November 12, 2019

What is High Blood Pressure? | New Hypertension Guidelines! | Doctor Mike

– Hey guys, what’s going on? I wanna take the time out and talk about a specific medical topic
that’s been making headlines all across the news this week. – Who should be diagnosed
with high blood pressure? – [Announcer] Blood pressure. – Half of all adults. – [Announcer 2] Redefining
the danger zone. – Plus it’s a medical issue that effects one in three individuals, at least here in the States. That topic is, hypertension. Before we start talking
about what hypertension is, let’s talk a little basic anatomy. The human body has a human heart, the human heart has two ventricles. The left ventricle is
the strongest ventricle and that part of the heart squeezes and pumps blood to the rest of the body. It does so through blood
vessels called arteries. Arteries take blood and allow it to travel away from the heart. The way we memorize that
in medical school is A away from the heart, A for artery. When you measure blood pressure all you’re doing is your
measuring the pressure that’s on the arterial walls. And there are really three major factors that play a role in this pressure. Number one is cardiac output which is how much blood your heart
pumps out with each beat, number two is blood
volume, and number three is that resistance your
heart has to pump against. Normally when you visit a doctors office or a hospital and you
have a health professional measure your blood pressure
you see them use a cuff. That cuff has a name, it’s
called a sphygmomanometer. That’s a mouthful I understand so we tend to use the
term blood pressure cuff. The way that the blood
pressure cuff works is by constricting the
arteries within your arm and while the doctor or other health professional’s listening at the brachial artery you hear that first sound of blood
rushing through the artery that’s know as the systolic blood pressure which is measured in mm of mercury. And then when that sound disappears that’s known as the diastolic pressure. Sometimes you see the numbers
written as a fraction. The top number’s the systolic number and the bottom number’s
the diastolic number. The top number also known as
the systolic blood pressure is the pressure during maximal
contraction of your heart, and the diastolic or bottom number is when your heart is completely relaxed. While it sounds like
taking a blood pressure is a fairly simple process there’s a lot that can go wrong and there’s
a lot of room for error: the blood pressure cuff is too small, if the blood pressure cuff
is used over clothing, if the patient hasn’t rested
for at least five minutes, if the arms, back, or
feet are unsupported, if the patient’s in an emotional state, if the patient is talking, if the patient just had a cigarette, if the patient just drank a cup of coffee or had some alcohol,
if the patient is cold, if the patient has a full bladder and really needs to use the bathroom. All those things can throw
off the blood pressure and make it look like your
patient has high blood pressure when they really don’t. Because there are so many external factors that influence a person’s blood pressure we don’t give the
diagnosis of hypertension until we have two elevated readings from two separate visits. Let’s do a little hypothetical here. You, or even your family member, is diagnosed with hypertension. What does that mean? What are you at risk for? Doctors make a really big
deal about hypertension so let’s talk about it. Hypertension damages the blood vessels throughout your entire body, starting from your brain, to your eyes, to your lungs, to your
heart, to your kidneys, and even to your penis, if
you have a penis that is. Normally I don’t like to be the doctor that’s all doom and gloom but
it’s really important to say that having hypertension
significantly raises your risk of having a heart attack, stroke, heart disease, and kidney disease. This is precisely why
hypertension is know as the silent killer because
you don’t have symptoms until you already have
some serious complications. Having your blood pressure well controlled decreases the risk of dying by 25% and it lowers your risk
of having a heart attack and stroke by 30%. Now, you wanna treat your hypertension and you’re not necessarily keen on going the pharmacologic
approach right away. There are lifestyle changes you can make in order to lower your
blood pressure naturally. In fact, 90% of hypertension
is caused by poor diet, lack of exercise, and other bad habits. So if you’re not exercising
you should be doing moderate intensity exercise for 30 minutes on most days of the week. Next comes diet, probably
the most important thing that you can do to alter
your blood pressure. The DASH diet, which is a specific diet which I’ll link down below
is one that’s been proven to lower your blood pressure by 11 points, one of the highest successes
we’ve seen for a diet. The two bad habits that have been proven to elevate your blood pressure is heavy alcohol consumption and smoking. When we say heavy alcohol consumption what we mean is more
than two drinks per day, per week for a man, and
more than one drink per day, per week for a woman. When we speak about smoking
we’re actually talking about smoking in any amount. So do not be a smoker and
do not be a heavy drinker if you don’t want your
blood pressure elevated. Now these lifestyle modifications to lower your blood pressure
work exceptionally well to prevent you from getting
hypertension in the first place. So I always like to think
in terms of prevention rather than cures so follow these habits, live a healthy lifestyle, and don’t develop high blood pressure. Now let’s get into the
numbers of the matter and talk about some of
these new guidelines that are making a splash in
the headlines across the news. Before we had these cutoffs
where we diagnosed people with either having normal blood
pressure, pre-hypertension, or what we called stage one
hypertension, or stage two. And now those cutoffs
have completely changed. Now a normal blood pressure
is less than 120 over 80, and an elevated blood
pressure is 120-129 over 80. And at that point we should recommend healthy lifestyle changes and check it every three to six months. Stage one high blood pressure
is now 130-139 over 80-89 which used to fall into
the pre-hypertension range. That’s the major change
within these new guidelines. Basically what we do is we plug in some of your statistics into a calculator and what it does is it spits
out a risk or percentage of you having a heart attack or stroke within the next 10 years. If you have less than 10% risk we have to stress the lifestyle changes and again reassess in three to six months. Now if your blood pressure
is over 140 over 90 that’s considered stage
two high blood pressure. At this point we can start to consider a pharmacologic approach in addition to lifestyle changes in order to get your blood
pressure to the normal values. Now, under these new guidelines, approximately 30 million more people in the Unites States will be
defined as having hypertension. And while that sounds like a dream for pharmaceutical
companies it’s not a party for them just yet. The reason being is that
these 30 million people will be defined as having hypertension but only about four million out of those 30 million people will actually need pharmaceuticals to keep their blood pressure in check. There are a few things these
guidelines do really well. The best research done in
the last two decades proves that controlling blood
pressure to a tighter limit of 120 over 80 actually
yields better results, it allows people to live longer and avoid heart attacks and strokes. Number two there’s a
strong emphasis placed on measuring blood pressure
in the correct manner. And number three they put a great deal of focus on lifestyle changes. This is something I preach everywhere I go and with every patient I meet. It’s much better to
prevent this problem than to take a pill once it’s already there. In the medical community we know we don’t treat hypertension well. There’s a couple of reasons for that. Number one, patients don’t
often come in for screenings unless there’s already a problem and we don’t catch
hypertension when we should. And number two is when we
actually do catch hypertension and we’ve tried lifestyle factors and they haven’t worked,
we prescribe a medicine, and often times patients are reluctant to take their medicines. Here’s the thing. If a doctor recommends a medication, I’m not saying you have to take it. What I’m saying is if
you tell your doctor your gonna take it, take it, because if you don’t you’re ultimately putting yourself at risk. Some people decide to not take a medicine because of it’s side effects. There are alternatives. Your not stuck to taking one medication or these two medications. There are definitely options
and you should always talk about your worries with your doctor because the last thing that
we want as doctors is for you to have a problem and not
have it treated simply because of a miscommunication. High blood pressure is a complex topic and it has major
implications for your health. I hope this video was able
to demystify a little bit of what the illness is and steps that you can do to not only prevent it but to treat it in case
you already have it. I know I didn’t cover everything there is to know about hypertension
within this video so if you have some remaining
unanswered questions leave them down below in the
comments so I can respond. Also if you enjoy this
format please let me know because I wanna continue making content that you guys enjoy. As always, stay healthy and
happy, see ya next Sunday. (static) Why can’t I say blood
pressure, brood pressure. Blah, blood pressure. (static) It’s called a sphygmamometer, a sphygmoma, a sphygmomanometer. That’s the right word, see. (static) Can these sirens stop today,
like I just don’t understand. Is there an emergency
everywhere on 42nd Street? Just leave guys, come on. (static) High blood pressure. (static) But only about 4 million
out of those 30 million will actually need pharmaceuticals to keep their blood pressure under check. Under check? (laughs) Let’s do that again. (static) (upbeat music)

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