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When to Worry About Your Blood Pressure with Dr. Marc Eisenberg

A cardiologist shares the basics of blood pressure and cholesterol, how to manage both, and how important exercise and diet are in relation to heart health.

February is American Heart Month. When’s the last time you measured your blood pressure? Do you know what “good” blood pressure even is? Or what about “good” cholesterol? Brush up on the fundamentals – and get some clear guidelines for keeping tabs on your heart health – from Dr. Marc Eisenberg, a cardiologist from NewYork-Presbyterian and Columbia.

Episode Transcript

Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

February marks American Heart Month, a perfect opportunity to have a heart to heart discussion about one of our most vital organs. This episode focuses in on blood pressure and cholesterol.

What are the risks of having high blood pressure? What about cholesterol? And what does cholesterol even look like? 

Cardiologist Dr. Marc Eisenberg from NewYork-Presbyterian and Columbia, joins me to discuss how individuals can manage their blood pressure and cholesterol levels, and what all those numbers tell us.

Faith: Dr. Mark Eisenberg, happy Heart Month.

Dr. Eisenberg: You too.

Faith: Thank you for being here

Dr. Eisenberg: Anytime.

Faith: We’re here today to talk about and understand a little better, maybe even bust some myths, about blood pressure and cholesterol. So, can we start with blood pressure? Will you define it and tell us why it’s important?

Dr. Eisenberg: So blood pressure is made up of two numbers. There’s the top number, which is called the systolic blood pressure. And there’s the bottom number, which is called the diastolic blood pressure.

The top number, the systolic blood pressure, is a number of the arteries in your body see – the pressure it sees – when the heart’s contracting. The bottom number, the diastolic blood pressure, is the pressure the body sees when the heart’s relaxing.

Faith: Should we kind of remember our numbers?

Dr. Eisenberg: Exactly. You should remember your numbers and actually it’s good for you to jot down the numbers so you at least can follow it throughout the years. 

So what are normal numbers? So, normal blood pressure is 120, the top number, over 80, the bottom number, or less. So you really want to be 120 over 80 or below. The American Heart Association and the American College of Cardiology came up with guidelines and they said normal blood pressures below 120 over 80 and actually, they came up with a whole new category, so that people with elevated blood pressure, in fact in the 120s, should start to be concerned. Okay. That actually, just don’t say, ‘Oh, I’ll see you in about three years.’ They should actually be followed. 

And the definition of hypertension– which is known as high blood pressure–Hypertension is high blood pressure, is when the numbers are 130 over 80 or above.

Faith: You said people should have it monitored regularly. What does that mean? Not many of us have one of those blood pressure cuffs in our home.

Dr. Eisenberg: One in two people, it looks like, has a monitor on their wrist that tells them what their heart rate is or tells them their sleep cycle. The truth is probably the most important number that you should be concerned about is actually your blood pressure, which almost none of these devices do.

How often do you need to get it checked? Well, you know, not that often if your blood pressure is normal. You know, I think for young people if you go to a doctor and your blood pressure is good, once a year is good enough, but if it starts to ever be elevated, then you should be followed more frequently.

Faith: Would you know if your blood pressure was high without a reading? Like, what are the symptoms?

Dr. Eisenberg: The problem with high blood pressure is people feel fine. In fact, you know It’s called “the silent killer” because people can go on with high blood pressure for 20, 30 years without even knowing they have high blood pressure.

One in four adults between the ages of 20 and 44 actually are walking around with high blood pressure and the problem is they feel fine. So you have one in two adults walking around not even knowing they have high blood pressure and the 50 percent that know it, only 25 percent of them are actually really at goal.

Faith: You just said something really interesting to me, which is that people can walk around with high blood pressure for 20 or 30 years and not really know it. So I gotta ask, well then, what’s the big deal?

Dr. Eisenberg: Well, if you went to a dialysis unit and you saw, like, 30 people having to come for dialysis every three days or every two days, it is a big deal.

Faith: So you’re saying, you may not see the impact now, but you might down the road.

Dr. Eisenberg: Absolutely. People who are walking around with high numbers, whether it’s the top number or the bottom number, they’re at increased risk of a whole slew of medical problems, including heart failure, kidney failure, blockages in your legs, blockages in your heart, strokes, blindness, sexual dysfunction. 

Faith: What causes high blood pressure?

Dr. Eisenberg: What really causes it – it’s genetic. Most people with high blood pressure, like 95 percent of people have high blood pressures, you got it from somebody in your family.

There are some other causes of high blood pressure, uh, which can be due to, like, thyroid abnormalities or blockages in one of the arteries to the kidneys, or blockages in the aorta that rarely happen, and they tend to happen more in younger people. So anytime, like, someone in their 20s has high blood pressure, anytime someone with high blood pressure doesn’t even have a family history, you try to look for what they call secondary causes.

And as people get older, all the arteries, all the vessels in your body get stiffer. You know, imagine like a balloon that’s hard to blow up, you know, you have to keep blowing it. Basically, you know, due to calcification, all your vessels get stiffer as you get older, and that basically contributes to people having high blood pressure.

We might all have susceptibility to having high blood pressure, but if you let yourself go, you’re going to have high blood pressure. But limiting alcohol intake – once you go over like one to two drinks a day, your blood pressure is going to go out of control. If you actually cut back on the alcohol, you know, watch your diet, and exercise every day, you might never get to the point of needing blood pressure medication. So the ball actually is in your court.

Faith: I’ve heard this term white coat hypertension?

Dr. Eisenberg: So that’s actually brilliant you brought that up.

Faith: You’re wearing a white coat, by the way, so I’m gonna listen to you.

Dr. Eisenberg: Yes. And anytime I go to the doctor, my blood pressure is out of control. So even doctors have white coat hypertension. 

Faith: Really?

Dr. Eisenberg:  Yeah. So anytime somebody actually goes to a doctor’s office, the likelihood is their blood pressure might be much higher than it normally is. You’re actually supposed to do your blood pressure, have your blood pressure checked after sitting relaxed in a room for like three to five minutes. So let’s say you run to a doctor’s office, you’re late, you just dealt with the subway, or your car, like, had problems, and you’re running late, they throw you in a room, put a cuff on you, and take your blood pressure right away, it might actually be high.

And then if they take – took it again like five minutes later, it might actually be much lower. So they’re supposed to let you relax for five minutes, and then take your blood pressure to get an accurate reading. 

Faith: Gosh, I’ve learned so much. Number one, silent killer. If you’re not thinking about it and you haven’t checked, you better go check and take steps now by looking at your lifestyle, walk more, less salt, less alcohol.

Dr. Eisenberg: Exactly. Very interestingly, if you lose five pounds, they’ve been shown losing five to ten pounds might actually drop your blood pressure equivalent to being on a whole medication.

Faith: Holy smokes!

Dr. Eisenberg: So let’s say somebody is on two blood pressure medications, which a lot of people are with high blood pressure. If they got five to ten pounds off, they might be able to drop it to one medication. And if they got another five to ten pounds, they might actually be off all medications.

Faith: So when is medication advised?

Dr. Eisenberg: Medication is advised when you actually have documented high blood pressure with lifestyle changes that you’re able to do and you still have high blood pressure, then medication is great. And you should be on medication because being on medication clearly reduces the risk of all the outcomes from having high blood pressure including stroke, heart attack, heart failure, kidney failure. You know, so definitely blood pressure medications are great now.

There’s about four to five classes of blood pressure medications that are used routinely. There’s diuretics, there’s beta blockers, there’s calcium channel blockers, there’s what’s called ACE inhibitors or ARBs. There’s definitely different, you know, blood pressure medications that are out there and a good doctor or nurse tailors it to each individual problem.

For instance, if you’re somebody who actually has leg swelling, you know, a lot of people have leg swelling, they eat too much salt, their legs are swollen by the end of the day and their blood pressure is high. Being on a low dose of a diuretic might actually get rid of the leg swelling and get your blood pressure under control.

You know, a lot of people who have migraines, it turns out a lot of the migraine medications are actually blood pressure medications. So you might actually go on a blood pressure medication that might prevent migraines and you might actually have no migraines in the future and your blood pressure will get under control.

Faith: Okay, I, thanks to you, I feel like I have a very good handle on blood pressure, so, let’s move on to cholesterol. 

Dr. Eisenberg: Cholesterol.

Faith: What is cholesterol? What does it, what does it literally look like?

Dr. Eisenberg: Oh, like fat globs circulating in your body. Look, cholesterol is actually the precursor to hormones, you know, so I mean, we need cholesterol. 

Faith: Really?

Dr. Eisenberg: Yeah. So there’s cholesterol, but we talk about cholesterol and heart attack and stroke risk, what we look at is the cholesterol numbers that the body has. So cholesterol is made up of three numbers, okay? The triglycerides, the HDL and the LDL.

And everyone concentrates on the HDL and the LDL, which they should. And nobody really knows which is which. So HDL is the high density lipoproteins and the LDL is the low density lipoproteins. But if you really want to remember – HDL, H for healthy high density lipoprotein. H for healthy is the good cholesterol. 

LDL. Lousy, L for lousy, low density lipoprotein is the bad cholesterol. 

So the HDL is the good cholesterol. We actually want good cholesterol. Okay. So HDL, what number should people hope for? So men should hope for 40 and above. And women should hope for 50 and above.

Faith: Is there a ceiling to how high your good cholesterol can get?

Dr. Eisenberg: That’s actually a brilliant question, and I’m now going to confuse people. There’s some data that’s coming out, which is a little freaky for all of us who’ve been telling people – it can never be too high the HDL – that actually some people with the HDL higher than 100 could actually predispose you to memory problems.

The jury’s still out about HDL being too high, but in general, you really want men above 40 and women above 50. Or if you actually want to say something that’s more important, men below an HDL of 40 and women below an HDL of 50 are at high risk of heart attacks and strokes. So looked at the other way, low HDL puts you at a very large risk of having an event.

Faith: How exactly is this measured?

Dr. Eisenberg: It’s actually just measured at the lab.

Faith: So it’s a blood draw.

Dr. Eisenberg: It’s a blood draw.

Faith: Is it important to fast before getting your blood drawn?

Dr. Eisenberg: For a select group of people, fasting gives you more accurate numbers for – but for most people, if you don’t fast, it’s still probably giving you accurate numbers. The other number involved – remember the total cholesterol is made up of three numbers: the HDL, LDL, but also the triglycerides. 

So the problem is in some people, they’re very sensitive to triglycerides. What happens if they eat beforehand, the triglycerides could be falsely high which actually through the calculation makes your HDL cholesterol falsely low. I mean you could have coffee, you could have tea in the morning, but in general, try not to eat before your blood tests.

Faith: How is cholesterol related to heart health?

Dr. Eisenberg: When your cholesterol is high, it gets built up in all the vessels. So if blood is not able to get through vessels, you know, imagine your shower, you turn on the water and nothing’s coming out, ‘cause none of the water’s going through because now all the pipes have gook all over the walls.

If your cholesterol is really, really high, besides that, the fact that it makes your vessels, it makes them smaller by, like, causing wall buildup and like the blood flow can’t go through, they also, some of these, like, buildup in the walls can fling off and cause a heart attack or a stroke.

Faith: What factors contribute to high cholesterol?

Dr. Eisenberg: Oh, a lot of factors. So, diets that are high in saturated fats, including cheese, you know, whole milk, the, you know, ice cream, potato chips, could really raise your cholesterol.

Faith: Not exercising…?

Dr. Eisenberg: Exercise can definitely lower your cholesterol. So for people with high cholesterol, exercising will clearly get your HDL or good cholesterol higher, and it will get your LDL or bad cholesterol lower. You know, heart attacks and strokes are about inflammation when it comes down to it. It’s about thrombosis, which is clotting and inflammation. So, exercise reduces inflammation in your body, which actually will get these numbers better.

Faith: The only cholesterol medication I’ve ever heard of is a statin. What do they do?

Dr. Eisenberg: Statins, besides lowering your cholesterol, they stabilize all the plaques in the walls of your vessels so they don’t fling off and cause heart attacks and strokes. They’re anti-plaque. They stabilize plaque so they don’t fling off, causing problems. 

So besides lowering your cholesterol, they decrease your risk of heart attacks and strokes by like 30 to 40%, even if they don’t lower your cholesterol much, by stabilizing plaques in your body. I mean, there’s a lot of benefits from statins.

Faith: Are there any downsides?

Dr. Eisenberg: One percent of people, they have muscle pain from the statin, which is reversible. So if you all of a sudden start a medication, you realize your thighs hurt when you stand up or something like that, then you stop the statin. And within five days, the muscle pain should go away. It’s reversible. 

Faith: Before we wrap up – Are there any other specific tips related to cholesterol or blood pressure that you want us to know?

Dr. Eisenberg: Anyone walking fast or the equivalent, 40 minutes, five days a week, just doing that, walking fast five days a week for at least 40 minutes is probably better than anything a doctor will ever do for you. You decrease your risk of heart attacks, strokes, having high blood pressure, bad cholesterol, leg clots, a whole slew of problems, including even depression and anxiety. It changes around serotonin levels in your head.

Now that being said for you, all of you are actually being good and exercising, if you start to have symptoms of shortness of breath, chest pain, dizziness, or blacking out, stop exercising and go to a doctor or an emergency room. Okay? Exercise is great for the majority of people, but actually, if you have actually a heart problem and you don’t know about it, it could unmask it.

I think it’s great that people are active or proactive in their care. So again, I think the majority of people who have, like, these watches out there or these rings that tell you your sleep cycle, your heart rate, all this other stuff, that’s wonderful. But at least if you’re already going to be that concerned about your health, be concerned about the things that really do also matter, including your blood pressure and including your cholesterol.

Most people, young people only really need to have their cholesterol checked once a year, unless it’s high and then you’re going to monitor it. For people, it’s always good to have a blood pressure machine in your house and you shouldn’t spend more than 40 or 50 dollars. A lot of insurance companies might actually pay for it. And it’s not unreasonable to take your blood pressure every few weeks and see how it is. It’s actually very helpful. Everyone should have it at home.

Faith: It’s heart month, so get somebody you love a blood pressure cuff.

Dr. Eisenberg: I agree!

Faith: I learned a lot. Thank you so much for joining us, Dr. Eisenberg.

Dr. Eisenberg: Thanks for having me.

Faith: Our many thanks to Dr. Marc Eisenberg. I’m Faith Salie.

Health Matters is a production of NewYork-Presbyterian.

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