Dr. Katherine Gergen-Barnett explains what hypertension is, how it's diagnosed, risk factors and treatment options available.
Dr. Katherine Gergen Barnett
Dr. Katherine Gergen Barnett is the Vice Chair of Primary Care Innovation and Transformation and the Program Director in the Department of Family Medicine at Boston Medical Center (BMC). Katherine joined BMC in 2009 after completing her residency and chief residency there. Prior to BMC, Dr. Gergen Barnett attended Yale University School of Medicine, worked at NIH, and completed a fellowship studying a model of group prenatal care for underserved women. Her primary interests are behavioral health integration, preventive medicine, nutrition, mindfulness-based stress reduction, women’s health, and group care. Dr. Gergen Barnett's research career has been primarily focused on innovative models of care to address chronic medical conditions, physician burnout, and engaging community partners in creating feasible solutions to increase health and wellness in urban communities.
Melanie Cole (Host): If you’ve been told that you have high blood pressure, you may wonder what’s next. Is there a way to bring it down? What am I supposed to do? My guest today is Dr. Katherine Gergen-Barnett. She’s a Family Medicine physician at Boston Medical Center. Dr. Gergen-Barnett, it’s a pleasure to have you on with us again. Give the listeners a little physiology lesson. What exactly is blood pressure?
Katherine Gergen-Barnett, MD (Guest): Blood pressure as the name implies, it’s got the name pressure in it, is really how much pressure is going on your vessels as your heart is squeezing. So, there are two numbers that you often see when you are given a blood pressure reading. There’s a top number and a bottom number and the top number is called your systolic blood pressure and it’s really how much pressure is going on your vessels when your heart is squeezing. And the bottom number, called your diastolic blood pressure is how much pressure is going on your blood vessels when your heart is relaxing.
So, those are the two numbers and it’s really important to think about how much pressure you’re putting on your vessels.
Host: Completely and sometimes I use the hose reference, water going through a hose or the harder hose reference and if it goes through. So, explain now to the listeners what is hypertension? What is high blood pressure and why would it happen?
Dr. Gergen-Barnett: Hypertension or high blood pressure, it can happen for a number of reasons but really, it means that just as you were saying, that kind of hose analogy. It means that your heart is having to work really hard to get your blood through your vessels and it can be for a lot of different reasons. So, for instance, that hose can be really thick or hard to squeeze and that can happen when you have really high cholesterol or you’re getting older. It can happen also really for hereditary reasons. So, some people are born into families where blood pressure just runs in the family. But there’s a lot of environmental reasons that we can think about high blood pressure happening and sometimes I like to talk to patients about these being lifestyle choices that we all make that can either improve our blood pressure or make our blood pressure worse.
Host: Excellent explanation. So, why is it important that we know our numbers and why is hypertension sometimes underdiagnosed?
Dr. Gergen-Barnett: It’s important we know our numbers because first of all, it’s just really good to know how your heart is working and how your blood vessels are working because you want to know that you’re not putting too much stress on your vessels and on your heart. So, for instance, the vessels run through all different organs in your body including your eyes and your kidneys and obviously your heart and every other place in your body. And if you have high blood pressure, what can happen is you can actually get damage to the vessels that go to those organs. So, you can get problems with your kidneys, you can get problems with your vision and obviously, you can get things like heart attacks and even stroke and it’s really hard for people to know sometimes that they have high blood pressure because it is what we call a silent killer.
Which sounds very ominous. But the reason it’s called that is because people don’t know that they have high blood pressure. A lot of other diseases we sometimes have signs and symptoms that are much more obvious. But high blood pressure we can be just walking around doing our day to day things and not know that we have high blood pressure.
Host: Tell us a little bit about diagnosis because some people might have a blood pressure rise just going to see you, the white coat factor. So, how do we know that it really is high?
Dr. Gergen-Barnett: Blood pressure probably anybody who is listening to this has probably gotten their blood pressure checked at some point, some visit seeing a physician, get a little cuff put on your arm and you feel a squeeze but those – and those numbers like I said, the top number and the bottom number; will be recorded. But it’s really important – I think you addressed it well thinking about all the other factors that can raise blood pressure when somebody has first come in. Maybe they are feeling stressed and anxious about the visit. Maybe they’ve just had a cup of coffee. Maybe they are running to their appointment and they are running a little bit late. So, that first number that we get in the office, we often almost always in fact repeat that blood pressure when someone’s been resting with both feet on the ground for at least ten to fifteen minutes in the office. And that we know that their arm, it’s a very specific technique, their arm is raised to a heart level. So, there are many different ways to repeat it and also high blood pressure is not necessarily diagnosed at that first visit.
So, if you have a high blood pressure, we often may have you come back after some lifestyle changes and retest it. We also like to retest it at least three times to think about whether or not you truly have hypertension or whether your blood pressure was just raised for any of the other number of reasons which I just mentioned.
Host: So, before we talk about treatments, medications, lifestyle changes; some new guidelines were recently instituted which has caused some confusion for people. Not knowing if it used to be 139/90 and that was borderline and now it’s all different and are you seeing more people now considered hypertensive? What do we need to know about these new guidelines?
Dr. Gergen-Barnett: One of the things that I really appreciate about guidelines and these new guidelines is that they teach us to be more mindful of the implication and impact to that even slightly higher numbers can have. So, in the past, we had been as you suggested, less likely to treat with medications if somebody’s blood pressure is in sort of the 120s over 80s and 90s. And now we are just looking at that more thoughtfully. But again, I really want to emphasize that with all of these things; the guidelines are really important in terms of driving a conversation about lifestyle change. Because like you said, there’s many, many ways to treat hypertension and my practice and the practice of my colleagues is always to look at lifestyle changes first.
Host: So, then let’s start with those. We don’t have a lot of time in these podcasts Dr. Gergen-Barnett, but this is such an important topic. So, exercise, salt intake, dietary factors; what would you like us to know about those kinds of things that we can do that can help to control our blood pressure?
Dr. Gergen-Barnett: So, really thinking first about what are you putting into your body in terms of food? So, you want low sodium foods that are also high in potassium. Exercise, really thinking about moderate daily exercise so 30 minutes a day of exercise is more helpful for high blood pressure that sort of a weekend warrior type where you are only exercising in the weekends. No smoking. So, smoking really impacts your blood pressure. We ask people to really reduce their caffeine intake and alcohol intake. And the weight, so, really even a moderate weight reduction of five to ten pounds can really make a difference on your blood pressure. And in terms of looking at specific diets; there is something called the DASH diet, dietary approaches to stop hypertension which is excellent for anybody looking to have some immediate dietary changes.
Host: I agree with you. DASH diet is an excellent way to understand how the food can really impact your blood pressure. So, now when you look at the medications; sometimes one medication doesn’t work, sometimes you have to use two. Sometimes you have to represcribe and look, so it’s really for you doctors helping us to lower our blood pressure, it’s not always an exact science the first time is it?
Dr. Gergen-Barnett: No. It’s really an art. But there are some medications that we know are well-tolerated by everybody and some medications that are well-tolerated in specific subgroups. For instance, there is a type of medication called an ACE inhibitor which we know is excellent for people with diabetes because it protects their kidneys. And so, we really think about who is the person that is sitting in front of us, what kinds of medication do we think that they can tolerate in terms of is it once a day, twice a day, what are their other chronic illnesses that they have and how do we think about what – the effect the medication will have for them in the long term.
Host: That’s great information and it’s so important for people to hear so wrap it up, your best advice about this very important topic Dr. Gergen-Barnett, high blood pressure and blood pressure in general and why as you said earlier, it can affect so many of our organs and so many other parts of our body. Why is it important that we keep good track of it and keep it in those acceptable ranges?
Dr. Gergen-Barnett: The most important thing is to really stay informed. So, make sure you know your family history, know if there is a family history of high blood pressure, also really think about what your numbers ever single time you go into see the doctor, make sure that that’s being remeasured if it’s high. Before it even gets high though, really take care of yourself and bring in all of those lifestyle techniques we were talking about including stress reduction. So, really thinking about how you bring joy and stress-free items to your life and then if you are going to go on a medication; really make sure that you are working actively with your healthcare provider and telling them how it’s making you feel so they can help you track it better.
Host: Thank you so much Doctor, for joining us today. You are an excellent guest as always and I’m so glad that you brought up stress because all of those things contribute whether it’s stress reduction and dietary factors and exercise. That way we can be our own best health advocate. Thank you again for joining us. And that wraps up this episode of Boston MedTalks with Boston Medical Center. You can head on over to our website at www.bmc.org for more information and to get connected with one of our providers. If you found this podcast as educational and interesting as I did, please share with your friends and family. I’m sure you know somebody with high blood pressure and this was really a great lesson on things that we can do to bring that down. And be sure not to miss all the other fascinating podcasts in the Boston Medical Center library. Until next time, I’m Melanie Cole.