Hi Dr. Barrett, great article, love the very practical guidance.
What do you think about the impact of inadequate sunlight, as Americans spend >90% of their time indoors. My understanding is the NO response in the skin to sunlight is blood pressure lowering.
Thanks. It’s not an area I know a lot about but from memory I recall that even very low dose sun light can stimulate that response. If I had to bet however I suspect exercise provides substantially more NO release and potential for BP lowering.
As always, a great read. An ideal blood pressure goal is quite important and depending on how far away someone is from their ideal goal every little thing they can do can add up to make a huge difference. For some, at some point, medications are necessary. These days, there are quite a few safe medications to choose from but of course convincing someone of taking a medication life-long isn't easy. In my practice, I've found stress to be a huge factor in elevated BP, preceded by only family history.
Hi Dr Barrett, as an aspiring cardiologist this is probably one of the most important article I have read, as well as the article where you mentioned the key 3 trials (I believe the ESPRIT trial has published the full paper recently!).
As you pointed out rightly, we can’t manage what we don’t know, and I suspect most adults are not measuring their blood pressure at home for 10 days unless they were found to potentially have hypertension in a doctor’s visit.
This surely means a significant population could have been diagnosed earlier and thus managed earlier if we could encourage the public to do the protocols you have suggested. What strategies do you think we could implement to raise public awareness on a larger scale?
There is a relationship based on lots of different physiological factors but in general just because you have high a diagnosis of high blood pressure does not mean you will auto my have a high heart rate and vice versa.
What are the harms related to low blood pressure? I was surprised when my doctor mentioned that low blood pressure can damage brain cells. Is that true, how low a BP is worrisome, and are there other concerns related to low BP? Tx!
Any recommendation for a blood pressure measurement device? I'm not sure which are good, which has kept me from doing this.
By the way, when I've mentioned at the doc's ofc that we're not going to be able to get a useful reading (like, stop peppering me with questions 🤦🏻♀️) I get looked at like I'm an alien 👽
My general recommendation is any upper arm based cuff and not a wrist based device. Omron is a good brand but no need to go for a very expensive monitor. Even borrow one.
Great post. Another fact I would love to include as part of your statistic is the fact that 1 in 25 children in the United States between the ages of 12 and 19 have high blood pressure or hypertension. Our kids are starting to practice at a very young age how to prepare for vascular dementia, cardiovascular accidents, kidney failure, vascular resistance, and stroke even before they become adults. That is a wonderful insight, and I will surely reference your book.
If blood pressure is consistently normal or better when at the doctor, despite the white coat syndrome, is there still a reason to test at home as described in the article? My last two readings were 102/52 and 98/61. My assumption was that if it is good at the doc, it’ll probably be good at home so I don’t have own a BP monitor.
When i visit my doctor my blood pressure is always high she made me take my blood pressure at home for 10 days At home it ranges from 134/75 to 110/70. At the doctor even after i try to relax it is 156/75 My doctor call it the white coat syndrome.
Hi Dr. Barrett, great article, love the very practical guidance.
What do you think about the impact of inadequate sunlight, as Americans spend >90% of their time indoors. My understanding is the NO response in the skin to sunlight is blood pressure lowering.
Thanks. It’s not an area I know a lot about but from memory I recall that even very low dose sun light can stimulate that response. If I had to bet however I suspect exercise provides substantially more NO release and potential for BP lowering.
As always, a great read. An ideal blood pressure goal is quite important and depending on how far away someone is from their ideal goal every little thing they can do can add up to make a huge difference. For some, at some point, medications are necessary. These days, there are quite a few safe medications to choose from but of course convincing someone of taking a medication life-long isn't easy. In my practice, I've found stress to be a huge factor in elevated BP, preceded by only family history.
Stress is a huge driver but thankfully at least it’s modifiable.
Hi Dr Barrett, as an aspiring cardiologist this is probably one of the most important article I have read, as well as the article where you mentioned the key 3 trials (I believe the ESPRIT trial has published the full paper recently!).
As you pointed out rightly, we can’t manage what we don’t know, and I suspect most adults are not measuring their blood pressure at home for 10 days unless they were found to potentially have hypertension in a doctor’s visit.
This surely means a significant population could have been diagnosed earlier and thus managed earlier if we could encourage the public to do the protocols you have suggested. What strategies do you think we could implement to raise public awareness on a larger scale?
Sounds like a good job for an aspiring cardiologist;)
What is the relationship of blood pressure to pulse rate, if any.
There is a relationship based on lots of different physiological factors but in general just because you have high a diagnosis of high blood pressure does not mean you will auto my have a high heart rate and vice versa.
What are the harms related to low blood pressure? I was surprised when my doctor mentioned that low blood pressure can damage brain cells. Is that true, how low a BP is worrisome, and are there other concerns related to low BP? Tx!
Blood pressure that is too low can cause dizziness or fainting which can lead to other problems. Something we want to avoid.
I was surprised by the instruction to take three readings and discard the first. Can you explain why?
Any recommendation for a blood pressure measurement device? I'm not sure which are good, which has kept me from doing this.
By the way, when I've mentioned at the doc's ofc that we're not going to be able to get a useful reading (like, stop peppering me with questions 🤦🏻♀️) I get looked at like I'm an alien 👽
My general recommendation is any upper arm based cuff and not a wrist based device. Omron is a good brand but no need to go for a very expensive monitor. Even borrow one.
Great post. Another fact I would love to include as part of your statistic is the fact that 1 in 25 children in the United States between the ages of 12 and 19 have high blood pressure or hypertension. Our kids are starting to practice at a very young age how to prepare for vascular dementia, cardiovascular accidents, kidney failure, vascular resistance, and stroke even before they become adults. That is a wonderful insight, and I will surely reference your book.
A very sad fact but also a tremendous opportunity.
Sad indeed. Thanks for your response
If blood pressure is consistently normal or better when at the doctor, despite the white coat syndrome, is there still a reason to test at home as described in the article? My last two readings were 102/52 and 98/61. My assumption was that if it is good at the doc, it’ll probably be good at home so I don’t have own a BP monitor.
Reasonable assumption and likely correct but when it comes to blood pressure I’m with the KGB “Trust. But verify.”
When i visit my doctor my blood pressure is always high she made me take my blood pressure at home for 10 days At home it ranges from 134/75 to 110/70. At the doctor even after i try to relax it is 156/75 My doctor call it the white coat syndrome.
Blood pressure measurements in a doctors office are in general as close to useless as makes no difference when trying to diagnose high blood pressure