Patient Care, Where Every Heart Truly Matters.
Patient Care, Where Every Heart Truly Matters.
This is the third and the last article in the series of why, what and how of blood pressure.
My practice has a large percentage of couples. During their clinic visit, the couples may not chose to share the same exam room with each other but generally share many of the same diseases. So when the Taylors requested a same day and same time appointment, it surprised me. Talking to them, later in the exam room, it was apparent that the Taylors were committed to their new year's resolution of improving their outcomes with high blood pressure.
We start with non-medical strategies to achieve their new year's resolution. Maria Taylor chips in, "Doctor, you recommend 30 minutes of physical activity five times a week and I can easily do it in the morning once the kids are off to school. However, George snores all night long which renders me sleepless and groggy in the morning with no desire to exercise." Here George interjects "Really? Do I really snore heavily?"
Snoring is no longer just a cause for divorce. Snoring and other altered breathing patterns during sleep have been associated with increased risk of heart problems including irregular heartbeat, high blood pressure, stroke and even sudden death. Just as exercise drops the blood pressure by 4-9 points, treatment for sleep disorders also helps with improving blood pressure readings.
"Healthy eating is such a cliche and it certainly does not help me with my grocery shopping" says Maria. "Is there a better cheat sheet to use for meal planning?" she adds. I can understand the frustration in her voice.
Nutrition is a vital part for both prevention and treatment of high blood pressure. Meal planning should comprise of mindful and dedicated reduction in saturated fats, sugars and cholesterol rich food. At the same time, incorporating fruits, nuts, whole grains and vegetables would drop the blood pressure by 8-14 points.
I go on to tell the couple "Pizza and cheese are the major sources of saturated fats at our dining table." Meal planning with two days of vegan dishes would go a long way in favorable outcomes with blood pressure. And the best way to plan or consume a vegan diet is to hold or look at the food always ask yourself "Did this food ever have a mama?" If the answer is yes, it is not vegan. Maria says "That will be easy. With George being a Cuban American, we eat beans three to four times a week." "That is great" I say and add "as long as the beans are not eaten with sour cream." With a twinkle in her eye, Maria says "I get it! Sour cream comes from a mama and so I will be careful."
George complains that salt prudence or salt restriction are general terms and wishes for some precise guidance. An easy way to remember is one-quarter of a teaspoonful is equal to 600mg. An intake of 2,400mg is a good target which means that the total salt intake of both cooked and un-cooked food should not exceed one teaspoon! "Wow! I never knew this fact" says Maria. Adhering to salt intake of one teaspoon or less can drop the blood pressure by 4-8 points.
I remind both Maria and George that their weight loss is going to help them lower their blood pressure also. George asks "When and what kind of results are we looking at?" I inform him for every 20 pounds of weight loss, the blood pressure drops by 7-20 points.
Anxiety at work, home or in any interpersonal relationship adversely affects the blood pressure. Utilizing stress busters like yoga, breathing exercises and acupuncture if supervised by a physician also drops the blood pressure by 5 points.
"I am no champagne George but I would still like to know the alcohol limits and its impact on blood pressure" asks George. As long as the alcohol intake is restricted to no more than 7 drinks a week the drop in blood pressure is 2-4 points.
Maria has been a winner so far with a complete interdiction of tobacco for the past 8 months. I informed her that her cessation will help drop her blood pressure by 3-5 points.
Our clinic visit is coming to an end. I am summarizing the various interventions including exercise, salt, alcohol, diet, weight reduction and stress busters and their effect on blood pressure. "By profession, I am an accountant” George adds "I have summed all the points and to me it looks like by Halloween of this year, I would drop my blood pressure by 33-45 points. Maria smiles and gives him a high five and says "Me too!"
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