ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore. I’m a photographer and editor here, and I’m also a long-time podcaster.

KATIE MCCALLUM: I’m Katie McCallum. I’m a former researcher, turned health writer, mostly writing for our blogs.

TODD ACKERMAN: I’m Todd Ackerman. I’m editor of Houston Methodist Leading Medicine and On Health.

KIM RIVERA HUSTON-WEBER: I’m Kim Rivera Huston-Weber. I’m a copywriter for Beyond Health blog.

ZACH: Alright, so what are we talking about today guys?

KATIE: We’re talking about blood pressure. We’re talking about lowering high blood pressure.

ZACH: How low is your blood pressure Katie?

KATIE: How low is my blood pressure?

ZACK: Or is that the incorrect question to be asked.

KATIE: I think it would be like, what is your blood pressure?

ZACH: Okay.

KATIE: I’m gonna be honest, I don’t have it memorized. But I did -- I did get it checked recently.

ZACH: Did you go to the drug store and put your arm in the thing?

KATIE: I was at a doctor’s appointment, and they did it for me and I wrote it down on my phone ‘cause I like to…

ZACH: A little more professional then. You guys remember when you were kids and you’d run around the drug store. It’s like a free -- it’s like a free arcade game. Right? The blood pressure machine.

KIM: I had my blood pressure recently taken at the dentist, and that was the first time that had ever happened to me, and I don’t know if it was because I semi recently hit a milestone birthday. And so, now I’m wondering if getting my blood pressure checked at the dentist is now a thing that I have to have.

TODD: That’s a regular recurrence for me now.

KATIE: Okay, so this is like…

KIM: So, I’ve leveled up is what you’re saying.

KATIE: We’re putting two and two together here.

KIM: Yeah.

[Laughter]

KATIE: Might be something that becomes more common with increasing age.

ZACH: And no one ever asks my blood pressure, I’ll tell you. But I know I have blood. I know it has pressure. That’s what I know.

KIM: Okay, perfect.

TODD: Even though we did a podcast on this, and we talked about the importance of blood…

ZACH: Probably at the end I was like, “I’m gonna take this knowledge and use it for myself moving forward.” Well, clearly, I haven’t so I need to get -- That’s why we’re doing another episode about blood pressure.

KATIE: Yeah, the last episode was like a deep dive into the specifics of blood pressure, right Todd? Like, why it’s important, how often should you check it, things like that. But what we’re gonna talk about today specifically is the lifestyle factors that affect it and how to modulate those if you need to, whether your blood pressure is high and you need to lower it, or if your blood pressure is healthy but you just wanna maintain that healthy blood pressure.

ZACH: Who do we talk to about this Katie?

KATIE: We talk to Dr. Sadeer Al-Kindi. He is a preventative cardiologist here at Houston Methodist.

 

[Sound effect signaling beginning of interview]

 

KATIE: We’re here with Dr. Sadeer Al-Kindi, preventative cardiologist and associate director of cardiovascular prevention and wellness program at Houston Methodist. Thanks so much for being with us today, Dr. Al-Kindi.

DR. SADEER AL-KINDI: Thank you for having me.

KATIE: I’ve seen a lot of stats about how common high blood pressure is. They seem to range, you know, through the years and maybe based on how people are sort of defining what they’re looking at. But generally, seems like it’s, you know, fairly common. I would say one thing I saw was that almost half of all American adults have high blood pressure even if they don’t know it perhaps. So, it seems to be something that we should probably all have our eye on whether we’re thinking, “I’m trying to prevent high blood pressure,” or, “I already have it and I’m trying to lower it.” Does that sound right?

DR. AL-KINDI: Yeah, absolutely. And think that you hit the nail by saying that it varies year by year, because the methods of measuring it, the methods of outreaching to the individuals that have it have been changing over time. And I think that speaks to the heterogeneity and kind of prevalence that we see in studies. But in general, it’s very common. It’s probably one of the most common risk factors for heart disease. And what we call it, the silent killer because it does have no symptoms oftentimes, unless it actually leads to heart disease or brain disease or any other kind of disease downstream.

KATIE: And you call it a silent killer so maybe we start off just off the bat, what’s going on when blood pressure is elevated in the body? So, it’s obviously not causing any obvious symptoms but what’s happening in the body that the body is experiencing?

DR. AL-KINDI: There are different things that happen both at the heart level, the vessels that, you know, let the blood go from the heart to the rest of the body, but also at the target organs. So, when we talk about the heart, the heart is under so much stress when the blood pressure is so high, and it can actually double its amount of energy that’s spent just by dealing with higher blood pressure. And there is also damage, wear and tear. Remember that the heart is pumping between 60 and 90 times a minute and that’s every second, every minute, and you can see that this is the amount of work that the heart has to put, and has to push against that high blood pressure is tremendous. So, that leads to when we think about it is -- we can think about it as the wear and tear of heart. Both the vessels, the valves, but also the heart muscle. The same thing can happen at the vessel level. So, these pipes that take the blood from the heart into the rest of the organs makes them more stiff. It leads to damage of these pipes and it's very similar to what you see with pipes in oil and gas industry where there is a lot of corrosion, there’s a lot of pressure and things like that. And it’s really the same thing that happens in the arteries of the body. But the same thing because of the elevation in blood pressure and that kind of pressure wash that’s happening at the target organs, the same damage happens at the target organs. So, including the kidneys, you get kidney failure, including the brain you get damage to the brain and sometimes these blood vessels, the tiny ones get really fragile and kind of burst and cause bleeding in the brain, cause bleeding elsewhere. So, a lot of different things that’s what we know about. There’s a lot of things that we don’t know yet, but we have a good understanding of what can be catastrophic when blood pressure goes up, and especially for extended period of time.

KATIE: Yeah, and give how common it is essentially in sort of the downstream effect that we, you know, essentially none of us want happening. Certainly, worth talking about lowering blood pressure, maintaining a healthy blood pressure if it’s already at a good place. As far as why high blood pressure happens, what are the most common things that lead to it?

DR. AL-KINDI: There are some what we call modifiable risk factors, but there are other things that are non-modifiable risk factors. So, when we talk about the non-modifiable risk factors, a certain proportion of bloo -- of blood pressure, although small, is actually determined by genetics, right. So…

KATIE: Yeah.

DR. AL-KINDI: And genetics and there are other things that we don’t fully understand including, you know, how the genetics interact with the environment and other things. There is a lot of things -- There are a lot of things that are actually very modifiable. And one of the major things that are modifiable and they’re very common is weight. So, over -- be overweight or being obese can actually contribute to elevation in blood pressure. And this is something that reduction in weight, maintaining healthy weight can reduce blood pressure tremendously. And when we talk about -- and when we measure blood pressure, we measure it in millimeter and mercury. And that top number for example can go down by about ten if you lose the weight, you know, starting from an overweight and obese, and maintain a healthy weight.

KATIE: Wow.

DR. AL-KINDI: Other things that kind of somewhat behavioral, but somewhat environmental as well is how much salt do we have in our intake. And that could be characteristic of the food that we try to eat but also part of it is in the water, part of it is in everything that we do take. And maintaining that amount of salt to a minimum is ideal and kinda the lower the better in my opinion.

KATIE: Yeah.

DR. AL-KINDI: But there are some cut offs that are -- have been kind of proposed and kind of advertised in public in a kind of com -- in communications with people and making sure that it’s sustainable, not, you know, we cannot say zero salt, but it’s something that’s sustainable that can be achieved without having to sacrifice a lot of the pleasures of life so to speak.

KATIE: Mhmm

DR. AL-KINDI: So, salt, I think salt intake is one of the other things that are contributing to, you know, the epidemic of hypertension or high blood pressure. Other things including smoking and vaping and other things can actually -- they also contribute. There are things that are really unseen or not thought about in the environment, how air quality looks like, temperature changes and things like that. They can also contribute to high blood pressure. So, I would say, you know, looking at it holistically is the key to understanding how blood pressure impacts and individualizing, you know, how people can lower their blood pressure is also key. It doesn’t make sense for an individual who has a healthy weight to lose weight to kind of control their blood pressure, and that’s why there’s a little bit of individualization for kind of lifestyle changes and behavioral changes that can reduce blood pressure and maintain healthy blood pressure measurements.

KATIE: Yeah, and to that end I mean, I think today we can kind of dive in to some of the things you mentioned a bit deeper which, you know, is a tall order obviously since I think a lot of these things probably could be their own podcast episode essentially.

DR. AL-KINDI: Of course.

KATIE: But we’ll sort of touch on each that way, to your point, people could decide what they need to change in their life, what they’re already doing correctly that they need to maintain. But as you were rattling off this list you know and the end of is -- as you are rattling off this list and the individualization part of it, it kind of -- also to me seem additive in some ways, you know. There’s more than one lifestyle factor that can raise your blood pressure. There’s several, and people might need to be considering several.

DR. AL-KINDI: Absolutely and I think, not just there are several, but they actually coexist, right? So, you know, people who for example have, you know, unhealthy diet they also have other unhealthy behaviors, but they’re also stressed, and stress by itself can contribute to this, and it becomes a vicious cycle of increasing blood pressure and not maintaining blood pressure. And we have to think about also, you know, whether they can afford medications, whether they can have access to health care and other things. So, it’s unfortunately that, you know, that additive effect becomes multiplicative because of the coexistence of a lot of these risk factors, so to speak, and the fact that we sometimes don’t do a good job of identifying those in the first place and diagnosing the proximate determinant of blood pressure increase.

KATIE: And again, to that point there’s issues that maybe need to be fixed. If someone has high blood pressure, there’s probably some issues that need to be fixed. Would you say is it ever too late to start fixing things? So, I mean, if your doctor is saying, “Hey, your numbers are elevated.” You’re starting to get worried. Can you reverse the issue? Or if you’re already diagnosed with high blood pressure, can some changes be made to where we can either prevent medications or get off medications. So, what does that kind of spectrum look like.?

DR. AL-KINDI: Yeah, absolutely. And I think when we talk about abnormal changes that happen in the body, whether it’s elevated blood pressure or elevated sugar levels, we always talk about how severe they are and what is the context, right? So, in a patient who has elevated blood pressure that’s very significantly elevated and they already have an organ damage, whether that’s congestive heart failure or prior stroke, we really don’t wait for lifestyle changes, and we start to initiate medications right away. Now that’s not to say that lifestyle changes are not important, they’re actually very, very important and they can help the individual often if they had -- if they’re kind of followed religiously so to speak. They can help the individual lose the medications and kind of get off of them some of the medications and become -- maintain blood pressure in a way that does not require medication. But I think as clinicians, when we think about disease, we really want to prevent the worst, right? And that’s really -- and the -- to answer your question there is no time where things are too late. This is not something that is not reversible, everything in blood pressure is reversible. The downstream effects, some of them can be reversible, cannot -- and some of them are not reversible. But to prevent things from getting worse, adopting healthier lifestyle changes and other behavioral changes can actually have significant impact on the burden of medications but also the burden of high blood pressure in general.

KATIE: You’ve mentioned some of the causes of high blood pressure, so kind of working back from that and the steps of how to lower blood pressure. Sounds like the list -- and I’ll kind of rattle it off and you can tell me what you think. But it sounds like the list is, you know, maintaining a healthy weight, losing weight if you’re overweight, reducing salt intake, exercising, being physically active, stopping smoking if you’re smoking. We’ll talk about vaping, I’m glad you brought that up because I’m interested in that part. Limiting alcohol, does that -- does that come on to the list?

DR. AL-KINDI: Yeah, I think it does. It’s one of the top kind of contributors to cardiovascular disease in general but also to high blood pressure as well. So, limiting alcohol, and everything in moderation is probably okay, including salt. Salt in moderation is fine. But I think limiting alcohol is key as well to kind of improve blood pressure. But, you know, it’s not only blood pressure, and that’s really a point that I wanna emphasize that all these risk factors or behavioral changes and things like that they have, you know, we’re talking today about blood pressure, but they have really significant co-benefits, right? When it comes to -- you know, a lot of them are also risk factors independently of high blood pressure, of cardiovascular disease, of diabetes and other things. And there’s a lot of things that can be considered in general in addition to what we’re talking about in terms of co-benefits when it comes down to improving lifestyle changes.

KATIE: Yeah, I love that ‘cause kind of, you know, you get more bang for your buck that way, right?

DR. AL-KINDI: That’s exactly right. Yes. Yes.

KATIE: I’ll take that. I’ll take that ‘cause it’s hard to do some of this stuff. So, as I’ve mentioned, you know, I obviously wanna run through this list of ways to lower blood pressure. Where I wanna start is if there was one thing on your list that you would say kind of reigns supreme above all, does that exist? Is there something you want every single person listening to this episode to examine in their own lifestyle?

DR. AL-KINDI: Yeah, absolutely and I think it’s a combination of how common it is, but also how impactful it is on blood pressure.

KATIE: Yeah.

DR. AL-KINDI: And this is the combination of the two is really overweight and obesity. I think if there was one thing that you can do to reduce your risk of blood pressure elevation, hypertension and a thousand other things is lowering your weight to a level that is healthy. And we call -- healthy weight is very, you know, variable by different individuals because it depends on the height. So…

KATIE: Right.

DR. AL-KINDI: A better metric that we use as opposed to a kind of an absolute weight by pounds or kilograms is something called body mass index. It has it’s own problems, but it’s probably a good metric that people depend on thus far. And that number, we want it to be less than 25.

KATIE: Okay.

DR. AL-KINDI: So, that’s a combination of your weight and height and kind of indexing your weight to your height so that, you know, every person has different cut off for their weight.

KATIE: Gotcha. What is it about excess weight that’s impacting blood pressure? Is it just, you know, more blood parts working harder or what’s going on there?

DR. AL-KINDI: Yeah, I think it’s very complex. But the way I think about it is extremely simple. The body is not used to or built for this much weight, right? It’s built for your ideal weight, and any extra pound that you build, the heart has to struggle. And not just the heart, but really everything else, right, they have to struggle and work harder to actually come up with the power and the energy to survive this. Of course, this is an oversimplification but in reality, excess weight is mostly fat, and that fat has significant impact on the risk of heart disease, stiffness of the arteries, making these pumps and pipes becoming really rusty, causing a lot of different things, including high cholesterol and high sugar levels that contribute to diabetes, which by itself can actually contribute to the preexistence of, you know, everything that causes blood pressure. So, I think it’s complex, the biology is complex. But just thinking about it conceptually, very simple that the body is not used to or should not be dealing with this much weight. And that’s really the key here.

KATIE: Yeah, I actually love that the way you described it. I’ve never really heard it like that. And I think that is, like, for me, actually the simplicity of that is kind of perfect. Sometimes I think that in my brain, I can get a little too in the weeds. I’m like, “Why is something happening. I need to know.” And then by the end it’s like, “Oh, I haven’t even done anything to try to lose weight now.” I’m mostly just fixating on this sort of thing. But weight loss, tricky topic I would say, but I think we need to touch on it in the sense of somebody who needs to lose weight. I think there is -- I think the landscape is very cluttered right now, I would say. You know, there’s a lot of fad diets, there’s wellness hacks constantly on social media. You know, weight loss medications have kind of come bursting back into the scene here. So, like, there’s a lot of ways to lose weight that are out there right now. If you’re talking to somebody about, again, staying simple with weight loss, what’s your message with losing pounds so that you can lower your blood pressure?

DR. AL-KINDI: Yeah. And I think this probably needs not only one podcast, but it needs like 10 podcasts just to talk about this issue specifically. And I would say that the stigma around weight gain and weight loss and the changes around weight are critical because they contribute to the stress that is associated with the stigma and so on and so forth. So, I think obesity in general, or being overweight is such a complex issue that has biology related to genetics but also has relationship to the upbringing and how, you know, behavioral changes. How does your environment contribute to weight, and how does, you know, as an individual, how do you deal with it mentally. And the availability of things. You know, believe it or not, for example, people who have food insecurity, they tend to be obese, right? They have -- overweight. And that's really because it's the interaction with your environment and upbringing and how you deal with food and what your relationship is with food. But I think coming out of this, and this is really the kind of the transition over the past few decades, is that we are starting to think, to understand how obesity is a disease, right? This is not only behavioral change, right? This is not only a lifestyle issue, but it's actually a disease by itself. And we should deal with it as if we're dealing with diabetes, high blood pressure, by removing the stigma, but also thinking about it as a central theme for a lot of the different health outcomes that, you know, are becoming pandemics and epidemics in the community. But everybody has a role, right? So, there is a role that you start with as an individual and that, you know, to maintain your healthy weight by eating healthy diet. And healthy diet is also a very loaded term. And it means different things in different -- for different individuals. Because simply we don't fully understand how nutrition works and how what is a healthy nutrition, but we have good evidence now that suggests that Mediterranean diet is actually very good and it's healthy, and beyond reduction in weight and maintaining healthy weight, it can actually reduce the risk of heart disease and other things. So, that's really an important measure that can also by itself reduce blood pressure. And I think in maintaining Mediterranean diet is a little bit difficult in the United States because people are not used to the, you know, a lot of olive oil, a lot of nuts and things like that. But it's something that has been proven over and over again to be really healthy. From a blood pressure standpoint, though, I think DASH diet is probably, which has very similar things to Mediterranean diet. It has, you know, it has been shown to reduce blood pressure. And maintaining that to a certain degree by lowering your sodium and maybe increasing a little bit of your potassium levels and intake can maintain blood pressure. Its impact on weight is not very clear. But I think it has at least health impact. I think exercising is what the American Heart Association and other societies also recommend as part of maintaining healthy weight, but also to prevent and reduce risk of downstream effects of heart disease and diabetes and other things. And the recommendation is about 150 minutes a week. It's up to you how you do it. And it doesn't have to be 150 Friday to Friday. It can be really any, you know, any time. You can do 150 one day, you can do 30 minutes every day for five days. You can do whatever you want. But other -- at least moderate physical activity of 150 minutes is what's recommended. And that's really, these are the two kind of -- maintaining healthy diet and exercise are the two main things. But again, I think there are other things that we don't fully understand, including stress reduction maneuvers and their impact on blood pressure and their impact on, on weight in general.

 

[Sound effect signaling break in interview]

ZACH: Dr. Al-Kindi has mentioned the Mediterranean and DASH diets. And while it may sound like these are just two more add-ons to the ever-growing list of diets we hear about these days, both are really more of an eating pattern than a diet. There's no special list of foods to follow or calorie restrictions either. Here's a look at what each prioritizes. The Mediterranean diet emphasizes eating plants over meat and animal products. It's based on the eating habits of people who live in countries bordering the Mediterranean Sea and has been heavily researched with many studies showing that when compared to the standard American diet, the Mediterranean diet leads to lower rates of heart disease as well as type two diabetes and certain types of cancer. As a testament to this, US News and World Report recently ranked the Mediterranean diet as the best overall diet for the sixth year in a row. The DASH diet stands for the Dietary Approaches to Stop Hypertension. As the name implies, it's designed to prevent or stop high blood pressure. The DASH diet emphasizes limiting salt intake and in doing so, encourages eating mostly plants and small amounts of lean meats. The DASH diet is also well researched, proven to significantly lower blood pressure. It's why the US News and World Report recently ranked the DASH diet as the second-best overall diet. If you're noticing your recurring theme here, yes, both diets essentially embody the same principles. Number one, fill most of your plate with vegetables, fruits, and whole grains. Number two, enjoy moderate amounts of low-fat dairy products, fish, poultry, beans, nuts, and extra virgin olive oil. Number three, reduce the amount of saturated fat in your diet by keeping fatty meats, including many cuts of red meat, full-fat dairy products and tropical oils like coconut oil to a minimum. Number four, limit processed foods such as sugar-sweetened beverages, sweets and candies, and snacks that are full of refined carbohydrates.

 

[Sound effect signaling resumption of interview]

KATIE: As far as the whole salt issue, I think again, like I could see this being a whole podcast episode, mostly 'cause I feel like I have tons of questions about salt. What is your ideal number for how much is too much? I know there's a recommended amount that's maybe a realistic, quote unquote, “realistic” number, but might still be too high as I understand it. So, if you really wanted to say to lower blood pressure, try to limit to this amount, what would you say?

DR. AL-KINDI: I would say the lower, the better. There's really no -- it's a spectrum, right? There is really no cutoff, right? But I would argue that having a very low limit or very low kind of threshold that you wanna get to or a target, becomes unsustainable and people kind of fall off the wagon so to speak, because they're not able to achieve it. It's unachievable. So, I think more than that, actually doing as much as you can by reducing your salt -- and that aligns well with eating healthy, because a lot of the foods that are salty are the foods that are usually ultra processed because that's how you keep the food edible, so to speak, right? And things that we don't necessarily think of them as salty, but they're actually pretty salty. And this includes really any deli meat, all canned food, you know, pickles is something that I think it's intuitive, people think about it, but sometimes a lot of the things that I hear from my patients is I -- you know, “I don't feel like I'm eating a lot of salt,” but because it's so embedded into the processing of the food, and if when you look at the can you read through this table that is usually printed, you get really shocked by how much salt there is. And that could amount to a week's supply of salt that you're taking in one bite or, you know, a one meal.

KATIE: Yeah, it's crazy. I mean, I think, yeah, to your point, just the processed foods being kind of packed with it, and nowadays, so much of our life is kind of about those. You know, we all have these busy lives. It's hard not to end up with a basket full of processed food when you come home from the grocery store. And then you flip 'em over, I remember one week some -- one of our doctors challenged me to like look at the labels and I was staggered by like, just things that I would not expect that had much. I mean like soy sauce. Okay. I know that's salty. But then things that I didn't really expect. I was just like, “Okay, there's salt in here for some reason. There's salt here. There's salt here. It's everywhere.” Okay. Okay. So, no, like ideal number probably. I think to your point, true. If it's not obtainable, why try to attain it at that at that point? So…

DR. AL-KINDI: Yeah, And I think, you know what re -- something that's reasonable, it’s still, although it's it's attainable, you still have to keep in mind what the numbers look like, just so you inform yourself in terms of food. And I think the easy number to remember is two or 2,000 depending on what the units are. Mm-hmm.  Usually 2,000 milligrams a day is kind of what we think as a good target to achieve, which is very achievable. I achieve it myself. Others do. And that really requires you to have, you know, fresh food, right?  And not take any kind of canned food or, or ultra processed food. Two grams or 2,000 milligrams a day is probably very reasonable a target.

KATIE: If only those foods weren’t so delicious. Man, they know what they’re doing.

DR. AL-KINDI: Exactly.

KATIE: That’s for sure. They definitely know what they’re doing. Another part that I wanted to dive in on is exercise, physical activity, and sort of how that helps lower blood pressure. But then also, the context of is it physically moving that’s helpful or is that we sit too much? I understand that the two are essentially the opposite of each other, but like, what’s the actual problem when it comes to our blood vessels and things like that with either being unactive or just not being physically active enough?

DR. AL-KINDI: Yeah, and again, I think this is something that just sim -- I can give you a simple answer is go back in thousands and thousands of years, we are not -- nobody was sitting this much, right? It was -- our bodies are built to move, and the arteries are built to kind of pump this much blood for this much exercise. You know, just recently over the past century, we kind of transitioned into a more sedentary lifestyle and that leads to kind of changes in our bodies that lead to kind of an increased blood pressure. That's the simple answer. I think the complex answer is there is a lot of biology behind it that we don't fully understand. We probably just understand a little bit of it. But in reality, that leads to kind of, when you're sedentary, your arteries are not recoiling enough, so they become a little bit more stiff. And that stiffness is what contributes to elevation in blood pressure. Remember that blood pressure is a contribution of how your kidneys are performing and kind of removing some of that extra fluid and extra salt with it, but also how your artery tone is. And if you are sedentary and your heart is not exercising, not pumping strong enough, then your arteries become a little bit more stiff and the pipes, you know, start becoming rusty over time and contribute to that vicious cycle again that leads to elevation in blood pressure.

KATIE: Yeah, literally as you're talking and stiffness, like I know I've heard stiffness before in terms of arteries, but like my mind went straight to like muscle stiffness too. Like, yeah you know how stiffness feels and like what it does. It pulls on your joints and that hurts. So, like, of course your arteries being stiff too probably is doing awful things to what they're connected to and stuff. So yeah, that's interesting. I hadn't quite thought of it that way.  You know, you mentioned 150 minutes of moderate intensity exercise. Does it matter, you know, what you're doing, really? Or is it really just getting and move -- getting out there and moving and doing something?

DR. AL-KINDI: Yeah, and, and the simple, instruction I give to my patients when I counsel them on exercise, get your heart to be pumping harder than what it is doing right now.

KATIE: Okay.

DR. AL-KINDI: That’s really, I mean, the key is you want to exercise your heart. It's not so much toning your muscles, it's not so much -- but you just want to have your arteries exercise with you, right? Your pipes exercising with you, your pump exercising with you. And no matter how you do it, just -- and that's why we measure our heart rates typically when we exercise, because we want that heart rate to go up a little bit. So, it's been shown over and over again that, you know, no matter how you do it, it's helpful, no matter how little exercise is helpful. And the way to do it is cardio. And it's one of the, you know, across the spectrum of cardio, right? It's not so much that toning or lifting weights and things like that, but it's really the cardio exercising your body, because that has, you know, beyond the benefits on blood pressure, it has benefits on heart troubles and diabetes. And again, we go back to the same point of co-benefits.

KATIE: Yeah, exactly. Next one I wanted to touch on was smoking. I grew up in the time where the messages to not smoke were very prominent. So, I think, you know, tobacco smoke in my mind, like that message has been pretty clear in the sense of stop smoking if you smoke, don't start smoking. You alluded to this, vaping. I think that's where we are today in the world of, you know, a lot of young kids vaping, even things like that. What do we know about vaping and blood pressure, and is it just as bad as smoking, worse maybe, not as bad? Where -- what do we know?

DR. AL-KINDI: Yeah, and I think again, I go back to the simple answer and the complex answer. I think the simple answer, it's -- we're still learning about this. But what we know is, as it -- when it comes to smoking and blood pressure, part of the impact is really the nicotine. Part of the impact is the other chemicals that lead to kind of long-term changes in your arteries, in your pipes making them more stiff and so on and so forth. And, you know, of course there's the lung cancer and so on and so forth. But I think when it comes to blood pressure, a significant portion of, at least the acute elevation in blood pressure is related to nicotine. And that nicotine is still present in significant amount and sometimes even higher amounts in vape and electronic cigarettes and other things. The way I think about it is from a community standpoint, from a public health standpoint, this vaping is a gateway to getting to smoking.  And that's really the challenge that I have is, you know, people have an easier threshold to cross when they go for vaping as opposed to smoking, which has been, like you mentioned, embedded in our minds that this is wrong, wrong, wrong. Vaping has not had the same aura around it, so to speak, right? So, it becomes a little bit, in my mind, it becomes a gateway for especially young individuals to kind of get on the trend or, you know, start vaping and then all of a sudden, they’re hooked on nicotine, and they try to find, you know, other ways to satisfy that craving.

KATIE: Yeah. Another vice that we sort of talked about already, but wanted to get into some specifics here, alcohol, alcohol intake. I would say, you know, I'm calling it a vice, which probably like alludes to my personal relationship with it a little bit, but when we're talking about blood pressure and elevations in blood pressure, is it if I save up my seven drinks a week for, you know, a Saturday and a Sunday, is that worse on my blood pressure than if I'm only having one a day? Or what does that look like for me?

DR. AL-KINDI: Yeah, it’s a little hard to know, quite honestly, because alcohol has so much impact on the cardiovascular system in general.

KATIE: Oh boy.

DR. AL-KINDI: And it also depends on the type of alcohol, right? So, there is some data to suggest that a little bit of wine can be helpful for the heart, although this is again, being questioned. But I think there are a lot of other impacts on the cardiovascular system, including atrial fibrillation, congestive heart failure, and other things, especially with significant amount of alcohol drinking in addition to the amount of calories, which is not something that we think about all the time, right? Alcohol is heavy on calories, and that by itself can lead to other things. So, how you dose it, so to speak, is a little difficult to know, you know? And my mind is, you know, leaving alcohol altogether is the best thing to do. But again, going back to the same theme of being pragmatic, being sustainable, I think that is way more important to me than doing something that's unattainable that you try for a week. It's like a crash diet, right? You try it for a week and it doesn't, you know, it works maybe for a short period of time, but then you start regaining the weight. Same thing with alcohol, same thing with salt, same thing with -- it's all the same kind of pathways that we talk about.

KATIE: Yeah. You know, as you were talking, one thing that came to mind was, you know, you mentioned sort of weight and weight management being sort of at the forefront of making steps towards lowering blood pressure. And the two pieces of that being what I would say are some of the hardest things to control, which is, you know, your diet and your exercise. Would you say, you know, if someone knows they need to work on both, let's say, like, I know my diet's not great. Maybe I'm gonna start trying the Mediterranean diet. And I know I'm not exercising enough, I'm only getting 20 of my 150 minutes, but like, I can't really start both at the same time. It's just too much. It's too hard. Like you said, it's, it can be -- it's hard to achieve getting everything perfect. Would you pick between one or the other to start with, or is it just, you know, whichever you can do best and work from there?

DR. AL-KINDI: Yeah, I think it has to be individualized and has to come from the values of each patient, right, or each individual. I think that, you know, for some people doing everything at once is important and it works for them. And for some people doing things gradually and, you know, getting used to the system and incorporating things gradually works best. And I think, you know, it's hard to kind of prioritize things because physical activity, for example, can lead to weight loss, and weight loss can actually lead to more physical activity because you know, it's easier for you to do physical exercise. So, I think you know, has to be individualized. It has to be kind of person centric and understanding what their individual's values, how their work is, what is their day looking like, what is the available resources for them and what is it that they can do on, you know, in a specific amount of time. And prescribe something that is sustainable as opposed to something that's extremely unrealistic, although it has been “proven”, quote unquote, in studies that it works.

KATIE: Yeah, I gotcha.

DR. AL-KINDI: Stress is important, managing stress, and no matter how you do it, it's key because stress is one of these things that elevate the amount of hormones in our body. These are the stress hormones that have, you know, direct impact on blood pressure. And over time, that stress leads to high blood pressure, but also leads to other co-harms, you know, when it comes to diabetes and other heart disease issues. So, you know, managing stress is a very tricky area because it has to be very individualized, but at least realizing that you have stress, and everybody has stress. The point is how do we deal with stress and how do we identify ways to kind of meditate, for example, yoga, other things, but also how to eliminate stress from our lives. It's something that is not very well talked about, not commonly talked about in terms of linkage with blood pressure, but I think it's one of these areas that are very proximate to everything else because stress by itself can lead to unhealthy diet, and you know could lead to smoking, vaping, lack of exercise, and all of the above. And that's really something that we have to start to think about a little bit more, at least in medicine.

KATIE: Yeah, I gotcha. Well, you know, I think this has been a really good conversation of like, you know, we've said, probably some of these topics should be an episode, maybe several episodes.

DR. AL-KINDI: Absolutely.

KATIE: But I think it's a good starting point. Like, I know for me at least, like there's some areas that I've identified that's like, okay, I need to dig into these a bit more. I’m not all of 'em, you know, and so I think that's what's good about this. We can kind of cherry pick what we need.

DR. AL-KINDI: Right.

KATIE: Anything else you'd leave us with as far as lowering blood pressure or some other messages you would -- you wanna leave people with today?

DR. AL-KINDI: Yeah, no, I think start with checking your blood pressure. I think that's the problem.

KATIE: That’s a good point.

DR. AL-KINDI:  And it's something that's free. You go to a CVS, you go to Walgreens, go to anywhere, right? Any of these community fairs. Take your grandma's kind of blood pressure machine, measure your blood pressure. Because, you know, oftentimes, we see people who have not known about their blood pressure being elevated for decades. And that’s where things start to, you know, they get in trouble. And, you know, get in the habit of -- if your blood pressure is elevated, get in the habit of measuring your blood pressure. I think starting from that, and if we leave people with one message right now, I'm not too worried about people who know about their blood pressure because I trust that they're gonna follow up on it after this podcast. But I'm really worried about people who don't have -- who don't know, and they don't have a knowledge of their blood pressure is elevated, and it could have been elevated for decades since they were born or, you know, since they were children. And that's something that I would urge young individuals specifically, but even a little older individuals who have not had blood pressure check and -- to measure their blood pressure at least once.

KATIE: Gotcha. Yeah, that's a great message. It's probably been a minute since I've checked mine actually. So, yeah, definitely need to do it. Well, thank you so much for being on the podcast today. We really appreciate your time.

DR. AL-KINDI: I appreciate it. Thank you so much.

 

[Sound effect signaling the end of the interview]

 

ZACH: So, Katie, what are some of your biggest takeaways from this conversation?

KATIE:  I think my biggest takeaway was that it's very personalized, the lifestyle factors that everyone's gonna maybe need to focus on. So, like, I know the ones that I took away for myself that I wanna focus on. I already exercise pretty often, so like I'm -- I think I'm good there. I actually keep my salt intake pretty low, so I think I'm good there. But my overall diet could be cleaned up I would say. Processed foods, that's something I eat a lot.

ZACH: Yeah, processed meat, we did a podcast about that last season, Katie. And I’m still struggling with that battle.

KATIE: I mean, I will say I am actually pretty processed meat free these days. but I still eat a lot of processed snack foods. I had a bag of hot fries yesterday.

ZACH: Well, I had -- I had two hotdogs yesterday at the baseball game.

KATIE: Okay.

ZACH: So, I’ve been -- same problem.

KATIE: But when we talked about processed meat, you had just come back from a baseball game eating hotdogs. So, maybe your problem is baseball games.

[Laughing]

ZACH: Listen, I don’t eat two hotdogs every day, just whenever we happen to talk about it.

KATIE: Okay.

ZACH: I had eaten two hotdogs the previous day.

KATIE: Yeah. But yeah, I think knowing which factors -- you know, we hit the factors kind of at a high level, which I think is perfect because everyone can kind of like go back and do either research on their own or talk to their doctor about like, “Hey, I probably need to exercise more. Can you help me?” Or “Hey, I need to clean up my diet, can you help me?” I think, you know, for me, like alcohol intake and probably like overall diet are the two things that I took away, and that my blood pressure's fine right now, but I don't wanna get to a place where, you know, we're talking about medications and things like that. So, just keeping that stuff in check I thought was great.

KIM: Yeah, same for me. I think really focusing on continual movement and getting walking, running, doing whatever you can during your day to make sure that you're keeping your blood pressure on the right track. 'Cause I'm -- I feel lucky that my blood pressure is pretty good right now and I don't wanna get to that place where we're gonna talk medication. I know I could clean up my diet too.

KATIE: Yeah, diet's hard, man. There's just -- foods taste so good these days.  They make it really hard to not want the hot fries and not want the cookies and things like that. I think the message too that I found that was really nice to hear, though, I don't have high blood pressure, but I know, you know, almost half of America has at least elevated or high blood pressure. So, I think all -- any listeners out there, it did really sound like lifestyle factors are enough to make a really huge improvement in your blood pressure. It's not this like doom and gloom, like, well, it's high. Now I need, like, all I can do is take medicine. Like, you may still need to be on medicine, but there are things you can do to maybe get off medicine or even just bring it down to a normal level with medicine for a while and things like that. So, the lifestyle factors are huge, and I thought it was affirming in that way for sure.

TODD: Well, you're looking at me like you're, you're waiting for mine. You’ll all hate me, but I actually was good on every one of those things that he talked about.

[Laughter]

KATIE: I am not surprised, even a little bit.

[Laughter]

ZACH: Were you always good at those things? Like, did you have to make any adjustments over the years or?

TODD: Ah, well, your -- the processed food podcast made an impression on me, so I eat less of that. I’ve never been a big drinker. I’ve always worked out. Haven’t been overweight. I do live in a smoggy city, so…

KATIE: Yeah, that was interesting that he brought up air pollution and kind of some of the environmental factors. I found that interesting. I you know, we did an episode previously on air pollution and how it affects your lungs. Maybe we need to do one about air pollution and how it affects your heart.

 

ZACH: Yeah, it’s not a very obvious correlation between the two of them is there?

KATIE: No, and I mean, the other kind of part of this is can't really change that there's air pollution around you. So, it's one of those lifestyle factors that's less under your control than the other ones we talked about.

ZACH: True. So, for real, I know we kind of joked about it off the top, but I, I really do need to take this more seriously as far as like keeping track of it. Todd, you’re a model citizen over here. I need to follow your example, and just keep up with this, really. Because it’s so easily, and I think a lot of us probably feel this way. People out there like, it just so easily drops off your health radar.

KATIE: Yeah.

ZACH: You know, it’s something that should stay on your scopes.

KATIE: It’s as easy as getting it checked. Just start there. So, you know, it’s a first simple step.

ZACH: You will help me make my first appointment?

KATIE: I guess.

ZACH: Thank you, Katie.

[Laughing]

Alright, well, that’s gonna do it for us this time for On Health with Houston Methodist. We drop new episodes every Tuesday morning. So, share, like, and subscribe wherever you get your podcasts. Until then, stay tuned and stay healthy.

[Music ends signaling end of episode]