 Welcome to Quality of Life, a program where we look at the aspects that contribute to one's well-being and ultimately the quality of life. In this episode, we're going to talk about hypertension or otherwise known as high blood pressure. Joining us today is Dr. Michael Johnson from the Sheboygan Internal Medicine Associates or CIMA. Welcome to the show, Dr. Johnson. Thank you for having me. Excellent. Just to start off with your background as internal medicine, how long have you been doing that? Roughly. I've been in Sheboygan for 13 years and I moved here from Denver where I had practiced internal medicine for three years there and did my residency at the University of Colorado. So I've been a resident here and practicing in this town for 13 years. Okay. I know medicine has got really specialized component when it first started out where it used to be one person did it all so to speak and it's gotten more specialized and your specialty is internal medicine. Could you give our viewers just a background on what that really means and what it covers? Sure. To figure out what the guy does, most people would think you're a surgeon if you're an internist because things inside are things you operate on but we're actually general care doctors for adults. So we take care of usually most internists will start seeing people at age 16 and then we take you the rest of the way on down the road and we do primarily preventative medicine as we might talk a little bit about today but also treatment of disorders, heart attacks and strokes and cancers and those types of doctors are all basically internists as well so we kind of run the gamut of taking care of anything that might happen to an adult and be their primary care physician. Okay. Just one more step I wanted to touch on it so if I wanted to really think about it you'd be almost be the first point of contact to do the initial here's what's going on and then you can refer on if we need other resources to bring in kind of at your disposal like the other specialists. Correct. That's exactly right the government and the insurance industry has been pushing to have a single point of care for all of their patients say a quarterback so to speak they call it in the legislation from the government a medical home and we aim to be people's medical home so things start with us and we treat probably 95 percent of what we see and then the 5 percent of the stuff or whatever that percentage is that is tougher we can ask for consulting care from our heart doctors cancer doctors kidney doctors things like that and they usually will give us answers to questions help us with management decisions and then the patient comes back to us and we usually continue to manage them so that what we'd be think of as a quarterback for your for your health care. Okay wonderful. Okay hypertension who is our candidate for hypertension? Everybody it's an unfortunately it's a very prevalent disease in the world it's about 25 percent of the world's population has high blood pressure if you take all of them there's different incidents in different populations for instance Indians in I'm talking Indian Asia not here they have a lower rate of high blood pressure Europeans have higher rates of blood pressure of hypertension they're in the 30 30 percent range 30 to 40 percent range in Europe in the United States again all all taken together the the population had about 25 percent incidence of hypertension back in the 90s in the early 2000s it started to creep up to 30 percent and last data is somewhere on the order of 40 percent it was it was very high it was in the mid 30s percent I think when we last had some data in the mid 2000s and so you're talking one in three Americans have high blood pressure among the Americans there's certain groups that have higher rates of a hypertension American Indians African Americans they have rates up to 40 to 45 percent whereas white Americans have slightly lower rate of hypertension it also is shifted on the economic class the more poor you are the more likely you are to have high blood pressure so about in general one out of three Americans have high blood pressure and anybody can get it okay why the change it seems like you know as you said it's trending up what's changing that people are you know getting it more is it just they don't take care of themselves eating habits don't exercise or are we just getting better at measuring things that we didn't detect before yes yeah it's it's all those you know we are you know if you've I'm sure seen the statistics of obesity is rising our diets are shifting towards the fast food prepared pre-prepared meals and those tend to have a lot of salt in them and they have a lot of calories and we are slowing down as we're sitting down more we're doing less by hand we're moving less and that's leading to obesity and that those dietary habits and habits of lifestyle will certainly increase your risk of high blood pressure also not eating your fruits and vegetables like mom told you actually right now that actually lowers blood pressure it substitutes in healthy food for salty ones but there's also good stuff in a good diet that will keep your blood pressure low but that's the main reason and we are right we are watching for it more you're right it's we're screening much more aggressively now which is good and that that will lead to the numbers you know getting raised a little artificially just because we're looking a little harder but mostly it's our habits starting computers they give us high blood pressure yeah exactly exactly so if I wanted to tell if I had high blood pressure now what are some of the symptoms I should look for usually if you have symptoms from high blood pressure you're in you kind of having you're in a little bit of trouble we want to catch a person long before they would ever get symptoms so the take-home point is that you people with high blood pressure most the vast majority of the time do not know that they have high blood pressure it's it's a symptomless disease until it progresses you know and and gets much more severe and then once the body sustained damage from the high blood pressure over years then you start to see the symptoms but we like to catch it in the asymptomatic phase when it's starting to maybe crop up in a 25 year old for the first time okay could you go a little bit more on the causes of it I know you mentioned briefly but I'm sure there's more than just you know sure there's two we break it up into two different ways of two different classes or categories of high blood pressure one is first category the most common one is what we call essential hypertension which is for lack of a better way of understanding it it's kind of the way your genetics are some people have high blood pressure run in their family and it's a mixture of that genetics with your lifestyle are you caring for yourself are you eating a healthy diet are you fit are you overweight that category of a hyper essential hypertension is the most common cause that a person would have high blood pressure so a little bit of genetics and a little bit of environment mixed together secondary hypertension is the other major class and that's when blood pressure in the body is being driven by some other process there's many different disorders that can cause the body to get high blood pressure for reasons other than the way God made you so to speak but other than your genes and other than how you behave and eat and things some there's certain tumors for instance that can secrete things that will make you get high blood pressures if you get clogging of the arteries that supply blood to your kidneys you can get high blood pressure and these are areas where we can go in and maybe fix this disorder and the blood pressure will correct itself and that's secondary hypertension that's much less common of course than the garden variety high blood pressure patient which just has it because they need to live a little better and maybe they got a bad genetic deal when they got felt those carts okay so let's say I'm kind of old school I don't have high blood pressure I don't have hypertension or doctor doesn't know what they're talking about or they're just kidding to get you know whatever so what happens if I don't do anything about hypertension or if I don't have it treated or do anything that's a good question eight one of my favorite professors told me that the most important thing a doctor can do to save wives to get a smoker to quit smoking that's absolutely the most important thing you you can do as a doc that you'll save more lives doing that than everything else that we do in all of modern medicine he used to say number two on the list is normalization of blood pressure it's more important than anything else you can do besides smoke quit and smoking if you happen to be a smoker so it's very important to treat it and fortunately it's very easy to treat actually as well the medicines we use for it are incredibly safe incredibly well studied and fortunately incredibly cheap they've all gone generic so there's really not a lot of reason to bury your head in the sand and not treat high blood pressure the medicines are very well tolerated and really give you a lot of bang for your health care dollar so to speak just checking the simple blood pressure and normalizing it does more than than most of the other things you do to keep healthy so it's important if you fail to treat it in answering your question if you decide you're not going to pay attention to it that's one of the leading reasons people die young they get heart attacks and strokes and kidney disease and eye disease and and other things vascular disease blood vessel clogging and these are all hypertension plays a major part in all of those disorders so you're really playing Russian roulette so to speak if you fail to ignore that one there's certain things if you ignore it it's probably not as big of a deal but this is not one of them this is one of the most important things you can do is get your blood pressure checked it's like you kind of describe before it's you don't know about it so it's kind of the silent killer it is from commercials from years ago yep that's a great way of putting it a silent killer is a great way of putting it I have hypertension and I'm on medicine for it that my doctor prescribes and it really you know does well it's like my blood pressure right now it's not right now but the average you're gonna maybe a hundred over 60 or something like that so it's under control and you know it's I feel good good you know I feel good lost some weight lost about 40 pounds from a year trying to do that so I'm finally listening to him so to speak so I mean is one of those bullheads anyway with the prescriptions that you can take I know like in my dad's case he has multiple medications to take because there's different ways you can help treat could you go into that a little bit sure usually the rule of thumb is when you catch a high blood pressure in a young person when it's first starting you generally will need one medication to cover it maybe sometimes you'll need to depends upon the case as the longer high blood pressure sits untreated as well as other factors that would damage anything that'll damage the blood vessels will make your blood pressure more resistant to treatment things like smoking diabetes cholesterol and some genetic things in there too things that are out of your control so to speak but the longer you leave blood pressure in these other risk factors for your blood vessels uncontrolled your blood vessels become for lack of a better explanation very very rigid like lead we call them lead pipes when we're talking among doctors the guys got lead pipes that means they're very those are very hard to to relax and usually is if you come in if you get a 70 year old guy that walks in your office never seen a doctor his blood pressure is 170 over a hundred you can look him in the eye and pretty much guarantee him you're going to be talking three four maybe even five medications to control it whereas you get a 25 year old with just a barely high blood pressure just started much easier to control but regardless of how old you are and how hard it is to control if it takes five medicines to control it you're much better off having a normal blood pressure on five medicines then you are off medicines with a high blood pressure so as you get older it'll be a little bit more resistant but you just got to work at it a little bit harder as a doctor and a patient as a doctor and the patient relationship I suppose it's a little bit harder with the older the patient as well you know to try and convince them to change or we have to take these medicines and sure you know what a sure for some to look at it so to speak into the mirror so to speak yeah usually when you're treating patients and you try are trying to convince them to take a medicine you need to take time to explain to them why they're taking it and especially when you're trying to add on a third or fourth medication for the same problem so that comes down to spending time with your patient to make sure that you pause and tell them why you're doing what you're doing generally you'll find with those people when they understand why you're doing this and what the statistics are and how much you could benefit them by doing this they'll generally listen to you and begrudgingly take their pills sure and like with anything else it's communication if you're you know in simplest terms this is what this one will do this is what this one will do and this is what this one will do usually more receptive you know as far as what's going on exactly so along with that what process you know do you go or a physician go through to you know treat and or diagnose and evaluate the hypertension I think it's pretty important with with blood pressure because we as we talked about earlier it's maybe the one of the most important things we do in a day is treating high blood pressure it's important that you get good data and so I'm reason I'm reluctant to treat a patient for high blood pressure based on having let's say one reading in the office that day was high they they might have just been nervous because they were in the doctor's office so I think it's really important that anybody who has high blood pressure should have a home cuff it's you can buy them at the Walgreens or Walmart or or Glanders or wherever you want to go and you you push a button and it gives you a reading and those are actually most of them are very reliable and if you take them to your doctor's office they'll make sure that they're accurate and you watch your readings at home when you're sitting down resting and you take a reading and see where you're at at home a lot of my patients are high in the office and very normal at home and they don't need treatment but a lot of them are high at home as well so so that's how you diagnose it and once you have that cuff and you start them on medicines if you want to know if it's working or not if they need more it's very hard to do that by just checking a blood pressure that one day they might have had a cup of coffee maybe their boss was yelling at them and they're high just because of that but at home they're fine so an integral part of figuring out whether they have it and what you're going to do with it is is those home blood pressures so that's a key thing. Any idea what the average cost of one is is it like 50 bucks 35 bucks or generally if you go below 35 bucks and this is just my you know I haven't done a study of course but you know if you go below 35 bucks you probably aren't getting much you know you get in that 40 maybe $50 to $70 range that's where you're going to probably get a pretty reliable cuff if you can ask your doctor also some of the brands he may recommend but generally if you go into the Walgreens store and spend somewhere between 45 and 70 bucks you'll get yourself a pretty good cuff that's going to give you pretty reasonable results and it isn't like it's an outrageous cost or whatever that you know monitor your health as far as blood pressure plus multiple family members can use it as well so it's actually sure if you to get put it in perspective if you were a woman who had high blood pressure and you had to choose between that and a mammogram you choose your blood pressure now you should do both but that it's a big deal so yes spend the money on it it's deductible on your tax form and you can use your HSA account your flex accounts at work that's a that's a doctor's medical vice that we recommend to have and they'll pay that so oftentimes you can get some benefits that way so it's because it's such an important disease it's it's worth taking the extra effort to monitor yourself at home if you have high blood pressure if you don't have high blood pressure you don't need to go off and be buying these monitors of course right just for the ones who are told so by their doctor right just like a diabetes monitor you don't have to rush out and buy one get the strips if you don't have it just exactly exactly I can think of better things to do didn't stick your finger yeah and check your blood exactly yeah okay excellent what are some of the things that I can do to either help from getting high blood pressure hypertension or reducing it right the main things are the you know practicing a horse sense you know if you're if you're taking in more calories than you're burning you're gonna expand if you're if you're if you're overweight and you you got to start to burn more calories than you take in and you got to lose weight and and that's that's an important thing you got to watch salt salt is incredibly important with high blood pressure and in general we we as a population eat way too much salt and the people who tell you they never touch the salt shaker they are getting too much salt a lot of them are as well because the foods are so laced with them as a preservative and a flavor enhancer that you can get quite a bit of extra salt without knowing so you got to count it you want to stay below 3,000 milligrams of salt a day that's a good goal 3,000 milligrams and salt is the same as sodium so when you're reading your labels you got to find sodium on there and you got to take a time and realize what you eat that has a lot of it general rule of thumb is canned foods microwave foods fast foods eating in restaurants unless it's labeled as healthy low salt generally it'll have a little bit more salt so you got to be conscious about that learn where salt hides luncheon meets all kinds of examples you want to of course practice physical fitness three days a week you should be getting your heart rate up and doing some cardio workout for a good 3045 minutes so weight loss exercise in a low salt diet just like you probably learned in third grade health classes is the way to the way to handle it yeah and one thing with salt I always love salt and growing up whatever you got to take the salt shaker and do whichever but you know like you had said and now I hardly use salt and I think you know it's like anything else you wean yourself off and all of a sudden you eat the food and just like oh my god is a salty yes you know you don't add it anymore it's like I had my eggs in the morning already got to be nice and salty or whatever you got to add that salt absolutely there's so many alternatives and you can watch these fun shows on the on the TV of cooking cooking healthy and my wife buys these these salts these various spices the Greek spice and this and you know none of them have salt in it and they can you actually make food taste better and you can still put some salt on your eggs sure you know it's a dash of it and you add some other things maybe on to your eggs that that spice them up maybe some salsa sauce or something else so a lot of things out there actually tastes better but you got to kind of learn to cook that way and change your life definitely is especially in today's lifestyle where everything is fast-paced exactly you know everybody's working you know hours around the clock well you guys especially you know you guys work around the clock being on call and everything and you don't have that time to really either yeah just shoving McDonald's yeah and you're on your way again you know or that or you know you really don't have the time to exercise you got to make time sure one thing when I lost the weight I did a lot of it I lost just on portion control that's another thing because we're in Sheboygan County what's the biggest plate of food I can get for the lowest cost double Cheboygan County double brats double hamburgers cheeseburgers all that stuff loaded up with a big pile of fries and you know one thing I noticed is cut down on the portions and don't go back like buffets don't go back for that second or third thing or just take smaller portions and be surprised how much right there exactly right that's exactly right that's the key to it anything is in moderation exactly too much of anything is not always good that's exactly right so what about some of the products that you see advertisements you know weight loss you know now life has eased out there and some of these oh take this and you'll drop 20 30 40 pounds sure sure you know does that stuff really help or is it just a gimmick or is there something to it but it's not going to be the quick silver bullet sure there's there for weight loss there there's you'll find for just about any physical disorder that ails a human you'll find a natural supplement that that has claims to make it better and and so with the weight loss that was specifically with weight loss there have it's been disappointing what we've seen out there the drugs that have been approved by the FDA have proven to be a bit dangerous and some have been taken off the market the present drugs that are approved by the FDA for treatment of weight loss are I never use them so that should give you an idea of how well I mean they may be a law for you 10 pounds of weight loss but you're gonna be paying $100 a month in the study show that the minute you stop the pill the 10 pounds comes back so you know they're that kind of the stuff that's out there that's approved is not great and the stuff that is that comes from the back of the magazine article or the stuff you might see in a commercial three in the morning if you're up that late watching something those kind of things as you might imagine don't work and for you can almost universally say that if these companies truly found something that actually led to weight loss you can bet they'd be getting the FDA approval because they'd be billionaires and they're not so the best way to do it is to use horse senses we discussed you know lose some weight eat eat reasonably take care of yourself and your blood pressure and your weight will go down and the same of course goes with supplements or blood pressure there are actually some interesting supplements potassium in certain patients seems to lower blood pressure and there are a few things out there that actually supplements that work for blood pressure lowering unfortunately when they they work they were talking three or four points off your blood pressure so instead of 143 or maybe 140 pretty modest something you might dink around with I suppose but that's not the real answer the real answer is you know that the obvious stuff losing weight exercise and and things like them watching your the good old-fashioned exactly the hard way the hard way that we were taught there is no magic bullet for whatever you're doing a silver bullet exactly so I know we've been kind of talking about it but what are some of the other things you might do to help treat my hypertension the main thing is is we tell people the way I approach it with my patients is if they have a blood pressure that's very mildly elevated I'll usually give them one cycle you know maybe I'm gonna see him back in four or six months and say you got you got four months you got six months to get your butt back in here and get your blood pressure under control you're you're not high enough that I'm nervous about it right here immediately I'm nervous about it for the next 30 years but I'm not nervous about it for the next four months get your button gear they come back and they're not under control I'll start them on some medication and still tell them to get their button gear the thing to remember is is if you treat your blood pressure aggressively early on and you keep your blood pressure low but you're not really listening to the other stuff your doctor's telling you but then 10 years later you retire I've had this happen many times the guy all the sudden is in a stress he starts exercising he's eating right he's losing weight and all the sudden that blood pressure comes down you've been on it for 10 years hey we will stop it you're more likely to be able to be off medicine long term if you start medicine early because it keeps those blood vessels again back to what we're talking about earlier healthy so aggressive early treatment is critical and if you fail to do your lifestyle stuff but later on you decide your gunner we can always take you off that pill if you start to behave you won't become dependent on it which a lot of what my patients think if I start a pill I'm gonna have to take this the rest of my life the actually the opposite is true so if your doctor tells you to take a pill take it and and also work on those lifestyle things and if your blood pressure is really really nice and low and you're doing better maybe we'll wean you back off of that if you're if you're doing well it all contributes to your quality of life there you go there you go that's stress has got well like we mentioned earlier stress and even you know today's fast-paced everybody's running wide open it's so stressful you got to do it now hurry up you know get this and right you know it's just it's winding us up more like a spring at some point it's got unwind he was good you pointed I mean we talked earlier about weight loss and salt and and cardiovascular fitness we did omit and stress when I was younger I I really didn't believe stress had much to do with high blood pressure until of course I became stressed and then you realize it has a lot to do with it one important thing to talk about with stress is it's important you try to minimize that in your life and but sometimes that's easier said than done but I do have a lot of patients who tell me that that the reason my blood pressure is high is because of the stressful situation maybe a loved one to sick you got a boss that's running you 70 hours a week and you don't you know you're a little too old to go get another job so you can't leave and you hear all these stories and and they're right that might be why their blood pressure is high but those people need to take their pills too so if it's high because of stress and you aren't going to get unstressed and normalize it take your pills you know and then maybe when you retire someday we'll be able to get you off of them excellent so with all that being said what's my goal where should I be on the measurement scale as far as blood pressure usually we have we've lowered that over the years when before I was practicing medicine the old saying what it was that it was a hundred plus your age so if you were 80 you're allowed to be a hundred and eighty if you were 50 you're allowed to be 150 if you're 30 130 we were learned that that was very bad advice very bad advice and then it got shifted to 150 over a hundred then 140 over 90 and now most recently 130 over 80 the reality is is that risk from high blood pressure probably starts somewhere around 125 over 75 when you get above that you start to get into a little bit higher risk do we treat people who are 128 over 78 with drugs no certainly we don't when they're in the 130 to 140 range over 80 to 90 we usually yell at them for a while maybe a half-year defense pun who your doctor is and if they aren't listening to you we'll start medicine if you if you can get down in that 130 140 range off medicine you behave and you get under control you can avoid taking pills but 130 over 80 is the goal for the vast majority of people there are certain special patients where we'll run their blood pressure is very low because of heart conditions and other things but for the general population a good goal is to be less than 130 over 80 I know to talk about the other extreme my wife her blood pressure on an average day is like 80 over 50 yes really low yeah sure you know she goes in and they try and get her blood pressure up actually it's tell them right out that's not gonna work or when I a couple times we had a because of her conditions or whatever we went in they said oh my god the blood pressure it's normal don't worry about it try and bring it up you don't have to do it it's normal it's like she baffles just about every doctor that Caesar sure sure there's a lot of patients who walk around with low blood pressure we have a lot of them in our clinic my wife happens to have the same thing and the vast majority of those patients are physically fine in fact their risk for heart attack and stroke is lower than that of the average person because by virtue that low blood pressure as long as the patients not having symptoms from it they're not passing out and getting lightheaded and feeling weak and you think that this is for lack of a better term the way God made them don't get in the way of that just step out of the way and tell them good for you you got a good nice low blood pressure a very small number of those people have some other disorder that's leading to a lot of pressure of course you got to go treat that and figure that out but most of them come in say they're feeling fine they're 85 over 45 so good for you yeah and you don't worry about it too much excellent any other closing comments or advice about hypertension we've got about a minute or so left so sure the main thing that you want to do is is is get screened go to your go to your clinic at work if you have one go to your doctor to get screened there's many places to have your blood pressure checked go ahead and get yourself checked if it's high don't bury your head in the sand about it go go get treated for it work on your lifestyle modifications if your doctor tells you to take a pill take it it's one of the most effective things you can do to improve your quality of life so make sure that you get screened and make sure you get to go and then again the goal to repeat that's 130 over 80 so you get to goal you should be good to go okay this concludes our show on hypertension and Dr. Johnson I'd like to thank you for sharing your vast amount of knowledge on hypertension and going over the subject so if anybody has any subjects they would like us to cover discuss you know for future programs please let us know you can get on our website at www.wscsheboygan.com thank you again for watching quality of life I'm Dave Augustine