35 Burst results for "Hypertension"
"hypertension" Discussed on WNYC 93.9 FM
"A disease. A disease. But a rather peculiar one. We're also publishing data on things like prevalence of hypertension, the prevalence of diabetes. Well, you have to have a medical encounter to have a diagnosis of hypertension. Someone has to measure your blood pressure, diabetes, then doctor will decide or assess you would see if you have diabetes. We are publishing estimates of obesity, this just on our own measure, we're diagnosing ourselves. You don't even have to have any medical encounters or anything to have a diagnosis of obesity. That's a very strange kind of disease that really doesn't need any medical person to diagnose it. That's what makes obesity so baffling. Just step on a scale, mock your height on a door frame, check out a chart, and you can see whether your part of the great American obesity epidemic. Some decry the lack of science. Others, the insult as a diagnosis born more of bias than data. Now that we have good research to back up more qualified conversations about weight, what gives the BMI still the power to sound the alarm. Why aren't legals the numbers so often cited on the nightly news? A moral panic is kind of a cultural freak out. Katie levesque researches food, pop culture, and fat activism. Just a few years before fleegle published her meta analysis, debunking the deftly data about fat, levesque was probing our attitudes about it. She found
"hypertension" Discussed on The Health Quest Podcast
"Thing is that people truly are capable of healing themselves. I believe that the body is a divine creation. And based on that, it has its own self correcting mechanisms. The problem is the body breaks down because it's fundamentally malnourished and toxic. Because of the chemicals in the food and even pharmaceuticals are alien to the body. And so they are considered by the body's own intelligence as being toxins. My attitude in my goal and what we're trying to accomplish with the podcasting is stop treating your body. Stop treating your condition. Nourish your body, give it what it requires in your body will come back to balance and harmony. On some levels, it is very simple on very other levels. It's difficult to do because of the emotional conflict somebody would get into in the sense that, like, for instance, taking medication for hypertension. They may feel that if I get off my meds, I'm going to stroke out, I'm going to be in deep trouble when the reality is that the way blood pressure is regulated is called the negative feedback system, which requires calcium magnesium just as two fundamental examples. So by adding calcium and magnesium in supplement form along with potassium or the other minerals, you end up nourishing the negative feedback system. That in turn allows the brain and body to work together to bring blood pressure back down to a healthy level. So we're not treating hypertension, we're nourishing the negative feedback system which regulates blood pressure. That's my approach to things. And this is, I think, probably why we're working together is because it fits perfectly in what I try to teach. Everyone that I come in contact with and there's so many concepts and I think maybe this is what we're trying to do here is talk about these concepts which people can appropriate or choose to engage in and you set something that I think is so profound there in talking about drugs and healing..
Study Reveals the Secret to Longevity in Japanese Centenarians
"To ancient things. A new study is pop. The is a japanese study and his japanese study was looking at a group of japanese centenarians. Who seem to have these seemingly magical powers. They have an average age of one hundred seven amongst the healthiest longest living humans on earth protected from chronic diseases that that inevitably haunt a lot of the rest of us as we age like obesity and diabetes hypertension and cancer. But what they found these people that really stood out was the trillions of microbes that lived in their gut It wasn't the amount of the microbes but it was. It was the composition of those gut bugs. The composition of those gut bugs basically. They had a bacterial signature. Those similar to the strains of bacteria in in each and every single one of the centenarians but a lot of them had a very similar microbiome in one strain in particular stood out and it was type of bile acid. Okay or is it a bacteria that synthesizes bile acid now bile acids what you might know. Is this kind of boring bodily fluid that's commonly known for digesting fats. But it's now being called as a class of entering hormones hormones that go beyond their classic role in fat digestion and absorption. So what they found. Is that these bile. Acids helped to protect sensitive gets infection and other environmental stressors. So it's really interesting because we know that that the gut bile acid content to decrease a little bit as one ages in the secondary by lasts a really powerful so they've done studies in mice before they looked at the these these microbiomes humans and they found that the gut bile acids to regulate immune cells and prevent some dangerous microbes from taking over the gut. And what a what they looked at in the seniors a particular group of gut bugs called or owed oral back to rasaie adora backdoor and that turned out this little bile acid called eyeso- aloe lithocholic acid or eyeso- aloe
Google and Apple Shake up Health Initiatives
"Insider sources say apple will scale back. Its internal app. called health. Habit used by employees to track fitness calls talk to clinicians and manage hypertension health. Habit is part of apple's larger apple health organization and reportedly was seen as a potential model for a consumer product if successful internally. It's unclear if health habit. We'll continue with the smaller team or just be shut down in a memo to employees. Google knows it intends to break up. It's health division planning to split its various projects across other parts of the company. Insiders sources say google health. Chief dr david feinberg will leave the company to be the ceo at the electronic medical records firm. Turner
Dr. Neal Barnard: The Effect of a Plant-Based Diet on COVID-19
"Barr. Thank you so very much for being here. Jeff these are some really interesting studies and it kind of goes back to what it is that we've been talking about throughout this pandemic and and that is the healthier. You are the less at risk you seem to be. So if you wouldn't mind can you talk to us a little bit about these two studies and what it is. Researchers have discovered yeah. Let me preface this really by saying we've kind of suspect. The diet ought to be a big actor here because when people are overweight when you of diabetes hypertension particularly when these things are really out of control. Kobe just becomes so serious and often fatal but when people have these things under better control they do better. That suggests that if your diet is really good these conditions are going to be better but the question really was well. What if you actually are following a mostly plant-based diet will that help you and the answer seems to yes The first of these studies was involving. Healthcare workers were healthcare workers in six different countries. They tracked they ate and they rated them for more plant based or based or less plant based in other words. If you were less plant based at your eating chicken fish beef and cheese and kinda neglecting your vegetables and fruits and then if you were more plant based at mentor vegan or closer to it and the people who are more plant-based had a seventy three percent reduced risk of severe cove. It but i got to tell you the flip side of this was they looked to people who were doing kito or low carb diets and they did substantially worse a forty eight percent increased risk of severe. So don't go there.
How Deadly Heat Waves Are Affecting Our Cities
"Is absolutely an underappreciated. Whether related natural disaster it's really easy to understand flooding when like a big hurricane comes in. It's really easy to understand. Wildfires threatening your house they to get out of the way but heat is. It's a killer. It's it's steady and people don't really recognize that. This often lack of information on heat related deaths a lot of times a medical examiner on a death certificate will just say this person died of exhaustion. This person died of hypertension. This person died of cardiovascular disease but the death certificate notice that that person was an apartment with no air conditioning and it was one hundred and five degrees for five days in a row. If you're older if you're younger if you have pre existing conditions like heart conditions or asthma you are much more likely to be affected by heat. People don't think about he as being a keller but it is. An event of this magnitude really sends shockwaves through society. This is action this our infrastructure system. Our ecosystems and society at large are not well equipped to be able to handle this level of intensity feedback is a professor of climate adaptation at portland state. University and part of his research has involved monitoring heat in different places in cities such as portland oregon and looking at how heatwave effects people and which people are most affected. We've been talking several folks who live in multifamily residential apartments these are low income social housing and the windows aren't applicable or they just opened a few centimetres. The sun solar radiation is hitting those apartment buildings it's being pushed in often through the materials at the apartment. Buildings were built with and then temperatures in there. We were noticing from some informal stations. We have set up. It was getting up to fifty seven sixty degrees in doors. In some of these apartment complexes in that's very very dangerous for human health
Blaming Patients for not Doing Enough Is a Waste of Time with Dr. Matti Peura
"Capacious health physician and in the past. He has worked as a plastic surgeon. Dr motti pera helps people overcome their medical issues and achieve their best health. In the second part we will discuss the role of physical activity in our mental and physical wellbeing. And we'll also talk about behavioral chains and about the tools that may help making a change. Easier we are living in a time of sedentary behavior and obesity pandemic in the world. Many of us are thinking about making change towards better. We know what we're supposed to but still quite often. We fail in fulfilling the expectations of others and ourselves as efficient. Do you consider patients about these topics. I mean physical activity obesity so quite a lot of faces. The of this deal with the problems related to obesity obesity and current conquering disease just as diabetes hypertension So that's like an everyday topic for you to talk about it. It's quite it's it's very common. It's well to be honest to to continue from the previous topic the idea of them the value definition. I i have i have. I have applied this same method of thinking. we written helping a faces with obesity. Because like you said that we know what we're supposed to do it's everywhere so it would be kind of like actually a waste of time for me to work as a authority again for a patient to blame them for not doing the right thing. Not trying enough. That really really helps so we have to dig with obesity. We have to go behind to the actual calls. What causes
Using a Digital Cognitive Behavior Therapy to Treat Diabetes
"David thanks for joining us. I'm happy to be here. Thanks for having me dating. We're gonna talk about better therapeutics. Its efforts to improve outcomes for patients with cardio metabolic conditions through what you call your nutritional cognitive behavior therapy and your prescription digital health products. Let's start with the diseases. you're targeting. how big healthcare problem do they represented a over half of. Us adults have one or more major cardio metabolic disease including diabetes hypertension in hybrid. Dania maids a yard. It's a we use the word epidemic for a lot of things. But i think it applies. Here it's a it's a massive problem to what extent are cardiovascular diseases and diabetes and related conditions driven by behaviors opposed to biology and perhaps more to the point. To what extent. Can these be treated by behavioral therapy rather than pharmacologic interventions so You know a fascinating a fascinating topic. So if you if you think about our evolutionary history i you know we didn't we didn't really have ancestors with cardio metabolic disease yup in in order to in order to survive and thrive and reproduce You know people were lean and fit. And and those are things that seem tend to reduce or eliminate cardio metabolic disease
Out of Sight But Center Stage, Jurors Weigh Derek Chauvin's Fate
"I'm Julie Walker jurors in Minneapolis continue to weigh the fate of former police officer Derek Chauvin charged with the murder of George Floyd what or who killed Floyd that's what both sides argued long closings yesterday defense attorney Eric Nelson told jurors Chauvin was doing what he was trained it was drugs in a bad heart disease heart hypertension all of these things existed before Mr Chauvin rocked prosecutor Jerry Blackwell argued it would show that kneeling on Floyd for nine minutes and twenty nine seconds and not an enlarged heart reason George Lloyd is dead is because Mr Schoen hard was too small jurors are being sequestered as they decide the case which could land show been in prison for up to forty years on the most serious charge audio from court TV I'm Julie Walker
Derek Chauvin's Murder Trial Heads to Jury Deliberations
"The murder case against former Minneapolis police officer Direct showman in the death of George Floyd has now gone to the jury and Ed Donahue has this report. In closing statements, Defense attorney Eric Nelson said It wasn't a lack of oxygen that killed Floyd Drug ingestion. Huh? A bad heart. Diseased heart. Hypertension. Prosecutor Steve Slater told the jury showman had to have known what he was doing to Floyd. He heard him but he just didn't listen. Continued to push him down. Slater also pointed out it's all on video that force for nine minutes and 29 seconds that killed George Ploy. He betrayed the badge tape from court TV show Bin showed little expression. He took off his mask as his attorney, presented his closing statement.
Murder case against ex-cop in Floyd's death goes to the jury
"The murder case against former Minneapolis police officer Derek show open in the death of George Floyd has gone to the jury in closing statements defense attorney Eric Nelson said it wasn't a lack of oxygen that killed Floyd drug ingestion and the bad heart the diseased heart hypertension prosecutor Steve Slater told the jury Chauvin had to have known what he was doing to Floyd she heard him but he just didn't listen he continued to push him down Fletcher also pointed out it's all on video that forced for nine minutes and twenty nine seconds that killed George Floyd he betrayed the batch tape from court TV show been showed little expression he took off his mask as his attorney presented his closing statement I'm a Donahue
Interview With Paul Farmer on Global Health Inequity
"Paul farmers it professor at harvard medical school chief of global health equity at brigham and women's hospital in boston and the co founder of the organization partners in health began by asking him to describe the global health care situation in his own words. Well right now. We could focus almost entirely on the setbacks. You know one of the biggest problems we faced all over. The world is that with a shutdown. Obviously people aren't able to readily accessed their their care. What if they have cancer. Whatever they have diabetes have severe hypertension. So those are ranking problems. I think to anybody who's involved in global health. But that's just the tip of the iceberg. A lot of the efforts that we have engaged in to address. Social determinants of health are also being set back economic educational programs cultural endeavors employment opportunities There's been a major contraction. An anti poverty efforts overall. so it's going to be Troubling reflection on what's happened this past year and a lhasa worried it's gonna be projected poured into a futures. Will
How To Work Through Pregnancy And Menopause.
"Hi and welcome to help each other hurt a podcast dedicated to uncovering many of the women's health issues many of us are wondering about but few of us are talking about my mission is to expose the current gaps in knowledge and Care on all things Women's Health. Enjoy. Welcome back to the show. So today's episode is going to be all about pregnancy and how conditions may may have affected your pregnancy can come back to play a role in perimenopause and menopause. So you may think these two are completely unrelated and I am here to let you know. There's actually some really interesting themes that we may be able to gleam from our pregnancy that we can use when we look forward to or as we're entering into perimenopause and menopause. Before we get into that let's hear a word from our sponsor from Pharma. Thank you so much for sponsoring. Today's episode film Pharma is a woman's health care company the focuses on putting women first off then Farm was established to help women who are often forgotten about the pharmaceutical industry their products address vaginal and Volvo dryness itching and pain. We're always told how important it is to moisturize our face, but our intimate areas just as important many women have trouble talking about dryness with their doctors and do not know where to turn them far. My mom is here for you. This company feels women should feel comfortable making intimate skin hydration a part of their daily skincare routine try their products today for relief from vaginal and Volvo, dryness wage and pain check them out at fem pharma.com. That's, you are not going to be disappointed. All right, so here comes a fun job. Moment of Truth one of the reasons I wanted to do this episode today is because I am expecting and I've been hiding this fact for a pretty long time. I am in my third trimester and so far pregnancy has gone just fine. I'm not one of those people who really enjoys being a pregnant. I know many women who do simply not one of them. So I have been trying to hide it and I guess that's my way of not focusing so much on it. Thankfully. I'm lucky to be pretty healthy during this pregnancy. And this will be my third child is a surprise. We don't know yet if it's going to be a boy or a girl so it'd be really fun if you want to stick around and see I'm due in early June and not anything like my last baby. This baby might be a little early. So if there is a little break in podcast episodes, it's probably because I just had a baby now you also log I love working and I love what I do is I'll probably be back pretty quickly. And at this point I've gotten really efficient at getting podcast episode out to you. So I wanted to let you know because I do not feel like I was being honest hiding this any longer and I am really excited but it really led me to think about let's talk about how pregnancy relates to. Pause and menopause now. I just said I'm one of those people who loves being pregnant. That's mostly because I'm uncomfortable a lot. However, I have been really blessed to have healthy pregnancies, but every single pregnancy can be thought of as a stress test. So do you know what a stress test is if you don't we typically think about cardiovascular stress tests where they put the little leads you and you have to walk or run on the treadmill and they're looking at the EKG to see when you're under stress what happens to your body and this is gleaming information about future cardiovascular or current call log. Vascular risks that you may have and pregnancy is a very similar. It's a, you know, forty weeks stress test to see when we put your body under a little bit of stress or conditions that arise that may play a role in your health as we go down the line and we're starting to clean so much more information about what we can take from our state and as pregnant women into our health as we go forward, for example, if you had gestational diabetes or gestational hypertension preeclampsia, a preterm birth postpartum depression off or any of these other complications, and I'm going to talk to you about what all those could mean and we're still Gathering a lot of this data. So more and more is to come now what you've never had a baby or you haven't had a pregnancy in your lifetime. I think this episode will still be really interesting because we're learning so much about maternal health and female birth. Factors that are completely independent or different from the traditional and I'm saying those are question. You can't see me risk factors, which is based on the mail system. So thinking about these is also really interesting as well as if you have a friend or a daughter or a niece who's going to be pregnant. This is such a really interesting information to know about first. I'm going to walk you through some soft findings and soft findings means. This is just what I see clinically and I don't really know how it's going to go on to apply but one of the things that I do see a very common basis is women who have had a postpartum depression seemed to have an increased risk for either pmdd, which is severe PMS or mood symptoms in perimenopause and into
More Californians Are Now Eligible for COVID-19 Vaccine
"If you are 16 or older and you have certain health conditions you actually qualify for a vaccine Doctor. Robert Schooley is a professor of medicine in the infectious disease division at UC San Diego. He tells KOGO news. It's complicated to decide who's in the category. Some are wondering why Type Two diabetes is included, but not Type One. The reason for that is the Type two diabetes is adult onset diabetes. It's often associated with obesity and can be associated with heart disease. These patients with diabetes being in it Get her disease, the one to get into trouble with covert type One diabetes is juvenile onset diabetes, often with younger, skinnier people. Dr. Scully also says, Well, some heart issues qualify. Hypertension does not know the county says that is the number one condition among most hospitalized covert patients. Marilyn Haider KOGO News, the
DECLARE-ing Another Victory for Dapagliflozin
"Well hello and welcome to the i former x podcast where we explore the evidence that informs aleatory care pharmacy practice. This is stuart hanes the host of the i former x podcast in about a year ago we reviewed and discussed the data h f study which evaluated the benefits of the sodium glucose transporter two or s. l. t. two inhibitor. Adaptable flows in in patients with reduced ejection fraction. Heart failure even in patients without diabetes. And if you are not familiar with a data h f study. I strongly encourage you to read the original study. And the i former x commentary of course. The data regarding the use of the sglt two inhibitors to prevent cardiovascular events and to treat heart failure or quite compelling but can they also slow the progression of renal complications in patients with chronic kidney disease. Well i was excited to see the much anticipated data. Ck d. study published in the new england journal of medicine a few weeks ago. And i knew just the right people. I wanted to review this study for i former expert. Dr jennifer clements dr stephanie. Nitro jennifer and stephanie are no strangers to i former x. They are members of the i former x oriel board and have been frequent contributors over the years. That clements is clinical pharmacy. Specialist in diabetes transitions at spartanburg regional health. Care system in spartanburg south carolina indoctrinate grow is associate professor of pharmacy practice at the university of connecticut. Stephanie jennifer it's great to welcome you back on the i former x podcast. Thanks for the invitation stewart. Thank you for having us back so before we get started per usual. I'd like to get your thoughts on a patient case. A i think that is not unlike. What many of our listeners encounter in their practices and want to imagine. You're seeing k t a sixty one year old african american female in the primary care clinic today. The patient has a longstanding history of hypertension type two diabetes dyslipidemia and. She's morbidly obese. She also has osteoarthritis internees. She recently was diagnosed with chronic kidney disease in her primary care physician referred her to you to make certain quote. We are doing everything we can to protect your kidneys. According to her medical record katie has been prescribed lysenko pearl twenty milligrams twice daily resume astatine twenty milligrams daily metformin thousand twice daily and insulin Twenty it's bedtime and in addition over the counter. She takes aspirin eighty-one milligrams and naproxen sodium for arthritis pain. She currently weighs two hundred sixty four pounds of bmi forty point. Nine blood pressure today when thirty. Eight over seventy six and her most recent labs yesterday include a fasting glucose of eighty seven and a one c of six point seven percent. Sam crat nin of one point seven milligrams per deciliter and an estimated. Gfr of thirty seven seven potassium of four point seven. Ldl cholesterol fifty six hdl cholesterol. Forty eight triglycerides of one. Oh seven in addition. The patient had a timed urine protein tests performed and the album into creating ratio was three hundred fifty. So stephanie. Before we talk about the study that you reviewed in your i former x commentary. I'm wondering what's going through your mind in this case What are some of the key questions you ask this patient during the encounter and what additional apps if any might you want to obtain and is there any additional treatment options. Who'd be considering at this point to stewart. I would agree that. Kt really does mirror. Many of the patients that are encountered in clinical practice. And i think this case excites me because there are many opportunities for the pharmacists to intervene here and if we're going to utilize the ppc process. I would. I want to collect additional information from kt. for example. Does she smoke. How often is she using her naproxen. And at what dose. I'd also want to collect possible. Her a. one c. Blood pressure and serum craton and trends and we know how important it is to not evaluate labs in isolation so seeing her patterns would provide additional insight or care planning. It's really important to know. Kt's renal function is stable or if it's consistently fluctuating as this information would help our assessment of how we can manage. Her current metformin does since her egfr is approaching the cutoff for continue at minimum. She needed both reduction. And also story the for thinking about the potential use of sglt two inhibitors for katie ensuring that arena function is stable. What help us feel more comfortable recommending. Its use since we know that there have been reports of a two kidney injury and volume depletion upon initiation of these drugs. I don't want wanna collect a bit more information about her. Lifestyle habits including a general understanding of her dietary choices notably her sodium and protein intake and see if she is engaging in any physical activity given her need when the patient and osteoarthritis. I'd also wanna know her insurance provider and learn if she's burdened by any of the cost of her current medications in case we want to add anything in the future cd management perspective. I'm really happy to see that. She's on than a pro because she has albumin. Urea but further management is needed to help delay rano progression and when we think of good. Ck d. management. We need to consider it. I optimizing her glycemic control which looks really good for. Kt at this point and also painting and maintaining a blood pressure will have less than one thirty over eighty if we can do that safely
Mexican president tests positive for COVID-19, symptoms mild
"Of consistently downplaying the pandemic. Mexico's president contracted the virus, making him the latest world leader to fall ill from covert 19. His government says he has mild symptoms and is running the country's affairs from the National Palace. As NPR's Carrie Kahn reports, the Mexican leader is sick at a time when the country is witnessing a record number of coronavirus deaths. For many, it was just a matter of time before president and dress Manuel Lopez Obrador would contract the virus. He's rarely seen in public, using a mask and throughout the pandemic has kept up a grueling schedule, touring the country, flying commercial airlines and interacting with many people like he did just this past weekend. The military band played the national anthem, Lopez Obrador inaugurated new basis for his National Guard troops. He told a small crowd that the pandemic yes has been rough on Mexico. But it needs to be put into perspective. Lack is masking a panda Mia. There's been a basically, corruption has done more damage to Mexico. It's worse than a pandemic. It's a plague, he said. On Saturday, Lopez Obrador's underplayed the spread of covert in the country even as the death toll is approaching 150,000, the fourth highest in the world. More than 1.7 million people have tested positive for the virus. But officials admit that is an undercount since only the sickest are tested, and his ambitious vaccination plan is stalled recently after Fizer temporarily halted shipments of its vaccine to the country, do the logistics problems. Critics of the president's handling of the pandemic say they're not surprised. He himself has now fallen ill. Let's face it, The odds were increasingly against him Kindness. Bravo is a political analyst and teaches at sea. They in Mexico City University does not even try to be a social model. In terms of basically taking precautions. Early on in the pandemic, Lopez Obrador famously held up religious ambulance declaring that they along with his good morals. Would protect him from the virus and the cool protector. It is. Alone 80 that the best shield against the virus is to be honest, not to steal and not to betray. His comments, made back in March, are now being rebroadcast continually on TV and social media. For now, Officials say. President Lopez Obrador is isolating in his quarters at the national Palace and has only mild symptoms at 67, though he suffers from hypertension, and he had a heart attack in 2013. His Interior minister, Olga Sanchez, oversized morning press conference today, but kept it far under the two hours the president usually takes sink winter studly, pronto pronto Sirica Pereira, especially the president is stable and will recuperate very soon. I'm sure of it, she said. Soon after the morning conference, the president's office sent out pictures of Lopez over door in a suit behind his desk, taking a call with Vladimir Putin. Russia will reportedly send 24 million doses of its but make the vaccine over the next two months to Mexico.
"hypertension" Discussed on Cardionerds
"You're going to just get the patient of big bill as not going to be worthwhile. Everyone always thinks that they're going to diagnose feel chroma saitama or paraguay allman. It never comes back like that now. It's not that we don't see it we do. It's just that these patients presenting with sales of elevated blood pressure or blood pressure liability typically. Don't have it so that's important. It's fine to send off the testing but really the results when you get them back. They're not they're not subtle. Okay if you're actually going diagnose it. In a lot of times. We can see mildly increased at an effort norman an effort given in just hypertensive individuals. Got your laundry list of other things that people typically check for hyper cortisol ism patient looks cushing roy. That would be something to look at it. Check at t s h. It's reasonable particularly resistant. Hypertension hypo hyper. Thyroid can lead to those changes. Grab you've mentioned a case of Court tation likely. They're just take some imaging. That would be a young patient with hypertension that we would look for. And then we we think about congenital hyperplasia primary hyperthyroidism very rare mineralogy quarter excess syndromes other than primary. Last ism so those would present with a typically low australian rain and they akra magli. Those are really the major categorisations of them. The one thing. I want people to take away from this. Podcast is send more although raanan reenen levels and savoring and right to but send more of them. Because you're going to pick up when you actually look for it. That's awesome daca laughing. I really is such a phenomenal review in chock full of pearls definitely taking away the pronunciation for reenen as well and i had my fair share of launching into is thorough secondary hypertension workup only to fall short. Really just diagnosing a patient with primary hypertension. This is important for next patient. Tom perez is a fifty eight year old man with a long standing history of hypertension at gird. Blood pressure in clinic is one fifty two over ninety two. Despite being on three eight his clinic blood tracks with his home blood pressure diary and evaluations for secondary causes were revealing in the past. He's usually quite religious with his medications. But does sometime have trouble remembering bicknell so with this mind. Dark laffin treat resistant hypertension. And what is your approach in these challenging scenarios here. That's a good question. And this is a patient that might show. We all can relate to others a few issues going on so really. The crux of it is water. Resistant hypertension because important. Understand what that definition is. That's a patient. That's taking a three or more blood pressure. Medicines typically fi a diuretic appropriately dose for kidney function a-block the ninja tencent system and then i had appeared in calcium channel blocker and then they're not at their goal blood pressure. That's typically what we think about with the definition of resistant hypertension and you can have controlled resistant hypertension. And so that means you're on those medicines plus another one and your blood pressure's controlled so that's the definition under the umbrella of resistant hypertension often times to point to that. There's a increasingly push over the last ten years or so a group down at uab has really made more of a push to define subset of those patients as refractory hypertension. So we don't wanna be using resistant refractory. Hypertension it's anonymously and they defined refractory hypertension is patients with uncontrolled blood pressure on.
"hypertension" Discussed on Cardionerds
"How do you approach the choice of initial blood pressure. Medication in general. And what would be your top choices for this patient in particular so You know looking at his overall picture suggests that he's at a high risk for cardiovascular. Disease is still primary prevention patient but but pressures are elevated in the clinic and he's got a lot of risk factors. He's got past three c. K. d. he's got known diabetes sleep apnea obesity. So the american guidelines recommend typically in these folks that are in that stage to hyper-tension ranges. Everyone gets the lifestyle that we talked about. But then what we want to be. Starting with is fixed. Dose combination therapy. And so when you're when you're have lower blood. Pressure's it's reasonable to start with single agent therapy. Interestingly the european guidelines really unless there's overwhelming circumstances were worried about side effects really push fixed combination therapy as the first thing that you add in american guidelines. They give you a little bit of leeway so if you're twenty over ten above where we need to be then we should be starting fixed dose combination therapy and these folks in this guy. I definitely would start fixed us combination therapy right off the bat now. There's a few factors that we have to take into consideration here. The accomplish trial published back in. I believe it was two thousand eight looked at combination of a ac a statistic and so we know in that trial acc be tend to do a little bit better in terms of cardiovascular events but a couple things and keep in. Mind here one. He's african american gentlemen. Just in general to african americans tend to have more of a low green and hypertension so have a little bit less efficacy with ace inhibitors. Entry attention receptor blockers in the absence of a diuretic. So those medications work but we gotta get people on a diabetic so for someone like him. We'd probably go with combination. Enter tencent receptor blocker and fis type. Diuretic would be the best choice for him and typically affixed dose combination pill. Now the one problem with that when we think about it is a lot of the fixed dose combination pills. Don't come with a real good design tech. They come with hydrochlorothiazide and they don't come with napa my salad really. The most significant fixed those combination that comes with valid on is still brand name. It's asil certain and so it will be a good choice when it comes off patent but it's really unaffordable for most patients. And if you can't do that then what i would ultimately recommend in this gentleman is thinking about something like cloth or dabba might for his. I type diabetic particularly with his. Ckd because we know a lot of resistant hypertension is driven especially in kidney disease by volume. We know that at lower fires we're going to see a little bit less efficacy of hydrochlorothiazide. Then i would add on an ngo tencent. Receptor blocker can got a little bit of kidney protective effects without lower. Gfr i probably screen them for albumin. Urea as well because that can impact some of our choices in terms of blood pressure. Medications about really are cutoffs. Typically if are under forty five. I won't use hydrochloride. I don't use it very much anyway. But i i will more go with clark alanon. It has a more consistent affect all the way down to. Gfr thirty once we get into those. The stage four chronic kidney disease. Then you really looking at either sequential nefer on blockade. So if i type anna loop diuretic which can have a good blood pressure lowering effects particularly resistant hypertension but in your primary hypertension which we don't know if this guy's resistant pretension because we don't i don't have any medicine right now but we'd probably think about just their clark owner that might and if you were under thirty for gfr so stage four chronic kidney disease. Then we'd be thinking about adding a loop diuretic as well if he were caucasian than i probably be more likely to go with a die..
"hypertension" Discussed on Cardionerds
"There was definitely news to me owen. Hey dan just walked into the clinic. Luckily dan is an intervention fellow and was just catholic one of our patients but he really wanted to make sure that he got an episode to learn from you. Because we've been thinking about this for so long doctor laughing. I m so those are late. I came as soon as i can. But for me beverly never because i definitely don't want to miss an opportunity to listen to some serious hypertension knowledge bombs from you. You're such an expert in this field than just. I couldn't miss out so sorry major fomo but here i am. That's great. you'll probably be more interested in when we talk about interventional stuff at the end. So there you go. No no intervention is really really fun. But i definitely want to know more about hypertension. This is incredibly important to know this. Okay so let me pick up where greg left off with miss bologna's horace. Her blood pressure is one thirty. Five over eighty five and her predicted tenure. Asc dvd risk or by old cohort is two point. Nine percent say we confirm that she is stage. One hypertension. I have two questions to pose to you number one. What lifestyle recommendations do you advise for. Blood pressure control specifically and two. Is it time to start medical therapy. Should we take the plunge and order some pills great. So i'll answer question number two for he. I is no not quite at this point. That gets back to this idea. The threshold of risk where we think where we should be starting medications and that's essentially a ten percent risk based on that that twenty seventeen american guidelines stage. One hypertension really. What we recommend is a lifestyle modification for blood pressure control in. That's really the crux of when you're talking about dealing with any type right pretension primary hypertension on one drug. All the way up to resistant. Hypertension what i typically tell. Patients is blood pressure. Control is seventy percent lifestyle thirty.
"hypertension" Discussed on Cardionerds
"Org and what that does is that really shows all the well-scrutinized devices that have been validated for blood pressure measurement. Now is not a large less. So i'm not saying for patients if they can't afford one of those or They can't get one of those specifically that that they shouldn't go out and get themselves Break your blood pressure cuff. But that's a nice resource that if patients are looking for cuff to get print them out that website or give them that website so they can have that and it's really important. You know home blood pressure monitoring for someone like ms taurus that we've been describing hold up pressure monitoring going to be helpful if she was a little bit more hypertensive or she was on medicines. Any patients that on medicines. We wanted to home blood pressure monitoring because as we can get when we think about blood pressure we have to think about it as concordant or discordant. Blood pressure's depending on if we're in the office or the or the out of office setting and we have discordant of those so i e low clinic. Blood pressure's high out of office blood pressures or at the opposite. We have high blood pressures low out of office. Blood pressure's those are gonna be these subtypes of hypertension so masked hypertension and white coat hypertension respectively. And so. it's really important that we're not under treating over treating those patients so that plays a big role in most hypertension specialist practices and increasingly in primary care settings in value based care settings where we can upload that information to the electronic medical record. Because there's good data that if patients at least for the first few months at least when they're in studies looking at home blood pressure monitoring are pretty good in in can have good results in terms of lowering blood pressure when we talk about other ways to measure out of office. Blood pressure the thing. That always comes. Up is ambulatory blood pressure monitoring and typically when we think of ambulatory blood pressure monitoring for those. That are not familiar with it. It's essentially in oslo metric break. Your blood pressure cuff. It attaches to looks like i. Nineteen nineties cellphone in terms of the size of it it hooks onto your belt and the cough is programmed. Inflate every fifteen to thirty minutes during the day. Sometimes people use a twenty minutes and then every thirty to forty minutes overnight. And it'll do that for a twenty four hour period. Technically that is the gold standard. Four blood pressure measurement. The obviously i issues with access to that technology ambulatory blood pressure machine costs a couple of grand. So you're doing that. They are can be difficult to schedule. Not all clinics cardiology nephrology clinics. Have them available but they can be very useful in certain circumstances. Interestingly see amass recently not recently. I guess a year ago now released a new guidance on reimbursement for the atari blood pressure monitoring which was previously just for white coat hypertension and they added the indication of type pretension..
"hypertension" Discussed on Cardionerds
"Use of home. blood pressure cuffs enrolled ambulatory. Blood pressure monitoring. Greg definitely a we can talk about it. That's a really big deal in a real big push recently in. The hypertension community is make sure measuring blood pressure correctly. Okay i'll i'll touch on it in a sack of the sensor on your iphone se can measure blood pressure through your thumbprint. That's going to be not helpful. So it's really important that we take the time in clinic to measure blood pressure correctly. The standard recommendations are patients can't have had any coffee rector cise or anything like that significant for thirty minutes before we check the blood pressure. Want them to sit alone. Not new chatting with the medical assistant nurse are getting on the phone for at least five minutes before we check blood pressure in that applies to checking at home as well when you do it. You wanna make sure that feet flat on the floor. Legs crossed arm has to be resting heart height. He can't be holding it up. And and you wanna make your make sure. Your back is supported in street. You have to make sure the bladder is empty because a full bladder will raise blood pressure by ten to fifteen millimeters of mercury and most patients. And then what we recommend is then checking blood pressure. Newer statement put out by the american heart association. Talking about should we be doing Or metric in really the push has been more towards oslo metric blood pressure measurement because we we eliminate the human error associated with listening to the cough sounds and so we got him sit there we check the blood pressure. Typically when you're seeing clinic for a new patient appointment you wanna be checking blood pressure.
"hypertension" Discussed on Cardionerds
"Journal of medicine in twenty fifteen sprint bloodpressure. Trial the spread blood pressure. Trial got a lot of publicity at that. Time and trial is perfect. And i don't think sprint was perfect. But it provides a lot of evidence for clinicians about how aggressively to treat hypertension. So i think it's helpful to go briefly through what it actually showed was. It was comparing lowering systolic blood pressure to one. Twenty or lower versus is less than one forty for the systolic pressure in what it alternately showed was that those patients that we use more aggressive blood pressure treatment strategies some typically more medications ultimately they died less and they had less the composite primary endpoint which was major adverse cardiovascular events as well as inclusion of heart failure events not surprisingly as i think a lot of us would would've thought when they announced the trial at stopped early. Was that a lot of this. Primary endpoint little. The primary point was predominantly driven by changes in heart failure k. There's a lot less heart failure in the group that was more aggressively treated and so that really drove a lot of clinical decision making from the end of twenty fifteen forward and then the discussions about changelings thresholds for four blood pressure management. Because it seems like people do better when we treat them a little bit lower in one of the criticisms to sprint is. How representative is it of the general population that we see a main certain respects. It is in certain respects. It isn't you gotta remember. They weren't enrolling people with really wide pulse pressures or quite low diastolic blood pressures. So you want dealing with those isolated systolic hypertension where diastolic are starting out in the fifties. You know one forties over fifty for examples didn't earn all those people important to note that the enrolled people with high risk of cardiovascular disease so it wasn't individuals walking around at thirty years of age okay with with elevated blood pressure. Because it just weren't going to see the number of clinical events that they would need to and then the way that they measured blood pressure in the way that they titrate medications was also interesting. They did automated unattended office. Blood pressure measurement which typically tends to be a little bit lower than what we see in a typical office setting for measuring blood pressure and then they were pretty aggressive in the control arm so the less than one forty arm about deep prescribing and ultimately their goal was to get people for that systolic blood pressure between one thirty five and one thirty nine. Now that that's where some of the controversy comes from as well because if someone's doing fine and their blood pressure's one twenty nine thirty. Are we really going to prescribe for them. Certain people in their criticism of sprint would say no. We're not but but that's what they didn't a trial so that was the sprint trial in that really drove a lot of these changes in the blood pressure guidelines the following year. The european society of cardiology brought out some guidelines as well. They didn't change the definition of hypertension. They kept it at one forty over ninety but the important thing to note about these guidelines is that oath make a point that if someone's high party vascular risk so similar to the sprint trial population we should consider leasing the european guidelines the languages. We should consider getting them to one thirty over eighty or below and obviously the american guidelines. That's really the goal in anyone with secondary prevention for cardiovascular disease or those individuals at high risk for for cardiovascular disease but are still a primary prevention patient and what they typically use..
"hypertension" Discussed on Cardionerds
"Not meant to be used for medical advice. The views expressed hey do not necessarily reflect the opinions or policies of our employers. The goal is to enjoy learning cardiology directly from expert cardio nerds hey cardio nerds craig and i are here to learn all about hypertension from a true expert. I have the distinct pleasure of introducing docker. Luke laffin cardiology faculty in the division of preventive cardiology and medical director of cardiac rehabilitation. Here at the cleveland clinic dr laughing at medical school at vanderbilt university school of medicine. He trained in internal medicine and cardiology at the university of chicago where he also completed a dedicated fellowship in hypertensive diseases. He is a clinical specialist in hypertension designated by the american society of hypertension which is now merged with the american heart association. Daca laughing only recently joined the cleveland clinic. And it's been so incredible to work with you and learn from you dhakal. It is such a pleasure to welcome you to the show. Thanks very much for having me looking forward to chatting with you has done a great job with the podcast. Daca laffin russo. Glad you joined us today. We have a very busy schedule for the cardio. Narrates hypertension clinic. Could sure use your help. That's can start with our first patient dilemma as the fifty eight year. old woman. With the history of hyper libya -demia return for follow up. She's asymmetric imports. No major issues until last visit on november twelfth. Two thousand seventeen her blood pressure. Today is one thirty. Five or eighty five is same as her last visit. She's prized when told she may have stage one hypertension. Why didn't they tell me last time she says that laffin. There's a lot to unpack here. Do you mind reviewing the old versus new office. Based blood pressure thresholds for defining hypertension. Sure yeah greg happy. Happy to so really what. The difference is a two thousand seventeen. American blood pressure guidelines came out in november in those endorsed by a variety of organizations most prominently the american heart association and the american college of cardiology and probably the most controversial aspect was really redefining. At what levels of office blood pressure hypertension is defined and so whereas previously stage one hypertension had been defined at one forty above for the systolic blood pressure. Ninety or above for the diastolic blood pressure. The shifted that definition down to stage one hypertension was one thirty to one. Thirty nine mill. News-mercury systolic over eighty to eighty nine millimeters of mercury systolic. And this. You know there's a lot of different opinions out there but there's also reasons behind why they made this change to actually call systolic blood pressures in the one thirties. Hypertension probably the most significant reason was clinical inertia whereas we tell someone you have pre hypertension orange some term. That really mean a whole lot. There are a little bit less likely to change their lifestyle and their patterns and we may not be treating people as aggressively as we need to and that really comes down to understanding what the evidence was behind that change from one forty to one thirty and that was driven predominantly by the publication in the new england.
"hypertension" Discussed on Cardionerds
"Affects the lives of hundreds of millions dedicated cardio nerds everywhere are working hard to fight this global epidemic. These are their stories. Hey everyone it's amid. Thanks for joining us for today's visit to the cartoon hypertension clinic in this part of our prevention series. We get to learn all about hypertension from becker. Luke laffin preventative cardiologist and hypertension experts. We are also so excited to be joined by dr greg. Ogono a brand new first year cardiology fellow here. At the cleveland clinic. Gray completed medical school at the university of south carolina school of medicine and internal medicine residency training at washington university in st. louis. He served as an academic hospitals there before moving to cleveland to dive into cardiology. Greg enjoys traveling exercising and experiencing new cultures through their food. Greg thank you so much for joining this episode and it's been an absolute pleasure has an avid listener. I feel extremely fortunate to be able to take part in the car owners. Podcast and also be able to learn from dr luke. Laugh in this afternoon. Great when i met you you recognize that i was one of the co host partners right away knowing that that you listen to the show was just so special for really all of us and even after an episode comes out you. You're right there. The next day to give me feedback about the episode. And so it's just it's so special for us to hear that that we're having impact and thank you for listening. And i told the team that we just we have to get great on the show so really appreciate it. Wow yeah i mean i mean..
Fauci: Up to 90% of population needs vaccine for herd immunity
"The cdc is now requiring a negative test for any travelers coming from the uk but officials had been downplaying the threat of these of these new strains that we are seeing these variations in the uk. I think you had said earlier this week. That a mutation doesn't mean the virus more dangerous or more deadly. Dr fauci said that these these these variations may already be here in the united states. So why why this new step. Why this new restriction important for people to know that we're layering protection on top of protection on top of protection. No individual protection is going to be one hundred percent. A lot of americans don't know that back in march through the presidential To twelve f authority we restricted. The ability of people to come to the united states from the uk and travel is down ninety percent even pre knowledge about this new variant from the uk. So we've already had severe travel restrictions from the uk. testing within seventy. Two hours isn't one hundred percent. It's not perfect but it does. Further decreased the number of people who will come in and then what we recommend to people according to the. Cdc is that once you get here you still isolate for seven days if you've had a negative test or for further longer than that if you don't get a test on this end ten to fourteen days so those things layer together. We'll significantly decrease chance of exposure to a new variant. But here's what the american people most need to know. Mitigation works the shows that it works. So if you're worried about a new potentially more contagious variant. It that much more important that we follow the four ws. Where a mask wash your hands. Watch your distanced and the fourth one is weight on gatherings especially with one last holiday coming up new year's we need to be very careful. You said that you understand the skepticism. From many african americans about the vaccine obviously given the history of medical racism in this country and you of course got vaccinated on camera to to to to send a message. What else needs to be done to convince people including some of those most vulnerable that this vaccine is not only safe but it's effective and necessary. Well we need to continue to acknowledge what's happened in the past. And i've talked about ski. Talked about henrietta lacks but they were real issues going on today right now in this country when you look at seven hundred women dying pregnancy related complications. Most of them black and brown in the united states. When you look at not just cova hypertension and cancer disparities. We need to acknowledge these things. And we need to show people meaningfully in a real sense what we're doing to improve on these measures and that's why a surgeon general before covid health equity was a critical part of everything that i did. And then we need to engage with trusted influencers. We need to make sure our pastors in e moms in rabbis. All of whom. I'm working with. Have the facts so that they can spread it to to their congregants and we need to walk the talk and that's why i got vaccinated on live tv. I want people to know that as a scientist at the doctor. I've looked at the data. I know the protections that are in place. I know an african american female helped. Develop this vaccine and tony foul. She and i made sure that the trials were were enrolled with diverse participants. And i got vaccinated because i trusted and how we end this pandemic
"hypertension" Discussed on WJR 760
"I'm like, seriously, it's like well. And it looked like that. I mean, these were the experts and I said, Well, looks do it. And so we penciled it in. We scheduled it was going to do it over the holidays, and I thought that would be you know, I could use the holidays for recovery time, but it was quite a quite an ordeal that you have to go through. But I thought, you know the pain was at the point where it's like, I just didn't want to deal with it. And it's like it's time to, you know, get proactive and and get this done. It's like having a cavity you gotta Hey, kids got to get the shot. You got to get it taken care of. It's gonna in the long term, It's gonna hurt you worse so So we schedule it and But in the meantime, I talked to a couple people when I said We may want to look at a couple alternatives and you were talking about him and I thought, And so I got a second opinion and And I tried. This really was a physical therapy type of an approach. But it worked. I mean, I basically that within about 30 days, the pain of subsided and I didn't actually need the surgery that was never suggested to me. By the guys that wanted to do the surgery. I'm like so in a conflict of interest, I don't know television who knows what it is? But But I'm sure they had good intentions. But my goodness and you know, second opinion in that case, save me from having to go through because what then what I learned is one operation can Can precipitate another operation. Who knows you're off to the races. And so as you relate that to financial planning, I think it's just a serious because your health and wealth are inexorably tied together. You know, because you know if you lose your control of your finances that begins the slippery slope tol losing control of your health because you're You're now looking at, you know what's the What's the biggest factor controlling your health? This is stress and all sudden you're homocysteine. Cortisol levels go up waking comes on and And and now it's hypertension that has diabetes. I mean, all of this is tied together in and she could be very careful that you're dotting the I's in your crossing the tease when it comes to making the right decisions on here in this area. So the point here is make sure that you you get a second opinion on this, maybe even a third to make sure you're going down the right path here when it comes to your finances, because again is tied directly to your health as well. Yeah, I mean, well, you gotta after the heart attack, Mark. What did the doctor tell you? You got to start eating better yet to take this prescription. These air the changes that you need to make right? I think your portfolio the same way. We just had a massive heart attack earlier this year. How did your portfolio perform? That's a great point. Yeah. Now we need to make changes. We watch the market just roar back. Don't have another heart attack. Go back to deceit in the bathroom. Maybe I'll go to McDonald's is what you're saying. Yeah, right, right. Yeah, position the portfolio properly, especially if you're at the end of the accumulation face. Early on in retirement. That's when you have the highest exposure to loss. That's when you've built the portfolio up to its highest amount ended the accumulation phase early on in retirement, you know, slowly start spending the money down. So that's when you're at the highest risk for loss. So make sure if you are entering that face that you shield at least a portion of the portfolio from loss that you know how you're gonna move through any type of downturn. Should we see one in upcoming years? So if any of this actually your resonates with you Is you're listening to this and say, Hey, that's me, Or I really relate to what you guys were saying, and you'd like to come in for that complete planning review. It's real simple. You don't get a pencil right now grab a pen and pencil and write down this number. 248305 99 11. Or if you're driving, this is easier to remember our W. Paul. Hey, you well dot com rw paul dot com Look us up on the website, Make the appointment through the website and or our numbers there as well. Call us if that's easier for you. Get on the schedule. It cost nothing to come in to sit down for about an hour with one of our advisers to see if we might be able to help you, and we're good fit as it relates to your personal situation. And and if we are great, and if not, then hey, then, as we said, get a second opinion and keep looking, But But hopefully you could put us on the list is as one of the opinions and I think you'll be happy with what you see you get a copy of our our book, The baby Boomers Retirement Survival guide. If you're a foreign worker, we're going to make sure that you get a copy of the book. You know the auto workers guy to love some versus pension or if you're a nun, automotive worker, Then we'll give you the guy to alarm. Some versus pension. That's not automotive specific. And so either way, you're gonna leave with a lot of just great information. And you're gonna be able to make a better decision whether you end up hiring us somebody else or doing it yourself. So again. Give us a call 248305 99 11 get on the schedule. It's an hour of your time in if your little bit still leery of the covert thing. Hey, let's do what we call the zoom call. So we're all familiar with that now so we could do it right over the phone. Or do it over the computer so we can actually talk face to face. But we do it. Elektronik Lee. So whatever works for you main thing is that you take action. Quit procrastinating and.
How to Improve Cultural Competence in Dermatology and Skincare with Dr. Susan Taylor
"Okay. So we're here with Dr Taylor, don't worry we gave a nice bio on you before you came on the line do truly one of the most amazing dermatologist in the United States like I'm so excited you're here we want to hear about your career little bit before we start talking about the issues of the day that we brought you on to talk about. So first off what made you want to become dermatologist well, you know. When I went to medical school, I. wanted to be an interest and I wanted to treat people from the inner city with hypertension and diabetes and cardiovascular disease. But then during my fourth year medical school did my very first dermatology rotation and I loved everything about the specialty The fact that he could range from Piatra patients to you know those in their eighties and nineties the fact that there was a little bit of surgery. Pediatrics was cosmetic. Dermatology in general dermatology. The fact that you could actually see in feel in touch the pathology as opposed to like pretending, you can hear it you know through the stethoscope so that really changed my whole focus. Now when I graduated I decided nonetheless to do a internal medicine residency. But halfway through I said, you know you've got to remain true to yourself and what are you gonna be happy you know thirty years from now practicing so I went back and did another residency in dermatology in here we are. Also, that added a little bit of time onto your career. It did. Yes it was so worth it. Yeah, and so you I know you're the founder of many amazing things that I've gotten many resources from one of the things that you're known for is. Working at the skin of Color Center can you and you co-founded that ready did yes. So I'm back with that is when that started back in nineteen ninety eight I did my dermatology residency at Columbia. Presbyterian. Medical Center in about ten years after I had finished I got a call from one of my professors who said you know here in New York, there's the need for a center that specializes in skin disorders for people with darker skin tones, and he said, this was my my mentor. Dr Deleo. He says, you know they say to me you're a nice guy but I want someone who looks like made and so he called me one day and said, would you be interested in coming to New York in creating some type of center and for me it was an incredible challenge an incredible need. This type of center didn't exist anywhere in the world and my mandate was to name it started to figure out what the mission was and that was a wonderful wonderful challenge. So what I decided was. This would be a center for. Instance in clinical dermatology, we would also perform clinical trials, research trials, and at that point, many dermatologists were very afraid of doing any types of cosmetic procedures on people with darker skin tones. So we wanted to really gorge path that. So that's Why we created the skin of Color Center, I am delighted to report it still in existence. Now, it's now affiliated with Mount Sinai and there's a new wonderful director WHO's there? Can, I just ask Dr Leo was he a White Guy? Dr Dalil I didn't know you. Know can Dr till now goes bad. You know I'm a tall white guy and they don't want to see a tall white guy. They want someone who looks like you and you know he's just been a wonderful inspiration over all of these years I'm very fortunate to have had him as a mentor Academic Sense. So when you let your medical residency, did you feel like you were prepared to treat all the patients that you were about to say is at the level of care that they are. Yeah. So I had the distinct honor and privilege of a doing my dermatology residency New York City in Manhattan like one of the most diverse places on earth. So from the time I was the first year. Dermatology residents I saw people with all skin tones. And all ethnicities and racial groups. So when I completed three years of residency, I did indeed the very prepared in diagnosing and treating disorders in people with darker skin tones. Then I opened up a private practice in Philadelphia, which is my hometown and I found that over time many women and men of color sought me out because you know it's not just the skin tone, but it's also the customs habits. Women did not have to explain to me what they do with their hair because I have the same hair and so there is a cultural competence and we wanted to create a center were all the doctors no matter what their race or ethnicity was culturally competent.
COVID-19: ‘little or no’ benefit from remdesivir: WHO
"Results from a UN coordinated international trial looking at four cave nineteen therapeutics have shown little or no positive impact on preventing death in patients infected with new corona virus, the Solidarity Therapeutics Trial, overseen by the world. Health Organization who found that REMM disappear hydroxy chloroquine, Lapenne Aveer. Rootin- and Interferon. appeared to have little or no effect on twenty eight day mortality or the hospital course of covid nineteen among hospitalized patients. The study involved more than thirty countries and investigated the effects of the treatments on mortality ventilation and length of stay in hospital. It did not examine other uses of the drugs such as preventive treatment, which would. Require further trials in a related announcement. The WHO said that Covid nineteen had also highlighted the increased vulnerability of people with high blood pressure to the coronavirus. The warning is based on data for more than one hundred twenty countries showing significant caveat related disruption to treatment for people suffering from chronic health conditions with findings showing these patients make up fifty to sixty percent of all deaths through covid. Dr Bent Mickelson director of WHO's Department of noncommunicable diseases said that more than one point one, billion people around the world suffer from hypertension mainly in low and middle income countries when it comes to call it nine, thousand, nine, hundred, hypertension, one, hundred and twenty two countries that has reported. US that in over fifty percent of the country's the healthcare services disrupted fully or partially fifty percent of the country's, and in addition we see a high number of is we don't have global figures yet, but we see in the rain show fifty, sixty percent of the people that are severely ill and died in hospitals from code have hypertension diabetes, and so forth and the working on the global targets.
The Pandemic Behind The Pandemic
"This episode, we're going to be talking about the most pressing issue of our time, and there's a statement that you cannot solve a problem that you don't understand. You cannot solve a problem that you don't understand and to take that a step further, you cannot solve a problem you don't know you have. Right now we're dealing with a worldwide pandemic and there are many pieces of this situation that are not being analyzed. It's such a broad wide ranging issue with many components and today when a break some of those things down in a reminded me of a statement and this was published in the journal Invention intelligence referring to Albert. Einstein. Stating that quote often the problem as given is misleading. And you have to work through a mass of data to define the real problem. Often this step consumes more time than deriving the solution. Einstein was quoted to have said if I were given an hour in which to do a problem upon which my life depended. I would spend forty of those minutes studying the problem fifteen minutes reviewing the problem. And just five minutes solving it. So today we're going to get a better understanding of the underlying problem the pandemic behind the pandemic. and. This starts for me with the report that I talked about back in April when this situation really began to kick off and it really was alarming and I wanted to make sure that people knew about this data. Now, here in the US, we had early access to some data because several other countries had experienced the ramifications of covid nineteen being spread throughout the population most notably Italy was really hit the hardest and their data really gave us an opportunity to be aware of our. Underlying susceptibility. To, Cope in nineteen to infectious diseases of really all types but specifically and looking at the data with covid nineteen after thousands of people lost their lives. The Scientific Advisor to Italy's Minister of Health stated that quote on re evaluation by the National Institute of Health only twelve percent of the death certificates have shown a direct causality from corona virus alone. While eighty eight percent of patients who have died have at least one pre morbidity in many times two or three. Pre existing chronic diseases that have become absolute pandemics in our today themselves have really left susceptible. And we had this data and even take it a step further and I talked about this the very beginning of the pandemic. This was published the Journal of the American Medical Association in April. This was back in April. This analyze data hospitalized Kobe nineteen patients in New, York City, which was really the epicenter of a lot of the the turmoil, the fallout. In an covered that already approximately ninety percent of people having severe reactions to Kobe nineteen or those with pre existing chronic diseases with the most common co morbidity is being hypertension, obesity and diabetes. And now in the real reason that this show is happening today, the just published a report. Updated on September thirtieth twenty. Twenty. Reiterated with the data has been showing us from the very beginning their official report stated that ninety four percent of the lives loss from covid nineteen. When people who had additional diseases they stated that for each death noted to be related to cope nineteen, there were on average two point, six additional conditions or causes for each death. Most notably type two diabetes and hypertension. This is not to say that covid nineteen has not been absolute destructive force. In our society. This is to say. That, these chronic diseases loaded the gun. In Cova nineteen pulled the trigger. Our susceptibility. Our underlying pre existing health conditions as a society sets up when I saw that data coming out of Italy, I was like all we're in trouble. We're in trouble here in the United States we're in trouble. And this is why today we're going to take a deep dive and really look at this issue we're going to get a face to face good look in the mirror at the issues that are underlying. So many of the problems experiencing. As. A culture, we cannot turn a blind eye to this stuff anymore. This is our opportunity to change things right now but we need to get face to face with this problem and we need to understand truly how bad it is in all the different components so that we can come to a solution because as Albert. Einstein. And by the way with all the quotes that might come from Albert Einstein or from Abraham Lincoln or whatever we don't know who said it whoever did is pretty SMART But in that statement of like if you've got. An hour for problem spending forty minutes on the problem itself studying the problem looking at all angles of it then reviewing your study of that problem. Right and then you spending five minutes on solution this because the solution will be much more effective. Much more poignant. When. You actually understand what you're trying to do. You actually understand the problem.
"hypertension" Discussed on Dr. Jockers Functional Nutrition
"Let's talk about and you went into detail on how insulin resistance impacts hypertension. Let's talk a little bit about that how it impacts our ability to you know, basically retain or excrete sodium and everything else that goes on with the pathogenesis of high blood pressure. Yeah. In fact that connection is so strong that if someone has hypertension like typical hypertension where there's no known aggravate being caused, you know, there's no doubt like obvious endocrine defect or kidney defect it is I I submit it's a very safe bet insulin resistance is the cause of most instances of primary hypertension, which is the most common form of hypertension. So anyone listening is and hypertension. It's probably insulin resistance and and to your point and I of course elaborate in much greater detail in the book than I will. Yep. Now but in some resistance has a really phenomenal and even broad effect on causing hypertension from the level of the kidneys and even including the nature of blood vessels themselves, the the caliber the the width or diameter of the blood vessels, but High insulin will stimulate the a different hormone called gastrin to be over secreted or overproduced and aldosterone tells the kidneys to retain salt like like you said and then we're salt goes water goes off. The person is basically they're they have too much water in their blood and if they have too much water, that means the volume of their blood is too high and as volume goes up of of birth in pressure follows, and that's just fundamental physics. So the pressure is hired just because they have too much water and the kidneys are just waiting to dump this water, but they can't because in school. Will let them but this phenomenon is so acute that someone can lower their insulin by just making dietary changes within just one day and they will find that there's pressure will go down there. They're systolic blood pressure. The first number it'll go down like 10 or 20 points in a day just by following a diet that will lower them insulin..
"hypertension" Discussed on Cardionerds
"They had more dilated more dysfunctional right ventricles the method vitamin, Associated Group. Had more than double the risk for clinical worsening or death compared with patients with idiot pappy pony hypertension they found that the methamphetamine group was subjectively reported to be less adherent to therapy. They also received less IV in suck detainees process. As treatment which are usually used in more advanced disease. The reason for this was stated as concerns for the delivery sites and possible infection risk, and so forth they tried to sort this out with a multi very model and still thought that the meth group had significantly worse outcomes compared with the eightieth ethic group in the current era treatment of pulmonary arterial hypertension. Doesn't reverse or stabilize the pathophysiology of the disease, but instead seeks to reduce RV after load by multiple pathways which visa dilate the pulmonary arteries medication. Wise. There's about six different classes of medications. We can use the process cycling's or processing analogs in these can be IV sub Q. P., O. R. inhaled agents the PD five inhibitors such as Sildenafil into Dalla fill the. And receptor agonists Bo centene amber centene mass attended the soluble one sickly stimulators such as real CIGUATERA, the selective process aikman. Receptor agonists such as selective pag, and in an increasingly select number patients with positive as a challenge in normal cardiac output calcium channel blockers can be considered in early disease and finally the old paradigm for treatment of pulmonary hypertension with medications was to start a single agent wait till there was. Clinical worsening start another agent wait until there was clinical worsening and so on and so forth. The ambition trial in the New England Journal of Medicine in two thousand fifteen looked at single agent versus combination of agents, and they looked at to Dallas Phil, Amerson or the combination of the two their primary endpoint was clinical failure event, which they defined as the first occurrence of composite endpoint of death hospitalization for worsening. Disease Progression or unsatisfactory long-term clinical response and found that the combination group reached clinical failure, Ben Eighteen percent the single agents alone to Dallas Phil reached in twenty percent Amerson reached it in thirty four percent..
"hypertension" Discussed on Cardionerds
"But conversely, as you said, there is a palliative approach to creating a shot to load the right side and so two really at a fulcrum right now because you're thinking that, hey, is for the cause of a paradoxical ambulance with essentially embolic semi. But on the other hand, if you close a structural problem will cause acute right sided overload and human dynamic collapse. And so how did you guys navigate the management conundrum? Before we go on, I just want to echo your point the ach a guidelines for treatment of d actually specifically states that closure is contraindicated when you're hungry pressure is graded in two thirds of your systemic systolic blood pressure, and also if you're palm vascular is great in two thirds of the systemic resistance. So the ratio remembers two thirds, two-thirds and uniform. Thank you can apply in the case of PF. Oh, correct I would think. So it seems like a very similar physiology. These are really great points in it really highlights the importance of follow up for. So many things you click was follow will just follow sds pf owes things that really could be game changers in terms of human dynamics consequences that develop over time sometimes used you see NASD as symptomatic patient and tell him it's nothing to worry about you have to be very careful that you them this story about now this needs to be followed very closely and nothing to worry about could be confusing. Maybe the better term is nothing to intervene on right now but definitely something to watch. Wait you definitely don't want to catch these patients when they come back on the flipside when. Too late there's been a human amick setup that country indicates closure. Yeah and this was sort of a different situation right? Because this isn't a patient as ast or AVI SP and they've developed. Hypertension because of excess pulmonary circulation over time, this is a patient with pf? Oh, which usually cause pulmonary hypertension and so this patient has a pf Oh that may be the culprit for an embolic semi but in addition to that also pulmonary hypertension that will complicate how we push pf. Oh so and wondering what the heck pretensions about because I sure can't blame that on the PO general and we don't really have baseline heart disease to coupon react pretension. So I think this question why does young patient as pulmonary hypertension and then tying it back into how we proceed with the possible need for closure great points guys in just. A, tie back to the case. So after that, she was referred to are harder potential specialists before annual was allowed to get anywhere close to the PF. Oh, for further workup, she had a right Heart Cath and in standard unit had showed right atrial pressure three pommery through pressure of seventy four over twenty four with a mean of forty pulmonary capillary wedge pressure five cardiac output index of three point three and two point one systemic vascular resistance, twenty, two, hundred and pom. Rescue Resistance of eleven. WHOA. Wait hold on just for all the early cardio nurse listening to this the mean PA pressure.
"hypertension" Discussed on WZFG The Flag 1100AM
"African American community and it's really terrible because it's just one of the failings of our society is that African Americans have a disproportionate prevalence and incidence of the very coal morbid conditions that puts you at high risk for hypertension and asthma obesity diabetes if you get infected you're going to have a poor outcome when it's all over is the focus a bright shining lie stop with the bright get the pharmacy delivery boy off the show so there's your answer this answer the question I think a little bit does I mean it's very straightforward thank you very much that's so she I can combine it it's a combo job today it's a mixture of all of the desperate elements of my soul that art now go like rising to the surface of my being I can't just sit here and talk about the epidemic stuff how many of you out there okay is another call on something to do with the disease let's do that then I'll clear the decks for the next thing Hey whatever happened to the guy from some from Brooklyn what was his name the the Italian guy used to call a time where is he Jimmy Jimmy from Brooklyn's not listening anymore members his cousin died of cold when he was depressed and then he got they never called the show again I hope you didn't get sick what if Jimmy went on the from too much too much Italian food there in Staten Island a Staten Island Chuck line three on the savage nation hi Mike yes Sir what's on your mind with twenty six million subscribers and listeners you can use any of my aims and let's not twenty six million it's it's in the millions but okay what's on your mind shock couple weeks ago I take as many supplements you do X. ago you mentioned not taking vitamin D. well I wanted to give you a heads up on something because it was a hold let let me say something let me give a copy it to the audience I said if you have an immune response if you have an immunological problem don't take vitamin D. that's what I said well there was another words if you have an auto immune disease or you are immune compromised in any way do not take vitamin D. that's what I said okay I didn't say I didn't say generally you shouldn't take it well the article in the post the other day how I'm going to give you a heads up on it because the researchers at Queen Elizabeth hospital foundation and used Anglia said that the deaths in twenty different countries in Europe were directly related to having low vitamin D. levels and hold hold on please but you have to look at those who died and see whether they had underlying conditions to begin with just passing along the order I get it but you see this is the problem with an epidemiological study unless you break it down and go into the really specific details if it isn't necessarily what the headline is saying what are the the corner a second ago that you answered you know what the BCG vaccine is so you don't it was the one that was given no I said so hi what are you getting out now I will my wife was given it as a kid in America but it's not giving him a North America but is given to the rest of the world and apparently it has a direct protective relationship with the corona virus as well as the be you know and so you're arguing in favor of a vaccine no no no no this is given years ago and all around the world for T. B. it just coincidentally began you saying those who got the vaccine have a lower up incidence of this disease covert apparently that's what they found that's one of the reasons why Europeans and Asians around the world are dying in the quantity that Americans are we know why they are where they all got the vaccine yeah with it because I got debate if North America is not it hasn't been given since the sixties my wife eight years ago is again why did she get it within a week we haven't found that out it was waiting she from Asia no no that's the point she's from queens and in nineteen sixty sixty one I got the story I got so if you get the TB vaccine you're you've got a little bit of a resistance against the covert is what you're saying all right I still haven't read a page for my novel can I do that please no no one wants to hear it then I got a very straight audience that don't Oscar on a stick to the subject vaccine the only winners vaccine drug epidemic pandemic Newsome drugs that's old stone don't read that crap you wrote in the eighties savage we don't hear anymore no more no more art science poetry literature just stick to the one dimensional stuff do the one dimensional banjo come on let me read a piece of the I won't read it I'll be back to something else join those savage nation call now eight five five four hundred savage eight five five four hundred seven to eight to savage the savage nation is sponsored by Swiss America.
"hypertension" Discussed on iForumRx.org
"Greetings and welcome to the. I former ex podcast where we explore the evidence that informs Tori Care Pharmacy Practice. My name is Stuart Hanes. The host of I former ex hypertension is perhaps the most common chronic disease encountered in clinical practice and while high blood pressure does not cause symptoms at least not routinely. It leads to end organ damage to the kidneys. The eyes brain and his a major contributing factor to atherosclerotic cutting vascular disease thus helping patients achieve and maintain optimal blood. Pressure is among the most important goals that pharmacists and ambulatory and Community Pharmacy. Settings should be striving to achieve now. While optimal blood pressure is clearly important preventing cardiovascular events and organ damage is really the ultimate goal and in this regard how we achieve good blood pressure. Control may be just as important as getting to goal. That's why the recently published Hijja chromotherapy study caught my eye my guest today. Dr Joseph Sustain and Dr. Vivian Chang from the University of Colorado skaggs pharmacy and Pharmaceutical Sciences Dr Secene is professor in the departments of pharmacy practice in family medicine. And Dr Chang is a PG way to ambulatory care pharmacy. Practice resident together they authored a commentary for I former ex about the Hijra chromotherapy study entitled should bed time be mid time for hypertension Joe. It's great to have you back on the Iphone X. PODCAST and did IAN. Thank you for becoming a first time contributor. Thank you stuart. It's always a pleasure talking about hypertension at topic near and dear to my heart high. Thank you so much for having me on. I four RX. I've been a subscriber some time now and I'm excited to be here so before we get started. I want you to imagine you're seeing L. Are a fifty nine year. Old African American male in the Family Medicine Clinic today for a routine blood pressure. Follow up visit. The patient has a longstanding history of high blood pressure are L. is also overweight but is otherwise healthy. He reports no personal history of cardiovascular disease states that his sister has kidney problems and his father died at age. Sixty from stroke. The patient currently takes Lysenko Parole Twenty Daily hydrochlorothiazide twenty five milligrams daily 'em Load Pin ten milligrams daily. And last week. He was started on spiral. Aktan twelve point five milligrams once-daily now. He weighs two hundred one pounds and his team is thirty. Six point to his.
"hypertension" Discussed on Veterans Helping Veterans
"Certain aircrafts and stuff like that. That were transporting each and orange so so when we're talking about Agent, Orange exposure and a diagnosis of hypertension. That's another big one because if they ever add hypertension as presumptive to to Agent, Orange exposure that open up so many other avenues for veterans to be service connected for because as many people know, you can have hypertension it can be controlled medication, but there's so many offshoots. Hypertension that can happen stroke, heart disease, things of that sort self and those are all service connected as well. So if you have a disability that that's secondary to hypertension that's open for service connection. So it just kind of keep in mind. If you're exposed to Agent Orange, and you have through tension get the claim in because 'cause that claims should warrant benefits down the road if they ever. Our ad hypertension. Well, I thought I'd pretend too much one of the empty John. But I would not know. Oh, man. Hard about as man. Yeah. Ski mccart this use coronary artery disease, heart conditions like that. Yeah. Yeah. But, but hypertension is it's a very how should I say, it's a type of disability that many many people have including a number of veterans in and the bean counters at the department of extra terrorist are just terrified here that they're gonna have to add. 'cause it's no it's not so much. Hang ten percent. Disability for hypertension, which is usually qualified when you're on prescription and your diastolic, and let's call up and hypertension or above a certain level. Even if it's controlled you can get a ten percent disability. What the afraid of is paying out for the severe chronic does not that calm innate as a result of hypertension, especially stroke cause heart disease. I already be service connected on presumptive to Agent Orange. But but any other disability that's not an already on the presumptive list, like stroke or any other? Residual shoot a hypertension would be service connected as well. Yes. So. Involved in that, it's it's more complex and people realize just keep an eye on the oaks. And like like, we said that if he had it, especially if you're blue water navy bathroom, and you had Mitch us or if your spouse and and. Surviving spouse get climbing get in there and talk to to metrics rep or someone like John Dory here, he's a certified metrics claim agent. And I don't know how many or cross country, you know, Dionne. You know, I looked at the website one time. So I was kinda curious how many people are there that do what I do on a claims agent level and the credits that appearance age if he's not including Ernie's there's a lot of attorneys. That are authorized and do what what we what we do is claims agents. I think there's only a couple of hundred throughout the country, maybe to two hundred fifty throughout the country, and and I would recommend guest of those two hundred hundred fifty accredited appeal to agents maybe half on some trade on time. I'm just guessing at that. But I know for the state of Minnesota, we've got three, and and I'm fulltime the other guy is that I know of John Brown was sitting on this show years ago. He's still fulltime. And I think there's two others that are registered I know one to do it full time. But I guess the point being is this Gerald what I guess plan. So the question eight I would reckon to guess credited appeals agents at do it fulltime, and it hit me maybe a couple of hundred safety somewhere around there. Well, we're many veterans all in claims, that's not very many. Well, I tell you there's a lot of work out there to be had. I sometimes I rubbed shoulders with threes. Co workers, and tears that have run into from previous jobs and still this is the job you gotta get into. I if you wanna make a difference. You wanna, you know, make a living doing it, your old boss, and you're good at what you do. It's a perfect job. It's best thing. I ever did..