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DR. SALGO: IT'S OFTEN CALLED THE SILENT KILLER BECAUSE THERE MAY BE NO SYMPTOMS UNTIL THERE IS SERIOUS PHYSICAL DAMAGE. ONE OUT OF FOUR ADULT AMERICANS HAVE IT, MANY OF THEM DON'T KNOW IT. THAT'S COMING RIGHT UP ON SECOND OPINION.
MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION. THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING: THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.
DR. SALGO: WELCOME TO SECOND OPINION WHERE EACH WEEK WE SOLVE A REAL MEDICAL MYSTERY. WHEN WE CLOSE THIS CASE A HALF AN HOUR FROM NOW, YOU'LL NOT ONLY KNOW THE OUTCOME, YOU'LL ALSO BE BETTER ABLE TO TAKE CHARGE OF YOUR OWN HEALTH CARE. I'M YOUR HOST, DR. PETER SALGO, AND AS ALWAYS, WE'VE ASSEMBLED A NATIONALLY RECOGNIZED HEALTHCARE TEAM-EXPERTS IN TODAY'S TOPIC. SOME ARE DOCTORS, SOME ARE NOT, BUT THEIR EXPERIENCE WILL HELP US TACKLE TODAY'S CASE. NOW, NO ONE ON THE PANEL, AS WE ALWAYS DO, KNOWS THIS CASE EXCEPT, AS ALWAYS, ELISSA ORLANDO, OUR CIVILIAN, WHOSE JOB IT IS TO GIVE US ALL A REALITY CHECK FROM TIME TO TIME.
DR. SALGO: AND THIS WEEK'S PRIMARY CARE PHYSICIAN IS DR. LISA HARRIS, THE PHYSICIAN THAT YOU MIGHT ENCOUNTER AS YOUR FIRST PORTAL TO THE HEALTH CARE SYSTEM. HOW ARE YOU? IT'S TIME TO OPEN THIS WEEK'S CASE FILE. LET ME TELL YOU ABOUT TOM. TOM IS A 55-YEAR-OLD VOLUNTEER FIREMAN. HE WEIGHS 218 POUNDS ON A 5'11" FRAME. HE'S RECENTLY DIVORCED. HIS LAST PHYSICAL WAS 5 YEARS AGO. HE THINKS HE'S HEALTHY, HE'S ALWAYS FELT GOOD, BUT NOW HE'S NOTICING THAT HIS VISION IS CHANGING AND HE'S HAVING TROUBLE READING. SO HE GOES TO THE LOCAL DRUG STORE, PICKS UP A PAIR OF READING GLASSES, AND THEY DON'T WORK. SO EVENTUALLY HE DECIDES TO SEE AN OPHTHALMOLOGIST. THE DOCTOR EXAMINES HIM, SEES SOME CHANGES IN THE BLOOD VESSELS IN THE BACK OF TOM'S EYES AND SAYS TO TOM, "I SEE SOME CHANGES IN THE BLOOD VESSELS IN THE BACK OF YOUR EYE AND I'M WORRIED ABOUT IT." WHAT IS THE OPHTHALMOLOGIST WORRIED ABOUT?
DR. HARRIS: WELL, THERE'S SEVERAL THINGS THAT KIND OF POP INTO MY MIND. DIABETIC CHANGES WOULD BE ONE, HYPERTENSIVE CHANGES COULD BE ANOTHER. IF HE'S HAD ANY TYPE OF STROKE OR SOMETHING LIKE THAT HE MIGHT HAVE HAD SOME CHANGES, SO THERE'S IT JUST BOTHERS ME THAT HE WENT TO THE EYE DOCTOR AND DIDN'T COME TO SEE ME FIRST.
DR. SALGO: BUT WHAT IS THE OPHTHALMOLOGIST TRYING TO TELL TOM? MAYBE BY INDIRECTION, MAYBE BY IMPLICATION, "I DON'T LIKE THE BLOOD VESSELS IN THE BACK OF YOUR EYE."
DR. GREENBERG: TIME TO SEE YOUR DOCTOR.
DR. SALGO: WHAT ELSE CAN DO THIS? CAN DIABETES
DR. HARRIS: DID THE OPHTHALMOLOGIST HAVE THE PRESENCE OF MIND TO HAVE HIS BLOOD PRESSURE CHECKED WHILE HE WAS THERE?
DR. SALGO: YES. THE OPHTHALMOLOGIST DID CHECK HIS BLOOD PRESSURE.
ORLANDO: DO OPHTHALMOLOGISTS LOOK FOR OTHER THINGS? I JUST THOUGHT AN EYE DOCTOR ONLY DID YOUR EYES. WOULD THEY LOOK FOR OTHER THINGS? WOULD AN OPHTHALMOLOGIST SAY, "OH I SEE SOMETHING THAT'S NOT GOING ON WITH YOUR EYES THERE?"
DR. HARRIS: TYPICALLY NO. I MEAN, THEY'LL CALL THE PRIMARY, IF THEY HAVE A RELATIONSHIP, THEY'LL CALL THE PRIMARY CARE DOC AND SAY, YOU KNOW, I HAVE ONE OF YOUR FOLKS HERE, I THINK SOMETHING'S GOING ON. CAN YOU SEE THEM? AT LEAST THAT'S BEEN MY EXPERIENCE.
DR. SALGO: BUT YOU KNOW, WHAT IS THIS RELATIONSHIP BETWEEN LOOKING IN YOUR EYES AND THE BLOOD PRESSURE AND THE DIABETES? YOU ALL JUST JUMPED RIGHT INTO THE THING. HOW DO THEY RELATE?
DR. BISOGNANO: WELL MANY DISEASES HAVE MANIFESTATIONS THAT OCCUR IN THE EYES FIRST, I MEAN PARTICULARLY HIGH BLOOD PRESSURE AND DIABETES AND IT'S REALLY NOT ALL THAT UNCOMMON THAT SOMEBODY LIKE TOM, HITTING THE AGE OF ABOUT 55 WOULD SHOW UP IN SOMEBODY'S OFFICE, EVEN FOR A ROUTINE EYE CHECK, EVEN IN AN OPTOMETRIST'S OFFICE AND FIND SOMETHING LIKE THIS WHICH REALLY REPRESENTS THE TIP OF THE ICEBERG OF ALL THE TREATMENT THAT TOM NEEDS.
DR. SALGO: YOU KNOW WHEN I WAS YES, GO AHEAD.
DR. SANDERS: ALL THESE DISEASES AFFECT THE BLOOD VESSELS AND IN YOUR EYE YOU GET A VERY CLEAR PICTURE OF WHAT THE BLOOD VESSELS LOOK LIKE IN A LOT OF YOUR BODY, AND SO IT'S JUST A GOOD PLACE TO SEE THEM.
DR. GREENBERG: WELL IT'S THE ONLY PLACE WHERE YOU CAN ACTUALLY SEE A BLOOD VESSEL DIRECTLY. WHAT'S A LITTLE DISHEARTENING IS THAT IN THIS DAY AND AGE THAT SOMEONE REACHES THE AGE OF 55 AND HAS WHAT IS AT LEAST STAGE 2 OR STAGE 3 HYPERTENSION THAT HAD NEVER BEEN PICKED UP BEFORE.
DR. SALGO: BUT YOU'RE MAKING AN ASSUMPTION, RIGHT?
DR. GREENBERG: I'M MAKING AN ASSUMPTION THAT MAYBE TOM HAS NOT BEEN DEALING WITH HIMSELF APPROPRIATELY.
DR. SALGO: WELL LET ME TELL YOU WHAT HAPPENS WITH TOM BECAUSE UNLIKE MANY PATIENTS, TOM ACTUALLY DOES WHAT HIS FIRST DOCTOR TOLD HIM TO DO. HE GOES TO SEE ANOTHER DOCTOR. SO I GUESS A LOT OF PATIENTS ARE AT LOSS TO FOLLOW, BUT NOT TOM. IN HIS SECOND DOCTOR'S OFFICE, HIS BLOOD PRESSURE'S 158/98. HE'S TOLD THAT THAT'S VERY HIGH. IS IT HIGH? HIGH EVEN THOUGH HE'S A PRETTY BIG GUY?
DR. HARRIS: WE LIKE TO CATEGORIZE PEOPLE IN LITTLE BOXES AND IT MAKES IT EASIER FOR US TO TREAT THEM AND FIGURE OUT HOW TO TREAT THEM AND THERE WAS A HUGE STUDY CALLED JNC7 THAT LOOKED AT HOW TO CATEGORIZE PEOPLE INTO THESE BOXES AND WHERE YOU SHOULD TREAT THEM. SO "NORMAL" IS CONSIDERED 120/80, BUT UNDERSTAND THAT BLOOD PRESSURE IS DYNAMIC. IT'S NEVER THE SAME FROM SECOND TO SECOND AND HAS A RANGE THAT WE CONSIDER NORMAL.
DR. SALGO: NOW YOU THREW TWO NUMBERS AT US, THIS HIGH NUMBER AND A LOW NUMBER. I KNOW THEY'RE CALLED DIASTOLIC AND SYSTOLIC. WHY DOESN'T SOMEBODY JUST GIVE US THE DEFINITION HERE, PLEASE?
DR. SANDERS: WELL THE TOP NUMBER, SYSTOLIC NUMBER REFLECTS THE PRESSURE THAT'S GENERATED WHEN YOUR HEART BEATS. THE BOTTOM NUMBER CALLED DIASTOLIC THE DIASTOLIC BLOOD PRESSURE IS WHAT HAPPENS IN BETWEEN THOSE BEATS, SORT OF THE TONE, THE AMOUNT OF PRESSURE THAT'S THERE WHEN THERE'S NOT A BIG BURST OF PRESSURE COMING THROUGH. BOTH NUMBERS ARE IMPORTANT AND WE REALLY HAVE TO MAKE SURE THAT BOTH NUMBERS STAY WITHIN A GOOD RANGE. PEOPLE ALSO USED TO NOT TREAT HYPERTENSION UNTIL IT WAS, YOU KNOW, VERY ABNORMAL AND I THINK THAT PEOPLE ARE MUCH MORE AGGRESSIVE ABOUT TREATING BLOOD PRESSURE NOW AND I THINK IT'S ONE OF THE REASONS THAT OUR RATE OF HEART DISEASE HAS DECREASED.
DR. SALGO: ALL RIGHT.
ORLANDO: YOU GUYS ARE TALKING ABOUT HYPERTENSION AND BLOOD PRESSURE IN THE SAME WAY IN THE SAME SENTENCE. ARE THEY THE SAME THING?
DR. GREENBERG: SAME THING.
DR. BISOGNANO: HYPERTENSION MAY BE THE DISEASE, BUT BLOOD PRESSURE IS JUST THE MEASUREMENT OF THE NUMBERS.
ORLANDO: OK.
DR. SALGO: ALL RIGHT, HERE'S WHAT TOM SAYS. TOM HEARS THIS BLOOD PRESSURE READING, HIS DOCTOR SAYS "IT'S TOO HIGH". TOM'S NOT WORRIED. I MEAN TOM SAYS, "LOOK, MY BLOOD PRESSURE'S ALWAYS BEEN-" AND THIS IS THE NUMBER HE GIVES THE DOCTOR, "95 TO 100. I ALWAYS CHECK IT AT THE DRUG STORE, I ALWAYS CHECK IT AT THE HEALTH FAIRS. THESE NUMBERS ARE NORMAL FOR ME."
DR. GREENBERG: THE HARDEST SELL FOR TOM IS GOING TO BE TO CONVINCE HIM AT THIS POINT THAT HE ACTUALLY HAS A DISEASE.
DR. SALGO: WHY IS THAT?
DR. GREENBERG: BECAUSE HE DOESN'T THINK HE DOES. HE'S SOMEHOW ACCUMULATED ALL THE PUBLIC INFORMATION THAT'S BEEN AROUND ABOUT BLOOD PRESSURE AND THINKS HIS NUMBERS ARE NORMAL AND HE'S QUITE INSISTENT AS YOU PRESENT HIM THAT HE FEELS GOOD. AND IF I FEEL GOOD, THEREFORE I AM WELL. AND BREAKING THROUGH THAT BARRIER JUST TO GET HIM UNDER TREATMENT IS IN A SENSE PROBLEM ONE.
DR. SALGO: OK, HOW GOOD ARE THOSE MACHINES, BY THE WAY?
DR. HARRIS: I WAS JUST GOING TO SAY THAT THEY'RE INCREDIBLY INACCURATE. THE ONES AT THE DRUG STORE AND THE ONES AT THE HEALTH FAIR, THEIR MEASUREMENT DEPENDS ON THE EXPERTISE OF THE PERSON TAKING IT.
ORLANDO: WOULD THERE BE SOMETHING THAT WOULD BE TELLING HIM IF HE WAS SICK?
DR. GREENBERG: TOM COULD BE THE POSTER CHILD OF THE FUTURE.
DR. SALGO: I'M AFRAID TO ASK YOU WHY!
DR. GREENBERG: HE'S OVERWEIGHT, HE'S GOT HIGH BLOOD PRESSURE, WE HAVEN'T DONE ANY TESTS YET, BUT HE MAY WELL BE DIABETIC OR PRE-DIABETIC, AND HE IS BECOMING EPIDEMIC IN THE UNITED STATES.
DR. SALGO: NOW CATHYANN, YOU'VE HAD HIGH BLOOD PRESSURE DIAGNOSED.
HOWES: YES I HAVE.
DR. SALGO: DID YOU FEEL SICK WHEN YOU HAD YOUR HIGH BLOOD PRESSURE?
HOWES: I DID NOT FEEL SICK AT THAT TIME.
DR. SALGO: WHAT BROUGHT YOU TO THE DOCTOR?
HOWES: JUST A REGULAR HEALTH CHECK AND THE BLOOD PRESSURE WAS ELEVATED AND I EXPLAINED IT AWAY AS "WHITE COAT HYPERTENSION," YOU KNOW, I'M IN THE DOCTOR'S OFFICE, YOU'RE GOING TO TAKE MY BLOOD PRESSURE, IT'S GOING TO MAKE ME NERVOUS. AND WITH THAT DIAGNOSIS WE HAD A LOT OF DIFFICULTY TRYING TO SORT OUT WHERE TO GO TO CONVINCE ME THAT IT WAS ACTUALLY A DISEASE AND NEEDED MY ATTENTION.
DR. SALGO: I'LL TELL YOU SOMETHING ELSE THIS DOCTOR DOES I'M SORRY ELISSA. THIS DOCTOR MEASURES BLOOD PRESSURE IN BOTH ARMS AS OPPOSED TO JUST ONE. HE'S BEEN USING THE SAME ARM IN ALL OF THESE DRUG STORE AND HEALTH FAIR BLOOD PRESSURE CHECKS AND HIS DOCTORS FINDS, THE INTERNIST FINDS, THAT THE BLOOD PRESSURE IS HIGH IN BOTH ARMS. WHY IS HE DOING THAT?
DR. BISOGNANO: BECAUSE SOME PEOPLE HAVE SOME NARROWING OF ONE OF THE ARTERIES OF THEIR ARMS THAT CAN MAKE THE BLOOD PRESSURE IN ONE ARM LOWER THAN THE OTHER, IF THAT ARTERY IS NARROWED. SO REALLY TAKING THE HIGHER BLOOD PRESSURE OF THE TWO ARMS UNFORTUNATELY IS THE BLOOD PRESSURE THAT COUNTS.
DR. SALGO: I'LL GIVE YOU ONE OTHER FACT AND THEN WE'RE GOING TO STOP FOR A MOMENT AND SORT OF SUMMARIZE WHERE WE ARE. WHEN HIS INTERNIST ALSO LOOKS IN HIS EYES-AND BY THE WAY OPHTHALMOLOGISTS TAKE BLOOD PRESSURES, INTERNISTS LOOK IN PEOPLE'S EYES-HE CONFIRMS WHAT THE OPHTHALMOLOGIST FOUND, WHICH IS THERE ARE CHANGES IN THE BLOOD VESSELS IN THE BACK OF THE EYE WHICH ARE CONSISTENT WITH LONG-STANDING HYPERTENSION. HIGH BLOOD PRESSURE. YOU WERE RIGHT. TOM'S GOT HIGH BLOOD PRESSURE. SO YOU'RE ALL RIGHT! JUST FOR A MOMENT THOUGH, LET'S JUST SUM UP WHERE WE ARE. BLOOD PRESSURE NUMBERS ARE THE NUMBERS YOU'VE GOT. YOU CAN'T FAKE THEM, YOU CAN'T CHEAT, YOU CAN'T SAY I'M BIG SO MY NUMBERS ARE HIGH. HIGH BLOOD PRESSURE IS HIGH BLOOD PRESSURE AND EVEN IF YOU THINK IT'S NORMAL FOR YOU, IF THE NUMBERS ARE UP, YOU'VE GOT HIGH BLOOD PRESSURE. THAT'S ALL THERE IS TO IT. AND AS YOU'RE GOING TO HEAR, OF COURSE WE ALL STARTED TO TALK ABOUT THIS, YOU'RE PROBABLY GOING TO WANT TO BRING IT DOWN. IS THAT FAIR?
DR. SANDERS: ABSOLUTELY. YOU KNOW, BLOOD PRESSURE GOES UP AS WE AGE PRETTY MUCH NO MATTER WHAT, SO IF YOU CAN BUY YOURSELF POSSIBLY A LITTLE BIT OF TIME BY LIFESTYLE MODIFICATION SOMETIMES, DEPENDING ON HOW HIGH YOUR BLOOD PRESSURE IS.
DR. SALGO: WELL HERE'S WHAT TOM ASKED HIS DOCTOR. TOM SAYS, "LOOK, I THINK I'M HEALTHY AND FIT. I'VE NEVER HAD HIGH BLOOD PRESSURE, I HAVE NO SYMPTOMS. HOW DID I CATCH IT?"
DR. HARRIS: YOUR MOTHER AND FATHER.
DR. SALGO: HE PICKED HIS PARENTS POORLY?
DR. HARRIS: THAT'S HOW HE CAUGHT IT. I MEAN, IT'S JUST
DR. BISOGNANO: I THINK ALSO A PROBLEM OF TREATING HIGH BLOOD PRESSURE IS THAT MANY PEOPLE WHO HAVE HIGH BLOOD PRESSURE HAVE PARENTS AND AUNTS AND UNCLES AND THEY'VE ALWAYS HEARD OF BLOOD PRESSURES OF 160 AND 180 AND 200, SO THEY DON'T GET PARTICULARLY EXCITED WHEN WE TELL THEM IT'S 158 AND THAT THIS IS SOMETHING THAT HAS TO BE TREATED.
DR. SALGO: SO THEY'RE GOING TO SAY TO YOU, "BUT MOM ALWAYS HAD THAT BLOOD PRESSURE. IT'S NORMAL FOR MY FAMILY."
DR. BISOGNANO: THAT'S RIGHT. AND IT'S NOT NORMAL BECAUSE FOR EVERY INCREASE IN 20 MILLIMETERS OF SYSTOLIC, THE TOP NUMBER, YOUR CARDIOVASCULAR RISK IS DOUBLED.
DR. SALGO: HE DOESN'T KNOW IF HE HAS HIGH BLOOD PRESSURE IN HIS FAMILY, BUT HIS FAMILY ALWAYS TOLD HIM THAT GARLIC IS GOOD FOR YOUR HEART, SO HE'S TAKING A GARLIC PILL EVERY DAY. HE LIKES A REGULAR DIET, LOVES SALT, HIS BMI IS 28. WHAT ON EARTH IS THAT, LISA?
DR. HARRIS: THAT'S HIS BODY MASS INDEX, WHICH GIVES US AN IDEA OF HIS WEIGHT IN PROPORTION TO HIS HEIGHT AND BONE STRUCTURE.
DR. SALGO: HOW'S THAT NUMBER? ANYBODY?
DR. GREENBERG: HE'S OVERWEIGHT, BUT NOT OBESE BY CURRENT STANDARDS.
DR. SALGO: OK, HE'S BEEN THROUGH A DIVORCE, HE'S BEEN UNDER STRESS, HIS AGE IS 55, HE USED TO SMOKE, HE DOESN'T ANYMORE, HE DOESN'T DRINK, HE DOESN'T USE ANY DRUGS. HE IS MAL,E AND THE EXERCISE THAT HE GETS IT THROUGH HIS FIREMAN DRILLS. SO THAT'S HIS BASIC HISTORY. WHAT ARE YOUR THOUGHTS NOW ABOUT TREATING HIM, ABOUT THE NEED FOR TREATING HIM, THE URGENCY FOR TREATING HIM?
DR. HARRIS: I STILL WANT TO KNOW IS HE DIABETIC AND WHAT HIS CHOLESTEROL IS IF YOU HAVE IT.
DR. SALGO: WELL, WE'RE GOING TO SEND SOME LABS BUT I DON'T HAVE THEM AT THIS POINT IN THE CHART. BUT I CAN TELL YOU, THEY'RE COMING.
ORLANDO: I JUST WANT TO GO BACK TO THE IDEA THAT HE'S DIVORCED. I MEAN, I KNOW THAT YOU SAY REALLY FAMILY HISTORY IS THE MAIN THING BUT HE LIKES SALT AND HE HAS A LOT OF STRESS. AREN'T THOSE THINGS THAT CAN CAUSE YOUR BLOOD PRESSURE TO GO UP?
DR. HARRIS: THAT CAN CONTRIBUTE TO IT.
GREENBERB: YOU KNOW, IT IS-THERE ARE PATIENTS WHO YOU TREAT FOR HIGH BLOOD PRESSURE AND WHO COME BACK AND SAY, "I'VE CHANGED MY DIET, I'VE LOST WEIGHT, I'M NOW EXERCISING" AND YOU CAN CERTAINLY HAVE A TRIAL WHERE YOU WEEN PATIENTS OFF THEIR DRUGS AND SEE WHAT HAPPENS. IT IS UNCOMMON, HOWEVER, THAT THEY STAY AT A BLOOD PRESSURE THAT'S ACCEPTABLY LOW. THEY MAY GO BACK ON A SMALLER DOSE OR LESS PILLS THAN THEY WERE BEFORE. BUT IT'S DECIDEDLY UNCOMMON.
DR. SALGO: WE'RE ALL TAKEN TOWARD MEDICATION HERE. LET ME GIVE YOU ONE MORE PIECE OF INFORMATION. TOM IS AFRICAN AMERICAN. DOES THAT MAKE A DIFFERENCE?
DR. HARRIS: INCREASES HIS RISK.
DR. SALGO: INCREASES HIS RISK OF WHAT?
DR. HARRIS: ESSENTIAL HYPERTENSION, HEART ATTACK, AND STROKE.
DR. SALGO: SO THAT'S MORE COMMON?
DR. HARRIS: ABSOLUTELY. AFRICAN AMERICANS TEND TO HAVE HYPERTENSION MORE COMMONLY.
DR. SALGO: OK.
DR. HARRIS: AND TEND OFTEN TO ALSO BE UNDER-TREATED, UNDER-DIAGNOSED AND HAVE MORE COMPLICATIONS, AND SOME OF THAT HAS TO DO WITH THE POLITICS OF HEALTH AND SOME OF IT HAS TO DO WITH ETHNICITY AND GENDER.
DR. SALGO: ALL RIGHT, WELL TOM'S DOC GRABS A BUNCH OF OTHER TESTS AND I-YOU KNOW HE'S GOING TO GRAB A CHOLESTEROL SOMEWHERE AROUND HERE. AND WHILE THEY'RE WAITING FOR THE TESTS TO COME BACK, TOM BASICALLY IS TOLD TO DO WHAT YOU WANT HIM TO DO. HE GOES HOME, EATS A LOW-SODIUM DIET, HE CONTINUES NOT SMOKING AND DOESN'T DRINK. HE DOES MORE AEROBIC EXERCISES AND HE TRIES TO LOSE WEIGHT. THAT SOUNDS LIKE WHAT WE ALL SHOULD BE DOING. LISA SANDERS, YOU WROTE THE BOOK "THE PERFECT FIT DIET". HOW MUCH CAN HE EXPECT TO BENEFIT FROM THIS?
DR. SANDERS: DOING ALL THOSE THINGS WILL CERTAINLY MAKE HIM FEEL BETTER AND WILL PROBABLY IMPROVE HIS LIFE AND HEALTH OVERALL. HOW MUCH WILL IT AFFECT HIS BLOOD PRESSURE?
DR. SALGO: RIGHT.
DR. SANDERS: I BELIEVE THE OFFICIAL TERM IS "MODEST."
HOWES: EVERYTHING THAT I'M HEARING YOU SAY IS EVERYTHING WE ALL KNOW THAT WE NEED TO BE DOING ANYWAY, WHETHER IT'S HYPERTENSION OR ANOTHER KIND OF ISSUE. AND IT'S A TOUGH, TOUGH THING TO DO. HE HAS A HIGH BLOOD PRESSURE AND YOU CAN START THESE THINGS BUT THAT TAKES A WHILE AND WE'RE TALKING ABOUT SOMETHING THAT REALLY IMMEDIATELY NEEDS A JOLT TO GET READY. THE FRUITS AND THE VEGETABLES AND ALL THOSE KINDS OF THINGS IS A HUGE CHANGE FOR SOMEONE WHO'S A FIREFIGHTER AND NOT EXERCISING VERY MUCH AND GONE THROUGH A LOT OF STRESS-THAT'S BIG.
DR. SALGO: TOM IS OUT THERE, HE'S BEEN DOING HIS BEST, ALL RIGHT? AND HIS DOC WHO SENT OFF SOME LAB RESULTS, GOT THEM BACK, TOM'S GONE IN FOR A CHECK. TOM'S BLOOD PRESSURE IS DOWN, IT'S NOW 150/93.
DR. HARRIS: OH YAY.
DR. SALGO: "OH YAY" SAYS LISA.
DR. SANDERS: DID YOU START HIM ON ANYTHING OR NOT?
DR. SALGO: WE DID NOT START HIM ON ANYTHING, JUST THAT DIET AND EXERCISE.
DR. BISOGNANO: BUT WE HAVE TO RECOGNIZE THAT THESE ARE TOOLS TO HELP A LITTLE BIT, BUT THEY ARE STILL HYPERTENSIVE AND WILL PROBABLY NEED A MEDICATION.
DR. SALGO: HIS TOTAL CHOLESTEROL'S 192. LDL CHOLESTEROL, THE BAD CHOLESTEROL, 168. HIS HDL-THERE'S A GRIMACE OVER THERE-HIS HDL IS 34. NOW HIS TOTAL CHOLESTEROL'S UNDER 200, RIGHT? SO EVERYTHING'S FINE, RIGHT, HENRY?
DR. GREENBERG: WRONG. THOSE NUMBERS DON'T PARSE. BUT LET'S ASSUME FOR THE SAKE OF ARGUMENT THAT WE HAVE AN LDL OF 168 THAT IS, TO COIN AN EXPRESSION, OFF THE WALLS HIGH.
DR. SALGO: OK.
DR. GREENBERG: THAT HAS TO BE TREATED ALSO. AND YOU KNOW DIET WILL HELP IT WILL HELP "MODESTLY" RIGHT?
DR. SANDERS: I THINK THAT'S-I'M AFRAID THAT'S THE WORD.
DR. GREENBERG: SO HE'S STARTING TO GET A WHOLE STACK OF PILLS THAT HE'S GOING TO WALK OUT OF HIS DOCTOR'S OFFICE WITH.
DR. SALGO: BUT THIS IS CHOLESTEROL-I'M SORRY, GO AHEAD.
ORLANDO: WELL HE JUST WALKED IN FOR GLASSES, OKAY? NOW HE'S CHANGED HIS LIFESTYLE AFTER GLASSES, AND NOW YOU'RE TELLING HIM THERE'S A CHOLESTEROL PROBLEM AND HE HAS HYPERTENSION.
DR. GREENBERG: THE REASON IN THIS COUNTRY THAT WE HAVE DROPPED THE STROKE INCIDENTS SO MUCH IS THAT PEOPLE WENT IN FOR GLASSES AND GOT TREATED FOR HYPERTENSION. AND THE STROKE INCIDENTS IN THIS COUNTRY HAS PLUMMETED.
ORLANDO: BUT HOW DOES THE STROKE HAPPEN BECAUSE OF THE HIGH BLOOD PRESSURE? WHAT HAPPENS IN THE BODY?
DR. GREENBERG: YOU'RE JUST BANGING HIGH BLOOD PRESSURE-HIGH PRESSURE INTO YOU BRAIN AND A VESSEL WILL EITHER HEMORRHAGE OR YOU WILL DEVELOP-AND THIS GETS INTO THE CHOLESTEROL A BIT-ACCELERATED ATHLEROSCLEROSIS AND HAVE NARROWED VESSELS IN THE HEAD.
DR. HARRIS: YOU CLOG THE PLUMBING.
DR. SALGO: THAT'S THE STROKE. WHAT ABOUT THE HEART ATTACK AND THE CHOLESTEROL AND THE HIGH BLOOD PRESSURE? HOW DOES THAT ALL WORK TOGETHER?
DR. GREENBERG: WELL HIGH BLOOD PRESSURE IS PROBABLY THE MAJOR FACTOR BEHIND HEART FAILURE. IT IS CERTAINLY A DOMINANT RISK FACTOR FOR CORONARY ARTERY DISEASE OR HEART ATTACKS, IT IS THE MAJOR CAUSE, OUTSIDE OF DIABETES, OF KIDNEY DISEASE. I MEAN IT IS THE WORLD'S NUMBER ONE PROBLEM. HYPERTENSION. GARDEN-VARIETY, BORING, EVERYDAY HYPERTENSION.
DR. SANDERS: WHAT HAPPENS TO YOU DEPENDS ON WHICH BLOOD VESSEL GOES SOUTH FIRST. GET A CLOT IN YOUR HEART AND YOU HAVE A HEART ATTACK. GET A CLOT IN YOUR BRAIN OR A CLOSING OF THE VESSEL IN YOUR BRAIN AND YOU HAVE A STROKE. IT'S ALL PART OF THE SAME DISEASE.
DR. HARRIS: AND A REAL GOOD ANALOGY-BACK TO PLUMBING. BUT IF YOU THINK ABOUT THE PLUMBING IN YOUR HOUSE AND IF YOU USE THAT ANALOGY AS THE BLOOD VESSELS IN YOUR BODY AND IF YOU ARE PUTTING GUNK DOWN INTO YOUR GARBAGE DISPOSAL CONSISTENTLY OR GUNK INTO YOUR TOILET SO YOU'RE EATING A LOT OF FAT, HIGH FAT FOODS, HEAVY FOODS, OVER AND OVER AND OVER AGAIN THAT'S ANALOGOUS TO PUTTING GUNK IN YOUR PIPES. AND THEN YOU ADD TO THAT SALT WHICH PULLS WATER OR FLUID INTO THOSE BLOOD VESSELS. NOW YOU'RE TURNING ON THE WATER AND YOU'RE TRYING TO RUN WATER THROUGH ALL OF THIS GOO THAT'S IN THERE. SOMETHING'S GOING TO BACKLOG AND EXPLODE SOMEWHERE IN YOUR HOUSE ALONG THE LINE.
DR. SALGO: ALL RIGHT LET ME GIVE YOU-GO AHEAD.
DR. BISOGNANO: I THINK THE KEY IN TREATING THIS GENTLEMAN IS TO LET HIM KNOW EXACTLY HOW SEVERE THE SITUATION IS BECAUSE HE FEELS FINE AND HE'S WONDERING WHY THIS IS ALL HAPPENING TO HIM AND WHY WE'RE GOING TO SEND HIM OUT WITH 6 OR 7 MEDICATIONS ULTIMATELY THAT ARE GOING TO ALL COST HIM, ARE PROBABLY-NOT PROBABLY, BUT PERHAPS GOING TO GIVE HIM SIDE EFFECTS-WHY THIS IS IMPORTANT FOR HIM TO DO.
DR. SANDERS: WITH HIS CHOLESTEROL AND HYPERTENSION, HE ALREADY HAS METABOLIC SYNDROME WHATEVER HIS GLUCOSE IS.
ORLANDO: NOW HE'S GOT METABOLIC SYNDROME?
DR. SANDERS: NOW HE HAS METABOLIC SYNDROME.
ORLANDO: WHAT IS THAT?
DR. HARRIS: THAT'S OUR NEW BUZZ WORD.
ORLANDO: OH, IT IS
DR. SALGO: IT'S A BUZZWORD FOR WHAT?
DR. SANDERS: THAT'S OUR PRE-PRE-DIABETIC CONDITION.
DR. SALGO: OK.
DR. SANDERS: THAT IS A GUY WHO GIVEN THE CHANCE AND A FEW MORE TWINKIES, COULD POSSIBLY DEVELOP DIABETES-COULD PROBABLY DEVELOP DIABETES.
DR. SALGO: ARE WE GOING TO LEAVE HIM ON EXERCISE ALONE? ARE WE GOING TO HOPE IT ALL WORKS OUT? OR ARE WE GOING TO PUT HIM ON MEDS?
DR. BISOGNANO: I THINK IT WAS A MISTAKE FOR THE STARTING GATE TO PUT HIM ON DIETARY AND EXERCISE THERAPY ALONE.
DR. SALGO: OK.
DR. BISOGNANO: IT MIGHT HELP BUT FIRST OF ALL REALIZE THAT THIS IS A THERAPY THAT MOST PEOPLE CAN DO FOR A MONTH. WE'VE ALL LOST WEIGHT FOR A MONTH, WE'VE ALL GAINED IT BACK IN THE FOLLOWING MONTHS SO THAT'S HOW MOST DIETS GO IN MOST OF OUR PATIENTS. THESE PATIENTS NEED TO BE ENGAGED AT THE FIRST VISIT THAT SOMETHING IMPORTANT IS GOING ON, SOMETHING CAN BE CHANGED TEN YEARS IN THE FUTURE.
ORLANDO: SO YOU'RE GETTING THEM READY FOR, "YOU'RE GOING TO GET A PILL, YOU'RE GOING TO GET MEDICATION AT SOME POINT". DO YOU GET THEM READY FOR THAT BECAUSE IF I WENT AWAY AND THOUGHT I COULD TAKE CONTROL AND THEN CAME BACK AND DID A LOT OF THINGS LIKE TOM DID AND SOMEBODY SAID, "EH, NOT ENOUGH", THAT WOULD REALLY UPSET ME.
DR. HARRIS: YOU CAN TAKE CONTROL AND YOU NEED TO UNDERSTAND THE PILL IS NOT A PANACEA. THE LIFESTYLE HAS TO CHANGE ALONG WITH IT.
DR. SALGO: OH SO IF YOU TAKE THE PILL THAT'S NOT ENOUGH?
DR. HARRIS: THAT'S NOT ENOUGH.
DR. SALGO: YOU GOING TO MAKE HIM EXERCISE?
DR. HARRIS: YES I AM.
DR. SALGO: MAKE HIM WATCH HIS DIET?
DR. HARRIS: I'M GOING TO MAKE HIM EXERCISE AND DIET.
HOWES: BUT EVEN BEFORE THAT I REMEMBER YEARS OF TRIAL AND ERROR WITH MEDICATIONS. YOU KNOW, YOU START OFF WITH A DIURETIC AND THEN YOU HAVE TO TAKE POTASSIUM TO MAKE UP THE BALANCE OF THAT AND WE'RE STILL CHANGING. I'VE GONE THROUGH ALL THE DIFFERENT CLASSIFICATIONS OF MEDICATIONS TO MAKE IT WORK AND BALANCE AND IT IS A TRIAL AND ERROR TO FIND THAT MAGIC THAT'S GOING TO WORK.
DR. GREENBERG: YOU HAVE TO TELL PATIENTS, ONE, THAT THE MEDICINE, THE MEDICAL THERAPY IS TRIAL AND ERROR.
DR. SALGO: WHAT I WANT TO DO IS SORT OF SUMMARIZE WHERE WE'VE COME THIS FAR. WHEN IT COMES TO BLOOD PRESSURE CONTROL, LIFESTYLE CHANGES DO HAVE THEIR LIMITS. ONCE DIAGNOSED WITH HIGH BLOOD PRESSURE IT IS CRITICAL THAT YOU MEET YOUR GOAL AND THAT GOAL IS A NORMAL BLOOD PRESSURE. IN MANY CASES THAT CAN ONLY BE DONE WITH THE ADDITION OF MEDICATION. IT WOULD BE NICE, I GUESS, IF THIS WERE OTHERWISE BUT IT SIMPLY IS NOT. SOMETIMES IT TAKES A PILL. IS THAT FAIR?
DR. SANDERS: MOST TIMES.
DR. HARRIS: MOST TIMES.
DR. SALGO: MOST TIMES!
DR. SANDERS: THE VAST MAJORITY OF TIMES.
DR. SALGO: OK, WHAT ARE YOU GOING TO DO FOR TOM? WHAT DRUGS ARE YOU GOING TO GIVE HIM?
DR. BISOGNANO: FOR TOM WE MIGHT WANT TO USE, WE CERTAINLY WANT TO USE MEDICATIONS THAT INCLUDE A DIURETIC MEDICATION, A MEDICATION THAT GETS SOME SODIUM OUT OF HIM. WE'LL PROBABLY HAVE TO USE OTHER MEDICATIONS SUCH AS CALCIUM CHANNEL BLOCKERS, INHIBITORS
DR. HARRIS: I GOTTA JUMP IN HERE.
DR. SALGO: PLEASE.
DR. HARRIS: THIS GUY HAS GLUCOSE INTOLERANCE. IN OTHER WORDS HE'S ALREADY PRE-DIABETIC AND HE HASN'T SEEN THE CARDIOLOGIST YET. HE'S IN MY OFFICE AND I'M PROBABLY GOING TO SEND HIM TO JOHN SO HE CAN GET AN ECHOCARDIOGRAM AND MAKE SURE A STRESS ECHO, MAKE SURE HIS HEART IS DOING WHAT IT'S SUPPOSED TO DO. HE WOULD START ON AN ANGIOTENSIN RECEPTOR BLOCKER AT MY OFFICE.
DR. SALGO: THAT'S AN ACE INHIBITOR.
DR. HARRIS: NO.
DR. SALGO: NO, NO
DR. HARRIS: I WOULD GIVE IT FOR A VARIETY OF REASONS BUT I'D GIVE HIM AN ARB ONE, BECAUSE IT WILL HELP PROTECT HIS KIDNEYS FROM THE DIABETES, TWO, BECAUSE THEY EXPECT THAT I'M GOING TO EFFECTIVELY LOWER HIS BLOOD PRESSURE AND I CAN USE IT IN COMBINATION WITH A DIURETIC SO HE HAS ONE PILL THAT HE CAN DO ONCE, MAYBE TWICE A DAY, AND I INCREASE HIS COMPLIANCE.
DR. SALGO: BUT YOU KNOW THERE WAS A TRIAL RIGHT, THAT SAID ALL YOU REALLY NEED IS A DIURETIC? THAT'S THAT ALLHAT TRIAL.
ORLANDO: RIGHT, THAT'S WHAT I HEARD. IF YOU TAKE A DIURETIC
DR. BISOGNANO: THERE WAS A RECENT TRIAL THAT WAS PUBLISHED ABOUT TWO YEARS AGO WHICH COMPARED FOUR DIFFERENT DRUGS FOR INITIAL TREATMENT OF HIGH BLOOD PRESSURE AND THE STUDY HAD A LOT OF FLAWS IN IT. THE CONCLUSION OF IT TRIVIALLY WAS THAT THE DIURETIC WAS AS EFFECTIVE AS THE OTHER MEDICATIONS IN TREATING BLOOD PRESSURE. AND THERE'S NO DOUBT THAT IT DROPPED BLOOD PRESSURE AS WELL, BUT IT DID CAUSE AN EXCESS OF DIABETES. IT ALSO CAUSED A LOT OF PATIENTS TO HAVE TO TAKE SUPPLEMENTS OF POTASSIUM PILLS, WHICH ARE BIG, HEAVY PILLS THAT NOBODY PARTICULARLY WANTS TO TAKE.
DR. SALGO: I DIDN'T HEAR ANY OF YOU GUYS DIVING IN TO DEFEND THIS ENORMOUS TRIAL THAT GOT ALL THIS PRESS. DOES ANYBODY LIKE IT?
DR. GREENBERG: NO, NO. I MEAN-
DR. SALGO: IS IT YOU OR ANYBODY?
DR. GREENBERG: ACTUALLY THE JOURNALS KEEP COMING UP WITH EDITORIALS THAT LIKE IT, BUT AS JOHN SAID, 12% OF PATIENTS IN ALLHAT HAD LOW POTASSIUM.
ORLANDO: ALLHAT, IS THAT WHAT IT'S CALLED?
DR. HARRIS: THAT'S THE NAME OF THE STUDY.
DR. GREENBERG: ALLHAT. 12% OF PATIENTS GOT LOW POTASSIUM IN ALLHAT LOW TO A DEGREE WHERE WE WOULD ALL START TREATING THEM WITH SUPPLEMENTAL POTASSIUM, WHICH IS BOTH BIG AND EXPENSIVE, AND ANOTHER PILL. AND THERE WERE NO MAJOR UNTOWARD EFFECTS IN THE CLINICAL TRIAL WHERE PATIENTS ARE FOLLOWED AND THEY'RE SELECTED BECAUSE THEY WILL BE FOLLOWED AND AGREE TO COME BACK. IN THE REAL WORLD-BIG PROBLEM.
DR. SALGO: I CAN TELL YOU WHAT HIS DOCTOR STARTED HIM ON. HE PUT HIM ON A BETA BLOCKER AND A LOW-DOSE DIURETIC. ARE WE HORRIFIED AT THIS OR IS THIS OK?
DR. HARRIS: WE ARE HORRIFIED.
DR. SANDERS: WELL-
DR. BISOGNANO: I THINK WE'RE HORRIFIED WITH THIS AND THE PROBLEM WITH A BETA BLOCKER IN MANY PATIENTS IS AS WE ALLUDED TO BEFORE IS THEY NEVER COME BACK MORE ACTIVE. THEY'RE TIRED, 20% TO 30% OF THE PEOPLE WILL HAVE SEVERE TIREDNESS SO THEY NEVER COME BACK 10 POUNDS LESS, THEY NEVER COME BACK INTERESTED IN CONTINUING THE THERAPY. TO TOM, IT'S BAD ENOUGH THAT HE HAS HYPERTENSION AND BAD ENOUGH THAT HE HAS TO TAKE THREE DRUGS, LET ALONE A DRUG THAT'S GOING TO MAKE HIM GIVE HIM SIDE EFFECTS. AND IF THIS WERE THE 1960'S, WE WOULD TOLERATE IT BECAUSE IS WAS IMPORTANT TO BRING THE BLOOD PRESSURE DOWN AND IF THERE WAS SIDE EFFECTS, THERE'S SIDE EFFECTS. BUT NOW WITH THE 95 MEDICATIONS ON THE MARKETS
DR. SALGO: WE'RE GETTING ONE OF THESE LOOKS FROM ELISSA.
DR. HARRIS: YEAH, SHE'S GOT THAT DEER-IN-THE-HEADLIGHTS LOOK.
ORLANDO: WELL I HAVE TWO QUESTIONS. FIRST OF ALL, I KNOW ESPECIALLY WHEN HEAR FROM SENIOR CITIZENS ABOUT HIGH BLOOD PRESSURE, EVERYBODY SEEMS TO BE ON A DIURETIC AND POTASSIUM. IT SEEMS TO BE-EVEN IF YOU DON'T LIKE THE TRIAL-IT SEEMS TO BE THE KIND OF TREATMENT THAT I HEAR A LOT ABOUT THAT EVERYBODY'S TAKING. SECONDLY, WITH TOM YOU JUST SAID A FEW MINUTES AGO THAT WE'RE GOING TO HAVE TO FIND OUT WHAT HE NEEDS FROM A WHOLE MIX OF 95 MEDICATIONS SO YOU KNOW THEY'RE CHOOSING A COUPLE NOW, WHY NOT JUST START THERE WITH THE BETA BLOCKER? IT SOUNDS LIKE IT WOULD BE GOOD FOR HIS HEART.
DR. HARRIS: BECAUSE YOU COULD CHOOSE A BETTER DRUG FOR HIM THAN A BETA BLOCKER. ONE WITH LESS SIDE EFFECTS FOR HIM. AND JUST TWO SECONDS TO YOUR OTHER QUESTION. SENIORS BEING ON DIURETICS-THEY'RE CHEAP.
DR. SALGO: SO WHY DON'T WE STOP HERE AND SEE IF WE CAN SUMMARIZE. WE'VE COVERED A TON OF GROUND HERE. THERE ARE MANY MEDICATIONS AND COMBINATIONS THAT CAN HELP GET YOUR BLOOD PRESSURE TO YOUR TARGET NORMAL. THE TREATMENTS HAVE TO BE INDIVIDUAL. IT'S LIKE A-IT'S LIKE A RECIPE. THERE IS NO STANDARD FORMULA, THERE'S NO ONE COCKTAIL THAT'S RIGHT FOR EVERYBODY. LET ME TELL YOU A LITTLE BIT MORE ABOUT TOM. TOM IS NOW TAKING THE MEDICATIONS-HE WASN'T THRILLED ABOUT TAKING THEM BY THE WAY.
DR. SANDERS: GOOD FOR HIM.
DR. SALGO: GOOD FOR HIM. HE HAS TO SPEND A LOT OF MONEY ON THESE MEDICATIONS AND HE'S NOT FEELING WELL FROM THE SIDE EFFECTS OF THESE MEDICATIONS. AND EVEN THOUGH HIS DOCTOR FIDDLED WITH THE MEDS HE STILL DIDN'T FEEL BETTER AND HE GOES BACK TO HIS DOC AND HE SAYS, "ALL I WANTED WAS A GOSH-DARN PAIR OF GLASSES! AND LOOK WHAT YOU'VE DONE TO ME!" TOM IS WORRIED THAT EVEN AS A VOLUNTEER FIREMAN THEY MAY NOT LET HIM CONTINUE BECAUSE OF WHAT YOU MENTIONED, THAT HE MAY HAVE SOME EXERCISE INTOLERANCE AND OTHER PROBLEMS IF HE HAS A BETA BLOCKER. SO BECAUSE OF ALL OF THIS TOM-GUESS WHAT?
DR. GREENBERG: HE WENT TO ANOTHER DOCTOR.
DR. SALGO: NO, HE STOPPED TAKING HIS MEDS.
DR. BISOGNANO: HE DOESN'T COME BACK.
DR. SALGO: HE DOESN'T COME BACK. AND THIS COMES BACK TO WHAT LISA WAS TALKING ABOUT, THE COMPLIANCE ISSUE. HE DOES NOT TAKE HIS MEDICATIONS THEN HE COMES BACK FOUR YEARS LATER AND THIS TIME TO THE EMERGENCY ROOM WITH AN APPARENT HEART ATTACK. HOW COULD WE DO YOU THINK, HOW COULD HIS DOCTOR HAVE HELPED HIM BETTER?
DR. BISOGNANO: I THINK WHAT WE'RE TREATING-AND WE HAVE TO GET THE PATIENT INVOLVED IN THIS TREATMENT-IS WE'RE TRYING TO PREVENT CARDIOVASCULAR DISEASE AND TO FOCUS ON EITHER HIGH BLOOD PRESSURE OR HIGH CHOLESTEROL EXCLUDING THE OTHER ONE IS NOT THE APPROACH TO TAKE.
DR. SALGO: I DON'T WANT TO LEAVE WITHOUT FINDING OUT HOW YOU'RE DOING.
HOWES: I DON'T HAVE THE ENERGY THAT I REMEMBER HAVING 20 YEARS AGO SO I CAN SAY THAT WITH THE MEDS OR WITHOUT THE MEDS. NO, I'M FEELING-I'M FEELING REALLY GREAT BUT IT'S BEEN A BALANCING ACT AND THE PIECE IS FINDING THE HOOK FOR THE PATIENT, FROM MY PERSPECTIVE, THAT MAKES THEM UNDERSTAND THAT EVERYTHING THAT YOU'RE TELLING THEM WHICH WE HEAR EVERY DAY ALL THE TIME REALLY IS CRITICAL FOR THEIR LONGEVITY AND FOR THEIR QUALITY OF LIFE.
DR. SALGO: I WANT TO THANK YOU FOR BEING HERE. IT'S JUST TREMENDOUS TO HEAR YOUR STORY. I THANK ALL OF YOU FOR BEING HERE AS WELL. WE COVERED A LOT OF GROUND TODAY. LET ME SUMMARIZE THE IMPORTANT THINGS TO REMEMBER. THE NUMBERS ARE THE NUMBERS. YOU BLOOD PRESSURE NUMBERS ARE WHAT THEY ARE. YOU CAN'T FUDGE THEM, YOU CAN'T CHEAT. JUST BECAUSE YOU'RE BIG DOESN'T MEAN YOU'RE ENTITLED TO HIGH BLOOD PRESSURE. IF YOU BLOOD PRESSURE IS HIGH, IT'S HIGH. IF YOU THINK IT'S NORMAL FOR YOU, IF THE NUMBERS ARE HIGH, YOU RUN HIGH BLOOD PRESSURE AND YOUR NORMAL IS HIGH BLOOD PRESSURE-IT HAS TO COME DOWN. WHEN IT COMES TO BLOOD PRESSURE CONTROL, LIFESTYLE CHANGES HAVE THEIR LIMITS, DESPITE WHAT YOU READ IN THE SUPERMARKET TABLOIDS. ONCE DIAGNOSED WITH HIGH BLOOD PRESSURE, IT IS CRITICAL THAT YOU MEET YOUR GOAL. AND IN MANY CASES THAT CAN ONLY BE DONE WITH THE ADDITION OF MEDICATION. NOW THERE ARE LOTS OF MEDICATION COMBINATIONS THAT CAN HELP GET YOUR BLOOD PRESSURE TO YOUR TARGET NORMAL AND THE TREATMENTS NEED TO BE INDIVIDUAL. THERE IS NO STANDARD FORMULA FOR ONE PERSON THAT WORKS FOR EVERYBODY. AND OF COURSE OUR FINAL MESSAGE IS THIS: TAKING CHARGE OF YOUR HEALTH MEANS BEING INFORMED, HAVING QUALITY COMMUNICATION WITH YOUR DOCTOR. I'M DR. PETER DR. SALGO AND I'LL SEE YOU NEXT TIME FOR ANOTHER SECOND OPINION.
SEARCH FOR HEALTH INFORMATION AND LEARN MORE ABOUT DOCTOR/PATIENT COMMUNICATION ON THE SECOND OPINION WEB SITE. THE ADDRESS IS PBS.ORG.
MAJOR FUNDING FOR SECOND OPINION IS PROVIDED BY THE GUIDANT FOUNDATION. THROUGH PHILANTHROPIC PARTNERSHIPS, THE GUIDANT FOUNDATION IS COMMITTED TO INCREASING PATIENT AWARENESS AND ACCESS TO ADVANCEMENTS IN CARDIOVASCULAR CARE, WITH ADDITIONAL SUPPORT FROM THE FOLLOWING: THE JOSIAH MACY JR. FOUNDATION AND THE PARK FOUNDATION.
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