This article is a transcribed edited summary of a video Bob and Brad recorded in December of 2020. For the original video go to https://www.youtube.com/watch?v=9FTn8JWH-6I&t=583s
Brad: Today we're going to talk about blood pressure. How high is too high, possibly life-threatening, and top three options to correct it safely. This is a serious topic. I've dealt with a borderline of blood pressure myself and been able to successfully treat it without medications, but we need to know the big thing, blood pressure, what is too high and what's not too high, but let's go back. There's two numbers with blood pressure. Let's kind of clarify this, systolic, diastolic?
Chris: Systolic, diastolic, top and bottom, whatever way is easier for you to remember. But basically the systolic is the first number that we see up here, that 120/80, that's a normal blood pressure, but that one is when the heart beats. So think of your heart as a pump, as soon as it presses that pressure that they feel in the vessels, that's what that top number is measuring.
Brad: So that's the big push.
Chris: Yep, that's the big push of the heart. And then when the heart is relaxed and it's filling back up with blood, that's what the diastolic number is measuring. So that's what that 80 is.
Brad: We don't need to know this, but it's in millimeters, that's a technical measurement.
Chris: Millimeters of mercury is how they recognize it.
Brad: I always remember diastolic, D for down. So that's the lower number.
Chris: Yeah, that's an easy way to remember it.
Brad: But you really don't need to know that, but you do need to know the numbers and where you're safe and where you need to be concerned, and then of course the extreme.
Chris: Absolutely, absolutely.
Brad: So we've got the chart here. Chris made this really nice chart. Let's start out with the normal blood pressure that is acceptable and you're safe.
Chris: Absolutely. We'd like to see that 120/80 with everybody. I think that's just a reasonable standard number that the American Heart Association, American Cardiology Associates, they all kind of recognize that. And it can be lower, it can be a little bit higher. As we progress through the whole chain here, that's where we want to strive for. And when people are healthy, that's what we see.
Brad: Now we're talking about high blood pressure and sometimes it's called hypertension. Are there any other terms you might hear?
Chris: No, I think high blood pressure and hypertension are used interchangeably. So I think that most physicians and nurse practitioners and PAs would probably say hypertension, but for you and me, high blood pressure.
Brad: Okay, so let's start out. We've got normal and then these are actual classifications that I recognized and the first one says elevated. So that's, if you're just a little over normal.
Chris: A little bit over normal.
Brad: But it's not dangerous yet?
Chris: Not dangerous yet, but it's a sign of things to come. So we do want to make sure that we're paying attention. When you go into your doctor's office and all of a sudden these type of numbers pop up, doctors will do a couple different things. They're going to measure it in a couple of different occasions. They might measure both arms just to kind of see what's going on because there's a thing called lab coat syndrome which suddenly or white coat syndrome. Basically when somebody walks in the room and they're in a very formal looking doctor and I say, "Oh my gosh he's going to figure out that something's wrong with me." People do get tense and it does raise your blood pressure. It's a known fact unfortunately.
Brad: Sure, it's just a natural feeling.
Chris: Yep, it's natural. A lot of us experienced that. So they want to take a couple of different readings and they'll eve n maybe at the end of the appointment they'll strap you up on a cuff again, kind of catch you off guard, so you're more relaxed. Because you've been talking about some things and I'll say, "Oh, look at that, it's normal." So sometimes it's just due to the stress. Maybe you walked up a couple flights of stairs to get the office.
Brad: Sure. Then we'll go to the stage one.
Chris: Stage one.
Brad: So that's another step in the wrong direction.
Chris: Yep, another step in the wrong direction. And you know I guess what I should mention is that in 2017, they changed all these numbers. It used to be the old norm before stage one. It used to be just 140/90, was like, "Okay, that's bad." Well, they decided to add this designation, this 130-139/80-89. That's stage one hypertension or a stage one blood pressure. And so it's kind of that first stage that when your doctor gets a couple of measurements, because they aren't going to put you on blood medication right away. They're going to look at it and observe it. They might have you come back in three or four weeks and do it again and all of a sudden, oh it's still there. So at this point, the doctor's in a lot of times they probably would have had this discussion about your lifestyle changes and things of that nature. What can we do to affect this? We'll move on to that.
Brad: Okay, we'll talk about what you can do without, so you can avoid medication.
Chris: Yes, yes. This group I think is a really good one to focus on and then we're in that point. And that's kind of the hallmark what most cardiologists and physicians are going to talk to the patients about.
Brad: But you could come in maybe you have progressed to stage two or maybe you came in before that and all of a sudden you see these numbers 140/90. Okay, so things are starting to open your or at least the doctors.
Chris: Oh yeah, you got 24 million Americans in this group right here, stage two.
Brad: So what percentage is that?
Chris: Probably right in that 30% range.
Brad: Okay, are touching up into that?
Chris: All adults. Yep, so it's something. And this is definitely going to require medication, at stage two. So this is the one we're still going to stress lifestyle changes but there's definitely going to be medications added. And they might even add medication depending upon your circumstances, genetics, cardiac risk factors. So there's a lot of other things that go into this.
Brad: Individual factors.
Chris: Yeah, but for the ease of simplicity, this is something that your doctor will probably at one point, you're going to be on medication to try and help to control that and keep you safe.
Brad: Right, because you might say, "Well can I do this with diet and exercise?" But you're saying maybe you can but you're putting yourself at risk.
Chris: Yeah, I mean, your doctor's going to have to be on board with your exercise plan and keep in mind exercise can be something as simple as a 30-minute walk. So I mean, that's enough, you got to raise your breath a little bit and get that heart rate pumping. And I think that's going to do a nice job of helping and it's exercise and diet are pillars of treating hypertension at any one of these ranges. So we have to make sure that when we're using that and then your doctor is going to be paramount. He's, like I've said before in other videos, he's your quarterback. So you're the team, he's the quarterback. And basically you're going to work together to try and make sure that we can bring it back towards this level.
Brad: Right, right. So let's say, because a lot of people may be living at this. They don't even know it. And if that goes on for a number of years, that's actually causing problems with your arteries which can lead into strokes, other cardiac issues.
Chris: You name it, stroke, heart attack, vascular dementia, kidney problems, organ failure, vision problems. I mean, it's a big umbrella that hypertension all of a sudden, you hear hypertension and everything underneath that umbrella kind of fills in. So there's lots of other things that can happen.
Brad: All these diagnosis is that you're associated with it. And so if you can correct that higher blood pressure early that doesn't eliminate, but reduces your risk for all these other problems that can come down the road.
Chris: Correct, and yeah, just to kind of put that in perspective. I mean you get 3 million Americans each year are getting diagnosed with high blood pressure or hypertension. So that's a lot of people.
Brad: So that means they're at stage two.
Chris: Not necessarily, it could be one, two. But they're going to call it hypertension one and two. So there's 3 million patients a year. We lose 500,000 to hypertension related conditions.
Brad: So you're saying 500,000 people, half a million. Half a million people die every year worldwide or in the United States?
Chris: United States of America.
Brad: So a half a million people die as a result of hypertension or associated causes.
Chris: Correct. Yep, hypertension with associated causes.
Brad: Okay, so that could be a stroke. It could be vascular problems, heart attack.
Chris: Exactly, exactly. So it's all encompassing. We have to be careful.
Brad: So now we're getting to that part of the title, life-threatening. So we got it in red, Hypertensive crisis.
Chris: Yup, that's the big word that they use, and it's nothing to sneeze at. This is a big deal. So if you are testing your blood pressure at home and you're caught popping in with a 180/120, it's kind of like monopoly, you go directly to jail or you go directly to the hospital. So you should certainly call your doctor if you feel it's necessary.
Brad: Would that mean that an emergency room or urgent care?
Chris: I would say an emergency room probably at this point, because they're going to be the ones that are going to decide. I mean, you got here for a reason. We don't know why. And if it goes sideways, stroke, heart attack could be eminent. So it's something that we just don't want to mess around with.
Brad: I always think of this as a therapist, I've worked with a lot of people with strokes. I don't work with people with heart attacks except for after the fact, if the rehabbing, but a stroke I see them very quickly after the event. It makes so much sense because what happened is the pressure is getting so high it bursts through the arteries, the vessels, the blood vessels in the brain, starving the brain of blood and oxygen, and then you have a stroke and it's a life changing issue. And it could be fatal.
Chris: Yup exactly.
Brad: So there's no joke about high blood pressure when you get this high Oftentimes people are feeling symptoms like headaches. There are some other things.
Chris: Well actually the scary thing about all of this, more often than not people don't feel anything. And that's the scariest part about this aspect. That's why they call blood pressure the silent killer. So when you have high blood pressure, it's something that you just may not even notice. People go for years and let's say they had an appointment in their twenties and you're healthy as a horse and you're feeling good. All of a sudden they haven't been to a doctor in years which is oftentimes the case. All of a sudden their 45 years old, they go in and see the doctor and they're like, "Oh my gosh you're 170/98." "What's going on?" "I don't know, I feel great." And all of a sudden it becomes this type of issue, and there's lots of long discussions at that appointment to how can we get this better and keep you safe?
Brad: And so I think nowadays, and this has been going on for years actually, people are taking their own blood pressure at home but it's easier now. I remember years ago with my father, he had high blood pressure and he'd be pumping that thing up around his arm and measuring his own at home to monitor. But now you just put the cuff on, push the button.
Chris: Push the button, it's really easy. So, and you always want to make sure too when you're getting a blood pressure cuff, unless you have an absolute problem where you can't get the cuff around your arm, you never want to do the wrist one. The wrist one, basically these two bones in your arm, you have one over here and one over here, it does not allow it to squeeze properly to give you a good accurate measure of blood pressure. But when you get it around the arm, you get that good, accurate measure. I mean, same way in the doctor's office, they don't measure your wrist, they always measured around your arm.
Brad: And if we're talking about this will minimize be comprehensive with this video. If you are taking your own, the same thing my dad had one of the wrists and the numbers weren't good. We ended up going back to the arm. And this was later on, just within the last 10 years, but you should take it in a consistent posture.
Chris: Perfect posture.
Brad: So you should be sitting with your knees bent at 90, with good posture and take it on the same arm, write it down or sometimes the digital ones have a history but if you're not comfortable with that, write it down. That's me, write it on paper so it's there and do it in the same location or same atmosphere.
Chris: Yeah, I always want to be consistent with it. So you always want to sit for five minutes. So maybe a walk, you had some breakfast and then you're like, "Oh it’s time for me to do my blood pressure." So you want to sit again with both feet on the floor, like you said, perfect posture, just kind of sit and relax.
Chris: And then wait five minutes and then put your cuff on your arm. And it's actually important to make sure your cuff is on your own properly too. So depending upon the unit that you use and I will tell you what consumer reports the most widely recommend one is made by Omron. So it's a fantastic machine. So it's the one that I recommend routinely at work because I just can trust their accuracy. So it's excellent, it rates well, they're reasonable in cost. You can get it anywhere, pharmacies, online, wherever you want to shop for something like that. The nice thing about the Omron product actually is they show you nice little pictures on how to use it. So you have your arm palm up resting on a table. You’re going to have your cuff round your upper arm and there's a little line, that's the tube that goes to the unit. And so you just want to make sure it falls down the center of your arm. And then while you're relaxed, you hit the button and basically about 35, 40 seconds, you're going to get your pressure and your heart rate.
Brad: All right, so we know where that really high blood pressure is, get to the doctor right away. Let's go back in here and let's look at the second part of our title. What are the three options?
Chris: Well basically, number one that, depending upon where you fall, it's always going to be exercise and diet, which are under that lifestyle changes. And sometimes if you use that exercise and diet as one and two, medications are probably number three. So from that standpoint, but medications you can easily become the primary course of treatment depending upon what your doctor and you decided is best for you and your particular case.
Brad: Do you know how many people are on blood pressure medications in the United States right now?
Chris: Yeah, roughly about 30 million people are on blood pressure medications right now or at least should be. And about many of those are actually falling in that 140 over 90 range. So, it's a large number.
Brad: And success rate with blood pressure medications?
Chris: 25 percent of people on blood pressure issues are well controlled. So everybody else is not.
Brad: So they have to monitor it?
Chris: They need to monitor it, and so that home monitoring, I think it's a very invaluable tool for us to utilize at home so that we kind of know where you are and you can always fill in the gaps with your doctor and just say, "Hey, I did really well." And you go to the office when it's up 10 points, so maybe it was you're just stressed out about seeing the doctor, but it helps them.
Brad: So, you were talking top three, diet and exercise but really that's kind of they're two separate topics, but they fit together.
Chris: They do, they do, and exercise is so critical because we want to get that heart rate up as long as your doctor approves you to do exercises. So that's one of the first things that we have to clear that hurdle before we just. I mean, it's always good to exercise, you and I are firm proponents of that. But I mean, it's something that if there's something cardiovascular in nature you want to make sure that what you're doing is safe for you, because if we're maybe somewhere between stage 2 and hypertensive crisis or really super high, your doctor might want you to ease into an exercise program because too much, too soon, too fast could have some very serious consequence.
Brad: So you could escalate or even cause a problem?
Chris: Cause some serious problems.
Brad: Right, if you have not if you're not an exercise person historically, and you don't want to go on meds and you think, "Oh, I'm just going to get after this right now. You better think again and you're going to gradually. You're not going to go out and start running a marathon, you're going to start by walking.
Chris: You're going to walk. Walking is great. I mean, 30 minutes, five days a week, just so that you're breathing a little bit harder than usual. It's probably the easiest way to kind of determine how hard am I really working? Well, if I'm kind of taking some deep breaths, you know you're working hard enough. So if you're not, you know. If it's too easy to have a conversation, I mean, you could exercise and have a perfectly good conversation, and that's probably the training range you want, but you're going to want that heart rate bumping a little bit too.
Brad: Not a casual, stop and look at the birds walk.
Chris: No, a brisk walk where you're moving. Something that if it's a nice, cool morning, it helps you warm up.
Brad: I want to mention, we're going to do another video, follow up on this probably in a couple of weeks. And we're going to go into more detail about diet and exercise and the medications I do want to come up with the good news is I looked at mine in my twenties and I was always in this range, the elevated range.
Chris: Back then it wasn't a big deal. It changed that 2017.
Brad: But actually at that point because my dad had it, I was looking at it and it was a little red flag for me. So I started back when I was about 30 years old, I started running. I didn't like running because boring. I was in karate at the time punching and kicking people is a lot more fun.
Chris: Its always more fun.
Brad: But it wasn't a rollback enough necessarily a lot of times. So I started running, went back to college. I needed something (indistinct) desk board anyways, started running and I dropped down 10 to 15 points at both ends. Dropped it down since I started running and actually my heart rate dropped way down too which is another benefit of cardiovascular exercise, you know, aerobics.
Chris: Yeah, exactly.
Brad: So, and I haven't had a problem since. So I think if you catch it in here and you're motivated to change your lifestyle, and then recently I've changed my diet, which probably has helped, but I haven't had a problem anyways. So get in early, get in that normal range and you don't have to get to the medication. I'd forget to take them, that's a problem.
Chris: Well, and that's a big thing in my world.
Brad: Is it really?
Chris: Oh yeah huge, 60% of people don't take the medications properly.
Brad: They don't take them daily or they forget.
Chris: Just forget, taking them the wrong time, maybe not consistently. Actually we do things called adherence calls and things of that nature. So it's actually how insurance companies reimburse pharmacies now. So it's a big deal.
Brad: If people don't take their meds on time then-
Chris: We don't get paid.
Brad: Insurance doesn't pay the pharmacy as well.
Chris: Not as well.
Brad: Yeah, that interesting.
Chris: It's a big deal.
Brad: Yeah, do you have to make sure you call people and see if they are taking them on time?
Chris: Yeah we do. And it's actually more with Medicare part D patients. So this is a long sideways sidebar, but it probably puts people to sleep.
Brad: We're getting at the end of the video anyways but there's a lot of things that revolve around this, so stay tuned, we're going to have another video on details of diet, exercise, and some more on meds as well. You know, what people that view this I think are hoping to stay away from the medication like most people are.
Brad: Well, you know and exercise and diet are a huge component of that. And if we work at it, if you treat yourself like your own best investment, I think it can be very doable, but you got to work at it. It's not just something you're just going to hop off the couch and run a marathon and I'm good. I mean, once you stop exercising, all those good benefits that you received go away. So it's a lifestyle change, means forever.
Brad: Now, I don't know if this fits right in, we can fix just about anything-
Chris: Except a broken heart.
Brad: But we're right on there.
Chris: We're working on it, we're working.
Brad: All right, very good. Take care.
Chris: Thanks everyone.
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