Hypertension: Risk Factor for Cardiovascular Disease
Guest: Dr. Perry Halushka – College of Graduate Studies
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Perry Halushka who is Professor of Pharmacology and Medicine at the Medical University of South Carolina and a noted expert in the field of hypertension. Dr. Halushka, I think people have a vague notion that if you have hypertension, or high blood pressure, it’s important to get it treated. But can you explain exactly why it’s so important?
Dr. Perry Halushka: Yes, Linda. What we have learned over the years is that if you successfully lower people’s blood pressure, their risk of cardiovascular disease, particularly heart attacks and strokes, decreases significantly. We also know that people that have multiple risk factors benefit even more so by aggressively lowering their blood pressure.
We’re talking about getting blood pressures down in the 120-130 systolic range. As you may recall, for many years we said any blood pressure above 140/90 is considered hypertensive. So physicians, in the beginning, would try to get the blood pressure just below 140/90 and feel that was a successful treatment. Today, we feel that, in most cases, we should try to lower it even more so.
Dr. Linda Austin: Now, you use a word that people may not be familiar with, systolic. Maybe we should stop and explain what those two numbers are. If one says a normal blood pressure is 120, which is the systolic, what does that 120 really mean?
Dr. Perry Halushka: That’s a good question. When the heart contracts and pushes blood out against the blood vessels, it creates the systolic blood pressure, or the higher blood pressure. Then, when the heart is relaxing and the blood is flowing through the blood vessels, that’s what we call the diastolic blood pressure, and that’s the lower reading. So systolic and diastolic are the two readings that you’ll always see in the physician’s office.
Dr. Linda Austin: So, in other words then, the systolic, the high number, is the highest the pressure ever is within the arteries, or the tubes going out of the heart, and the diastolic is the lower number, meaning, that’s the kind of baseline, that it’s always at that level, right?
Dr. Perry Halushka: Yes, that’s correct. One of the interesting things though, as people get older, the systolic blood pressure tends to rise a lot more than the diastolic blood pressure. And so, actually, we have one particular diagnostic category, called systolic hypertension, which, again, occurs more often in the elderly and that, too, we find, should be aggressively treated. Although, sometimes, we cannot lower the blood pressure down to the levels we talked about earlier because the patient often cannot tolerate the 120 blood pressures, for example.
Dr. Linda Austin: The high number, the systolic?
Dr. Perry Halushka: The high number, yes.
Dr. Linda Austin: Okay. So you’re saying that the high number goes even higher as you get older?
Dr. Perry Halushka: Correct.
Dr. Linda Austin: And that can be hard to treat.
Dr. Perry Halushka: Yes.
Dr. Linda Austin: So then, at what level of elevation does one have to get treated? I mean, 135, for example, 130/90? What do you recommend?
Dr. Perry Halushka: Well, there are two ways to look at it. Number one is, over 140/90 for most people is considered hypertensive and definitely should be treated. If it was 140/90 in a, let’s say, a 70 or 80-year-old person, we probably would say that’s fine. On the other hand, 140/90 in a young person, we would aggressively treat because we know that, again, we can reduce cardiovascular risk significantly.
If somebody has other cardiovascular risk factors, such as diabetes, obesity, smoking, male subject, kidney disease, in that setting, 140/90, just below that, would not be considered sufficient and we would try, actually, to get blood pressures down in the 120/70 range.
The nice thing about therapy today is that drugs are extremely effective with very few side effects. And we now have what we call long-term outcome data to show that people truly benefit from the newer classes of antihypertensive drugs.
Dr. Linda Austin: And yet, a lot of people are still reluctant to get their hypertension treated. Why is that?
Dr. Perry Halushka: Well, I think, probably, the number one reason is that they’re
scared of the side effects. But what I can assure you is that the side effects are few, minimal and, invariably, if somebody does experience a side effect, we have another drug that we can use that would be equally effective.
I have been around for a long time and one of the nicest things about treating high blood pressure now is that the drugs, as I said, are very safe, very effective and
rarely do you see a significant side effect.
Dr. Linda Austin: Don’t you think part of the problem, also, though is that low levels, or even moderate levels, of hypertension don’t really cause a symptom, so you don’t really feel it?
Dr. Perry Halushka: That is correct. In fact, we, in the field, call it the symptomous disease because rarely, if ever, does high blood pressure cause a significant symptom. And when it does, it’s usually in the accelerated, or malignant, phase. So, for example, people think that if you don’t have a headache, you don’t have high blood pressure. Well, that’s not true. On the other hand, you could have very high blood pressure and not have a headache and people would say, well, I, obviously, don’t have high blood pressure because I don’t have a headache. Those two things don’t go hand in hand unless somebody has really severe elevations in blood pressure, and then they’ll have a characteristic headache in the back of their neck.
Dr. Linda Austin: I’m sure you talk with patients who say, Doc, isn’t there something I can do myself, my lifestyle, what I eat, to bring down my blood pressure? How do you respond to that?
Dr. Perry Halushka: Well, I respond positively to that. Indeed, any algorithm that you see published today about treating people with high blood pressure starts with lifestyle modifications, exercise, for one thing, weight loss, if somebody is overweight and salt restriction. Now, salt restriction is a little bit controversial because not everybody is what we call salt sensitive. How do we know? The only way we know is by restricting somebody’s salt intake and seeing if that does, indeed, lower the blood pressure.
But if you lose weight, there are studies to show that your systolic blood pressure, in particular, can drop 10-15 mmHg. Without a major weight loss, sodium restriction in those people that are salt sensitive, again, you can see a 5-10 mmHg drop in blood pressure. You start adding those up with lifestyle modification and you may need fewer medicines in the long run.
Dr. Linda Austin: What kind of exercise do you recommend?
Dr. Perry Halushka: Well, we recommend aerobic exercise, things like bicycle riding, getting on a treadmill, swimming, running. Those are the kinds of things that, first of all, tend to lower blood pressure. They’re healthy. What we don’t recommend is weightlifting per se. In fact, there are studies that show pure weightlifters often have an elevation in blood pressure. So, aerobic exercise is what we recommend.
Dr. Linda Austin: How about walking?
Dr. Perry Halushka: Walking is good too. Brisk walking is even better. I like to tell patients when they say, well, if I walk, will I lose weight, you won’t necessarily lose weight from walking, but I point out to them, if you walk, you can’t carry the refrigerator with you. So there’s a good chance, if you’re a snacker and you go out walking when you’re used to taking a snack, maybe you can lose weight that way alone.
Dr. Linda Austin: Dr. Halushka, let’s talk about medications in another podcast. Thanks so much.
Dr. Perry Halushka: You’re welcome.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.