is really incredibly sensitive.
• 3:33
  It's affected by stress, by caffeine, by poor sleep, by pain, by rushing through
• 3:39
  traffic to get to an appointment or work.
• 3:41
  And I've seen patients sprint across a parking lot, sit down in
• 3:46
  an exam room, and have their blood pressure checked 30 seconds later.
• 3:49
  And of course, that elevated blood pressure is not representative
• 3:53
  of their true blood pressure.
• 3:55
  Sometimes that's actually their stress level.
• 3:58
  That's why I tell patients blood pressure is not a photograph.
• 4:01
  It's actually a movie.
• 4:03
  It changes throughout the day and it changes throughout the week.
• 4:07
  And because of that, I care much more about trends than
• 4:10
  I do about any single number.
• 4:13
  So, one elevated reading gets my attention, but a pattern of elevated
• 4:18
  readings really gets my action.
• 4:20
  And that's why home monitoring has become so important.
• 4:25
  In fact, if I could give every patient with high blood pressure one piece
• 4:29
  of equipment, it would probably be a home blood pressure cuff.
• 4:33
  And the reason is quite simple.
• 4:35
  I care far more about what your blood pressure is doing in your
• 4:38
  living room than what it's doing in my office, because that's real life.
• 4:44
  That's where blood pressure really lives.
• 4:46
  And if you're anything like me or any of my patients, whenever
• 4:50
  we go to the doctor's office, our blood pressure goes up.
• 4:52
  We call it white coat hypertension.
• 4:54
  But when you're sitting at home, relaxed in your normal environment, we get a much
• 4:59
  clearer picture of what's really going on.
• 5:02
  The benefit of home blood pressure monitoring is that it puts
• 5:05
  patients back in the driver's seat.
• 5:06
  They can see the impact of exercise or the lack thereof.
• 5:10
  They can see the impact of weight loss, reducing sodium
• 5:13
  in their diet, medications.
• 5:15
  The doctor only sees the snapshots.
• 5:18
  So, home monitoring fills in the rest of the story.
• 5:21
  But I don't really want patients to panic when you get a single high reading.
• 5:27
  A single high blood pressure reading should get your attention.
• 5:30
  And again, a pattern of high blood pressure should get your action,
• 5:34
  because most of the damage from high blood pressure occurs over
• 5:37
  months and years, not hours.
• 5:40
  And I'd much rather talk with someone today about high blood pressure than
• 5:45
  meet them six months from now after a preventable stroke or heart attack.
• 5:50
  Now, if your blood pressure is extremely elevated, we're talking about systolics,
• 5:54
  you know, 160s to 180s or higher, and you're having symptoms like chest
• 6:00
  pain, shortness of breath, severe headache, vision changes, confusion,
• 6:03
  weakness, numbness, or symptoms concerning for a stroke, well, that's
• 6:08
  not something to monitor at home, right?
• 6:11
  That's an emergency.
• 6:13
  That's a reason to seek immediate medical attention.
• 6:16
  And the way I summarize it for patients is this, really don't ignore it, but
• 6:20
  don't panic over one number either.
• 6:22
  Pay attention to the patterns.
• 6:24
  Melanie Cole, MS: Dr.
• 6:25
  Hall, tell us about some lifestyle changes that really make a difference.
• 6:29
  Dr. Kevin Hall:
• 6:29
  So, this is actually one of my favorite conversations to have
• 6:32
  with patients because it really gives them some control back.
• 6:37
  Now, one of the biggest misconceptions about high blood pressure is that
• 6:40
  lifestyle changes don't really work.
• 6:43
  And really, the truth is that some of the most powerful treatments for high blood
• 6:47
  pressure don't come from a pharmacy.
• 6:49
  They actually come from daily habits, from daily discipline.
• 6:53
  Not motivation, because honestly, motivation really fades with the wind.
• 6:57
  You have to be disciplined in your choices and in your habits.
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  And these are the choices we make over and over again every single
• 7:05
  hour, every single day of our lives.
• 7:08
  Weight loss, should I exercise, reduce sodium, getting better sleep.
• 7:13
  These things matter.
• 7:15
  So, here's where some patients get it wrong.
• 7:18
  They think success comes from dramatic change, when it usually
• 7:22
  comes from small decisions repeated consistently on a daily basis.
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  In fact, one of the biggest mistakes people make is trying
• 7:29
  to change everything at once.
• 7:32
  They decide that they're going to lose 30 pounds, eliminate all sodium, exercise
• 7:37
  every day, and never touch dessert again.
• 7:40
  And that motivation usually lasts for about two weeks, even in the best of us.
• 7:44
  Then, life shows up.
• 7:46
  And what I typically tell patients is this, "I don't need perfection,
• 7:50
  I need consistency" or maybe the better word is discipline, because
• 7:54
  when it comes to blood pressure and most healthy habits, discipline beats
• 7:59
  intensity almost every day of the week.
• 8:01
  So when I think about healthy living, I don't think about massive changes.
• 8:05
  I think about small decisions repeated thousands of times.
• 8:09
  Should I get up a little earlier and go for a walk before work?
• 8:12
  Should I eat that blueberry muffin or the slice of pizza, or should I make
• 8:16
  a better choice and choose minimally processed natural whole foods higher
• 8:21
  in protein and fiber, foods that we know will keep you fuller for longer?
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  Should I make a conscious effort to cut back on smoking, or
• 8:30
  better yet, just quit altogether?
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  Should I turn off the TV and go to bed a little earlier
• 8:34
  tonight so I can get more sleep?
• 8:36
  Those decisions may seem small, but over months and years, they really add up.
• 8:42
  And one of the biggest examples of that is dietary sodium.
• 8:46
  When most people think about sodium, they picture the salt
• 8:49
  shaker sitting on the kitchen table.
• 8:51
  When the reality is, is that for most Americans, that's not where the
• 8:55
  majority of sodium is coming from.
• 8:57
  In fact, one of the things I tell patients is, "It's not always
• 9:02
  the salt that you're adding, it's the salt already added for you."
• 9:06
  It's the restaurant meals, the fast food, the canned soups, the processed packaged
• 9:11
  foods, the sauces, the dressing, the foods that don't necessarily taste salty but
• 9:16
  contain a tremendous amount of sodium.
• 9:19
  And here's why sodium matters.
• 9:21
  Your kidneys have this immensely important role to maintain balance.
• 9:26
  So when we consume too much sodium, the body naturally holds onto more water.
• 9:31
  And more water means more volume in the bloodstream, and more volume
• 9:35
  means more pressure inside the pipes.
• 9:38
  And I sometimes tell patients to think of it this way.
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  Imagine that you're stranded in a desert with very little water.
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  Your body will do everything it can to hold on to every drop.
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  Sodium sends a similar signal.
• 9:53
  It tells the body to retain fluid, and that extra fluid increases blood pressure.
• 9:59
  Now, I'm not telling patients that they can never enjoy
• 10:01
  Thanksgiving dinner or Christmas dinner or Fourth of July barbecue.
• 10:05
  Life is meant to be lived.
• 10:06
  But what I am saying is that what happens between those holidays matters
• 10:11
  far more than the holiday itself.
• 10:14
  It's the daily habits that move the needle, not the occasional celebration.
• 10:18
  And most people don't get high blood pressure from Thanksgiving dinner.
• 10:21
  They get it from having Thanksgiving dinner every single day.
• 10:25
  Now, weight loss remains one of the most effective ways to lower
• 10:28
  blood pressure, and there are many different ways to achieve it.
• 10:31
  Some people do well with portion control.
• 10:34
  Some focus on improving food quality.
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  Some find success with approaches like time-restricted eating
• 10:40
  or intermittent fasting.
• 10:42
  The specific strategy matters less than finding something safe, sustainable,
• 10:47
  and realistic for your life.
• 10:49
  The goal isn't to look different.
• 10:50
  The goal isn't to live longer.
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  The goal is to lower your risk of stroke, lower your risk of heart attack,
• 10:56
  heart failure, and kidney disease.
• 10:59
  Melanie Cole, MS: Dr.
• 10:59
  Hall, what's the biggest challenge to patients staying on track?
• 11:03
  Dr. Kevin Hall:
• 11:03
  I think the biggest challenge is that success is invisible, because nobody
• 11:08
  really wakes up one morning and says, "Wow, my stroke didn't happen today."
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  Nobody feels the heart attack that they prevented, and nobody feels the
• 11:16
  kidney disease that they avoided.
• 11:19
  And that's what makes high blood pressure so different from
• 11:22
  many other medical conditions.
• 11:24
  If you have a headache, you take medicine, the pain gets better.
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  If you have an infection and you take antibiotics, you feel better.
• 11:31
  High blood pressure doesn't work that way, and most people feel completely normal.
• 11:37
  So after a few weeks or a month, it's natural to start asking, "Well,
• 11:42
  do I really need this medication?
• 11:44
  Do I really need to keep doing all of this?"
• 11:47
  The answer is yes, because we're playing a long game.
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  What we're trying to prevent isn't tomorrow's problem.
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  We're trying to prevent the stroke five years from now, the heart
• 11:57
  failure 10 years from now, and the dialysis 20 years from now.
• 12:01
  And honestly, the patients who do the best aren't necessarily the smartest, the most
• 12:06
  disciplined, or even the most motivated.
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  They're the ones who make treatment simple.
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  They take their medications at the same time every day.
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  They use a pill box.
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  They keep a blood pressure cuff at home.
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  They build habits that fit into their lives instead of relying on willpower.
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  Because your blood pressure isn't keeping score of your best day, it's
• 12:27
  keeping score of your average day.
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  Melanie Cole, MS: Thank you so much, Dr.
• 12:31
  Hall.
• 12:32
  When is it important to see a specialist?
• 12:35
  Dr. Kevin Hall:
• 12:35
  Most patients with high blood pressure can be managed very successfully
• 12:39
  by their primary care provider.
• 12:41
  In fact, primary care physicians do an outstanding job treating the vast
• 12:45
  majority of patients with hypertension.
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  But there are times when it makes sense to take a deeper look.
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  One of the most important things I tell patients is this, sometimes
• 12:54
  high blood pressure is the diagnosis, and sometimes it's a clue.
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  If someone is taking multiple medications and their blood pressure is still
• 13:04
  not controlled, then that's a clue.
• 13:07
  If their blood pressure suddenly becomes difficult to manage after years of being
• 13:11
  stable, then that's a clue as well.
• 13:14
  If we're seeing signs that high blood pressure is affecting the heart,
• 13:18
  kidneys, or blood vessels, that's a clue.
• 13:21
  Those are the situations where we start asking a different set of questions.
• 13:26
  Is sleep apnea playing a role?
• 13:28
  Is there an issue with the kidneys?
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  Could there be, for instance, hormonal calls driving the blood pressure?
• 13:35
  Is there something we're missing?
• 13:37
  And that's where a specialist comes in.
• 13:40
  The good news is that patients don't need to figure out all of this on their own.
• 13:44
  If you're taking your medicines, making lifestyle changes, and your
• 13:48
  blood pressure still isn't where it should be, it's okay to ask whether
• 13:52
  it's time for a deeper evaluation.
• 13:54
  Sometimes controlling blood pressure isn't about adding another medication.
• 13:59
  Sometimes it's about finding the reason it was high in the first place.
• 14:04
  Melanie Cole, MS: Well then, tell us about medications out there today for
• 14:06
  hypertension and high blood pressure.
• 14:09
  What works?
• 14:10
  What have you seen in your practice?
• 14:13
  Dr. Kevin Hall:
• 14:13
  One of the first things I tell patients is that needing medication is not a failure.
• 14:17
  The reality is that high blood pressure is caused by a combination of factors,
• 14:22
  whether it's genetics, age, weight, diet, activity level, stress, kidney
• 14:27
  function, and many things that are completely outside of a person's control.
• 14:33
  So if someone needs medication, I don't view that as a weakness.
• 14:37
  I view it as another tool.
• 14:39
  In fact, I often tell patients, "You know, I really don't care whether
• 14:43
  we lower your blood pressure with discipline, with medication, or both.
• 14:47
  I care that we lower it before it lowers your quality of life."
• 14:51
  Because at the end of the day, that's the goal, right?
• 14:54
  Protecting the heart, protecting the brain, protecting the kidneys.
• 14:57
  Blood pressure medications are a lot like members of a team.
• 15:01
  Each one does a different job.
• 15:03
  Some help the body get rid of excess salt and water, some relax
• 15:06
  blood vessels, some slow down the heart rate, and some block hormones
• 15:11
  that cause blood pressure to rise.
• 15:13
  They're all working toward the same goal, but they're doing it in different ways.
• 15:18
  And that's one reason many patients end up needing more than one medication,
• 15:23
  not because their blood pressure is unusually bad, but because using two
• 15:28
  or three medications at lower doses is often more effective and often
• 15:33
  causes fewer side effects than pushing one medication to the maximum dose.
• 15:38
  One of the biggest misconceptions I hear is, you know, "Doc,
• 15:41
  the medicine is working."
• 15:42
  And sometimes that's true.
• 15:44
  But more often, there's another explanation.
• 15:47
  Maybe doses are being missed.
• 15:49
  Maybe sodium intake is still very high.
• 15:52
  Maybe another medication is raising blood pressure.
• 15:56
  Maybe sleep apnea is contributing.
• 15:58
  Maybe we're treating the wrong cause.
• 16:01
  And that's why when blood pressure isn't controlled, I don't
• 16:04
  immediately blame the medication.
• 16:06
  I step back and I ask why.
• 16:09
  Because medicine works best when we're treating the cause,
• 16:13
  not just treating the number
• 16:15
  Melanie Cole, MS: Very well said, Dr.
• 16:16
  Hall.
• 16:17
  So when we think of hypertension, lifestyle modifications, medications,
• 16:23
  all the tools that we have now in our toolbox to help people with this
• 16:28
  hypertension, what would you like them to know about some new options that
• 16:34
  are expanding for those treatments and the modalities you have available
• 16:39
  Dr. Kevin Hall:
• 16:39
  So, Melanie, this is where it gets really interesting.
• 16:42
  Most patients with high blood pressure can achieve good control
• 16:45
  with lifestyle changes, medications, or a combination of both.
• 16:49
  But sometimes we encounter patients whose blood pressure remains elevated despite
• 16:55
  doing many of the right things, and that's what we call resistant hypertension.
• 17:00
  Resistant hypertension is blood pressure that remains above goal
• 17:04
  despite multiple medications, typically three or more medications
• 17:08
  working through different mechanisms.
• 17:10
  And when I see that, my first thought is not "What medication can I add next?"
• 17:16
  My first question is, why?
• 17:19
  Because resistant hypertension is often a clue, it's the body's way of telling us
• 17:23
  that something else may be contributing.
• 17:26
  Sometimes it's excess sodium, sometimes it's sleep apnea, sometimes it's
• 17:31
  obesity, sometimes it's kidney disease, or sometimes it's medications that
• 17:35
  unintentionally raise blood pressure.
• 17:38
  And occasionally, it's something more uncommon that
• 17:41
  requires a deeper evaluation.
• 17:43
  And one of the biggest mistakes clinicians can make is assuming every
• 17:46
  patient with resistant hypertension simply needs another prescription.
• 17:50
  Sometimes they do, but sometimes what they really need is a diagnosis.
• 17:54
  When something doesn't behave the way it's supposed to, the answer
• 17:58
  isn't always another prescription.
• 18:00
  Sometimes the answer is understanding what's driving the problem in the
• 18:03
  first place, and that's where a careful evaluation becomes incredibly important.
• 18:08
  So when it comes to new and emerging treatments, this is one of the most
• 18:12
  exciting areas in hypertension right now.
• 18:15
  For decades, our primary tools were lifestyle changes and medications,
• 18:20
  and those remain incredibly important.
• 18:23
  But we're now entering an era where we have additional options
• 18:26
  for carefully selected patients.
• 18:28
  One of those options is a procedure called renal denervation.
• 18:32
  The kidneys play a major role in blood pressure regulation.
• 18:36
  They communicate with the brain and nervous system through a network of
• 18:39
  nerves that run along the renal arteries.
• 18:42
  And in some patients, those nerves are overactive and contribute to
• 18:46
  persistently elevated blood pressure.
• 18:49
  Renal denervation works by reducing the activity of those nerves.
• 18:54
  The procedure is minimally invasive and performed through a catheter
• 18:58
  inserted into an artery in the groin, similar to many of the procedures we
• 19:02
  perform on a daily basis in cardiology.
• 19:05
  Now, it's important to understand what renal denervation is and what it isn't.
• 19:10
  It's not a cure, and it's not for everyone, and it doesn't replace
• 19:14
  healthy habits or medications.
• 19:17
  But for carefully selected patients with resistant hypertension, it can provide
• 19:21
  another valuable tool to help lower blood pressure and reduce cardiovascular risk.
• 19:27
  What excites me the most is that we're finally moving beyond a one-size-fits-all
• 19:32
  approach, and we're recognizing that hypertension isn't the same disease in
• 19:36
  every patient, and different people have different drivers of high blood pressure.
• 19:42
  The future of hypertension isn't really choosing between
• 19:45
  procedures and medications.
• 19:46
  It's really finding the right treatment for the right patient.
• 19:50
  And the more precisely we can identify those drivers, the more
• 19:53
  effectively we can treat them.
• 19:56
  At the end of the day, whether we're talking about lifestyle changes or
• 20:00
  medications, sleep apnea treatment, weight loss, or renal denervation, really the
• 20:05
  goal is always the same: lower blood pressure, protect the heart, protect the
• 20:10
  brain, protect the kidneys, and ultimately help people live longer, healthier lives.
• 20:16
  Melanie Cole (Host): What are some really important key takeaways you'd
• 20:18
  like to leave the listeners with?
• 20:20
  Dr Kevin Hall: If there's one thing I'd like people to remember, it's
• 20:23
  this: high blood pressure is incredibly common, but it is one of the most
• 20:29
  treatable risk factors that we face.
• 20:31
  The biggest improvements in health rarely come from one dramatic decision.
• 20:36
  They come from the choices we make over and over and over again.
• 20:40
  Choosing to take a walk, choosing water instead of another sugary drink
• 20:45
  or alcohol, choosing to stop smoking, choosing to prioritize the most
• 20:51
  important hours of your day, which are your sleeping hours, choosing a
• 20:54
  healthier meal more often than not.
• 20:57
  And the good news is that these changes don't have to be
• 21:00
  perfect to make a difference.
• 21:02
  So give yourself grace.
• 21:03
  Most of us already know what healthy choices look like.
• 21:07
  The goal isn't perfection.
• 21:08
  The goal is simply making those choices a little more often than we don't.
• 21:14
  Even modest weight loss can lower blood pressure.
• 21:17
  Regular physical activity also helps.
• 21:20
  Better sleep helps.
• 21:22
  And for some people, simply being more intentional about when they eat, not
• 21:27
  just what they eat, can help as well.
• 21:29
  Small improvements add up.
• 21:32
  And when lifestyle changes aren't enough, we have excellent medications
• 21:35
  and excellent new options like renal denervation that can help patients
• 21:39
  gain control of their blood pressure.
• 21:41
  But at the end of the day, the foundation remains the same.
• 21:45
  Your future health is being built by the choices that you make every
• 21:49
  single day, not once, not when you're motivated, but over and over again.
• 21:55
  That's how blood pressure improves, that's how hearts stay healthy,
• 22:00
  and that's how lives are changed.
• 22:02
  Melanie Cole, MS: Great information.
• 22:03
  Dr.
• 22:04
  Hall, thank you so much for joining us today and really sharing your
• 22:08
  incredible expertise for us today.
• 22:10
  I'd like to thank our Bryan Foundation partner, NRC Health.
• 22:15
  To listen to more podcasts from our experts, please visit
• 22:18
  bryanhealth.org/podcasts.
• 22:20
  That concludes this episode of Bryan Health Podcast.
• 22:24
  Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple
• 22:28
  Podcasts, Spotify, iHeart, and Pandora.
• 22:31
  Until next time, I'm Melanie Cole.