Welcome, my name is Dr. Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love. Dr. Warrick Bishop is a private cardiologist. Working in Hobart, he's a podcaster and general authority. Anything we discuss here, of course, is health information. It's not health advice. Get your own advice from qualified health experts. Hello, Warrick. Good morning, Rick. How are you? Yeah, good. Great to talk to you. Why is blood pressure so important? What is blood pressure? Look, blood pressure is the measured... pressure within the vascular system with each beat of the heart and each relaxation of the heart. So as the heart squeezes, the blood rushing into all those big blood vessels is the blood pressure that we can measure. That's the upper blood pressure, the systolic one. So people know that we talk about blood pressure with a top number and a bottom number. So as the heart squeezes, that's the top number blood pressure. And then the heart relaxes after its contraction and the blood pressure that's remaining in the system is what we call the diastolic. And that pressure represents the wear and tear on our entire vasculature, Rick. And so for that reason, it's really, really important. Is it different in the arm than it is near the heart? Look, if the heart and the arm are at the same level, which is... how it's normally measured, then the pressures are the same. But if you put your arms up above your head and then measure your pressure, then, of course, gravity has an impact on that measured pressure. And if you stand up straight and then try and measure your pressure in your legs, it's a little bit higher because, again, gravity has an input. So measuring it's important. But the wear and tear that I alluded to is absolutely critical because it's beat to beat, minute to minute, hour to hour, day in, day out, for years. And often when I talk to my patients about that wear and tear, I say, well, look, if you were a farmer with an irrigation system and we thought of our own vascular bed, all the blood vessels in our body is that irrigation system, then if you were a farmer and you knew that the pressure was too high in your irrigation system, you could get blowouts within the pipes. Now, we see that in humans as heart attack or stroke. We know that the timing of your pump as a farmer might go out. If the pump's under load, we call that atrial fibrillation. We know the pump might fail. That's called cardiac failure. And you might blow the filter, and that's called renal impairment. And we even have data that's come out in recent time that tells us that blood pressure probably has a major impact on risk of developing dementia. So if we can keep that blood pressure low, if we can keep the pressures within our irrigation system low... we can start to reduce the risks of those wear and tear problems. So Warrick, in general, low is better than high? And what is low? Are they golden numbers or does it depend on your body shape? Yeah, look, it's a really good question. And there are guidelines that come out regularly. Your listeners probably wouldn't be aware of it unless they're doctors, but there was a bit of controversy around what is low because a few years ago, the Americans and the Australians put out their guidelines and they had slightly different numbers. And the American numbers were lower based on a trial that they thought was really important to add to the mix. And so there's all this controversy about what is the actual number? Well, the honest answer to that, Rick, is I don't think there isn't. actual number. Because if you think about it, for the range of people that we see, as you alluded to, different sizes, different ages, a 12-year-old girl's perfect blood pressure would be different to an 85-year-old man's perfect blood pressure. I think the very best way to think of it is that blood pressure is a range. And for any individual, there's a low as possible. And once they get below that, they get symptoms of low blood pressure. They're lightheaded if they stand up and things like that. Yeah, so we've got this really interesting question from Ros who says, my blood pressure tends to be at the high end of the average range, but if I'm tired, it gets low, 117 over 77, and I get a bit fainty. What's driving that sort of dynamic? So without knowing too much about it, one of the tricky things measuring blood pressure is that it's very volatile. If there's a couple of things I can really underline today for your listeners, one is please go and get your blood pressure checked because it's just a simple thing to fix and it's such an important part of the wear and tear on your entire vasculature because you deal with it for years, so it's so important to know where it is. So number one, please get it checked. Number two, if there's any question about it, talk to your GP about wearing a monitor for 24 hours because that monitor... takes serial measurements and starts to average out the ups and downs that we see in individuals. And without knowing more about ROS, that sort of information, a 24-hour blood pressure monitor, would inform the timing of the day when the blood pressure changes. It might be work or stress-related. It might be related to hydration. But it's about getting some clear information, Rick. And it is true, blood pressure goes up and down a lot. So very important to get good information about it. This text says, can I use my smartwatch to do that? And is it accurate when it tells me my blood pressure? Look, at the moment, we don't have medical grade devices that give us momentary blood pressure. These things would need to be calibrated. But I think the future is going to see watches and other sort of wearable devices that give us instantaneous 24-hour blood pressure monitoring. At the moment, they're not particularly reliable. The gold standard for outpatient, for people who are not in hospital, the gold standard would be to wear one of these 24-hour blood pressure monitors. And your GP can access that for you through a cardiology service. And there's actually a Medicare rebate that's become available. for that testing in about the last year. If you are waking up Dr. Warrick Bishop, cardiologist, with your heart racing or have experience of panic attacks and things, is that putting your blood pressure under system or your heart system under strain or your heart under strain? Is that something you should be worried about? Look, panic attacks, of course, are driven by a stress response, and we know stress responses. push chemicals into the bloodstream, adrenaline and cortisol, and these put load on the system. And we also know that stress responses drive the nervous system and tend to increase blood pressure. So you need to get that treated and managed properly. Not good from a quality of life point of view or a long-term health point of view, having panic attacks. Finally, Dr. Warrick Bishop. It's 12 to 7 ABC Radio Hobart. What are the best things to do for managing blood pressure? Is it diet? Is it exercise? Look, number one, and I'll underline it again, is just make sure you get it checked because that's simple to do. Then lifestyle, very good results in looking after lifestyle. And one of the excellent equations I share with my own patients is if you can drop a kilogram, so for people who are overweight, carrying a bit too much weight and hypertensive, If you can drop one kilogram of body weight, you can drop your systolic blood pressure by one millimeter of mercury. And what that means is that if an individual who's overweight has high blood pressure and can drop five to 10 kilos, that's as good as me giving them a script for a tablet. So not only do they get their blood pressure down, but they've dropped some weight and feel better for it. Lifestyle is really central to the whole process. Exercise also helps dropping blood pressure. If need be, we've got some fantastic medications to do that. And it's so valuable. We know that as little as a 5% reduction in your, sorry, 5mm of mercury reduction in your blood pressure can give you a 10% reduction in major cardiovascular events. It's really important, but it's a silent killer because people don't feel it, Rick. That's why I'm making such a deal about people getting it checked. Dr Warrick Bishop, always so great to speak with you. Thanks so much. Rick, I really appreciate sharing and I hope your listeners got some value from today. Did you know that coronary artery disease kills one in four people? So most of us are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk, check out www.virtualheartcheck.com.au. It'll give you information about risk and what else can be done to be even more precise.
