Do you know what your blood pressure is?

High blood pressure (BP) damages arteries, hearts, brains and kidneys and does so while causing zero symptoms before the final blow. This is why high BP has earned the reputation of a silent killer. So how would you know if your BP is high if you don’t monitor it? The answer is simply that you wouldn’t.

High BP (defined as a BP higher than 130/80) affects two out of five US adults; it is even more common among African-Americans or those with a first degree relative with high BP.  As high BP is so common and usually causes no symptoms in the early stages, it’s important to monitor it on a frequent basis so that we can detect a BP problem as early as possible. It is worthwhile spending the 50 or so USD on a reliable automatic digital BP machine and learn to take it ourselves. We can ask our primary care physician or her/his nurse to help us and guide us so that we do it right (it is so easy to overestimate your BP if you do not follow the proper instructions). 

We are never too young to start monitor our BP. Even children can have a high BP (BP is considered high in children at even lower levels than the 130/80 threshold for adults). In our 20s we should monitor our BP every 3-6 months. Once we hit our 30s, especially if we are overweight (or have a positive family history for high BP), it is a good idea to monitor it monthly. For those who already have a high BP diagnosis, BP must be monitored once a week or even more frequently if the doctor suggests so. Not being aware of high BP can cost us dearly: even a few months spent with undiagnosed high BP can contribute to kidney failure, stroke or heart attack later in life. Self-monitoring our BP is one of the most palpable ways to show that we care about our health and accept responsibility for what happens to it. Know that as we get older, eat too much sodium or not enough potassium (meaning that we don’t eat those five portions of fruits and vegetables a day) our BP goes up: only one in five individuals at the age of 80 has a “normal” BP. 

Consider that both BP numbers (the high or “systolic” and the low or “diastolic”) are important for good health. An optimal BP for a 20 year old would be around 100-115/70-75. Later in life a BP of 120/80 is acceptable but even a mildly elevated BP (for example a BP of 130/85) can cause problems in the long run. If your BP is above 130/80 in spite of avoiding salt in your food, eating lots of fruit and vegetables and exercising, you must let your doctor or other health care provider know.

So, don’t become a victim of this silent killer. Learn how to monitor your BP yourself and how to keep it low.

To your health!
Dr. Anthony

When you hear “diabetes” what comes to mind?

When you hear “diabetes” what comes to mind? Most people think high blood sugar along with images of obesity, cookies, and desserts. Elevated blood sugar is indeed a prominent and obvious part of diabetes.  Patients see it for themselves as they check their blood sugar; they also experience first hand symptoms of out- of- control blood sugar like excessive urination, unquenchable thirst and even coma that sends them to the intensive care unit.

However, diabetes is more than just high blood sugar, it’s a disease of the arteries. Seven out of ten diabetic deaths are due to heart attacks and strokes, not elevated blood sugar. Diabetes makes all our arteries, large and small, much more sensitive to normal wear and tear. Artery damage due to smoking, high blood pressure, and high cholesterol is more susceptible as well.  Merely controlling blood sugar level and keeping A1c at no more than 7%, although necessary, is hardly enough to protect diabetics from the most feared complications of their disease.

So, what can diabetic patients do to get maximum protection of their arteries? Consistently practice a healthy lifestyle (NO smoking cigarettes, keep a healthy diet, and near-daily exercise) AND keep blood pressure low AND take statins AND, possibly, a low-dose (81 mg) aspirin (provided that there are no stomach or serious bleeding problems). Medications like lisinopril or losartan are also important in protecting the kidneys which can commonly fail in diabetes.  Additionally, some new non-statin cholesterol-lowering medications (Praluent and Repatha) are available but at a cost of approximately ten thousand dollars (US) per year of treatment.

Artery testing, especially testing of the heart arteries, is another element of good diabetic care. Within diabetes the nerves that signal heart pain do not work properly, so it’s not unusual for a diabetic patient to have significant clogging of the heart arteries without experiencing any chest pain. Due to this, the doctor may recommend a stress test from time to time. Diabetic patients need to create a partnership with their physicians in order to reap the full benefits of diabetes education and disease prevention.

Anthony Pothoulakis, MD, FACC

Do you know what Statins are? If not, you should ….

Statins: the Pros and Cons of a Heavyweight

Statins are life saving medications, literally. In the fight against heart disease, they are credited with reversing the tide of rising heart attacks. Of course, the decline in smoking and better use of blood pressure medications has helped with the reduced rate of heart attacks. The good news is that, since 1996, for the first time in over a century, we have seen a decline in heart attacks by 40-percent.

Statins are a group of medications that lower the bad (LDL) cholesterol and reduce inflammation in our arteries. They help stabilize cholesterol plaques that frequently (and permanently) reside in our heart and brain arteries. Statins keep the blood flowing and reduce heart attacks and strokes by 30 to 40 percent.

Since statins are a true heavyweight champion of modern medicine, they are among the most widely prescribed medications in the US (almost 20 million patients use them). Although they generally have a very good safety track record, statins also have a dark side.

The greatest problem with statins is that they are not muscle friendly. About one in five statin users develops muscle aches, pains or stiffness that, although not life-threatening, can cause discomfort and suffering. To many affected statin users, these symptoms make the expected benefits not worthwhile. Other negative aspects of statin use are much more rare and include severe liver damage (one in a million), kidney failure (one in ten thousand), or type 2 diabetes (one in a thousand).

For some individuals healthy choices may include statins, on top of a  healthy lifestyle. The decision to start statins (and continue them for the rest of your life) should be based on your particular risk for developing heart attack or stroke. Individuals with the highest risk include (but are not limited to) those who have:

• already suffered a heart attack, a stroke or mini stroke
• undergone bypass surgery or stent placement
• either type 1 or type 2 diabetes
• an LDL cholesterol above 190 mg/dl.

As you discuss with your doctor whether statins are right for you, you need to weigh the good and the bad when it comes to the side effects of statins. You must consider how statins can help your arteries and prevent life-threatening conditions that may be points of no return, like heart attacks and strokes.

Keep in mind that doctors routinely check (through a simple blood test) for severe liver or muscle damage. They may also recommend over the counter supplements (like Coenzyme Q-10 or Vitamin D) that can protect against muscle aches. Doctors also warn their patients that, in case of severe muscle aches or dark-color urine, they should promptly stop taking statins.

The list of the currently available statin medications includes:

• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Mevacor (lovastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin).
• Advicor (lovastatin/niacin extended-release)
• Simcor (simvastatin/niacin extended-release)
• Vytorin (simvastatin/ezetimibe).

Good health to you!

Anthony Pothoulakis, MD, FACC

Are you self-monitoring your blood pressure?

You are as old as your arteries, even if you think you are only as old as you feel or look. And blood pressure is one of the key factors that determine your artery health. For this reason, knowing your true blood pressure is important to both you and your doctor. Many people suffer from “white coat syndrome” where they are nervous at the doctor’s office. This may result in a blood pressure measurement that is higher than your true blood pressure, whereas your home numbers are likely to be more accurate. Monitoring your blood pressure at home and on a regular basis is the best way to know your true blood pressure. This way, you will give your physician a fuller picture of your blood pressure fluctuations over an extended period of time. Also you will be an important participant to your own health care, a true partner to your doctor.

A blood pressure reading has a top number (systolic) and bottom number (diastolic). To fall into the normal range, your blood pressure should be less than 120 over 80. Prehypertension, which is borderline high blood pressure is 120-139 over 80-89. (Stage one) Mildly elevated high blood pressure is 140-159 over 90-99; and (stage two or) severely elevated high blood pressure is a reading of 160 and above over 100 and above.

Both diabetes and chronic kidney disease make your arteries more sensitive to the bad effects of high blood pressure. Many doctors believe that for these patients the blood pressure should be kept at less than 130 over 80. On the other side, for people over the age of 60, some medical professionals suggest that a top number up to 150 is acceptable. Be aware that as we age the elasticity of our aorta (the largest artery highway that starts at the heart and divides to branches that distribute the blood all over the body) declines. This declining elasticity of the aorta is frequently responsible for a low bottom number (diastolic blood pressure) observed in older individuals.

Blood pressure fluctuates all the time. It is generally higher early in the morning (its highest value is actually one to two hours before we even wake up) and between six and nine in the evening. If the blood pressure between your two arms differs by more than 10 points (mm Hg), record the higher number of the two. There are also specific factors that may cause your blood pressure to temporarily rise. For example, blood pressure rises as a result of:

• Stress
• Exercise or even ordinary physical activity at home or at work
• Caffeine
• Certain medicines
• Smoking
• Cold temperatures

Avoiding as many of these factors as you can when taking your blood pressure will help improve the accuracy of your overall numbers. Depending on the situation, your doctor may want you to check your blood pressure several times during the day to determine how wide the fluctuations are.

Before Checking Your Blood Pressure find a relatively quiet place. Make sure that you are relaxed and comfortably seated. Be sure to have recently emptied your bladder since a full bladder may affect the reading. Remove any tight-sleeved clothing or roll up the sleeve on your arm (if you are using a blood pressure cuff that fits your elbow). How and where you sit is important in an accurate reading. Before taking your blood pressure, rest in a chair next to a table for 5 minutes. Your arm should comfortably rest at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with your palm facing up. If your are using a blood pressure cuff that fits your wrist, keep your wrist at the level of your heart.