Vital Signs Volume 9, Issue 3 | Page 3

What leads you to diagnose a patient as ha ving hypertension? “If someone has a borderline or mildly elevated blood pressure, we don’t immediately label them with hypertension. Pain and anxiety can cause blood pressure to go up temporarily. We usually require three measurements in as relaxed a setting as can be before we label someone with hypertension.” What are some common misconceptions about high blood pressure? “Some of my patients are shocked to hear that the heart does not control blood pressure. It’s normally an innocent bystander. The first stage of uncontrolled hypertension will lead to a thickening of the heart muscle wall. If it remains uncontrolled, the heart muscle will then start to fail. It will become weak and dilated. On a longer timeline, untreated long-term hypertension can lead to terminal heart failure. The kidneys do a lot of things to control blood pressure. So does the adrenal gland, the sympathetic nervous system, the brain – the heart takes a step behind these. It controls the pumping function, but blood pressure is much more complex than that.” What can patients do on their own to fight against hypertension? “The first thing we recommend is diet and exercise. We try to set a reasonable goal for weight loss. If a patient is morbidly obese, and we say, ‘We want you to lose 80 pounds per year,’ that’s not realistic. We tell them to start by losing a pound per month. If they lose more, great. Americans are greatly affected by inactivity, by sitting around. We encourage moderate activity. The American Heart Association has some guidelines for reducing the risk of heart disease. They suggest 40 minutes, three times per week of moderate intensity exercise. This can be things such as walking at a rapid pace, swimming or bicycling. Someone doesn’t need to spend a lot of money and join a gym, or buy a $1,000 treadmill they’ll hang clothes on. They really just need to get out and walk. Activity is key. We also encourage salt restrictions. In general, it’s a good idea to try not to add salt to your food or even consider a no salt diet. It doesn’t benefit all patients the same way, but it’s definitely something we suggest.” Barring dietary failings, how does hypertension come about? “The most common cause of high blood pressure is genetic or hereditary. We call that Essential Hypertension, meaning there’s no other cause. This is the type of hypertension developed in middle age. A mother or father or both may have had it. There’s a family history. The vast majority of people will have that kind of hypertension, and in that case we try to focus on healthy lifestyle and medication. If a patient does very well with her lifestyle, she may be able to avoid medications. If a morbidly obese person gets down VITAL SIGNS Volume 9 • Issue 3 to ideal body weight, we may be able to actually cure some hypertension altogether. The other type of hypertension is known as Secondary Hypertension. This is much rarer and comes about due to some other cause such as a blocked kidney artery or a benign adrenal gland tumor. There are several rare conditions that might be present, but most individuals don’t need too much specialized testing.” Has the role of treating these issues changed? “Treating hypertension has changed in the sense that we have so many more different medicines than we used to. We had just a few when I began treating patients, but nowadays physicians have multiple categories of medicine. We really do have a much better armament to treat hypertension.” Are there symptoms a person may experience with hypertension? “There isn’t really one specific symptom. Some people get a headache. They feel nervous or anxious. However, anyone can walk into a supermarket, the mall or a fire station and have their blood pressure checked. It’s not as accurate as having a doctor do it, but it’s a good start. Then, as people arrive at middle age, they should have a physical with a doctor at least once each year. Women go in once per year to their OB/GYN, and typically they get their blood pressure checked. Therefore, women get centered into a health environment at an earlier age then men. A young male with symptoms might not get diagnosed right away.” What are your most important goals for patient health in the future? “I want to try and focus more on preventative cardiology. I’ve visited several groups around Louisville to speak about preventative measures and try to help identify people at risk. We have a coronary calcium test which may be helpful in select cases. Equally, if not more important is to try to get people who are at risk to not smoke tobacco, to keep their cholesterol checked yearly and to address it if it gets too high. I’ve spent the first 20+ years of my career taking care of people with massive heart attacks, damaged heart muscles, plugged up arteries, you name it. It’s rewarding to help someone through those times, but then I started to think ‘why patch up the holes?’ Why not avoid the holes in the first place?” What positive trends ha ve you noticed regarding patient health? “One is that the incidence of fatal heart attacks has gone down. The public is more aware and there’s so much more we can do if we get to the patient quickly. I also think the general population is being smarter about not ignoring symptoms. It’s still the #1 health problem, but people are dying of heart problems at a later age with less impairment because of the strides which have been made over the last 30 years.” 3