The following
program presents principles
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designed to promote
good health and is not
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intended to take the place of
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personalized professional care.
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The opinions and
ideas expressed are those of
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the speaker. Viewers
are encouraged to draw their
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own conclusions about
the information presented.
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Welcome to Wonderfully Made.
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Our topic today is
High Blood Pressure.
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My name is Dr. Christine
Salter. I'm board certified
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in Family Medicine, and
I'm the medical director
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of Vibrant Health
Family Medicine in St Louis,
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Missouri. High blood
pressure otherwise know
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as hypertension. It
affects 15 million people in the
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United States and is
known as a silent killer.
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Why a silent killer?
Because many people do
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not have any symptoms
of high blood pressure,
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but it contributes two
of the three major killers
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in the United
States. The number 1 is heart
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disease and number 2 is stroke.
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High blood pressure
is defined as a systolic
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blood pressure
140/90 or greater.
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What do you mean by
systolic blood pressure?
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When the heart pumps
it generates a pressure we
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call that systole or systolic
pressure when it relaxes.
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There is a resting pressure
we call that diastole or
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diastolic pressure.
So, when you go to a
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doctor they say your
blood pressure is 160/90
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that means that your
heart generated a systolic
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pressure of 160 and
when it relaxed it had a
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resting pressure of
90. Why do we even care
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about high blood pressure?
Well it silent and it will
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kill and people just
don't realize that they
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have the problem.
So, how is it diagnosed?
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You have to see your
doctor or at least visit a
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practitioner that can
take your blood pressure.
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They use a cuff
around your arm. And they are
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able to pump that
cuff up and generate that
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pressure and tell you if
your blood pressure is normal.
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And you may ask what is normal?
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Normal is less than
140/90, but that is not
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optimal. What is
optimal? We would like to see
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your blood pressure
at 110/70 or even 60.
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Now for some people
if they have a blood
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pressure of 90/60
they may get disease and so
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that's not normal for
them. On the other hand,
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if you have a blood
pressure of 90/60, but you
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are exercising and you
feel just fine and that
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blood pressure is
just fine for you.
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As the blood pressure
increases 90/60, 100/70,
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120/80, 130/85, 140/90
that's generating higher
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pressures and that
cause the problem with the
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blood vessels in
addition with the heart too.
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What does the heart
do? The heart gets bigger
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and fatter, what
happens to the blood vessels.
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When that pressure
is generated damages the
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blood vessels and if
you have an addition to high
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blood pressure, high
cholesterol also then that
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high cholesterol
building up along the vessels,
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along with this high
pressure causes damage
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and clots like to form
there. Hence high blood
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pressure is the number
one risk factor for stroke.
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It also
contributes to heart attack
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and congestive heart failure.
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So, what can you do
about it, either to prevent
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having high blood
pressure or to treat it
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once you have it. Recent
guidelines call the JNC 7
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Guidelines have told us
that the foundation for the
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treatment of high
blood pressure as was for the
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prevention lifestyle factors.
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What all those
lifestyle factors?
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Weight reduction, unfortunately
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obesity and overweight
is increased in an alarming
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rate not only in
the United States,
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but worldwide. By 2030,
they estimate that there
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will be 300 million
people who have obesity.
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So, obesity and overweight
contribute to high blood
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pressure. And so if you
have high blood pressure,
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we would like you to
work on losing just 10%
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of your weight. So,
if you are 200 pounds
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would like you to lose
about 20 pounds or just
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a little more. So,
weight management that's the
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first lifestyle
factor known to prevent and
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treat high blood
pressure according to the JNC 7
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Guidelines. What is the
second? Physical activity,
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unfortunately in the
United States and other
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developed
countries, where used to being
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inactive. We sit in
front of the TV, we use the
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remote control, we roll
around on stools, we take
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the escalators, we
take the elevators.
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We need to have a more
physically active lifestyle.
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So, park little
farther from work and walk,
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take the stairs, instead of the
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elevator or the
escalator. Get up and change the
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TV channel or better
still go for a walk instead
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of watching the TV.
We would like you to
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have physically
active lifestyle.
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I would like you to
engage in exercise that
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is moderate and intensity,
that's about 3 miles per
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hour walking. So, if
you can do that for about
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30 minutes at
least 30 minutes ideally
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60 minutes that will
help lower your blood pressure
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and independently
help you lose weight,
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it's all the balance in
act. If you are taking more
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calories then you put
out you are simply going to
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gain weight. If you
are taking the same amounts
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of calories as you put
out, your weight is gonna stay
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the same. If you are
taking less and put out
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more, it's simple mathematics
you will lose weight.
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So, you either
decrease your caloric intake or
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increase your physical activity.
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Let's recap, weight
reduction, physical activity,
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that's moderate in
intensity for at least 30
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minutes a day.
What's the third thing?
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Salt restriction,
unfortunately again in the
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United States and
other developed countries,
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we like to use lot of
salt, that salt shaker is used
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while cooking, it's used
after cooking and we like
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to go to restaurants
that have a lot foods
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that have lot of salt
in them. We like to use
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ketchup, we like to get
French Fries, we like to
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add salt to the French
Fries that will raise the
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blood pressure by
increasing amount of sodium and
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where sodium goes water follows.
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And so we have an
increase in volume
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resulting in an
increased pressure.
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So, we would like you to
decrease your salt intake.
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We only need about a
teaspoon of salt or 2.5
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or 2.4 grams of sodium a
day. So, how you're going
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to know if you are
getting too much salt?
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You have to read your
labels. When you go to
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the store read your
labels and find out how much
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salt is in a serving.
Some people are getting
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all the salt they need
just at one meal and clearly
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that is a problem.
So, we would like you
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to put down the salt
shaker and not add salt
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to your cooking and
ideally eat foods that are
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not high in salts.
Some of the cheeses are very
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high in salt, tomato
sauce, tomato ketchup these are
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high in salt.
Chinese food in particular is
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fairly high in salt.
So, we hope that's not your
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regular fare. And so
we said weight reduction
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is one of the
lifestyle interventions,
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physical activity,
and salt restriction.
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What is the fourth one?
The fourth one is referred
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to as the Dash Diet.
What is the Dash Diet?
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Dash stands for the
dietary approach to stop
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hypertension and is composed
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of several food
groups. Whole grains, fruits,
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vegetables, low fat
dairy, lean meats, nuts, and
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legumes. Why do we
need these food groups?
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They supply fiber.
Fibers been shown in
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clinical trials to
lower blood pressure.
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They also supply
essential fatty acids.
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They decrease the
inflammation in the blood
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vessels and also help to
lower the blood pressure.
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What about the
fruits and the vegetables
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they supply potassium,
magnesium, and calcium.
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What did they do?
They also lower the
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blood pressure. Now if
you are eating a lot of
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salt that might
cause an imbalance with the
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potassium because it's
the potassium to sodium
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ratio that is really important.
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So, not only do we
want you to increase those
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fruits and
vegetables, we also want you to
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decrease the sodium as
we have said previously.
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Dash might also be used
to say Dash to exercise.
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Use just a dash of
salt, implement the Dash Diet.
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This will apply
whether you eat meat or whether
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you are vegetarian or
whether you are vegan.
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What about alcohol?
Alcohol is the problem,
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although the JNC 7
Guidelines says for men
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want no more then
one to two drinks a day
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and woman no more
than one drink a day.
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As in the Adventists
and quote to biblical
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principles, alcohol is
not good for the heart,
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for the brain. It is
one of the number reasons
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for car accidents
and so we do not endorsee
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alcohol at all. And
so we will talk about a
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modified JNC 7
Guideline that says no
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alcohol, lose
weight, increase exercise and
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physical
activity, decrease salt and
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implement the Dash Diet.
But, there are some other
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factors that
affect blood pressure.
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The use of
caffeine, tea, coffee, soda.
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Some people
drink these beverages
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through out the day.
If you have high blood
00:12:55.17\00:12:57.61
pressure, we want you to
eliminate those beverages.
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And you may see your
blood pressure come down.
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What about nicotine that
we find in cigarette smoke?
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That can also raise
the blood pressure again if
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you are a smoker and
your blood pressure is not
00:13:14.84\00:13:17.69
controlled, we want you
to quit smoking and there
00:13:17.72\00:13:20.76
are several
other reasons why you
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should quit
smoking. High blood pressure
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is just one of them.
Medicines can also be
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used to treat high
blood pressure, but the all
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medicines that you
maybe taking that maybe
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aggravating your blood
pressure and what are they?
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I said general class
they are called nonsteroidal
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antiinflammatory
drugs, nonsteroidal
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antiinflammatory drugs;
Motrin, ibuprofen, Aleve,
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Advil, Celebrex, Vioxx
these are all nonsteroidals
00:13:56.23\00:14:00.64
and they cause sodium
to be retained and as we
00:14:00.98\00:14:03.96
said earlier,
where sodium goes were to
00:14:03.99\00:14:07.86
follows we get an
increase in blood pressure.
00:14:07.89\00:14:11.25
I have had patients
who ordinary have been
00:14:12.34\00:14:14.30
controlled with their
blood pressure and then
00:14:14.33\00:14:16.84
all of a sudden that
blood pressure has gone up to
00:14:16.87\00:14:19.89
190/100. And it was
found that they just
00:14:19.92\00:14:26.52
recently had a
root canal done and the
00:14:26.55\00:14:30.23
dentist
prescribed ibuprofen and they
00:14:30.26\00:14:34.54
were taking this two
or three times a day for
00:14:34.57\00:14:37.11
several days and as result
the blood pressure went up.
00:14:37.14\00:14:40.79
If you are using
Advil, Motrin or any of the
00:14:41.44\00:14:45.10
nonsteroidal antiinflammatories
00:14:45.13\00:14:46.94
talk to a doctor
about changing to another
00:14:47.91\00:14:50.69
pain medicine. But,
there are some drugs that
00:14:50.72\00:14:55.28
are used to treat
blood pressure and if you
00:14:55.31\00:14:58.30
present to your
physician with a blood pressure
00:14:58.33\00:15:01.79
of 160/100 or higher in
addition to the lifestyle
00:15:01.82\00:15:08.03
measures, your
physician may also start you on
00:15:08.06\00:15:11.38
some antihypertensive medicines.
00:15:11.70\00:15:14.46
We want you to
understand that those
00:15:15.44\00:15:17.02
medicines are only
a temporary measure to
00:15:17.05\00:15:20.23
get your blood pressure
controlled while you are
00:15:20.26\00:15:22.79
implementing those
lifestyle measures.
00:15:22.82\00:15:26.41
Again lifestyle is
the foundation for the
00:15:28.00\00:15:31.35
treatment of
high blood pressure.
00:15:31.38\00:15:33.65
What about stress?
How does that implement
00:15:35.72\00:15:39.18
or affect high blood pressure?
00:15:39.87\00:15:42.08
Stress can cause an
increase in blood pressure
00:15:44.16\00:15:47.43
and it doesn't mean
that you are necessarily an
00:15:49.04\00:15:51.75
anxious person.
People who internalize stress
00:15:51.78\00:15:55.72
and on the outside
look calm may also have
00:15:55.75\00:15:59.32
high blood pressure
or what we call increased
00:15:59.78\00:16:02.71
sympathetic tone.
The heart may rise little
00:16:02.74\00:16:07.11
faster instead of
resting heart rate of maybe 70
00:16:07.14\00:16:12.06
beats per minute. The
heart rate is run about
00:16:12.09\00:16:14.75
90 beats per minute.
Clearly not abnormal, but
00:16:14.78\00:16:19.33
really isn't normal
either. So, if you are somebody
00:16:19.79\00:16:23.97
who internalizes stress
that you are not able to
00:16:24.00\00:16:28.50
cry or verbalize, we
will need to do something
00:16:28.53\00:16:32.84
about that. You may
need to see a counselor
00:16:32.87\00:16:35.83
to talk about the
stressful events that's going on
00:16:36.53\00:16:40.30
in your life. What
about the way that we breathe,
00:16:40.33\00:16:45.02
how does that
effect blood pressure?
00:16:45.28\00:16:47.12
Most people breathe
shallowly. So, as we take
00:16:50.22\00:16:56.26
a deep breath up
go the shoulders.
00:16:56.29\00:16:58.33
That's not the way
to take a deep breath.
00:16:59.80\00:17:01.89
If you are going to
take a deep breath, we wanted
00:17:02.23\00:17:03.92
to be diaphragmatic
breathing so that when
00:17:03.95\00:17:06.61
you inhale your diaphragm
flattens, the breath is
00:17:06.64\00:17:11.09
taken deep and
the chest expands.
00:17:11.12\00:17:14.81
What does that have to
do high blood pressure?
00:17:16.15\00:17:18.05
When we breathe deeply
it actually decreases the
00:17:19.74\00:17:24.83
sympathetic tone and we
have just mentioned that
00:17:24.86\00:17:29.71
an increased
sympathetic tone can raise
00:17:29.74\00:17:32.95
the blood pressure.
And so as we can see a
00:17:32.98\00:17:38.82
whole lifestyle the way
that we eat, the way that
00:17:38.85\00:17:43.60
we move, the toxins
that we may take into our
00:17:43.63\00:17:47.61
bodies such as caffeine,
alcohol, cigarette smoke,
00:17:47.64\00:17:52.78
the way that we think
and the way that we handle
00:17:54.30\00:17:56.46
stress will all
affect the blood pressure.
00:17:56.49\00:18:00.78
And so we don't want
you to look for that magic
00:18:01.68\00:18:04.61
bullet to treat
your high blood pressure.
00:18:04.64\00:18:07.43
Don't think of you are
a diuretic or your calcium
00:18:07.82\00:18:11.16
channel blocker that
your physician is prescribing
00:18:11.19\00:18:13.86
as the only way to
treat your blood pressure.
00:18:14.11\00:18:17.08
You have to look it
in an integrated fashion
00:18:17.66\00:18:20.04
looking all the different
aspects that will affect
00:18:21.71\00:18:25.26
your blood pressure.
Even the way that we sleep
00:18:25.29\00:18:29.31
and getting an adequate
amount of sleep will also
00:18:29.57\00:18:33.11
affect our blood pressure.
So, we want you to go to
00:18:33.49\00:18:37.08
bed on time at a
regular time and also wakeup at
00:18:37.11\00:18:43.97
a regular time.
Why is that important?
00:18:44.00\00:18:46.46
Because the body
is clearly, fearfully,
00:18:46.88\00:18:50.76
wonderfully made as
the Bible says and is
00:18:50.79\00:18:53.59
created to operate
on circadian rhythms.
00:18:53.62\00:18:57.23
There are rhythms for
us to sleep, there are
00:18:57.74\00:19:00.23
rhythms for us to
eat, there are rhythms when
00:19:00.26\00:19:03.00
then hormones are
released. If we are doing things
00:19:03.03\00:19:07.15
irregularly going to
sleep at irregular times not
00:19:07.18\00:19:10.31
exercising then that
hormone release goes into
00:19:10.34\00:19:14.82
a state of dysregulation
and that can also affect
00:19:14.85\00:19:19.28
the blood pressure.
And so we can see that
00:19:19.31\00:19:24.23
just simply doing some simple
00:19:24.26\00:19:26.14
lifestyle interventions.
You will lower blood
00:19:26.17\00:19:30.50
pressure and
decrease your chance from
00:19:30.53\00:19:34.84
sudden death, congestive
heart failure, and stroke.
00:19:35.31\00:19:41.34
Unfortunately, stroke
of course may not kill the
00:19:42.59\00:19:47.96
person right away, but
it causes major morbidity.
00:19:47.99\00:19:52.52
What do we mean by morbidity?
00:19:53.27\00:19:54.85
A person who was
ordinarily functioning
00:19:56.07\00:19:58.04
well now is not able
to walk properly, may not
00:19:58.07\00:20:02.55
be able to speak
properly, may not be able to use
00:20:02.58\00:20:05.71
their hand and be able
to write all because that
00:20:05.74\00:20:11.68
uncontrolled
high blood pressure.
00:20:11.71\00:20:14.23
And so the first step to
take is to find out do you
00:20:16.28\00:20:23.26
have high blood pressure.
Visit your physician go to
00:20:23.29\00:20:27.56
the mall where they can
check your blood pressure.
00:20:27.59\00:20:29.86
And find out do you
have high blood pressure,
00:20:30.39\00:20:32.37
if you do go to your
physician and follow your
00:20:32.40\00:20:36.62
physician's
guidelines. The lifestyle and if
00:20:36.65\00:20:40.30
needed medicines. Let
me give you a case study.
00:20:40.33\00:20:45.01
An African-American
gentleman who is about
00:20:46.09\00:20:48.84
50 years old who came
in for a cold and of course
00:20:48.87\00:20:54.19
as part of our
routine evaluation we took his
00:20:54.22\00:20:57.23
blood pressure. It was 170/100.
00:20:57.26\00:21:02.93
What was that to do
with this gentleman?
00:21:05.13\00:21:06.67
I treated his cold of
course, but he had to stay
00:21:07.63\00:21:11.66
a little longer while I
counseled him about high
00:21:11.69\00:21:16.16
blood pressure and
the fact that he is
00:21:16.19\00:21:18.40
African-American
increases risk even more
00:21:18.43\00:21:22.32
and so we talked
about losing weight.
00:21:23.97\00:21:28.30
We talked about
exercise, he smiled, he laughed,
00:21:30.12\00:21:34.85
I don't have time to exercise,
00:21:35.43\00:21:37.21
I'm too busy working.
I told him he does have
00:21:37.62\00:21:41.97
enough time not to exercise.
00:21:42.00\00:21:44.07
We talked about the
Dash Diet. Oh, but he likes
00:21:45.91\00:21:50.40
his pork and he likes
his Chinese food and he
00:21:50.81\00:21:55.55
likes his French
Fries. Fruits and vegetables,
00:21:55.58\00:21:59.50
oh he doesn't like
those. He can't afford not
00:21:59.91\00:22:04.74
to like those. And I
counseled him to this effect.
00:22:04.77\00:22:09.34
Hypertension is a
killer, it kills by causing
00:22:10.24\00:22:16.22
strokes, it kills by
causing heart attacks,
00:22:16.25\00:22:20.70
it kills by causing
congestive heart failure.
00:22:21.40\00:22:24.51
In elderly individuals,
congestive heart failure is
00:22:26.81\00:22:29.58
one of the commonest
reasons for hospitalization.
00:22:29.61\00:22:32.30
And so I have to
impress up on him as I now
00:22:34.44\00:22:37.17
impress upon you that
if you have high blood
00:22:37.20\00:22:41.16
pressure it is nothing
to smile or laugh about,
00:22:41.19\00:22:45.42
it is something very
serious. We want you to
00:22:45.71\00:22:50.48
exercise, treat exercise
as though it was a medicine.
00:22:50.51\00:22:56.92
I actually write
prescriptions for my
00:22:59.23\00:23:01.22
patients as I did
for this gentleman.
00:23:01.25\00:23:03.23
30 minute five times a
week at least and he is
00:23:04.34\00:23:10.12
given a written prescription.
He is given a prescription
00:23:12.79\00:23:14.09
to eat fruits,
vegetables, whole grains.
00:23:14.12\00:23:17.93
In fact, I encourage
him to become a vegetarian
00:23:19.30\00:23:21.68
if possible because that
would be healthier for him.
00:23:22.70\00:23:26.91
By becoming vegetarian,
he would decrease the
00:23:29.40\00:23:32.37
salt and
increase the potassium and
00:23:32.40\00:23:36.11
magnesium or fiber.
Let's keep in mind for
00:23:36.14\00:23:39.66
those vegetarians, who
use a lot of the protein
00:23:39.69\00:23:42.90
analogs that they
are also high in salt.
00:23:42.93\00:23:45.40
So, be careful read your labels.
00:23:45.58\00:23:49.12
When you go to the
store try to stick to the
00:23:50.65\00:23:54.24
parameter of the store.
Where you find the fruits
00:23:54.27\00:23:58.27
and the vegetables and
the whole grains, try and
00:23:58.71\00:24:01.78
avoid those middle
sections where you find
00:24:01.81\00:24:04.79
the canned products
that are so high in salt,
00:24:04.82\00:24:08.95
where you find the
processed products that
00:24:09.27\00:24:12.41
are so high in salt.
Stick to the periphery,
00:24:12.44\00:24:16.28
make a plan as you go
to the store this what
00:24:16.83\00:24:21.17
I told this gentleman
also. Plan to exercise, plan to
00:24:21.20\00:24:26.75
implement that Dash
Diet. And if you drink alcohol
00:24:26.78\00:24:30.11
now is the time to
stop, if you smokes now is the
00:24:30.85\00:24:36.17
time to stop.
Caffeine, I ask this patient to
00:24:36.20\00:24:43.04
replace the Pepsis
that you drinks 12 ounces or
00:24:43.07\00:24:48.92
16 ounce a time by
plain water. Water is the best
00:24:49.12\00:24:56.44
beverage for the body.
So, what prescriptions did
00:24:56.47\00:25:03.48
he have when he left my
office indeed he did have
00:25:03.51\00:25:07.72
a prescription for a diuretic,
00:25:07.75\00:25:10.68
he had a prescription
to exercise, he had a
00:25:13.04\00:25:16.87
prescription to
implement the Dash Diet, he had
00:25:16.90\00:25:20.94
a prescription to
strictly avoid alcohol, he had a
00:25:20.97\00:25:24.85
prescription to
strictly avoid caffeine.
00:25:24.88\00:25:27.29
I also asked him to
replace the Motrin that
00:25:28.99\00:25:33.25
he was using for
his occasional headaches
00:25:33.28\00:25:36.49
with something like Tylenol.
00:25:37.92\00:25:39.77
All these things
together will work together to
00:25:42.67\00:25:48.07
lower his blood pressure
and indeed after about a
00:25:48.10\00:25:51.49
month of therapy, he
came back and his blood
00:25:51.52\00:25:54.84
pressure was down to
150/80. Now what that
00:25:54.87\00:26:01.07
is better then the
original blood pressure,
00:26:01.10\00:26:03.58
it's clearly not at
goal. And so I can reiterated
00:26:04.46\00:26:10.69
the importance for
him to implement those
00:26:10.72\00:26:12.76
prescriptions the
same way that he takes the
00:26:12.79\00:26:14.82
diuretic faithfully he
is to also implement the
00:26:14.85\00:26:18.71
exercise faithfully.
He is also to implement
00:26:18.74\00:26:21.92
the fruits, vegetables
and whole grains faithfully.
00:26:21.95\00:26:24.97
He is to replace the
caffeinated beverages
00:26:25.48\00:26:28.83
with water or at least
diluted juices that are
00:26:29.74\00:26:34.24
non-caffeinated.
Again after a month of
00:26:34.27\00:26:39.59
therapy that
blood pressure came down
00:26:39.62\00:26:42.24
some more 130/80.
That's much better,
00:26:42.27\00:26:47.94
but again we know that
it's still not at goal,
00:26:48.86\00:26:51.40
the goal is to get
him down to about 115/75
00:26:52.52\00:26:57.90
that's way we need to
be because at levels about
00:26:58.77\00:27:01.73
that, that's where we
get increased risk for
00:27:01.76\00:27:04.97
cardiovascular events
for stroke, heart attack,
00:27:05.00\00:27:09.03
and also kidney
failure. So, the blood pressure
00:27:11.41\00:27:16.68
again is not just
affecting the brain not just the
00:27:16.71\00:27:19.98
heart, but it also
affects the kidneys.
00:27:20.01\00:27:22.58
And so all these lifestyle
interventions together in
00:27:23.89\00:27:27.70
addition to
carefully chosen medicines is
00:27:27.73\00:27:31.42
what bring his
blood pressure down.
00:27:31.45\00:27:33.64
Truly we are
fearfully wonderfully made,
00:27:34.45\00:27:36.75
the Lord our creator
made the wonderful circulatory
00:27:37.30\00:27:39.77
system to pump blood
to the brain, to the heart
00:27:39.80\00:27:43.33
and to the kidneys to
supply these vital organs
00:27:43.50\00:27:46.61
and other vital
organs not to have high blood
00:27:46.64\00:27:50.27
pressure that can cause
rupture of the vessels or
00:27:50.30\00:27:53.45
to cause rupture of
the major vessels running
00:27:53.48\00:27:56.42
through the chest
and abdomen or to cause
00:27:56.45\00:27:59.08
kidney failure.
Truly, he is woven us in our
00:27:59.11\00:28:03.85
innermost being. I
wish above all things that
00:28:03.88\00:28:06.95
you will prosper being
in health even as your soul
00:28:06.98\00:28:10.19
prospers, the Lord be with you.
00:28:10.86\00:28:13.48