No pressure. How to quiet the storm in your arteries. Episode 22

Monika Rachtan
Did you know that if you want to lower your blood pressure, you should give up the salty tomato and reach for a tomato with basil instead? Did you know that when you are eighteen, you should buy a blood pressure monitor to check your values regularly? Did you know that statins are proven and safe drugs that have been used in clinical practice for more than 40 years? Did you know that hypotensive drugs, i.e. those used to control blood pressure, should be taken for life? In the latest episode of the programme "Patient First", I talk to Professor Aleksander Prejbisz and Professor Piotr Dobrowolski about these and many other topics. I cordially invite you to watch the programme. Good morning. I am Monika Rahman and I welcome you to another episode of the programme "Patient First". And today we are hosting Professor Dobrowolski and Professor Aleksander Prejbisz. Good morning.

Alexander Prejbisz
Good morning.

Piotr Dobrowolski
Good morning, Madam Editor, good morning to you.

Monika Rachtan
Today we are talking about the prevention of hypertension, how to avoid it and how to manage it when it does occur. What steps should you take? Which doctor to go to? We will speak in simple language, as our programme is aimed at patients. Please do not use difficult terms so that everyone can understand. We will ask questions from our viewers at the end, so please remember that there are no stupid questions. The answers should be understandable to patients. Now back to hypertension prevention, I will ask Professor Prejbish: When should I buy a blood pressure monitor for my friends? For what birthday would it be a good gift?

Alexander Prejbisz
On his 18th birthday.

Monika Rachtan
Why so early?

Alexander Prejbisz
The guidelines of the Polish Hypertension Society, as well as experts, recommend that everyone should measure their blood pressure every year. Of course, you don't have to have your own blood pressure monitor, but it is a good idea to measure your blood pressure once a year. This is especially important for middle-aged and older people, but also for younger people. This is especially true for women. We often see patients with hypertension during pregnancy who do not know what their blood pressure was before pregnancy. This is important, because we have to distinguish whether the hypertension is due to pregnancy or whether it existed before. Vital pressure values can be helped as early as 18-19 years of age, so everyone should have their blood pressure measured once a year.

Monika Rachtan
This is surprising, Professor Prejbisz, because you could probably measure your blood pressure at the age of 18. At that time you had not yet studied medicine.

Alexander Prejbisz
True, I didn't measure, but now I probably would.

Piotr Dobrowolski
Times are changing and so are attitudes. We now know that the earlier the better. Why? Because we know that long-term exposure to high blood pressure is harmful. We will continue to talk about this.

Alexander Prejbisz
Also, it is worth noting that the availability of blood pressure monitors is now much greater. In fact, everyone we know or know in our family has a blood pressure monitor. We can even measure our blood pressure during a meeting. This is important!

Piotr Dobrowolski
Remember that at your aunt's name day you can measure not only your temperature, but also your blood pressure.

Monika Rachtan
This is good advice. That is why I am now passing on your word. Professor Dobrowolski mentioned that young people are taking more and more care of their health. I have noticed this as well, at least I wish they would. For example, we have a channel about health on TikTok and Instagram. Today, I would like to emphasise that it is a good idea to measure blood pressure at the age of 18, as recommended by professors. Now the question: at what age can the first signs of hypertension appear?

Piotr Dobrowolski
To begin with, it is worth noting that hypertension most often does not cause visible symptoms. High blood pressure is often asymptomatic. However, some patients may experience non-specific symptoms such as headaches, tinnitus, dizziness or general malaise. However, there is no single characteristic symptomatic hypertension. This is why it is important to regularly monitor blood pressure values from the age of 18 years, as previously mentioned.

Monika Rachtan
Thank you for the clarification. Are there ways to prevent symptoms, even if they are not there yet? Here is my question. Is there anything I can do to avoid hypertension, apart from measuring my blood pressure regularly, as a young person?

Alexander Prejbisz
We need to understand that hypertension is a certain threshold of pressure from which we recognise that treatment is necessary, because lowering pressure has health benefits such as prolonging life. However, there is a genetic predisposition to certain levels of blood pressure, which varies from person to person. In addition, there are lifestyle factors that affect our blood pressure. We are talking about physical activity, diet, salt restriction, avoiding excessive alcohol consumption, maintaining a healthy body weight and quitting smoking.

Alexander Prejbisz
All these factors add up in our lives and affect our blood pressure. Hypertension can occur at different ages, but there is a risk for all of us. By the age of 80, as many as 80% of the population suffer from hypertension. The key issue, then, is when these higher pressure values are reached.

Monika Rachtan
The professor mentioned that we are now going to talk about healthy lifestyles, and I would like to ask about that earlier, because we have already mentioned behind the scenes strong recommendations for patients. They need to start moving, eat healthily and stop smoking, not start smoking. How do you achieve this?

Piotr Dobrowolski
This is often the most difficult task. Prescribing medication is the easiest step in the doctor's office, both for the doctor and the patient. Nevertheless, it is important for all of us, including patients, to understand that what Professor Prejbisz talked about earlier is the key to lowering the risk of cardiovascular disease. You don't have to radically change your life straight away, but everyone has the opportunity to take small steps, such as stop smoking, start moving and change their diet.

Alexander Prejbisz
Exactly, it's about lifestyle modification. These don't have to be drastic changes. It's important for patients to understand that they can do a lot for their health themselves, not just by relying on medication. It's about understanding that avoiding risk factors such as smoking, lack of physical activity, unhealthy diet and stress has a huge impact on our cardiovascular health.

Piotr Dobrowolski
Yes, and it is worth remembering to eat a diet rich in fruit and vegetables, limit salt and avoid excessive alcohol. In addition, a stress-free life, regular sleep and physical activity are key to lowering the risk of cardiovascular disease.

Monika Rachtan
This is true, but it can all seem difficult to achieve. Patients often don't know who to turn to for help in making these changes. Who can help patients adopt a healthier lifestyle?

Alexander Prejbisz
It is worth pointing out that patients should not be afraid of doctors. Doctors are here to help patients achieve better health. When a patient lacks knowledge, they should boldly ask and ask for help. It is not scary, and it can help to avoid many cardiovascular complications in the future.

Piotr Dobrowolski
Patients should not be afraid of doctors and doctors are available to help. It is worth talking to your GP, cardiologist or hypertensiologist if there are concerns about a healthy lifestyle or changes in risk factors.

Alexander Prejbisz
It is important for patients to understand that doctors are available and ready to help them in their quest for a healthier lifestyle. Preventive action is key to reducing the risk of cardiovascular disease in the future.

Monika Rachtan
Thank you for your explanation. But what if, after regular blood pressure measurements since the age of 18, at 41 or 42 the values are approaching dangerous levels? Is it necessary to observe or react immediately? And who to go to for help?

Alexander Prejbisz
If, after regular blood pressure measurements since the age of 18, we notice that the values are approaching dangerous levels, it is not worth waiting. It is worth consulting your family doctor, cardiologist or hypertensiologist. A more aggressive approach to hypertension is now recommended in order to reduce the risk of cardiovascular disease as soon as possible. Postponement may result in serious complications in the future.

Piotr Dobrowolski
It is important that we do not underestimate the problem and do not delay action. Modern medical knowledge shows that a rapid reduction in high blood pressure is crucial for cardiovascular health. Therefore, immediate consultation with a doctor is the best step.

Monika Rachtan
This is understandable. Thank you for your clear answers and for talking about cardiovascular disease prevention. It is worth remembering that a healthy lifestyle and control of risk factors can make a significant difference to our future health.

Monika Rachtan
The professor said that measuring blood pressure in a pharmacy may not necessarily be the best idea. But what about patients who have the so-called white coat effect? Such patients are also encountered - they enter the surgery and suddenly, in the presence of the doctor, their blood pressure rises. How do you deal with this?

Alexander Prejbisz
That is why measuring your blood pressure in a pharmacy is a good idea, especially if you do not have a blood pressure monitor at home. However, the best solution is to have your own blood pressure monitor at home, especially if you have the white coat effect. The approach to this effect used to be more benign, but we now know that people with the white coat effect can develop hypertension in the future. In addition, home measurements, i.e. 24-hour blood pressure recording, are very important. It is the golden mean. Good home measurements can confirm or exclude a diagnosis of hypertension. Let us remember that measurements outside the doctor's office have many advantages and allow us to better control blood pressure and adjust the appropriate treatment.

Monika Rachtan
And how do you measure your blood pressure correctly at home? Are there any rules to follow?

Piotr Dobrowolski
From 2021, we have clear guidelines on how to measure blood pressure correctly at home. It is important to take two blood pressure measurements in the morning, one after the other, for 7 days before visiting the doctor. Also in the evening we take two measurements, one after the other. Together we record 28 measurements and bring them to the doctor. This is a simple and effective method of confirming or ruling out hypertension. Remember: 7 days, morning and evening, twice each.

Monika Rachtan
It is very important, as the professor says, not to forget to bring these results to the doctor. Often patients think that just measuring their blood pressure can cure them. This is important - the recorded results should be shown to the doctor, because unfortunately the professor does not have a device in his office to read the results remotely.

Piotr Dobrowolski
This is true. Let's remember the website www.dobrzemierze.pl for information on how to measure blood pressure correctly. This is a very helpful site. If you don't feel confident about measuring, it's worth having a look there as it describes both the mistakes to avoid and how to measure correctly.

Monika Rachtan
What if this page has not helped and we are still in doubt? Can you take your blood pressure monitor with you to your doctor's appointment and ask to be shown how to measure your blood pressure correctly?

Alexander Prejbisz
Of course it is. If you have any doubts about the measurements, it's worth doing. No doctor should mind.

Piotr Dobrowolski
I often invite patients into the office with their blood pressure monitors so that we can compare results together and rule out measurement errors.

Monika Rachtan
This is very important information. I also urge everyone to get a blood pressure monitor to their doctor. I will ask the professor what to do next. Once I have these bad blood pressure values, I see that they are not good. I go to the doctor. And now what will my, What will my diagnostic, therapeutic pathway look like next? What is going to happen?

Alexander Prejbisz
We have to abstract from the diagnostic side, but if it is the therapeutic side, it is most often the case that we sign this two-way contract, that is, we start treatment. In fact, the guidelines tell us that in a very small percentage of cases we can deviate and wait a while. We start the treatment and at the moment it's even said that we start with two drugs to act quickly. We are not afraid of this because it will not cause the patient to have super low blood pressure the next day. It is safe to do so. We can also now combine these two drugs in one tablet, that is, give a compounded preparation and start the hypertension therapy with it. The patient takes one tablet even half a tablet. There are two active substances in there, and we can control the pressure very well, because we may find in two thirds of the patients that we will control the blood pressure well.

Piotr Dobrowolski
But let us remember, ladies and gentlemen, that, unfortunately, once we sign a covenant with the devil Professor Prejbisz, we are already signing almost to the end, to the end of our lives we will probably still be talking about it, but in order to treat and properly manage arterial pressure we have to. It is a chronic disease and we don't treat. We don't really have a gene therapy that we turn one screw and there is no hypertension. We treat symptomatically. These are drugs that we give for hypertension. They are only symptomatic drugs, so we have to take them, and it is only the drugs that work that we take.

Monika Rachtan
And I know that our patients, unfortunately, when these values align in the diary everything looks beautiful. The doctors are happy with the results, they quietly put down one tablet and another. Once the hypertension is gone, they don't take any more. Exactly what can happen then? We were not going to scare people, but I would like to ask what can happen when we stop taking this treatment ourselves?

Alexander Prejbisz
Well we will continue to have untreated hypertension. It's a bit like that here. In treating all these factors we are talking about. As long as we are treating them, we are taking the tablets. The moment we stop taking the tablets, these factors return to baseline levels. Therefore, unfortunately, but we are still under a high risk of heart attack, stroke, premature death. It is believed in the case of a 50-something person, for example, that a 3-month delay in treating hypertension already increases the risk of stroke. So within that 3 months. So it is really important that we take this therapy regularly. It's not a problem to take one tablet in the morning. So we also think that this simplicity of therapy, one tablet in the morning, two drugs. If that doesn't work, we now have what are called three tablets, so we still have three active substances in one tablet.

Monika Rachtan
It could not be simpler.

Alexander Prejbisz
It could not be simpler. Consequently, it is easy to remember to take medication in the morning. Sometimes, of course, there are still doctors who use complicated treatment regimens. In some cases this is justified, but in some cases we can make it simpler, help the patient, as we will probably still get to that point. Immediately, what you mentioned about this diagnosis. The patient doesn't just have hypertension. We still have to look at other cardiovascular risk factors. It is very often the case that a patient comes to me for hypertension, he is surprised that I ask him about cholesterol, about glucose, when he had these measurements. I deal with his obesity. I look holistically at the patient, at all his risk factors for heart attack or stroke. Because we have to control everything. In fact, we pay attention to 10 exponents of health. The Americans talk about the ABCDEFGHI. So we control blood, we control glucose, we control cholesterol, we control blood pressure, we control weight, we control waist circumference, we control physical activity, we control food, we control alcohol, we control stress, we control smoking.

Monika Rachtan
Everything. But, Professor, are there any additional tests that we need to do? Can you tell us that in addition to these basic blood tests, as basic as they are, there are other tests that a woman over 60 years of age should perform? When do we start having preventive examinations to rule out cardiovascular disease? Which tests?

Alexander Prejbisz
Generally speaking, from the age of 40, so not from the age of 60, but from the age of 40 onwards, it is necessary to carry out preventive examinations which help us to assess the risk of cardiovascular disease. So at 40, we need to pay attention to cholesterol levels. We need to test our glucose levels, because that's diabetes. We need to pay attention to our blood pressure. So really our first visit to our GP, or to our cardiologist, should be at the age of 40. That's when we determine the risk of heart attack, stroke, life expectancy, but generally speaking to shorten it now, if we're in our 50s, that's when we need to pay attention to all these factors that we're talking about.

Monika Rachtan
And if we are over 60, are there any special tests that need to be done?

Alexander Prejbisz
If we are over 60 years of age, we should actually already be considering doing cardiovascular tests, i.e. an electrocardiogram. It would be worth doing echo heart tests. It would be worthwhile to do an examination of the carotid vessels, i.e. the carotid arteries that lead to the brain, to check for those atherosclerotic plaques that can lead to stroke. Also, it would be worth considering a Doppler study of the vessels of the lower limbs to see what the blood supply to the legs is like. So these are actually ultrasound examinations that would be worth doing initially to assess our cardiovascular risk. But here's the thing, 60 is such an age marker where we already have a higher risk of heart disease, vascular disease and therefore stroke. So everyone above 60 should assess their risk and pay attention to these factors.

Monika Rachtan
And are such tests available under the National Health Service?

Alexander Prejbisz
Well, yes. These tests can be done under the National Health Insurance scheme. As a result of the age above, to have our vessels checked, you actually already have to go to a cardiologist every year to have an ECG, to have our neck vessels checked, to have a Doppler, to have our lower limb vessels checked. This is now available under the National Health Service scheme.

Monika Rachtan
This is very important information. Then maybe we should also invite our listeners to see a cardiologist at 60? Well, at least for a cardiology appointment?

Alexander Prejbisz
Yes, I'm all in favour of having that visit as early as 40 to find out where we are with our risk. Are we at risk, are we at high risk? And, of course, in order not to remain in that risk group, you need to come in regularly for check-ups to monitor that, to assess that. And in fact these are the tests that are available. I am therefore in favour of controlling it, of looking at yourself, of looking at your statistics, of looking at these charts. I really like the charts. So, when a patient comes in, I immediately look at those charts and think about what could be changed in diet, what could be changed in eating habits or in living habits to make those results better.

Monika Rachtan
Professor, what can the patient do himself? Maybe the patient doesn't know something. He says that he eats healthy, that he exercises a lot, that he doesn't smoke, that he doesn't drink, that he doesn't have stress. And yet the test results are bad. What can such a patient do himself to improve these test results, to reduce the risk of heart attack, stroke?

Alexander Prejbisz
The most important thing is diet. A diet that allows you to lower your cholesterol. A diet that allows you to lower your glucose levels. So a diet that allows you to lower diabetes, to lower insulin resistance. So it's a low-fat, low-salt, or low-sodium diet, which is a diet that's low in salt, low in sugar, low in fat. So it is a diet that is already recommended to our patients from the age of 40. At that time, it is already worth paying attention to fats, salt and sugar, so that later on, at the age of 60, we don't have to look for solutions, but only to pay attention to those components that affect our cholesterol, glucose or blood pressure. So diet is really the most important thing.

Monika Rachtan
So we're talking about a low-sodium, low-salt, low-fat diet. And I guess that's kind of a recipe for a long life, right?

Alexander Prejbisz
Yes, exactly. This is a recipe for a long life. This is a recipe for a healthy life. This is the recipe for a peaceful life. So first and foremost, diet. So the food that we eat has an impact on our health. So, we have to pay attention to those foods that we supply to our digestive system. So diet is the most important thing. In addition to diet is, of course, physical activity. Physical activity is our daily portion. If we do a certain amount of physical activity every day, it really is a recipe for a healthy life. But what is important is that this physical activity is balanced. Not too much, not too little. But enough to reduce our risk of these cardiovascular diseases. Also, of course, physical activity helps control sugar levels, cholesterol levels, blood pressure levels. These are things that are very important. And that's the third thing, which is obviously very important, is smoking. That's something that needs to be stopped if we smoke cigarettes, so that we control our risk. But also alcohol. We have to pay attention to alcohol so that we don't abuse alcohol, because excess alcohol leads to high blood pressure, it leads to stroke, it leads to damage to our digestive system. So these are the three things: diet, physical activity, smoking and alcohol that we need to pay attention to.

Monika Rachtan
Yes, and stress? You mentioned stress. How does stress affect our heart, our body?

Alexander Prejbisz
Stress is very important in our lives. So stress affects our health, it affects our psyche, it affects our psychosomatics. That is to say, how we feel in our body primarily affects our cardiovascular system. Why? Because stress leads to an increase in our blood pressure, to an increase in our heart rate. So on heart rate and on blood pressure, these are the two components that increase our risk of cardiovascular disease. So stress is very important. But stress is actually part of our everyday life. We are exposed to stress. We're exposed to stress at work, we're exposed to stress at home, we're raising children, we're raising grandchildren, or we're in some kind of relationship or not in a relationship. All of these are sources of stress. So, as a result, it needs to be controlled. How do you control stress? First of all, think positively, look at your life with detachment. Also to think positively, to smile, to take care of your mental condition. That is, stress is actually one of the things you can control in your life. But to control it, you have to think about it. So thinking positively is very important. And also physical activity, because physical activity is a way to control stress.

Monika Rachtan
So movement is a way of dealing with stress?

Alexander Prejbisz
Yes, exactly. Movement is a way of dealing with stress. It is a way of controlling stress. So the more movement, the less stress. But also, above all, diet, because diet affects our mental condition. So that is also very important. And also that we deal with difficult situations, that we don't do everything to spite ourselves, that we don't cause stressful situations. So stress is a very important thing to pay attention to. It's worth controlling it, it's worth thinking positively, it's worth having your own strategies for dealing with stress.

Monika Rachtan
So stress is a risk factor for heart disease, yes?

Alexander Prejbisz
Yes, stress is a risk factor for heart disease, for vascular disease. So it is a factor that affects our health, it affects our heart, it affects our vessels. So it's worth thinking about, it's worth controlling that stress, it's worth controlling our reactions to stress.

Monika Rachtan
Well. And what signs can indicate that we are stressed, that our body is stressed? Are these any signs that we can look out for?

Alexander Prejbisz
Yes, the symptoms of stress are actually symptoms that vary, but mostly we talk about symptoms that are typical of our cardiovascular system. That is, they are symptoms of pain, chest pains, heart pains. These are symptoms of cardiac arrhythmias, that is, our heart beats fast, beats irregularly. These are symptoms of our vessels, that is, we talk about tightness, chest pain. But also these are symptoms of disorders of our digestive system, that is, we talk about nausea, about vomiting. These are symptoms of our head, that is, we talk about headache, dizziness, migraine, migraine attacks. So these are actually symptoms that we think are a symptom of stress. So these are different symptoms, but most commonly these are symptoms related to our cardiovascular system.

Monika Rachtan
Yes. So if these symptoms appear, it is worth seeing a doctor and consulting with him or her about the situation?

Alexander Prejbisz
Yes, if you get these symptoms, it's worth seeing a doctor and discussing it with your doctor. But also, it's worth helping yourself to eliminate it, to level it out. So it's actually to help our psyche, to help our cardiovascular system, so that it doesn't affect our health. So it's worth controlling it, it's worth thinking about it, it's worth seeing a doctor about it, but it's also worth thinking about ourselves to help ourselves.

Monika Rachtan
Yes. And what stress management techniques do you recommend?

Alexander Prejbisz
The techniques for coping with stress are different. So that's one of the questions that is very difficult, because everyone can find their own techniques to deal with stress. Whether it's company, whether it's music, whether it's relaxation, whether it's yoga, whether it's meditation. So these are all different stress management techniques that you can try. But it's also good to manage stress so that our stress doesn't lead to damage to our cardiovascular system. So stress is one of the factors that increases our risk of cardiovascular disease. So it is very important that we help ourselves to manage stress.

Monika Rachtan
That is to say, there are many techniques that can be tried and everyone can find something that helps them cope with stress.

Alexander Prejbisz
Yes, everyone can find their own techniques for dealing with stress, but it is also worth remembering those techniques that are generally available. That is, companionship, music, relaxation, yoga, meditation, and of course physical activity. So these are all different techniques that you can try out, that you can find, that you can implement in your life to control stress, so that you don't remain inactive to it.

Monika Rachtan
Yes, Professor, thank you very much for this valuable information on hypertension, on heart disease, on the risk factors that can lead to these diseases, on managing stress. This is really very important information for our listeners. Once again, thank you very much for participating in our programme.

Alexander Prejbisz
Thank you very much, too, for the invitation and for the opportunity to talk about hypertension, but also about heart disease, about cardiovascular prevention. It is really very important that we talk about it, that we think about it, that we control it, that we take care of it.