Under Pressure: Breaking down hypertension

High blood pressure, otherwise known as hypertension, is one of the most common diseases in the United States and is a leading cause of heart disease and stroke.  Join me in breaking down the medicine behind high blood pressure as well as some preventative measures, treatment options, and more.

Show notes: Season 1, Episode 1

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Transcript

S1 E1

"Under Pressure: Breaking down hypertension" 

Erin Layman Rhoads: [00:00:00] 
Hello, and welcome to Medicine in Layman's Terms. 
 
 

Whether you are a patient looking to understand more about your health, a student looking to brush up on common medical terms, or a provider wanting ideas to explain diagnoses to your patients, I invite you to join me every week as we break down basic medicine into layman's terms. I am your host, Erin Layman Rhoads, a certified physician assistant, and let's get started. 
 
 

Meet Adam. Adam is a 49-year-old male who's going to a doctor appointment today for his regular physical. Aside from some exercise-induced asthma for which he rarely needs to use an albuterol inhaler, he has no known medical conditions and does not take any daily medications. He does, however, have a family history of high blood pressure in both of his parents, his uncle, and both grandfathers. Today, he decides to ask his primary care provider what is blood pressure, exactly? How do we control it? And why do we care so much when it's high?
 
 Woohoo, episode one!
 
  Admittedly, I am a bit of a podcast intro skipper, so for those of you who are like me and want to jump ahead to the meat of the podcast and skip this introduction, feel free to jump ahead about one minute thirty seconds. Everyone else, I wanted to introduce myself and briefly explain why I started this podcast. 

My name is Erin Layman Rhoads. I am an urgent care PA based out of Denver, Colorado, and I have been in healthcare for a little under a decade.

I have worked as an EMT, a CNA, and then now obviously as a PA. During this time, I've developed a passion for patient education and community outreach. I feel like the farther along in my career that I get, the more interested I become and the more I realize how important of topics these are. As providers, we are often extremely limited in the time that we get to spend during our patient visits and with our patients and this can lead to unanswered questions and confusion sometimes with our patients and their diagnoses, their treatment plans, et cetera. I really wanted to start a project where I could help jumpstart the understanding and knowledge of basic medicine and communities to help bridge this gap.

However, with the pandemic and changing jobs, finding a space was pretty difficult. Then a friend of mine asked if I had ever thought a podcast. Which I hadn't, but here we are…so, voila! I decided to hop on this space and break down medicine in order to hopefully create a better understanding of the common medical terms and diagnoses that we often throw around, and patients and families, and friends and communities.

I also hope that this podcast can help my fellow providers with ideas for briefly summarizing common diseases and diagnoses to patients in basic language. Anyways, thanks for joining me and let's get started. 

Skippers, skippers, come back! You can stop fast-forwarding now. 

For this initial episode, I chose the ever-enthralling topic of high blood pressure, also known by the fancy medical term hypertension.

I chose this because, especially in the United States, hypertension is rampant and it's something that you can develop at almost any age, especially in adulthood. In the US the treatment of hypertension is amongst the most common reason for office visits and chronic prescription medications. Per the CDC, approximately half of the adults in the United States, around 47%, have hypertension. The American Heart Association estimates that number at around 103 million adults in the US. For those of you like me that have problems fathoming a number larger than a hundred, that is about the entire populations of Texas, California, Florida, and New York combined…combined!

Even scarier, the CDC also estimates that around one in three adults don't even know that they have high blood pressure. Therefore, that number could be much higher. So, what is blood pressure? Blood pressure is a measurement of the amount of pressure the blood has against the walls of our arteries.

Arteries are the vessels responsible for bringing blood away from the heart. Fun fact here for all my trivia nerds, the size of a great whale's heart is about the same size as a VW bug. Their aortas, which are the arteries that pump blood from the heart to the body, are about nine inches in diameter, and that is compared to the average adult's three-centimeter aorta. Anyways, I hope that wins you some sort of trivia question, adds a new meaning to the slug bug game or just feeds your inner nerd. 

But, moving forward, we generally read or report blood pressure using two numbers.  For example, Adam might be told by the nurse that his blood pressure is 126 over 70. That first number, the 126, is known as the systolic value. The systolic number is reading the amount of pressure in the arteries when the heart beats or contracts. The second number in this example, the 70, is known as the diastolic value, and it is a measurement of the pressure in between beats when the heart is at rest.

So, what is hypertension? Hypertension is the medical term for having high blood pressure, and there are different stages or degrees of hypertension. Generally, stage one hypertension is considered to have a systolic value between 130 to 139, or a diastolic value between 80 to 90. 

Of note, there is some variation here. For example, the American Academy of Family Physicians considers the threshold for hypertension to be 140 over 90. Also, of note, the higher value determines the stage. So, for example, the cutoff for stage one is 140 over 90. Let's say if someone has a blood pressure, for example Adam, of 130 over 96, we would say that he has stage two hypertension even though that top number, the systolic, is less than 140. That is because his diastolic value, which was 96 in this example, is greater than the 90 cutoff. So how does someone develop high blood pressure and how can we prevent it?

Just to confuse us a little bit more because, as will become an ever-recurring theme in this podcast, medicine is never exactly straightforward. To every rule there's an exception, to every trend an outlier, and of course everything can always be further subdivided.  There are two main classifications of hypertension, known as primary and secondary hypertension.

Sorry, my very sweet dog just figured out how to shove her way through the door, and now her cute little head is on my lap and it's very distracting to try to do a podcast, especially in under 10 minutes. But, anyways, the two main classifications for hypertension are primary and secondary hypertension.

Primary hypertension, or as some of us may know as essential hypertension, is by far the more common version of hypertension in the US. However, it is also less understood. The exact cause is often unknown, but we suspect that primary or essential hypertension is most likely the result of a combination of genetic and environmental factors.

Some of these factors include age advancing age, for example, obesity or weight gain, and family history. Secondary hypertension is the result of another medical condition, like a disease that affects your kidneys. This isn't as common though, so we're going to bookmark that in our memories as a possibility, but address the more common primary or essential hypertension with the remaining minutes of this podcast.

We can try to prevent hypertension or control our blood pressure by attempting to modify our risk factors. Obviously some factors, especially genetic components, may be outside of our control, so that's why we tend to focus on the factors that we do have control over.

Areas that I frequently touch on with my patients include limiting alcohol to moderate consumption. This is defined as one and a half standard drinks daily for women and two for men. No, to my fellow late 20, early 30-year-olds, that is not one and a half bottles of wine or two fuzzy taco beeritas, which PS are amazing.

Rather a standard drink is a can of Angry Orchard, one small glass of wine or approximately one ounce of spirit liquor. Another area is diet and exercise. We love this as providers, and of course this can be very individualized based on patient preference, activity level, allergies, lifestyle, so many things.

A good reference for diet is to ensure that your diet has veggies, fruits, whole grains, and healthy fats, which sadly are not found in bacon cheeseburgers, but more so our polyunsaturated fats in nuts, like walnuts. As for exercise, we recommend moderate intensity, aerobic exercise activity about five days per week.

Bonus points for adding two to three days of strength or resistance training. So, brush off that yoga mat, find that gym membership card that you've been paying for since Black Friday, and let's get started. People with high blood pressure are also encouraged to reduce salt intake. Basically, when we eat a lot of salt, our body decides to hold onto that extra water, and this can drive up the pressure on our vessels.

Ways to decrease salt intake can include limiting when you add salt to meals or cooking, limiting fast foods or processed foods, and a very sad fact here, many breads and cereals can be high in sodium. If you have a diagnosis of high blood pressure or you're just curious, you can look up the DASH diet, D A S H, on Pinterest, Google, Instagram, TikTok, you know, wherever you find your health facts... you could also use a dietician. They are great resources here. 

The final controllable risk factor is smoking and, just stop. Please just stop smoking. We had an ongoing joke in PA school that whenever you were asked to name a risk factor for a disease, you could almost always get a point with smoking. So, really, please just stop smoking.

Finally, why do we care about high blood pressure and how do we treat it once it's high? High blood pressure is associated with a significant increase in diseases that can affect our kidneys and heart, and these are organs that we really care about in medicine. This risk increases with the higher the pressure and the longer of blood pressure is high.

In 2020, an estimated 670,000 people died with hypertension as the primary or contributing diagnosis. When we have increased pressure, this puts strain on our heart as it's having to do much more than intended. Your arteries in your body can become damaged from the increased pressure placed on them, which can lead to a heart attack or a stroke. Eye problems, kidney failure and erectile dysfunction are also complications that we see. 

Let's say you're Adam and you find out that you have high blood pressure, and you care about your eyes, your heart, your kidneys…your penis, and you want to know your options for treatment. Another common question is if you start medication, are you going to be stuck on it forever?

The answer here is not necessarily. Some people focus on diet, exercise, reducing their risk factors, et cetera, and are able to come off of it. But sometimes people remain on medication even if they implement these changes.  Another key thing is, even if you are on medication, you still should work on reducing your risk.

Two main medications or medication groups that you'll probably hear about are ACE inhibitors and ARBs. ACE inhibitors include a medication called Lisinopril and ARBs, which PS is just really fun to say for some reason, include a medication called losartan. These medications focus on different parts of your body that can regulate blood pressure.

And that my friends, is the end of episode one and a grand overview of hypertension. Feel free to like and subscribe and join us next week while we talk about skin cancer. 

If you have any questions like wanting clarification on something, suggestions, or constructive criticism, feel free to reach out via social media. My Instagram handle is rhoadtopa, R H O A D T O P A. You may also email me at rhoadtopa@gmail.com. Again, the same spelling as the Instagram handle, R H O A D T O P A. Finally, feel free to hit the subscribe button and have a beautiful rest of your week. Thank you.

https://www.rhoadtopa.com/podcast