November 17, 2019
Dr. Khan & Dr. Rathi Discuss Hypertension and Heart Health

Dr. Khan & Dr. Rathi Discuss Hypertension and Heart Health

Hi, good morning. I’m Vikas Rathi and
cardiologist at Bon Secours. And I’m Shakil Khan also cardiologist at Bon Secours as well, at St. Francis. And welcome today to a Facebook Live. Thank
you for logging in. We’ll cover cardiology in general but I do want to start off by
talking about hypertension, high blood pressure. There were some new guidelines
published last year by the American College of Cardiology and it is a change
from prior guidelines inthat the goals for blood pressure are lower than they
have been in the past so I do want to go over that a little for a few minutes as
we get started here. So hypertension or high blood pressure is called the silent
killer because a lot of people have it and don’t even know they have it.
Hypertension is very common. A third of all people have hypertension and people
have about an 80% chance of having high blood pressure at some point in their
life as they get older. It increases the risk of heart attacks, kidney problems,
stroke, heart failure, and controlling blood pressure lowers those risks. So
it’s really important to find out if you have high blood pressure and if you have
it, control it. There are several risk factors for getting high blood pressure.
The most common thing is probably diet. A diet high in salt, low in potassium,
also a sedentary lifestyle, alcohol, obesity, sleep apnea, smoking, diabetes:
these all things are reversible risk factors that cause hypertension. And
there are things you can’t change like your age or genetics. So there are a lot
of causes for high blood pressure. A lot of people have it. It leads to a lot of
problems. So it’s really important that we find out if you have high blood pressure
and then control it. So the ACC, in order to help lower risk of heart problems in
the country, has published new guidelines and they’ve discovered that aiming for a
lower goal will be better than prior guidelines. And I’ll kind of show this
briefly up here. I know it’s kind of pretty hard to see but normal blood
pressure is less than 120 over 80. And elevated
now is a systolic of 120 to 129 with the diastolic less than 80 and stage 1
hypertension is 130 to 139. Stage 2 is 140 or greater. So these numbers for
stage 1 and stage 2 hypertension are a little lower than they have been in the past. And the
goal for the country is to try and get everyone, if feasible, under a blood
pressure less than 130 over 80. Dr. Rathi, what do you think about the
hypertension guidelines? Yeah I think these are very welcoming guidelines. It’s
been about 15 years since these are, these were updated and these were
updated based on the recent research which has come out in terms of the
threshold of blood pressure which we used to consider that was probably
normal. Even in that threshold people were having events, particularly heart
attack or stroke, so the premise of the guidelines are to
reduce the burden of high blood pressure by reducing the level of the blood
pressure which we were targeting and also to have increased education in
terms of why blood pressure is happening, what are the reasons, and how we can
prevent it and treat it. I think one of the key factors here Dr. Khan pointed
out was that 80% of the population in advanced age more than 60
years, 70 years of age, will have some level of high blood pressure whether it
is just elevated blood pressure by the guidelines which is 120 to 130 systolic
blood pressure or a stage one which is greater than 130, in stage two which is
greater than 140, the the key thing to remember is as we all get into the age
group greater than 40 or 45 about 95% of the African American population, or
blacks, will have chances of high blood pressure. And so
the ethnic group is also very important as we look across the board and the
second group which has high incidence high blood pressure which is about
80 to 90% of Hispanics would have high chances of having high blood
pressure. In about 70 to 80% of whites would have high chance of high
blood pressure beyond the age of 45. So when to check. I think it’s a good timing
in terms of the age group if you’re in 40 or 45 years or beyond and we should
be regularly checking our blood pressure and keeping in mind that the blood
pressure should be less than 120 which is a top number systolic and less than
80 which is the bottom number called diastolic. So when the people ask me a
lot of times is, you know, how to check my blood pressure at home? So home blood
pressure monitoring is important and it adds to the number information we get in
a doctor’s office. So people could be high in the office but ok at home, which is
called white coat hypertension or they could be they could be okay in the
office but high at home which is masked hypertension. And so getting home
measurements is really important. And one thing people ask me all the time is how
do I check on my blood pressure at home? When do I check it? So I’ll just read to
you what the guidelines have laid out which i think is really nice and makes
it very simple. So one thing to remember is make sure there’s no smoking or
caffeinated beverages 30 minutes before you check your blood
pressure. Sit down, be quiet, rest, five minutes before you check the blood
pressure. Sit with your back straight on a chair and legs flat, feet fla,t and
legs uncrossed and after that take two readings the guidelines say a minute
apart in the morning before taking medications and then again in the
evening before supper. And then keep track of these readings so when you see
your doctor you can show them either the monitor or a list of the readings. And
that is very helpful information for me to see what to do for the patient
to treat them. Yeah I absolutely agree. I think keeping a list of blood pressure
readings not only helps you understand, you know, where your blood pressure is
but also taking that list to the physician office will help physicians to
know what times of the day the blood pressure is higher, what activities you
were doing. What is your trend of blood pressure? Is it just one or two times you
had high blood pressure? Maybe there was some event which was happening, whether
it was you know something going on in your life. We can probe those areas and
probe it, some questions knowing, you know, what exactly is going on. Yes we
were focused on the blood pressure but what is causing that blood pressure is
also important, whether it is the life stressors, whether it is just that your
blood pressure is varying significantly, or is it related to some medications.
Those are really important. So definitely bring a list of blood pressure readings
from home whether you’re newly diagnosed or whether you are already have blood
pressure and you’re on blood pressure medications it’s always a good habit to
keep a tally of blood pressure readings. So on the same topic Dr. Khan would you
like to go over as to you know how to prevent or treat blood pressure without
medication. Sure. So they’re a lot of medication for blood pressure but before
we go there we want to make sure we have a good healthy lifestyle and the non
medicine approaches are the most important approaches. And that should be
done before we start medications in many cases. So things are important to
help prevent and treat blood pressure is weight loss. So for every kilogram of
weight loss there should be one millimeter drop in
systolic blood pressure. So five kilogram weight loss will lead to a five
millimeter drop in blood pressure for example. A healthy diet.
So the DASH diet is what’s recommended as one diet to help lower blood pressure.
And this is a diet that’s rich in fruits, vegetables, whole grains, low-fat dairy
products, and reduced saturated and total fat. Low sodium intake is an
important thing as well and by the way the DASH diet can lower blood pressure on
average by 11 millimeters of mercury. So that has a very robust benefit.
Low sodium, the goal is under 1,500 milligrams per day for most adults. Even
lower will be better. And increased dietary potassium so long as you have normal kidney function function increasing potassium in your diet helps lower blood
pressure as well by five millimeters of mercury and so the aim is for 3,500 to
5,000 milligrams daily of dietary potassium, foods rich in potassium.
Physical activity is important. Exercising aerobic 30 minutes a day, five
days a week is the goal. Doing dynamic resistance exercises as well, a little
bit of weight lifting, a low level, is helpful and reducing alcohol intake. So
alcohol, less than two drinks for a man and one drink for a woman is recommended
to help control blood pressure as well. We have a question from somebody watching. Bobby Hill asks “Are blood pressure readings on electronic machines generally higher than taking blood pressure readings manually?” Good question.
Actually I think looking at the data from before they’re a little bit lower
at home and to get at home compared to when is the doctor’s office
done manually. And the for the cuff it should be a right size cuff and should
be an upper arm cuff is what I recommend for most people to be most accurate.
And the size of the cuff is really important. So if you’re a larger size of
person it should be a larger size cuff. Just to add to that I agree with that
the cuff size is important. Many times if you don’t know exactly what cuff size
will fit you also look at, you know, there is tie cuffs which are available so if
you’re a larger person then ask for a tie cuff and use that on the arm.
Often times what I’ve come across in patients is it’s difficult to put the
cuff on the arm and that’s fine, arm is preferred but if that is the case that
there’s difficulty in putting the cuff on the arm, you can get a wrist
which are generally gives good reading. At least it’s a good start.
You know what the blood pressure is. The key things are also to make sure that
the batteries are new and at least are not discharging because when the
batteries are at the end of the life they can give you erroneous blood
pressure readings, sometimes very low, sometimes very high, so regularly change
batteries every one to two years or whenever the recommendation from the
manufacturer of the blood pressure cuff is. And also what I recommend my patients to do is bring your cuff
with you to your doctor so the doctor can check manual blood pressure in the
office and then you took your cuff blood pressure and compare. And how they, how
they correlate. That’s very helpful. There’s another
question from somebody online. Jane Alford asks “What about the keto diet?” The keto
diet this is diet high in ketones of protein? I’m not too familiar with this specific diet.
Yeah well I think the key principles of any diet, for example, would
be not to just focus on the diet but also focus on other key areas. The
lifestyle which Dr. Khan pointed out is looking at the amount of exercise
you’re getting, the amount of activities you’re doing, the sodium. Really the
most important factor is to reduce this whole salt intake. Just to give an
example how much salt we on an average eat, a slice of pizza has about on an
average 300 milligrams of sodium in it. So if someone ate three slices of pizza
that’s 900 milligrams to almost thousand milligrams and considering that our
limit should be less than 1500 milligrams that’s almost you got 2/3 of your sodium right there in three slices of pizza and that’s just one meal.
So I think there’s the important factors are any diet but whatever diet
has low sodium is the most important diet. High in fruits, high in vegetables,
nuts, Mediterranean diet, any type which is low in saturated fat will help
reduce the blood pressure. So there are a lot of diets out there besides the DASH
diet and Mediterranean diet and there are a lot of fad diets out there as well.
And they may show some benefit in people losing weight initially but they can
also have long term side effects and so there are a lot of diets and I would
stick with what is proven to work and be safe, what the American College of Cardiology
recommends and again, Dr. Rathi was saying, you know, high in fruits,
vegetables, high-fiber, you know, I would steer my patients away from a lot of these fad diets. They may be high in fat or, you know, just high in protein. This is —
just follow a sensible diet. Yeah so I think moving forward we wanted to also
touch base on the medications so Dr. Khan, you have any thoughts about
medications? You know, what are the right, what, you know, consider is the first
line, second lines. A good question and the guidelines did talk about this as
well based on data that’s shown to be most beneficial. So the first line agent
are drugs like thiazide diuretics, ACE inhibitors and calcium channel blockers.
And the choice what the patient gets depends on the patient itself. So in
African American respond better to calcium channel blockers than ACE inhibitors
for example. Better to thiazide diuretics than beta blockers. So it — what we choose
really depends on the specific patient. But there are there are three classes of
drugs that I mentioned earlier that are usually our first line then we go from there.
One other thing to add would be, this is away from the medications, also as the
risk factors. Know your family history. If you have a family history
which has high incidence of high blood pressure or heart disease or stroke then
be careful in terms of your own health because you’re more than
likely to get those kind of features in your own health. If you look outside just like your family more than likely you look the same from inside as
well. What that means is that if you have first-degree relatives who have high
blood pressure you have a high chance of having high blood pressure as well. So
genetics is really, really important which determines you know the chances of
you getting high blood pressure, heart disease or stroke. So always you know
what your family had and at what age they had because more than likely there
is a chance that at the same age you might get affected by that as well. Yeah.
So Bon Secours has a Heart Check Challenge that is a tool to help you kind of
figure out what your risks are and where you stand. So the Heart Check Challenge can be
done on website and there are three parts to it. There’s a
free heart assessment which is series of questions to identify your risk of heart
disease. There is a CT heart scan that’s
available, which is a CT scan of the chest and for early signs of heart
disease, early plaque buildup, and that’s at a reduced price for this month. And
also a directory for which physicians are available, they can help you with
your with your questions and problems. So about the heart scan. There are many patients
come and ask, you know, why can’t I get a heart scan to know the, you know, do I
have heart disease? So heart disease when we speak about is just a very broad term.
Heart disease can mean one can have blockages, heart disease can mean one can
have high blood pressure which can lead to heart disease or people can have
bowel problems or certain other heart diseases like cardiomyopathy. So one particular test cannot look at all aspects of the heart disease. However heart scan looks at plaque
buildup in the arteries of the heart which is the coronary arteries and that
is the number one cause heart attack so it is an indirect sign,
looking at this calcium score through the heart scan which is done
non-invasively. It is a quick test. It takes literally less than five minutes
to do the test, without starting an IV without giving any dye, and it’s a very
powerful test in certain patient population there. If the coronary calcium
score is zero that means no plaque buildup. That means the risk of having
heart disease is in next five years is very very low. Worse is if the coronary
calcium score is high. Depending upon their age then that could mean certain
level of risk of heart attack or heart disease in future.
So I think the heart scan is a great test. I recommended it quite a bit to my patients.
So again it’s for the — it’s not for everyone. But it is for a certain group
of patients, the ones we consider intermediate risk. So for example someone
who is young, you know, under age thirty, healthy, no risk factors, they’re low risk
for heart disease. They don’t need the heart scan really unless there is is a strong family history. If you’re diabetic, smoker, have vascular disease, these patients are
high risk. For them a heart scan doesn’t change too much to be honest with you
and they need to be treated aggressively anyway. But the ones who are intermediate
risk, with some risk factors, they’re obese, sedentary, family history, the
cholesterol is kind of borderline. For those patients the heart scan can be very
helpful to help guide therapy. Do we treat them aggressively as a patient
with heart disease or more conservatively with medication? So it’s
the test cost $99 this month, usually it’s $129, and it really helps us
kind of see how to best treat patients. Yeah. Two questions here.
Sandra asks, “What about POTS?” Okay. POTS is what’s referred as postural
orthostatic tachycardia syndrome. There is number of causes for pots or P-O-T-S
syndrome. One of the factors is autonomic dysfunction. It’s a form of heart disease
where the blood pressure kinda fluctuates with the
position of the patient, heart rate fluctuate with the position of the
patient. It’s not directly related to hypertension. It’s not related to, you
know, coronary artery disease. It’s something which people have based on
their neurogenic conditions or conditions which are affecting their control of
blood pressure internally through the signal mechanisms, the blood vessels with
their nervous system. Yeah if we see it, we see it quite a bit, more often in
young females definitely. It something you can grow out of too after
a while. I would say see your doctor to kinda look into it see if you really have it or
not. There’s some tests we can do to look into it. And the final question, “Is it possible that post
treatment of head and neck cancer in the area of the cardioid artery that can
cause high blood pressure with fibrosis?” Well to again I think, so the question is
the carotid arteries, if they were either scarred or they had injury because of
the surgery or radiation in the head and neck region, could they cause high blood
pressure? Not directly but again carotid arteries are involved in in the
signal mechanism of the blood pressure, particularly how the blood pressure is
regulated whether patient is laying down or sitting or standing or in certain
positions. So there could be variations in the blood pressure if there the
carotid bulb is affected, whether it is because of the surgery or because of the
radiation certainly can cause problems in the regulation of the blood pressure.
Yeah I guess is possible but patients who have vascular disease often high
blood pressure as well live other risk factors that lead to the vascular
disease and high blood pressure is one of them which they may have anyway. One
of the things which we also wanted to touch was there’s there’s a lot of risk
factors including our diet as we went over in quite detailed but also a lot of people we
have come across who have unknowingly or knowingly sleep apnea. It’s becoming
more of an epidemic in recent years, where more and more people have sleep
apnea either because of the weight gain, or the lifestyle. If their lack of
exercise or immobility or the just simply obesity can cause sleep apnea.
So hypertension is actually the number one cause — or sleep apnea is
actually the number one cause for hypertension. So always we want our
patients to be screened for sleep apnea as well. Dr. Khan, do you want to go where
if there some key points about the sleep apnea. So most hypertension is what we call
essential hypertension. This is from a diet, vascular stiffness. But when
there’s secondary hypertension, things that causes it specifically, sleep apnea is
a very common cause for that. Other thyroid disease, adrenal disease, kidney disease, those are all secondary causes. What was your question again, I’m sorry? Sleep apnea, you know, what are the key things people would want to know? What is sleep apnea? And what it can cause? And why it would cause that? Yeah, some signs you have sleep anpea are you snore at night
is a very common, you know, sign you may have it. You wake up tired, you’re tired all the time. Blood pressures’s hard to control. Those are signs you could have
sleep apnea and people who are overweight have it more commonly. So it’s
very, very common in the population and the treatment is you go to a sleep
center, you get tested for that. If you have sleep apnea the treatment could be
either a mouthpiece for mouth sleep apnea or a CPAP machine, a machine that
blows air to the airways, keep it open for more moderate or severe cases of
sleep apnea. In my practice I’ve come across many patients who thought that,
you know, this is how you know they accepted how to live.
For example I’ve had, you know, a couple patients who over the years had sleep
apnea and had all the features of sleep apnea like very disturbed night
nightmares, snoring heavily, waking up their partners,
partners finally decided to sleep in different room, being very tired during
the days, getting, you know, sleep, you know, or unable to function during the middle
of the day because they were sleepy. If you, if someone has any of those features
they could have sleep apnea so these are some things to look for or to
know about and when I interview my patients and I bring out these things in
their history they say “Well, you know, yeah, I had this for a number of years,
never thought about it” and we test them for sleep apnea and they are positive for
sleep apnea. Once treated their blood pressure improves, their overall health
improves in terms of their cholesterol, if they have any sort of arrhythmias it definitely helps them to have a healthy lifestyle with treatment. Yeah and as people are looking to get a
sleep study they go, you know, I can’t wear the mask or I go and tolerate it or
looks too weird — my mom could never tolerate it she hated it — but other
patients who feel much better with it. They use it, they get it treated, and then
they feel so much better they don’t like sleeping without it. I think it’s
worth getting looked into if you have it. Don’t be reluctant. Give it a shot. It can
make a big difference in how you feel. Great. Okay well thank you for your attention
and thank you for joining us today. This was Vikas Rathi from Bon Secours
Cardiology and with me I have Dr. Shakil Khan who is my associate
and partner over here at St. Francis Medical Center at Bon Secours. Thank you.
Thank you.

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