5: Hypertension Part 2: Treating Your Hypertension with Lifestyle Changes

Continue on our deep dive into hypertension through the power of lifestyle changes and medications to treat the Silent Killer. Discover how small tweaks can lead to big results and bid farewell to hypertension woes. Tune in now and unlock the secrets to a vibrant, pressure-free life!

Transcript

Ed Delesky: 0:05

Hi. Welcome to Your Checkup, where we bring health topics from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine resident in the Philadelphia area.

Nicole Aruffo: 0:16

I'm Nicole Aruffo and I'm a nurse.

Ed Delesky: 0:18

And we're so happy that you can be here with us today, especially our Cincinnati listener. Especially the Cincinnati listener. Shout out to you in Oklahoma. We're still thinking about you. What are we going to talk about today, Nick?

Nicole Aruffo: 0:32

Well, today we are continuing our hypertension journey.

Ed Delesky: 0:36

Right.

Nicole Aruffo: 0:36

If you didn't listen to our first hypertension episode, we explained what hypertension is, some of the risk factors that can make someone more susceptible to a high blood pressure.

Ed Delesky: 0:49

Right. It'll introduce the conversation today because we're going to talk about what you can do to address your blood pressure in your life, what changes you can make, and a little ditty about medicine.

Nicole Aruffo: 1:02

A little ditty. So there are two pillars if you are diagnosed as having hypertension, two pillars of treatment options. Great way to put it, you could say, right?

Ed Delesky: 1:12

Yep.

Nicole Aruffo: 1:13

The first is, I guess it doesn't necessarily have to be first. One of them is lifestyle changes. The other one is medication.

Ed Delesky: 1:20

Yep. And the lifestyle changes get at the modifiable risk factors. Before we get to that, I just want to say a couple risk factors that are not modifiable.

Nicole Aruffo: 1:32

So the geneticals.

Ed Delesky: 1:34

Correct. Or the societal ones. Things that play in that either time doesn't solve or society doesn't help us with at all. Family history is not a modifiable risk factor, but it does increase your risk of having hypertension yourself. Your sex, like your personal sex, does matter. Men have a higher risk of hypertension than women, period. That may go away after menopause. But men typically have a higher risk of hypertension than women. Race plays a huge factor. African Americans and Hispanics have a higher risk of hypertension than Caucasians. And age is also a non modifiable risk factor. So when we consider lifestyle changes, we focus on the modifiable risk factors. Right. And the first one we're going to talk about is diet. In the last episode, we discussed sodium, which is salt. Not this complicated answer. I was starting to give salt and it is often added to food and it already lives in a lot of food. If you take a look at the nutrition label, several people already probably know about calorie counting. Nice. Took a nice sip there and landed all over your chin.

Nicole Aruffo: 2:56

Okay. Not all over. Had a little dribble.

Ed Delesky: 2:59

A lot of people know about calorie counting, but have you thought about sodium counting? Probably not.

Nicole Aruffo: 3:06

Probably not.

Ed Delesky: 3:07

So what I want you to go look at, if you're someone who is struggling with hypertension, is the DASH diet. D A S H. It stands for Dietary Approaches to Stop Hypertension. Not going to give you a, like, walkthrough of what that is, but it's essentially a low sodium diet that gives you several different options. And it is a meal plan. Meal plans are usually really difficult to follow. And these lifestyle changes that we're going to discuss continue to be probably the most effective and the most meaningful for you and your overall health, but also the most difficult.

Nicole Aruffo: 3:50

Is there a certain number that's kind of generally recommended to keep your sodium at so people kind of know what to look out for?

Ed Delesky: 3:56

So the American Heart association recommends no more than 2,300 milligrams a day, but an ideal limit of no more than 1500 milligrams per day for most adults.

Nicole Aruffo: 4:10

That can add up quick. It sounds like a lot, but.

Ed Delesky: 4:13

But it can add up.

Nicole Aruffo: 4:14

Yeah.

Ed Delesky: 4:15

So next time you're thinking about eating something, take a look. Take a look at the back of the nutrition label. They have to list the sodium there and write it down. There's this intentionality and mindfulness is going to come up several different times throughout the episode when changing lifestyle. So you don't have to do it every single day for the rest of your life, but do a week, or.

Nicole Aruffo: 4:37

Even if you're doing it just to kind of track or what you're eating at baseline. So then you can go back and say, oh, my gosh, I'm having 7kg.

Ed Delesky: 4:46

Of salt a day.

Nicole Aruffo: 4:48

I'm having a million grams of salt a day. Where are those coming from? Where can I cut back? Not necessarily to tract limit at first.

Ed Delesky: 4:57

Right.

Nicole Aruffo: 4:57

Because you should have an idea of what you're consuming.

Ed Delesky: 4:59

Exactly. To take an inventory, if you will. Great point.

Nicole Aruffo: 5:03

So diet, Just to go back to that real quick. So the blood pressure is going to be most sensitive to the salt in your diet?

Ed Delesky: 5:11

Yep.

Nicole Aruffo: 5:12

Are there any other things that you should look out for in diet or is that kind of the focus for the lifestyle change?

Ed Delesky: 5:17

So diet also inherently plays in with.

Nicole Aruffo: 5:20

Your weight, and we said obesity was a risk factor in our last episode.

Ed Delesky: 5:25

It is. And we're very thoughtful in this household about how to actually identify obesity. We don't think that BMI is a great way to do it here.

Nicole Aruffo: 5:38

We are not BMI stands in this household.

Ed Delesky: 5:40

We aren't. And it's a bad way but it's the way that the medical system uses. And so for lack of a better one, I mean, I literally was a BMI of 30 a couple weeks ago.

Nicole Aruffo: 5:50

Yeah, like you would be obese.

Ed Delesky: 5:52

Right.

Nicole Aruffo: 5:53

So, and I'm looking at him now, you guys, and he's not obese.

Ed Delesky: 5:57

And so that's flattering. And so for lack of a better definition, the BMI of 30 still stands. But say that obesity is a problem and it's a conversation you and your physician have had. There are strides to be made with, with your to maybe lose some weight. Say you are carrying an extra couple pounds. Diet can play into how we maybe lose those couple pounds. But a really complicated and challenging conversation and very common is I want to lose weight. When people come to the doctor's office, a meaningful clinical like your body will notice this difference. Amount of weight to lose is 5 to 10%. And so just to get there for 10%, you just take the first number and then move the decimal spot over and that's 10%. If you want to do 5%, cut it in half. So diet also plays into that specific risk factor.

Nicole Aruffo: 7:02

All right, so we know kind of generally our diet will affect our weight. Anything else that can go into us losing weight that will also help our blood pressure?

Ed Delesky: 7:12

Yes, exercise. There's a lot of good evidence, and this is if anyone who is my patient, who's listening, knows that nearly every visit, especially if physical, that the live longer amount of exercise you can do is 30 minutes, five times a week at an intensity where it would be difficult for you to speak to the person next to you. So by that logic, you are working out more days or exercising more days than you're not. And like you wake up and the expectation is that you will work out that day and then you sparingly take days off. Say you're busy. They've also done research that two intervals of working out at a longer time also get the job done. And so say you're a weekend warrior and you have time on the weekend and you want to do 75 minutes, which also gets you to that 150 minute total. That also works for the live longer amount of exercise. Like people literally live longer if they do this. If I told you there was a.

Nicole Aruffo: 8:15

Name would suggest, right?

Ed Delesky: 8:17

If I told you there was a medicine, there was something you can do that would make you live longer. And you didn't have to put anything in your body, but it took a little bit of time each day people would be going nuts.

Nicole Aruffo: 8:29

And they can. And it's exercise. And 30 minutes is not a lot of time. You spend 30 minutes scrolling on your phone or online shopping for things you don't need or figuring out neck what next show to watch on Netflix.

Ed Delesky: 8:43

Yep.

Nicole Aruffo: 8:44

So you can exercise for 30 minutes, find something you like to do, and then scroll your phone.

Ed Delesky: 8:50

Yeah, it's.

Nicole Aruffo: 8:51

Or watch your Netflix show.

Ed Delesky: 8:54

Something I learned today was that people with Medicaid insurances actually may qualify for a free YMCA membership.

Nicole Aruffo: 9:03

Yeah. A lot of insurances, regardless of like, if it's Medicaid or commercial, they'll have like either some kind of program where you'll get like money for if you go to the gym x amount of times in a year, you'll get a gift card or you'll get like a discount on your premium or something like that. So you should look into that because a lot of them participating with these kinds of programs and I know it's kind of a touchy, touchy subject, but I think it's kind of their way of like wanting to keep the members of their insurance plan healthy by offering these incentives.

Ed Delesky: 9:39

Right.

Nicole Aruffo: 9:39

And we could also go down the insurance rabbit hole and how many problems there are with the system, but we're just going to keep it there. But yeah, look into regardless of whatever kind of insurance you have, because you might get some kind of incentive just for working out or joining a gym or might get a free membership or something. Makes it even better if you can do something for free.

Ed Delesky: 10:00

Yeah. Amazing. So look into it. Think twice.

Nicole Aruffo: 10:04

All right, so we talked about the diet, exercise, exercise being that essentially free thing that you can do without putting something into your body.

Ed Delesky: 10:14

That's like a professional transition.

Nicole Aruffo: 10:15

I know. That was good, right? I'm like a professional podcast girly. Now. Speaking of putting things into our body, there are some of those things that we put into our body that increases our risks for hypertension.

Ed Delesky: 10:29

Yep.

Nicole Aruffo: 10:30

What are they?

Ed Delesky: 10:30

And we talked about a few of them. Tobacco and some medications. And so we'll dive into some tobacco. Right now we will have whole episodes on tobacco cessation, which, if you see that written down somewhere or heard it said out loud, is the effort to stop smoking. That is what tobacco cessation means. And it is a challenging thing to say it out loud. It is an addiction and it's an illness that needs to be treated and can be treated. It's also a habit that people do because they like to do it. But it also increases your risk of hypertension. And so making a concerted effort to stop smoking actually will either treat Your hypertension, or we'll get rid of it sometimes. That's actually the first move I make with a patient, is that like, oh, you smoke. Let's get you to stop, stop that and then come back in a month and we'll take your blood pressure and collect information at home by taking your blood pressure the proper way.

Nicole Aruffo: 11:32

Is that realistic for someone to ask someone to fully stop smoking in a month?

Ed Delesky: 11:38

I don't think so. No. No. And I. There's a. There are stages of change, and within those stages of change, I fully anticipate someone returning to smoking. My goal will be to cut back.

Nicole Aruffo: 11:51

Okay.

Ed Delesky: 11:51

That's the first realistic goal I have for someone. And there are several different things. Nicotine gum, patches, medications, both directly for tobacco cessation or kind of off brand used. There are quit lines that you can call in and get a lot of these for affordable prices or free. So to that end, smoking, the other thing you can put in your body that will give you hypertension is a lot of alcohol. And it kind of lives quietly and is also another big behavioral thing. Would you know there are things to do about it if you want to drink less alcohol? There are. And I don't know why it's not talked about more. Maybe it's stigmatized.

Nicole Aruffo: 12:37

Yeah, probably, I would say.

Ed Delesky: 12:39

But there are, there are medications to do. There are behavioral health consultants to reach out to your primary care doctor who can coordinate all of this for you if you have a good one. And independently, a lot of alcohol can increase your risk of blood pressure. I've done this with someone that's been something. I'm like, hey, you're drinking a lot. Maybe we make that connection of the alcohol to your blood pressure that you're really worried about and put them together to motivate you to drink less.

Nicole Aruffo: 13:11

Is there kind of like a number of drinks per week that's quote, unquote, a lot that you would maybe advise a patient to cut back on for, you know, people listening. If you're kind of thinking, oh, well, I have two. Two drinks of. Or I have like two glasses of wine at dinner on Fridays.

Ed Delesky: 13:31

Yeah. So the CDC recommends two drinks or less in a day for men and one drink or less in a day for women.

Nicole Aruffo: 13:38

Okay.

Ed Delesky: 13:39

Don't ask me why they're different, but that's the general recommendation. And so more of that, more than that is something to think about and have a conversation. But it's a tough thing to kind of just bring up if you're meeting someone for the first time, especially from My perspective as a doctor or from a patient's perspective. And so it's something to be gentle about.

Nicole Aruffo: 14:04

Yeah.

Ed Delesky: 14:04

And to think twice. So that's the recommendation.

Nicole Aruffo: 14:07

And don't lie to your doctor when they ask you how many drinks a week that you have, because it's always on that paperwork.

Ed Delesky: 14:14

It is, yeah. It's always best to be honest. Yeah, that's. That's the best way to get the best help. So in the theme of things you put in your body that make your blood pressure go up are medications. NSAIDs, which stand for non steroidal anti inflammatory drugs. Ibuprofen, naproxen, aspirin.

Nicole Aruffo: 14:36

This is our Advil, our aspirin, our Motrin. Yep, Aleve.

Ed Delesky: 14:41

All of these names can increase your blood pressure. I've recently had a guy who I'm like, thinking about why he's having high blood pressure and as my hand is on the door to leave, he's like, oh, no, I'm taking 800 milligrams of ibuprofen all day. And I'm like, that was on me. I should have asked. And that could have been contributing. He's doing much better now. And some antidepressants can do it, some birth controls can do it, especially the estrogen containing birth controls that you take every day. Decongestants, actual illicit drugs like methamphetamine and cocaine. But the ones I mentioned before are really common medications that people are on that maybe you even present to your doctor and say, I am worried about this, I'm doing this. And with you being more aware and educated about your body and your health, maybe there's something here for you to think about.

Nicole Aruffo: 15:37

All right, so we kind of touched on the main modifiable lifestyle changes that one could do. There are also the social determinants of health.

Ed Delesky: 15:46

Right.

Nicole Aruffo: 15:46

And how do they play into high blood pressure? And what if there are things that can be done? What are they?

Ed Delesky: 15:53

Right, so chronic states of stress. We are learning more about them and how they impact someone's physical health. And we now understand that social determinants of health can impact your blood pressure and elevated. I think we're all trying to do better, but right now we're not amazing at treating these things because they're big societal issues. But there are different members of the team, the healthcare team that can help you. I know we have different. Like in our health records, there are different boxes that let you know about someone's risk and you can quietly fill out forms if you don't want to say it out loud if you're struggling. But we do know that the social determinants of health can independently increase your risk for hypertension. And as I mentioned earlier in the other episode and kind of earlier here, 90% of high blood pressure is called essential hypertension, but there is a bag of blood pressure that is caused by something.

Nicole Aruffo: 16:54

So this could be where we talk about things like sleep apnea with high blood pressure.

Ed Delesky: 16:59

Right.

Nicole Aruffo: 17:01

Often thought about what came first, the sleep apnea or the blood pressure.

Ed Delesky: 17:05

It's a great question. I'm actually like most of the. A lot of the people who, who come to me with problems of high blood pressure, I look at their neck and I'm like, do you. Do you snore? And then if they do, then I think twice and I'm like, maybe you have sleep apnea. Because sleep apnea itself can cause hypertension. And that treatment's so different than the other stuff. Like that's a whole CPAP machine that you're getting. And then who knows, like, if it's true and you have it, then your blood pressure's improved and your life has changed. So that's a huge one. And then there are other more complicated pathologies that can cause hypertension.

Nicole Aruffo: 17:44

And we don't need to talk about that.

Ed Delesky: 17:46

We're not going to go into them.

Nicole Aruffo: 17:47

Not the place if someone. Okay, so you mentioned someone's neck or the size of their neck.

Ed Delesky: 17:52

Yeah.

Nicole Aruffo: 17:53

Possibly relating to their sleep apnea.

Ed Delesky: 17:54

Sure.

Nicole Aruffo: 17:55

So we're making the assumption here that someone has a thick neck.

Ed Delesky: 17:58

Thick.

Nicole Aruffo: 18:00

Maybe in the obese category.

Ed Delesky: 18:02

Right.

Nicole Aruffo: 18:02

If someone loses weight.

Ed Delesky: 18:04

Absolutely.

Nicole Aruffo: 18:06

Does these modifiable lifestyle changes, could they also decrease their sleep apnea risk and high blood pressure?

Ed Delesky: 18:13

Excellent point. Right. You absolutely can. It happens. And that's losing a clinically important amount of weight. 5 to 10% can change your life. So that was a great point. Yeah, absolutely.

Nicole Aruffo: 18:29

Cool. So those were. That was the lifestyle pillar. Yeah, we're touch on the medication pillar because that can be very detailed and really should be just sorted out between you and your doctor because they're different avenues that you can go down. Totally specific to you. But what's kind of the main take home? I guess really if you are prescribed a blood pressure medication from your doctor, what's the most important part?

Ed Delesky: 18:55

The most important part is to take it as prescribed. And so if the blood. Usually they're taken once a day. And the most important part is to take the medicine. Be honest with your doctor when they ask you how often you take your medicine, it's not A test. When they ask you and don't answer.

Nicole Aruffo: 19:13

How you think they want you to answer, just tell them.

Ed Delesky: 19:16

Right? Because there are things to do. And so this kind of gets at the being a patient episodes that we're going to have coming up. Taking a medicine every day is hard. It's a habit. And be honest, because there are things that can be done, adjustments that can be made, or if there's a side effect that the medicine is giving you.

Nicole Aruffo: 19:39

Tell the, tell your doctor if you don't like the way this makes you feel, because there might be something else to do.

Ed Delesky: 19:45

Right. And at the end of the day, it's your body and you're making this plan with this person who you've given a lot of trust to, but let us know. It's so helpful.

Nicole Aruffo: 19:55

And along with the medication, I just kind of heard here and there of people kind of saying, like, yeah, like, I'm on a blood pressure bed now. Or like, it's not time for that. Like, I'm not old enough for that. You know, whatever. Some kind of, I guess, like, stigma, I guess, with the blood pressure med. So if you are prescribed a blood pressure medication, is that it? And like, that's your life sentence. You're on this med for the rest of your life?

Ed Delesky: 20:24

No.

Nicole Aruffo: 20:24

Or can you come off of it?

Ed Delesky: 20:27

You can come off of it. And I would, you know, see first half of episode because you can, you can change these things and someone may put you on a blood pressure medicine to temporize or give more time to the solution, because the solution may be you changing your life, which is within your grasp. It's right there. But we can't have you walking around with high blood pressure pumping throughout that body, knowing what happens when it lives there. And what if something happens and you don't come back and you don't see us, and then it's not as important. And like, it gives me a lot of peace of mind to know that you're on a medicine, your blood pressure is controlled, but at the end of the day, I want the solution that works for you. And that's how I.

Nicole Aruffo: 21:11

Maybe that is. You're paying attention to your diet, you're intentional about your activity and your exercise, maybe cutting back on some things that aren't so great for us. And then your blood pressure looks a lot better. Then you can work with your doctor about coming off of the medication and then you're not on med anymore. Yeah, your life is improved. Other things in your life are most likely improved by these changes that affected your Blood pressure.

Ed Delesky: 21:42

Yeah. You can change your life. It is within your grasp to do that. So taking the medicine every day, your blood pressure, if you're on the medicine, is probably only improved because you're taking the medicine. And when you stop taking the medicine, it will not be as good. You know, there's a common logic of, well, why do I need to take my blood pressure medicine? My blood pressure is better if it's controlled, but it's only working because you're taking your medicine. And so that's why we need to keep taking it. In the theme of side effects, sometimes your blood pressure can go too low. That's something that your doctor wants to know about. I can definitely speak for anyone providing healthcare. They wanna know about that. And sometimes if you're on multiple, you can inquire about a combo pill, because sometimes it takes more than one medicine to get your blood pressure down. And sometimes you can ask about taking multiple medicines and putting them in one, because we know that that increases the number of times that you take the medicine.

Nicole Aruffo: 22:43

Great.

Ed Delesky: 22:43

But without giving sounding too giving. Medical advicey, that's kind of where we're at. Okay, I think this.

Nicole Aruffo: 22:52

This was a great hypertension journey.

Ed Delesky: 22:55

I think it. I think it was. And please, I comment, leave messages, email us if you have other questions or things that you want us to discuss, special situations that we can do a little bit more reading on and kind of decipher for you. We would be happy to do that because you're definitely not alone. And so thank you so much for coming back on this episode and taking this hypertension journey with us. Make sure you subscribe, rate and review. Wherever you listen to your podcasts, follow our Instagram, your checkup podcast, and most importantly, stay healthy, my friends. Until next time. I'm Ed Delesky.

Nicole Aruffo: 23:34

I'm Nicole Areufo.

Ed Delesky: 23:35

Thank you and goodbye.

Nicole Aruffo: 23:37

Bye.

Ed Delesky: 23:38

This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments, or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a healthcare provider for personalized guidance based on your unique circumstances. We explicitly disclaim any liability relating to the information given or its use. This content doesn't endorse any treatments or medications for a specific patient. Always talk to your healthcare provider for a complete information tailored to you. In short, I am not your doctor.

Nicole Aruffo: 24:15

I am not your nurse, and make.

Ed Delesky: 24:16

Sure you go get your own checkup with your own personal doctor.