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Blood Pressure and Cholesterol: What’s That Number Mean?

May 15, 2019 1:00 PM with Dr. Sarah Stombaugh

Do you know what the healthy range is for your blood pressure? Or what kind of cholesterol is the good kind? Join Sarah Stombaugh, MD, a Family Medicine physician at NorthShore, for an online chat as she demystifies the numbers your doctor rattles off to you during a checkup. She will answer your questions on what those numbers mean for you and how you can get them in line with what your doctor considers healthy.

Blood Pressure Numbers

Ben (Moderator) - 12:43 PM:
We are going to get started in about 15 minutes. Feel free to submit your questions early so we have them ready for the Dr.

Ben (Moderator) - 1:00 PM:
Welcome to the Blood Pressure and Cholesterol: What's That Number Mean? chat. The chat is now open and you can submit your questions anytime.

Dr. Sarah Stombaugh (NorthShore) - 1:01 PM:
Hello all! This is Dr. Sarah Stombaugh. I'm looking forward to talking with you all about high blood pressure and cholesterol.

  Patrick (Evanston, IL) - 1:01 PM:
What is the best diet for healthy blood pressure, and does having a high blood pressure always mean poor health?
Dr. Sarah Stombaugh
Great question! 1) The best diet is one that emphasizes whole foods. Also, limit sodium by preparing your own food and choosing herbs and spices instead of salt. Try your best to limit processed foods and saturated fats (often in meat or dairy). 2) Having high blood pressure does not always mean poor health. There are many reasons blood pressures can be high. However, if you have consistently high blood pressure, you should talk with your physician. Even slight elevations in blood pressure long term can lead to impacts on health.

Dr. Sarah Stombaugh - 1:09 PM:
While we're waiting for more questions, let me share some tips for managing your blood pressure. We know that blood pressures taken at home in a relaxing environment are the most reliable. However, there are a few things you need to do in order to have an accurate reading. 1) Blood pressure cuffs that measure the upper arm (brachial artery) are more accurate than finger or wrist cuffs. 2) Bring your blood pressure cuff to your doctor's office to ensure it is accurate. 3) You should sit and rest for 5 minutes before checking your blood pressure. 4) Sit with your feet flat on the floor, legs uncrossed. Have your arm supported on an armrest or table.

  Bob (North Carolina) - 1:12 PM:
Is it realistic to expect my bp to drop to 120/60 after its read high for so long or is there a range of health BP that I can shoot for? Why does my blood pressure never read the same when I take it within 2 minutes or on different arms?
Dr. Sarah Stombaugh
1) You should talk to your doctor about the best blood pressure goal for you. I often recommend my patient's to obtain a goal of 120's/80's, although there are exceptions. It is realistic to achieve your goal, but it will take some time. Some people don't need medications and can manage their blood pressure with healthy eating and exercise alone. I have other patients who take 3 blood pressure medications! 2) It is normal to have slight variations in your blood pressure readings. Maybe you just sat down when you took the first reading, but then you have a minute to relax before taking the second reading. Or the opposite -- maybe the first reading was high and that caused more stress! You should have similar readings (within 10 mm Hg) on either arm. If you're consistently noticing a difference between arms, you should discuss with your doctor.

  Carla (Wilmette IL) - 1:13 PM:
Why is the top number of my BP so up and down? Today it was 145/80, yesterday it was 117/78? Thanks. Also, I do take medication for it.
Dr. Sarah Stombaugh
Great question. There are many things which impact your blood pressure reading. Time of day, the food you've eaten, hydration, stress, etc. You should continue to check your blood pressure regularly and log these numbers. Your doctor will often look at the average or trend over time.

  Richard (Skokie, IL) - 1:17 PM:
I'm confused about how they actually get those numbers when they take my blood pressure. I assume all they are doing is counting beats as the blood flows, as that's all I can really feel going on. But are they measuring something else?
Dr. Sarah Stombaugh
I love a technical question! When we measure blood pressure, we are listening for "Korotkoff sounds." We inflate the cuff above where we expect the blood pressure to be. When we start hearing the blood pulse through, this is your systolic (top) number. We listen until the sound goes away. When the sound goes away, that is your diastolic (bottom) number.

  Kathy (Evanston IL) - 1:23 PM:
My doctor has recommended fish oil for my high cholesterol. I have been taking 2- 1200 mg tablets daily. Is that enough? Is fish oil effective?
Dr. Sarah Stombaugh
Great question, Kathy. Fish oil is full of a type of unsaturated fat known as omega-3 fatty acid. Eating this type of fat regularly through diet or supplementation can help to increase your HDL (good cholesterol). HDL works to removal LDL (bad cholesterol) from your system. However, you should talk to your doctor about the right amount for you. Your doctor may recheck your cholesterol to see what impact your supplement has.

Dr. Sarah Stombaugh - 1:30 PM:
We've had some great questions! While I'm waiting for more questions, I'm going to take a minute to talk about cholesterol. Cholesterol is important! It is a building block if your cell walls. There are different types of cholesterol. Your triglycerides are a type of fat that circulates in the bloodstream. Your LDL is your "bad cholesterol." Too much LDL can build up in the system, leading to a risk of heart attack, stroke, etc. Your HDL is your "good cholesterol," which works to removal LDL or "bad cholesterol" from your system. In general, the higher your HDL, the better.

  Krish (Glenview, IL) - 1:30 PM:
My doctor diagnosed me with high blood pressure a few weeks ago and started me on a new medication. I went out and bought a blood pressure cuff from Walgreens and I was wondering how frequently I should be checking my blood pressure at home?
Dr. Sarah Stombaugh
Great question, Krish! Having a new diagnosis of high blood pressure can be stressful. I'd recommend checking your blood pressure a few times per week. You should also check any time you are feeling bad, as this could be a sign of too high or too low blood pressure. It is important to write these numbers down and share them with your doctor. Make sure to bring your new cuff to your doctor's visit next time you go so your doctor can make sure the cuff is accurate.

  Samuel (highland park) - 1:35 PM:
hi dr. Stombaugh, my question is if a physician prescribed me with a blood pressure medicine, but I exercise at least 2-3x/week , & watch my diet., can I sometimes skip taking the prescribed medicine., I'm in my 50's. Thank you.
Dr. Sarah Stombaugh
Samuel, there are many lifestyle interventions that can have impacts on your blood pressure. Regular exercise (at least 150 minutes per week) can lower your blood pressure by about 5 points. A healthy diet that emphasizes whole foods and minimizes salt can lower your blood pressure by 10 points. I've had patients who are able to control their blood pressure with these types of changes alone. However, other people can do everything right, yet still have high blood pressure. If you have elevated blood pressure despite your diet and exercise, you should take the prescribed blood pressure medication. Blood pressure medications only work while they are in your system, so it's not ok to skip some days.

Dr. Sarah Stombaugh - 1:43 PM:
While we're waiting for more questions, I want to discuss your cholesterol to HDL ratio. The next time you get labs, look for the subsection labeled "Chol/HDL." This ratio tells you how much of your total cholesterol is "good cholesterol." You will often see numbers ranging 2-5. In this case, the lower the better!

  Lisa (Evanston, IL) - 1:44 PM:
Is there a preferred method of monitoring blood pressure at home?
Dr. Sarah Stombaugh
Lisa, many home blood pressure cuffs are quite accurate. Choose one that measures blood pressure on the top part of the arm (brachial artery). Make sure the cuff fits ok. If the cuff is too small, it will make your numbers look worse than they are. (Large cuffs are available for most home blood pressure machines, but need to be ordered or bought separately.) I love this handout from the American Heart Association that reviews how to check your blood pressure at home. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home

  Patrick (Evanton, IL) - 1:50 PM:
What's your opinion on the Ketogenic state and of low carbohydrate diets. I've read results from both sides and am curious about the impact on these in regards to blood pressure. Thank you for your time.
Dr. Sarah Stombaugh
Patrick, the ketogenic diet is very popular right now. For those who don't know, the ketogenic diet minimizes carbohydrates in the diet, so your body must instead rely on fats for energy. It is especially popular for weight loss. If you are going to follow a ketogenic diet, I would do it under the supervision of your doctor, as it can cause electrolyte changes or low blood sugar in certain people. It could certainly have an impact on blood pressure (and cholesterol!) if done properly. However, eating only bacon all day long would technically fit a ketogenic diet, so food choices are still important. For most people, wholegrain carbohydrates can be part of a healthy diet! I think it is important to minimize added sugars or any processed carbohydrate, like white flour, in the diet.

  Tina (Willmette, IL) - 1:56 PM:
I'm an otherwise healthy 40-year-old, and when I went to establish a new doctor after moving here, he said I had high blood pressure and immediately put me on Rosuvastatin. Is that standard? There was no discussion about any alternatives (exercise or diet, or even family history). I honestly don't remember my numbers but the test said I was at 1.5x average risk.
Dr. Sarah Stombaugh
There are a few reasons your doctor may have wanted to start a cholesterol medication right away. Some reasons are an elevated LDL >190 or an increased risk of vascular disease. There is a calculator called the ASCVD risk calculator that looks at many factors that will impact your health. It combines information like age, gender, blood pressure, cholesterol, diabetes, smoking status, etc. to determine your risk of having vascular disease. You should talk to your doctor to understand why he thought this was important for you.

Ben (Moderator) - 2:00 PM:
That's all the time we have today for questions. Thank you, Dr. Stombaugh, for your time and expertise!

Dr. Sarah Stombaugh - 2:02 PM:
Thank you all for participating in my chat today! If you have further questions, please make sure to make an appointment with your primary care physician. If you don't have a primary care physician, I'd be happy to see you at my clinic in downtown Evanston!
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