Hi everyone and welcome to WWAD in New Jersey, number 807 on your AM dial. I’m your host, Brother Brucie from Asbury Park. Today on the Blood Pressure Show we answer all of your burning questions about hypertension. So email me, text me or hire an airplane to pull a banner over the shore with your question. Lets get started.
Meryl S from Summit asks, “How common is high blood pressure? Is high blood pressure a bad actor?”
High blood pressure (hypertension) affects nearly 1 in 2 people worldwide between the ages of 35 and 70 years old. Hypertension is a leading risk factor for stroke, heart attack, death and disability. Hypertension is often called the silent killer, as there usually aren’t any symptoms until an adverse event occurs. In addition to affecting the individual, hypertension impacts the health care system. It was recently shown that about one third of emergency room visits in heart patients were for high blood pressure. This represents about 2.7 million people. In addition, hospitalization for uncontrolled hypertension has increased in recent years.
Jon B from Perth Amboy queries, “How high is too high? What is the optimal blood pressure?”
Blood pressure is considered normal if less than 120 and less than 80. Elevated blood pressure is defined as a systolic pressure between 120 and 129 with diastolic less than 80. Stage 1 hypertension occurs with blood pressure over 130/80. Stage 2 hypertension is defined as a blood pressure of 140/90 or greater. Hypertension should be diagnosed if blood pressure readings are elevated on three separate occasions, several weeks apart. Once hypertension has been established, what is the target blood pressure? The landmark SPRINT study is the current gold standard answer to the question. The SPRINT trial compared two blood pressure goals, treating to under 140 and treating to under 120. The study showed that patients who were treated to under 120 had a significantly lower risk for cardiac outcomes. However, those treated to under 120 were taking more medications and had a higher risk for side effects from the medications. Therefore treating to a blood pressure under 120 is recommended for heart patients or those at high risk for cardiac disease. Other populations, such as diabetics and the elderly, should be treated to under 140.
Francis S. from Hoboken wonders, “Is it best to measure blood pressure in the doctor’s office or should I do it my way?”
The doctor’s office is not the ideal location for blood pressure checks. More accurate readings occur when patients take their blood pressure at home. Home blood pressure reading can be obtained either by the patient checking their own blood pressure or an ambulatory blood pressure monitor, a blood pressure cuff worn for 24 hours, which gives an average blood pressure reading during the day and at night. Both methods can confirm hypertension in patients who have high readings in the office or white coat hypertension (high readings in the office but normal at home). In addition, ambulatory blood pressure monitoring is a stronger predictor of cardiac disease and mortality than office blood pressure values.
Vincent L. from Ridgefield demands, “What is a winning game plan for blood pressure?”
The amount of time patients spend in a target blood pressure range is emerging as a therapeutic goal. More and more research is focusing on time in therapeutic range. The more time in range, the lower the risk for cardiac events. For example, studies have shown that increased time in the blood pressure range of 110 to 130 lowered the risk for cardiovascular death, heart attack, stroke and heart failure. Therefore, a winning strategy is to try to keep the pressure in range for the longest time. This has implications for office visits as well. If a patient comes in with an elevated blood pressure, it has to be placed in context and compared to home readings as well as prior office measurements. When blood pressure readings are taken also help describe the bigger picture. If blood pressure is 120 while sitting but is 160 after walking, or when under stress, or when in pain, then the higher reading again has to be placed in context and likely discounted.
Thomas E from Menlo Park, “If blood pressure readings at home and time in target blood range are keys, would wearable devices help achieve these goals?”
The blood pressure cuff was first introduced in 1896. Today, more than 120 years later, there is no significant difference in blood pressure cuff technology. This may be changing. Home blood pressure monitors and ambulatory devices all use a cuff that must be inflated to provide a reading. This limits the usefulness of these devices. There are now several cuffless wearable blood pressure devices on the market. These monitors hold lots of promise: the ability to record blood pressure comfortably, continuously, during the day and at night and provide good unbiased data on blood pressure variation. Several different technologies have been incorporated including photoplethysmography (the green light on the back of the watch). Unfortunately, the cuffless devices currently available on the market have not been shown to be accurate. For example, one smartwatch had a difference of 17 points compared to the standard cuff. Because of this, no device is recommended for use by any medical society. On the other hand, traditional home blood pressure monitors have been independently validated as accurate and a list of these validated devices is available at ValidateBP.org
One cuffless technology may prove to be both accurate and useful. The mechanism is a thin sticker that is worn on the skin and uses bioelectrical impedance, a method that has been used for years in medicine for other reasons. The sticker can be worn on the skin for a week at a time and in trials was very accurate (within 0.2 points of a standard measurement). While not currently available, it may be the future.
Joe P from Passaic asks, “My blood pressure is high when I am working on Saturday night. When should I take my blood pressure meds?”
There is an old debate regarding when to take blood pressure medications- morning or evening. There is logic to taking medications at night. Blood pressure usually drops at night. Patients who do not have the traditional nighttime blood pressure dip are at higher risk for cardiovascular problems. In addition, taking meds at night may lead to fewer side effects. So, taking meds at night makes sense. Does the data support this approach? Over the years, most studies supported taking medications at night. Recently a large, well-run trial showed no difference; morning or evening there was no difference in cardiovascular events at 5 years. When is the best time to take meds? The answer is to tailor to each patient’s individual needs, balancing efficacy (remembering to take the meds) versus tolerability (the time with the lowest side effects).
Lawrence B from Montclair asks, “Is one blood pressure medication sufficient? Or should I go for a four bagger?”
Doctors traditionally have been trained to use a step wise approach when treating hypertension. One medication is started and the dosage is increased if the blood pressure is not controlled. If one medication is maxed out and the number is still not good, a second or third medication is added. Is this the best approach? Recent trials have compared a single blood pressure pill to a “quadpill”, a tablet containing small doses of four different blood pressure medications. The quadpill dropped the blood pressure 7 points lower than the single agent. The appeal of the quadpill is that it offers better blood pressure control while providing ease of use (only one pill to remember) and lower side effects.
Robert J. from New Brunswick asks, “I have arthritis. Can I take Tylenol with my blood pressure medications?”
It is well known that nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided for patients with hypertension. NSAIDs include ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), indomethacin (Indocin), diclofenac (Voltaren) and celecoxib (Celebrex). These medications can raise the blood pressure and can interfere with some blood pressure drugs. Tylenol (acetaminophen) is often prescribed instead. However, recent data shows that Tylenol may not be innocuous. Patients who took Tylenol for two weeks saw their blood pressure increase nearly 5 points above patients who took placebo. Therefore, long-term use of Tylenol may not be safe for patients with hypertension. Short-term (few days) use may still be fine.
That’s it for our show. Thanks for joining me and hope to see you next week. This is Brother Brucie signing off (fade to music):
“This is Radio Blood Pressure
Is there anybody normotensive out there?
I was staring at a dumb dial
Just another lost number in a file
This is Radio Blood Pressure”
