Q&A with Dr. K
Do you have questions about your health? Need help navigating the health care system or understanding certain conditions, medications or other treatments? With decades of health care experience, Mountain Pacific Chief Medical Officer Dr. Doug Kuntzweiler (Dr. K) has the answers. And on Q&A with Dr. K, the doctor is always in.
Q&A with Dr. K
How Can I Stick to My New Year's Resolution to Lower My Blood Pressure?
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Whether is for a new year's resolution, an effort to follow doctor's orders or any other reason to improve your health, sticking to a lifestyle change can be challenging. Dr. K offers advice on how to set realistic goals to achieve a healthier you and responds to a listener's question about steps for lowering blood pressure.
Additional resources for this episode:
Centers for Disease Control and Prevention: https://www.cdc.gov/bloodpressure/index.htm
American Heart Association: https://www.heart.org/en/health-topics/high-blood-pressure
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410#overview
Cleveland Clinic: https://my.clevelandclinic.org/health/diagnostics/17649-blood-pressure
If you have a question for Dr. K, email QandAwithDrK@mpqhf.org. Your question will remain anonymous.
Welcome to Q&A with Dr. K, a podcast by Mountain Pacific Quality Health, where we sit down with Dr. Doug Kuntzweiler and get your health questions answered. Because on Q&A with Dr. K, the doctor is always in. Hi, everybody, this is Beth Brown, your host, and I'm here with chief medical officer for Mountain Pacific, Dr. Doug Kuntzweiler, and we're here for another episode of Q&A with Dr. K. So good to see you, Dr. K.
Dr. Doug Kuntzweiler:Good to see you again, as always.
Beth Brown:Thank you. And let's talk about today's question, which is actually great timing for this episode, because it is about sticking to New Year's resolutions. And this one is about a healthy new year's resolution. And so here's the
question we received:"My doctor told me, I need to get my blood pressure down, so I've decided to make it my new year's resolution for 2024. I talked with my doctor about what I can do without going on medications if I don't have to, and I wondered what Dr. K would have to say about it."
Dr. Doug Kuntzweiler:So I would say, "Good for you." I would applaud you, first of all, for having your blood pressure checked. And secondly, for being willing to try to get it down without medication. And it might be that you need medication as well, but the things you can do without medication are just generally good for you. So a lot of benefit.
Beth Brown:Great. Well, let's talk about all of that. So obviously, when it comes to blood pressure, high blood pressure, that has a lot to do with how healthy your heart is. So I think we should start there. Because people probably hear all the time you have high blood pressure, your blood pressure is a bit high, just like this person did who asked this question. But what does that really mean? What's happening when somebody has high blood pressure?
Dr. Doug Kuntzweiler:Yeah, so anytime you put a fluid into some kind of container, it exerts a pressure on it. And so our heart and our blood vessels contain the blood. Now, the blood vessels, especially the arteries can change their caliber, they can become narrower, or they can relax and become wider. When they become tighter, they exert pressure on the blood. And that pressure is what we refer to as high blood pressure. And it's one of the leading causes of heart disease, heart attacks and strokes. So it's very important. And congestive heart failure and kidney failure. All those things are directly related to having high blood pressure. And when your pressure is high, then the heart has to work harder, has to pump harder to push the blood through those blood vessels and that higher pressure takes a toll on your heart over time.
Beth Brown:Okay, that makes a lot of sense. Alright, so now we understand what high blood pressure is. So let's tackle this person's question specifically about lowering his or her blood pressure as a new year's resolution. So let's talk about that first, because everyone has the best of intentions on January 1, and then we're lucky if we stick to our new year's resolution in February. So let's start with that. Do you have advice for people who are trying to make healthy lifestyle changes, whether it's a new year's resolution or not? How do you make that decision, and then stick to it so that it really is a lifestyle change? And, you know, you're not just dieting and all those kinds of things that that come and go and isn't consistent?
Dr. Doug Kuntzweiler:Yeah, well, you know, I'm full of good advice.
Beth Brown:I know that.
Dr. Doug Kuntzweiler:So yes, I have some advice. I think it is worthwhile to make resolutions. I think it works better if you make it something that's very concrete and easy to measure. If you just say things like I want to lose weight, or I want to lower my blood pressure, that's a little bit ambiguous and easier to just give up on. So if you pick if you think about your health, and what sort of things do you do that that are working against your health and maybe even working against your blood pressure, one of the primary things would be smoking. And so if you were to say my new year's resolution is this year, I am going to quit smoking. That's something that's easy to measure. It's very concrete, and there are all kinds of resources you have to help you with that. Another one might be I am going to walk five days a week for 20 minutes at least. I prefer that and I always recommended that as opposed to weight loss. Stop worrying about your weight. Just get out and walk and if you make a commitment to that and mark it on the calendar, if you can have a buddy or a friend walk with you, or even a pet, as long as
Beth Brown:I've seen people walk cats, but anyway, go ahead. it's not a cat...
Dr. Doug Kuntzweiler:Well, they shouldn't, that's just wrong. At any rate, somebody to help hold you accountable and to help motivate you and that, so that works out pretty well. And then another one might be to improve your diet. Now that's fairly amorphous too. But if you say, I'm going to commit to eating more fruits, and fresh fruits and vegetables this year, and less deep fried foods, say that's something that's a lot more measurable. Every time you go to the grocery, you can buy two apples and say, I'm going to eat these over the course of the week and keep expanding that. So those are things that would be helpful. Another one might be I'm going to commit to seeing my primary care provider and getting up to date on all my vaccinations. That becomes more important, of course, as you become older, but pneumonia, vaccination, the shingles, vaccination, flu, and COVID, these are all things that can contribute to you being healthier in the next year. And they're fairly easy resolutions to make. It still takes some willpower, but they're easier to keep. You know, most people enjoy walking. And they may think that they don't like exercise. But don't think of it as exercise. Think of it as stress relief, you're gonna go take a walk, think about the day or not think about the day think about something pleasant, say hi to your neighbors, see what, you know, is going on in the neighborhood, and let your dog drag you around the block a couple times. And most people enjoy that. And that's the sort of thing that you can commit to and you don't have to feel bad then about breaking the resolutions. I think that's better than saying, "I'm going to achieve my ideal body weight." That's hard to do. And it's easy to backslide. But if you stop worrying about that and concentrate more on eating healthier and exercising, the weight will come off and it will help lower your blood pressure, quitting smoking, maybe cutting down on alcohol, if if you drink three or four drinks in the evening, try and cut down to one or two. Just simple things, you know.
Beth Brown:Yeah, that's all really good advice. And we in the business of change would say set those smart goals, which that's what you were talking about. They're specific that you're going to do something that's measurable, achievable, realistic, and time bound. Like, I'm going to eat two apples a week, I'm going to buy these two apples, you gave yourself a timeline much more helpful.
Dr. Doug Kuntzweiler:And you could say I'm going to explore new foods that I haven't haven't tried before. Grocery stores now are full of exotic, new fruits and vegetables. So explore it a little bit.
Beth Brown:And then you have to Google how to eat some of those. But yes, it's fun to get some of those exotic fruits.
Dr. Doug Kuntzweiler:Learning is good for your brain, you have less risk of dementia, if you keep learning lifelong. It depends on their individual situation.
Beth Brown:Yeah, look at all of the great advice. We're hitting If they're a smoker, the most important thing they could do is everything right now. So that's great. So okay, let's get back to lowering blood pressure, and talk about--So this person is to stop using tobacco. Nicotine is a chemical that causes our trying to avoid medication if they can, which is great. Where blood vessels to tighten up and it raises our blood pressure, should this person start? Then what are some of the, I mean, you've touched on them, in talking about some of the doesn't matter what form smoking a pipe, smoking cigars, vaping, specific goals. taking it orally. It's not good for our blood vessels, and it raises your blood pressure. So if you're a smoker, you should try and quit. If you do drink, alcohol can also raise your blood pressure. And I'm not a teetotaler myself, but I try to drink in moderation. And then exercise and walking is all you So avoid sodium. Are there certain foods that are going to really need. Walking at a moderately brisk pace for at least 20 minutes, at least five days a week will bring your blood pressure down. So those are the main things that you can do. Try to avoid the things that are working against you like nicotine and alcohol and try and do the things that work for you, which is primarily exercise and a healthy diet. You know, eating McDonald's every meal, you're getting an absolute boatload of sodium on the french fries, and then the oil they use to cook and et cetera, et cetera. So trying to cut down the sodium. And now with the labeling of products, you can look and see how much sodium you're getting and, you know, talk to your primary care provider and see what would be a good level for you. help people lower their blood pressure? Yeah, pretty much fresh fruits, vegetables, fish, and I think we've talked about this in the past, but all those also contain potassium. The more potassium you consume, the less sodium your body will hold. And that will help your blood pressure and as long as you don't have any Kidney disease that let's save. If you're a person who likes to add salt at the table, you can you can get potassium salt has the same taste as the sodium chloride or table salt that we think of. But it doesn't contribute to blood pressure in the same way that sodium chloride does. It's like the kryptonite of sodium? Like it's the opposite?
Dr. Doug Kuntzweiler:It displaces it. It displaces sodium. So the kidneys, if you eat some extra potassium, your kidneys get rid of some sodium in place of the potassium. Potassium replaces the sodium.
Beth Brown:What are foods that have potassium in them?
Dr. Doug Kuntzweiler:I'm gonna sound like a broken record here. But everybody first thinks of bananas. But I think if you consumed you know six bananas a week, you would hope to never see a banana again as long as you lived after a couple of months. So bananas are fine. But most other fresh fruits also are rich in potassium. Tomatoes are rich in potassium. Avocados are rich in potassium, most of the vegetables, broccoli, cauliflower, Brussel, sprouts, green beans, all those are pretty rich in potassium. We are trying to recommend that people eat less red meat, but fish is very high in potassium, especially tuna is high. Haddock is high, but pretty much any of the fish are a good source of potassium. You can be eating a little more healthy, eat more fruits, eat more vegetables, and eat more fish, and you will automatically have more potassium, and that will help lower your blood pressure.
Beth Brown:So you've talked about trying to get the things out of your life that work against you like smoking, you touched on that, maybe cutting down on alcohol and setting goals of if you drink three or four maybe go down to one or two. Stress is also in there, right? So how does stress affect our blood pressure? Do we know?
Dr. Doug Kuntzweiler:Yeah, stress is secondary to what's going on in your life that causes your adrenal glands to secrete adrenaline, and that's part of the fight or flight response. So every time you're feeling threatened, either because you have a deadline, or you're having a problem with a coworker or something, you know, your car's broken down. Anything that threatens you makes your adrenal glands release a little adrenaline, because adrenal glands are fairly stupid. They don't know if you're about to get into a fistfight or if you're worried about your mortgage. They secrete adrenaline, and adrenaline does a number of things. It gets us ready for a physical confrontation. It promotes blood flow to our muscles. It raises our heart rate. It raises our breathing rate, and it also raises our blood pressure to supply blood to those muscles so we can fight our way out of a situation. So that's how it does it.
Beth Brown:So we talked about walking as being a stress reliever. Are there other activities or things that people can do to help get their stress out of their way?
Dr. Doug Kuntzweiler:Staying socially connected, talking to friends, talking to family, those are generally stress relievers. Making sure that you're getting adequate sleep at night, that helps relieve stress. There are different kinds of meditation that people can find. And a lot of those you can learn about online. Things like yoga, light exercise, mild exercise, stretching, and then just doing things that you enjoy. Maybe going to a movie more often, you know, that that sort of thing. Get involved in some social group or volunteer group where you enjoy the company and enjoy, you know, feeling like you're doing something good for the community. All those kinds of things, I think, are good stress relievers, too. If you feel like you've been trying all that, and it doesn't really help, I would talk to your primary care provider, because sometimes counselors, cognitive behavioral therapy can be very helpful for helping people cope with stress. I think stay connected to your family and to your community that was kind of at the top of my list along with exercise.
Beth Brown:Yes, assuming you like your family.
Dr. Doug Kuntzweiler:Well, you don't have to associate with all of them.
Beth Brown:That's true. Pick the ones you like.
Dr. Doug Kuntzweiler:Exactly.
Beth Brown:Okay, so you did mention this earlier, though, Dr. Kuntzweiler, is that it's possible, that even if you do your best, and you try to set those goals, and whether you achieve them or not, medication might be inevitable. That might be something that you're going to have to do to get your blood pressure down. So when does somebody know that, and what kind of medications might help there? Or what should people know about the point of it's time to use medication?
Dr. Doug Kuntzweiler:Well, you can do all those things that I talked about and still have high blood pressure. I have high blood pressure, and I tried to follow my own advice. Because one of the biggest causes is genetic. And in my family, every male dropped over dead of a heart attack at about age 65. So I've outdone my genetics already. I'm not gonna say by how much, so so even doing the best that you can and all those other areas, you may still require medication, and the way to know is to go see a primary care provider and get your blood pressure checked. Also, there are very good automatic blood pressure monitors that you can buy. And generally they're under$50, run on batteries. And in my experience, they're really pretty accurate. And if there's any question, you can take your home monitor in and have your primary care provider check it against their blood pressure cuff and make sure that it's accurate. But if you go and you find that your pressure is elevated, then you're going to need to talk to your primary care provider about doing something. And if you're already doing the other nonmedication things then it may very well be that you need some medication. And we know that if you treat high blood pressure, we can reduce, by about 25%, the number of people who have heart attacks; by about 40%, the number of people who have strokes, and by half the number of people who develop congestive heart failure and chronic kidney disease. So it's very much worthwhile doing. Now there's some disagreement about what constitutes high blood pressure, at what point is high too high. And there's a little bit of disagreement about what that is. Some of the primary care, family practice organizations have a bit higher target. The American Heart Association and the American College of Cardiology have fairly low targets. And that's because what they have learned is that the lower you can get the blood pressure, and that is that the patient tolerates the lowest pressure that the patient tolerates, the less risk they have of having a stroke or a heart attack or chronic kidney disease. So the American Heart Association says, if your blood pressure is from 120 systolic to 229, or the diastolic, the bottom number, is 80 or above, you have by definition, high blood pressure. And so we used to always say, well, 120 over 80 was normal. And we didn't start worrying till the systolic got up around 140 to 150. And now we're saying if you are above 120 at all, you have high blood pressure. And then if it's between 130 systolic and 139 or 80 to 89 diastolic, that is stage one high blood pressure, at which point you should be thinking about medication. If it's higher than that, if you have a systolic pressure above 140 or a diastolic above 90, that's called stage two. And at that point, it's going to be doing some damage to your organs, again, over a long period of time, and you need to definitely be on medication. Now the top number, the systolic number, that's the pressure when the heart squeezes. So that's the maximum pressure that when the heart squeezes, your blood pressure cuff is measuring that pressure. In between your heartbeats your heart is relaxed, but there's still pressure in that blood sitting in your arteries in your veins, and that's the diastolic. So you could think of that as the constant pressure, that pressure is always there. When the heart squeezes, that's the systolic. It sounds complicated, but it really isn't. The American Heart Association, the American College of Cardiology agree, our goal should be to have our systolic pressure at least 130 or less and are diastolic at least below 80. And how low again, depends to some extent on what you tolerate. Older folks might have a little bit of trouble with weakness and kind of light dizziness, wooziness, if they get too low. And some people with chronic kidney disease, you don't want it to get too low because the kidney depends on a certain pressure to still function. So if you have chronic kidney disease, your primary care provider might want you to keep your pressure a little bit higher to keep your kidneys healthy. These are aggressive numbers. When I first started in medicine 35 years or so ago, the targets that we worried about were like once you got up to 150 over 100, then we definitely want to be on medication and now we're treating at a much lower value. And it's doing some good.
Beth Brown:I'm guessing heart experts did that because it is such a common issue among Americans and around the world that they decided we need to crack down on this sooner to try to prevent it.
Dr. Doug Kuntzweiler:Yeah, exactly. Because it's related to so many other critical diseases, heart attack, congestive heart failure, stroke, and kidney failure. Going on dialysis is no picnic, and the number one cause of dialysis is untreated high blood pressure. Diabetes is probably number two, but I don't think people generally realize that, and high blood pressure is dangerous because it is generally asymptomatic. That means you don't have any sign that your pressure is high. Now some people, when their pressure gets really high, they start having headaches and maybe some blurry vision and that kind of thing. But most people, you know, my pressure was around 150 over 90, and I was a runner and ate a pretty healthy diet and did not smoke, and I felt fine. But I realized that I needed to do something. And this was about 20 years ago. I probably had pressure that was higher and should have been treated even before that, but I never bothered to checkup because I felt fine. So it's sometimes called the silent killer, because you don't realize that you have it until it's too late. So that's why you need to go to your primary care or a community clinic somewhere maybe at a sporting event or something where people are checking blood pressures for free. And some of the pharmacies have blood pressure cuffs, automatic blood pressure cuffs. So it's, it's worthwhile making sure, and what's recommended is that at age 18 and above, you get your pressure checked by a primary care person every two years, so that it doesn't sneak up on you.
Beth Brown:And then you got to remember your numbers to so you can tell like if this has gone up or down and pay attention to what those are. So you've talked about the primary care provider multiple times, and that that's a resource for folks to check on blood pressure and what's going on for people who are trying to lower blood pressure. Are there other health care professionals that your primary care provider might refer you to or that a person could just seek out that could also support a new year's resolution to lower your blood pressure?
Dr. Doug Kuntzweiler:Yeah, this is such a common disease that most primary care people are pretty well trained in it. But if you have special problems, like maybe you've had a heart attack, and you had some heart trouble, or maybe you have some kidney disease, they might want you to see a cardiologist or a nephrologist. To help fine tune your blood pressure's that takes into account those other problems you have.
Beth Brown:What about a dietician or somebody if they need help with the food part of all of that?
Dr. Doug Kuntzweiler:Yeah, I think, and there's a lot of good dietary advice online too. But certainly, yeah, especially if you know, you were brought up with kind of a bad diet and have always eaten, you know, fast food and heavy meat and deep fat fried foods. In other words if you're from the south.
Beth Brown:Yeah, exactly. I come from a long line of Southerners myself, so yep!
Dr. Doug Kuntzweiler:You may benefit from sitting down, you know, for an hour with a dietitian and, and learning about what better choices are. I'm just picking on the south. I came from Iowa and they ate horribly.
Beth Brown:Yeah, that's true Midwest has its own reputation
Dr. Doug Kuntzweiler:Everything was deep fat fried.
Beth Brown:Yeah. So we always finished an episode with, "Where can people get more information if they want it?" So what's the blood pressure lowering resources, we want to go check out?
Dr. Doug Kuntzweiler:The American Heart Association has a good website, and you can follow that. And that will track you into high blood pressure, the Mayo Clinic if you Google Mayo Clinic, and then hypertension--oh, I should mention that hypertension and high blood pressure are synonyms. Those are just two different terms for the same
Beth Brown:Anything else we should close on other than those thing. But the Mayo Clinic has a lot of good information. Cleveland Clinic has a lot of good information or the CDC. Those are some of the best ones. resources?
Dr. Doug Kuntzweiler:One thing I wanted to mention is in terms of treatment, it's done in a stepwise fashion, or it's recommended that it be done in a stepwise fashion, then there are certain drug classes that make up the steps. So this comes from again, the American Heart Association, the American College of Cardiology, the American Academy of Family Practice agrees with this. So it is almost always the case that it takes more than one medicine to get you under control. And some people say, "Oh, that that sounds bad, like can I just take one medicine and push the dose up?" If you use two medicines from two different classes, they work better together. They work synergistically. Each medicine helps the other medicine lower the pressure, and you can get by with lower doses and therefore fewer side effects. Most people wind up on at least two medicines, sometimes three, if your pressure's hard to treat. The classes that are most often used to start or the one class is called the ACE inhibitors. The next one are called angiotensin receptor blockers, ARBs, and ACE inhibitors. One or the other of those is used as one of the two and then the other calcium channel blockers. And so either an ACE and a calcium channel blocker or an ARB and a calcium channel blocker are usually the way it's recommended that you start. If that doesn't thoroughly control it, then you can start pushing those doses up a little bit. And if that doesn't control it, then you would add a diuretic or a fluid pill that helps your kidney get rid of some of the sodium and fluid. So it's a stepwise fashion. You should expect that there's a very good chance you'll wind up on two medicines and possibly even three, but most of these are once a day, so they're really not hard. I'm on three medicines for my blood pressure and even I can remember to take it so.
Beth Brown:Okay, yeah, cool. And this is why people need to take notes when they talk to their doctor, too, so that they understand ARBs, and ACEs and all of these crazy words and terms that their doctor uses. Okay, well, I wish our new year's "resolutioner"
Dr. Doug Kuntzweiler:And there's information about these classes of drugs, because they are worldwide what are primarily used. I mean, there are lots of others that have been used in the past. And these seem to work the best. So if you go to the all the best with their blood pressure. Thanks for all your website, say American Heart Association or the Mayo Clinic, there'll be information about these classes of medications so information and Happy New Year to you. Yes, Happy New Year to you. Merry Christmas.
Beth Brown:Thank you. you can learn more about them.
Dr. Doug Kuntzweiler:I look forward to working with you next year.
Beth Brown:Yes, me too. All right. And thank you, everyone, for listening. We'll put in those resources so that everyone can see what Dr. K advised for more information that will be listed with this episode. And again, if you have a question for Dr. K for 2024 please email us at QandAwithDrK@mpqhf.org. And that email address will also be with this episode and we hope to hear from you, because on Q&A with Dr. K, the doctor is always in.
