35 Burst results for "hypertension"
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 <Speech_Male> into eclampsia <Speech_Male> in these individuals <Speech_Male> so that's generally <Speech_Male> my framework <Speech_Male> that i like to <Speech_Male> think about these folks <Speech_Male> when you think about <Speech_Male> Miss <hes> <Speech_Male> saito here. <Speech_Male> She's someone <Speech_Male> who had <Speech_Male> it on set at twenty four <Speech_Male> weeks. If i remember correctly <Speech_Male> <Speech_Male> station hypertension <Speech_Male> and i wouldn't be surprised <Speech_Male> if she is normal <Speech_Male> in clinic <Speech_Male> right now but <Speech_Male> unfortunately <SpeakerChange> that doesn't <Silence> mean she's out of the woods <Speech_Male> thanks to <Speech_Male> win over that duck <Speech_Male> laffin <Speech_Male> We have two additional <Speech_Male> questions one <Speech_Male> is. We're <Speech_Male> told that her <Speech_Male> onset of hypertension <Speech_Male> was twenty four weeks. <Speech_Male> Gestation a who <Speech_Male> <Advertisement> knows if she was being screened <Speech_Male> <Advertisement> for hypertension <Speech_Male> prior to that and so <Speech_Male> <Advertisement> my first question is <Speech_Male> how often do <Speech_Male> you screen people for <Speech_Male> hypertension in general <Speech_Male> and then my second <Speech_Male> question is if <Speech_Male> her <Speech_Male> position of hypertension <Speech_Male> is truly <Speech_Male> purely just station. <Speech_Male> Hypertension <Speech_Male> is she at risk <Speech_Male> <Advertisement> for developing chronic <Speech_Male> hypertension. Down the road. <Speech_Male> And how would you screen <Speech_Male> her for that later <Speech_Male> on <Speech_Male> so for her in <Speech_Male> particular <SpeakerChange> we know <Speech_Male> that individuals <Speech_Male> with history just <Speech_Male> ational hypertension <Speech_Male> brake clamps. Yeah <Speech_Music_Male> eclampsia hell <Speech_Male> syndrome. They <Speech_Male> clearly have an increased <Speech_Male> risk of hypertension <Speech_Male> so she needs to be screen <Speech_Male> annually from here <Speech_Male> on out okay. It doesn't <Speech_Male> necessarily mean you need <Speech_Male> to do and the type blood <Speech_Male> pressure monitoring on her <Speech_Male> but they've done studies <Speech_Male> where it's actually <Speech_Male> picked up a fair <Speech_Male> number of <Speech_Male> these individuals <Speech_Male> who we may miss <Speech_Male> Normally <Speech_Male> we think oh you had your baby. <Speech_Male> You're fine go <Speech_Male> about your life but we <Speech_Male> know. Those individuals <Speech_Male> are at higher risk for developing <Speech_Male> hypertension. <Speech_Male> Long talk so she needs <Speech_Male> to be screened on a yearly basis. <Speech_Male> Obviously <Speech_Male> not all thirty six <Speech_Male> needs to be screen <Speech_Male> on a yearly basis for <Speech_Male> hypertension typically. <Speech_Male> The guidelines <Speech_Male> are generally at least <Speech_Male> every three to five <Speech_Male> years. Now is <Speech_Male> a great screen them a little <Speech_Male> bit more often. Yeah <Speech_Male> depending on <Speech_Male> the patient population <Speech_Male> And <Speech_Male> that's why certain <Speech_Male> studies screening <Speech_Male> studies are <Speech_Male> affecting because <Speech_Male> not everyone is coming <Speech_Male> to the doctor every <Speech_Male> year to your point <Speech_Male> about not <Speech_Male> knowing <Speech_Male> what you should be doing <Speech_Male> in terms of exercise and <Speech_Male> physical activity. I'm sure <Speech_Male> a lot of people listening to <Speech_Male> this. Haven't him into a primary <Speech_Male> care doctor lately <Speech_Male> for their blood pressure <Speech_Male> screening and things like that. <Speech_Male> So that's what we really <Speech_Male> think about. One more thing <Speech_Male> about who we should screen <Speech_Male> in general. It's about <Speech_Male> every three to five years <Speech_Music_Male> in younger patients <Speech_Music_Male> and a little <SpeakerChange> bit more frequently <Speech_Music_Male> as we get older <Speech_Music_Male> <Speech_Music_Male> <Speech_Male> now. That <Speech_Male> was a great discussion. <Speech_Male> Thanks for tuning <Speech_Male> into hypertension. <Speech_Male> Part one be <Speech_Male> sure to follow up with <Speech_Male> our next hypertension <Speech_Male> partout <Speech_Male> as we kick it <Speech_Male> up a notch with causes <Speech_Male> and evaluation for <Speech_Male> secondary hypertension <Speech_Male> approach to resistant. <Speech_Male> Hypertension <Speech_Male> and interventional <Speech_Male> hypertension <Speech_Male> therapies. <Speech_Male> And will top it off <Speech_Male> with a note about cardiac <Speech_Male> rehab. I <Speech_Male> know i'm looking forward to
"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..
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
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.
Why Dr. Kumar is Changing The Wellness Game
"Welcome back once again, see the outcomes, rocket podcasts where we chat with today's most successful and inspiring health care leaders. I really WANNA. Thank you for tuning in again and I welcome you to go to outcomes rocket dot health slash reviews where you could rate and review today's podcast because he is one outstanding individual and healthcare is name is Dr Rajiv Kumar he's the president and chief medical officer at Virgin Pulse during medical school he realized that many of the worst health problems we face as a nation diabetes heart disease cancer hypertension. Et, CETERA. I related to the collective unhealthy lifestyle, and so he has pledged to make a difference in this industry. He's done and as a frontline physician and now through various different companies, some amazing things and so what I WANNA do is open up the microphone to Raji to fill in any of the gaps of the introduction and then a so we could get into the podcast. Reggie welcome to the PODCAST. Think saw glad to be here. So Rajiv, what would you fill in in your intro that I that I left out? I think that was pretty comprehensive. Just, a little bit about virgin pulse. You know what? I think that may not be familiar name to a lot of folks on your that are listening to your podcast. We are an employee wellbeing company. We work with large employers all around the world, and our goal is to help them activate their employees to lead healthier lifestyles which had to kind of go around the healthcare system a little bit, and go direct to the employees and figure out ways to motivate them to inspire them and to help them sustain behavior change over time, and it's not just about healthcare cost reduction. It really is about how do we help people be? Healthier, happier and more productive at work in their personal lives. So that's really what our mission is. That's beautiful and listeners for those of you who haven't connected the DOTS virgin pulse. One of Sir Richard Branson's Virgin Group companies. So you know with the gentleman like that behind something like this and and Rajiv as part of the executive leadership team, you can imagine some great things are happening. It's an exciting time for us. We definitely are inspired by Sir Richard Branson leadership in his philosophy is if you take care of your employees, they'll take care of your business, and so we're trying to empower employers to take better care of their employees. So strong, and and you know it's really interesting that you guys are tackling this employer perspective of the entire health career equation because costs are soaring and aside from labor costs, it seems like healthcare cost is oftentimes double digits in that front. What are your thoughts on what should be on every medical leaders agenda today? Well, I'm biased but I think it has to be a behavior change remember too often looking for a magic pill or magic device or something to kind of stem the tide of rising obesity, diabetes and heart disease in our country and at the end of the day, there's so much. We can do to actually change people's behavior a lot of what we're facing as a result of our diet, our physical activity or lack thereof the stress that we have in our lives just how we how we treat ourselves and how we don't take care of ourselves, and so I think it's not necessarily a hot topic I. Think it should be and and I wish there was more focus on it is the perennial that if we can change behavior, we can prevent a lot of disease and we can produce significantly greater outcomes and Reggie. What would you say right now at at at Virgin? Pulse. Is an example of how you guys are improving health outcomes. Well, I think we really tried to think outside of the box I think traditional health interventions and and health and wellbeing platforms have largely been ineffective and they've been around for decades. So we sat around and we said what if we took a different approach rather than making people feel like they're failures rather than telling them that they're sick what if we actually make them feel successful what if we make them feel good about themselves right off the bat what would that do for self esteem for their motivation and for their ability to change. Most of what we see in our industry is a heavy focus on screening, and so employers asked their employees to take health risk assessments and do biometric screenings and so forth, and the problem with that is they take a health risk assessment tells them you're sick. You know you have high risk, your unhealthy needs to do more change your lifestyle, get your biometric screening results and you have high blood pressure. You may not like the results that you get back and that can be very demotivating, and so we've said is, is there a scientist out there? Is there a behavior change model that focuses on success? We found a scientist by the name of Dr Bj fog out of Stanford University and Dr Fog is sort of a new guru of behavior change and he's come up with a behavior change model that he caused the fog behavior change model and it's very simple as model is is a formula to it is called B. Equals M. A. T.. Equals motivation times, ability times a trigger, and so what he means by that is to get somebody to do a behavior that we want them to do or they want to do. First of all, they have to have the motivation to do it. Second is they have to have the ability to do it, and a third is you have to trigger them. To trump to do that behavior and too often in the in the kind of behavior change space, we ask people to do things that require either too much motivation or too much ability. So we say something like go to the gym four times a week and exercise for sixty minutes. Each time you go that takes a lot of motivation and some people may not even have the ability a really know how to do that where to get started so forth so Dr Fog says, well, motivation is hard to change. Your motivation waxes and wanes on a daily basis on an hourly basis, we can't really change somebody's motivation that easily what you can do is changed the behavior you're asking them to do to make it easier. You can change the ability to perform the action, and so the idea is if you take a behavior like washing your teeth and you break it down to the smallest tiniest thing that somebody could possibly do like floss one tooth and you ask them to do that they can actually do. That very easily, it doesn't take a lot of motivation is very quick to do, and if they do that and you celebrate the fact that they did it, you can help them build what we call success momentum, and then they're going to feel better about going to the next step and try something harder and so in our entire approach to behavior change, we break behaviors down into their simplest most basic action we ask people to do that would trigger then and then when they do it we. Reward them make them successful. We give them social status. They might get some kind of points or some kind of reward, and then we ask them to do something harder the next time around and stuff feedback loop that builds up momentum, and it changes behavior in a very sustainable way in a very habitual way, which is really the key to behavior changes creating habits.
Uncontrolled hypertension is getting worse in the U.S., study finds
"A new warning today about blood pressure here. CBS's Sabrina Coop it up to 100. Million people in our country have high blood pressure, and a new report finds an increased number of Americans. Don't have their blood pressure under control, The American Medical Association, Dr Susan Bailey says. That's concerning. Especially now that we have Corona virus. We know that people with cardiovascular disease are at much higher risk of severe illness and death. If they become ill with covert 19. She urges everyone to have your blood pressure checked. And if it's hye, make sure you get it under control.
Uncontrolled hypertension is getting worse in the U.S., study finds
"New study is showing an increasing number of people in the US are suffering from uncontrolled high blood pressure. Brian Shook has more research from Jama showed that out of 18,000 subjects who had high blood pressure in 2017 and 2018, the number of uncontrolled hypertension cases rose by 10%. Nicknamed the Silent Killer. High Blood Pressure has also been linked to be a danger to anyone infected with the Corona virus.
"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..
Coronavirus: Hypertension, diabetes lead underlying conditions in Los Angeles County deaths
"L. A county is reporting the Corona virus has killed 58 more people, and there are more than 1600 new confirmed cases. Most of the cove it 19 related deaths in L. A county have involved one or more underlying health condition. Now we're finding out which one's underlying health conditions played a role in close to 5000 of the death well, over half of them involved. Hypertension. Diabetes was the second most common underlying health condition reported, followed by neurological conditions and cardiovascular disease. But if people have more than 100 health condition, so to the extent that individual might have two or more, it may very well increased the risk of having serious illness from perhaps having death Dr Jeffrey Guns and Hauser's chief medical officer for the county Public Health department. Points out. These health conditions affect a lot of county residents. These are people that go to work for shopping and all around us, and maybe any of us. We have a collective responsibility to protect them. Not on Ly have hospitalizations dropped. So has the average length of stay from more than 10 days in early May toe about five days in late July guns, and Hauser says this may be due to several factors, including better treatment. He also notes, hospitalizations have gone up among younger people who tend to be healthier. Claudia Mosquito can extend 70 NewsRadio
Dr. Philippe Friedlich On Pediatric Surgery And Neonatal Therapeutic Hypothermia
"Welcome to medicine. We're still practicing I'm Bill Curtis of course I my friend and Co host Dr Steven Tailback He's the quadruple board certified doctor of Internal Medicine Pulmonary Disease Critical Care and neuro critical care these days he continues to fight on the front lines of the COVID battle in California for which we are eternally grateful Steve How you doing I'm well thank you. It's good to be. I'm sure you've heard of children's Hospital of Los Angeles notice. Hla US News and World Report has consistently ranked the H. L. A. in the top five nationally and the number one pediatric hospital in California for thirty years. Running this remarkable nonprofit children's care hospital is nationally known for Neonatal Research and care that is funded entirely by generous philanthropists. Dr Felipe Friedli is chief of neonatologist at Children's Hospital. He is also co director of the fetal and neonatal? Institute. And he is professor of clinical pediatrics and surgery at the renowned kept school of Medicine at USC where he's published over one hundred, fifty abstracts, Peer Review Articles and book. Chapters Dr. Freedland is a rock star in one of the world's most complicated pressure filled and delicate specialties that include newborn respiratory failures newborn pulmonary hypertension even surgery on unborn babies. Can you imagine welcome Dr Felipe Free Lick? It is an honor to have you here tonight and having me. So doctor. Can you just bring our listeners up to speed on C. H. LA and your mission there? Sharon's HUSK local Sandra's mission is to care for sick children's no matter what their background cultural background or insurance they have we are. Laced to gear for family and children's in babies when there's no other place that could care for them. Are we talking about like one of the few medical specialties that truly couldn't wait for Covid to pause that's a great question fortunately or many children's covid has not been has impactful. They are some babies are insurance that are sick but by four unless we compared to adults we. Are Really lucky so far. So we're not going to spend the whole show on Kovin because frankly I think people wanted to know much more about your specialty, but maybe you could tell us a little about what kind of a regimen as C. H. L. A. Developed uniquely for this pandemic and what are some of the special things that you do at your hospital to manage this. A lot of it has to do with making sure that became screen families in staff when they arrive at the hospital in make sure that they're the environment for caring for the Germans you regardless of the reason why they're in the hospital is is optimal until the hospital has and significant resources to ensure that we screen families and visitors and parents when they arrive psychologically, how do you get your clientele to feel safe under these circumstances that has been Estonia As you can imagine a lot of families or speared to even go close to a hospital. So said, only our data's suggesting that we can provide a safest environment to bring Ren's and care for them, but it is a concern. Certainly, we can see that visit to the emergency room are significantly down obviously a lot of the outpatient clinic. I've had to restructure their environment, but I think that honest conversations with family in trying to make sure that. Children can get the care they need. So they don't have complications from their Biz orders diseases are we tried to do our best to get the message across
CDC study finds nearly half of US population at 'high risk' of severe case of COVID-19
"Study finds Nearly half of US adults are risk of covert 19 complications due to underlying medical conditions. ABC is Mark Rommel Art explains. The study estimates 45.4% of Americans are at risk of having a severe case of covert 19 due to a one arm or underlying medical conditions such as heart disease, diabetes, lung disease, hypertension or cancer. It found disparities in some racial and ethnic groups as well. The top three most at risk were American, Indian, Alaska native adults, where 55% had at least one underlying condition, followed by black adults at 52% and white adults at 48%.
Matthew McConaughey grills Dr. Anthony Fauci in Instagram interview on COVID-19
"Academy Award winning actor Matthew McConaughey cast a variety of questions about the virus to Dr Anthony Foulke, the nation's top infectious disease. Doctor. Details on their chat from ABC is Alex for Shay, the actor Ass Valachi of Sunlight kills the virus. But she said yes, McConaughey also asked if letting everyone get infected, so we all become immune is a viable strategy. No way felt, he said, particularly in America, where obesity, diabetes and hypertension are prevalent. The death toll. Would be enormous and totally unacceptable found, she said.
Fizz Fizz, with Fantastic History of Food
"Dating back at least the seventeen hundreds people of Europe drank natural mineral water believed to cure of variety of illnesses like gallstones scurvy. Even bathing from these natural springs was seen as therapeutic. People literally went for the waters, though that freezes only hanging on its fingernails through the expression I'm not here for the water's usually set of someplace. You don't want to be like work. Many people tried to sell the water off site, but packaging and transportation at the time were prohibitively difficult and expensive, so they went with the next best thing. They'd manufacture their own water. Fine I'll make my own mineral water with blackjack and hookers. Most y'all are confused, but one person just snorted coffee through their nose. Mark my words. In seventeen sixty seven British chemist Joseph priestley tried carbonated water as you would beer by fermentation with yeast. The results were weak, but they worked in seventeen, seventy two. He published a paper entitled impregnating water with Fixed Air. priestley's apparatus, which featured a bladder between the generator and the absorption tank to regulate the flow of carbon dioxide was soon joined by a wide range of variants. However, it wasn't until seventeen eighty one that carbonated water could be produced on a large enough scale with the establishment of companies specializing in producing artificial mineral water. Others improved on Priestley's work, and while he did get respect from the scientific community, he didn't make anything for the invention that made possible a four hundred billion dollar a year industry. American, Inventor John Matthews designed a Soda Fountain that Could Produce Enough carbonated water for all his customers all day in eighteen, thirty, two, leading to the opening of the First Soda Fountain. In Their Heyday Soda Fountains were elaborately decorated places for rejuvenation more like a walk-through health retreat a snack counter and they were usually found in pharmacies. Pharmacists already used sweet tasting flavor syrups like lemon lime to mask the taste of bitter medicines like Quinine, an iron liquid medicine, being the standard form time rather than pills. At some sparkling water and you've got something new on your hands. Sas Parrilla for example was used to treat syphilis, supposedly and phosphoric acid and ingredient in most colas was thought to help with hypertension. The oldest major soft drink America Dr Pepper was created by Pharmacist Charles Alderson in eighteen, eighty, five and marketed as an energy, drink and brain tonic. Soda, the Effervescent News Hadn't medicine. We might be frustrated by. It takes a new medication to get to the market or top of mine a new vaccine, but it beats the old way of doing things at least from the consumer side from the manufacturer's side. The late nineteenth century, the era of the patent medicine was the best time to be alive. You could put anything you wanted in a bottle and call it medicine. You could still go around calling yourself doctor without having to prove it. Mix Up some tap water. Whatever's handy something bitter to make? It tastes like medicine, and then something sweet, so it's not too bitter, and of course if you can booze and hard drugs. Have Pretty printed with filigree and vague, sometimes contradictory claims and watch the money roll in. Behold the age of the patent medicine. Patent medicines are named after the letters patent probably letters patent since it was granted by the English crown. The first letters patent given to an inventor of a secret remedy was issued in the late seventeenth century. The patent granted the medicine maker a monopoly on his particular formula. The term patient medicine came to describe all prepackaged medicine sold over the counter without a doctor's prescription early English patent medicines sold like Jordan's in the colonies like dice Dr Bateman drops, whose original patent was granted by King George, the I in seventeen, twenty six, and was still available into the twentieth century. Not About to let the Brits make off with all the Lucre America began to cultivate their own patent medicines, an industry that boomed in the decades leading up to the civil war in the US very few patent medicines actually had a patent. You could get yourself a bottle. Love hosters celebrated stomach. Bidders Phero China John cleese Kella CEO. Bark and iron tonic reaches embrocations Emerson's Rheumatic Cure. Brooks's Barefoot Appointment SP Goff's magic oil, ligament or something just called salvation oil patent medicine actually played its own small part in the war. The government tax their sale along with the sales of matches, playing cards perfumes at L. to fund the war effort and repay military debt. Just like cigarettes today, patent medicines had to have a tax stamp on them for decades. Thirty years after the civil war, the government returned to Patent Medicine Taxation to fund the Spanish American war, which ran from eighteen, ninety eight to nineteen o two using a distinctive battleship stamp. The second half of the nineteenth century with the rapid growth of industrialization and populations in American cities was a high point for such hokum. Literacy was also improving with meant that they were more magazines and newspapers for patent medicine makers to advertise in and more people who could actually read the ads. There was also a pervasive and widespread distrust for medicine of the day. This was the era of heroic, medicine. Doctors went to extremes like bloodletting and purgatory gives to cure disease. We. Know now that making it already sick person poop their brains out or cutting them with a blade that you didn't know you needed to wash between. Patience is a bad idea, but back then it was no pun intended cutting edge stuff.
Will the Best Atypical Stand Up?
"We have four Atypical Working Bipolar Depression Corinne Rey lar- larizza Don the Tuta Olonga. WALKS TEEN COMBINATION SYMBIOTIC CER- will call it. Oh, FCC, an top Ian Circle. Among them only Oh, FCC is supposed to be used with an antidepressant. That's the only way they gotta landscaping to work in the clinical trials, the other three work on their own for bipolar depression. And, what about the rest of the class? If you're thinking that the other atypical is probably work because these four do your betting on hope two of them era peppers, all and the president were tested in bipolar depression and failed. The others are untested. If we have to rest our hope on one, maybe it's a seraphine staffers. Osama. Pain has never been studied for acute bipolar depression, but it does have good evidence to prevent depressive episodes in bipolar disorder while the other eight typicals outside of the. FDA approved for that I. Just mentioned, do not. So that foot works, but how well do they work Leslie? Trauma and colleagues looked into that question with the likelihood to be helped or harm ratio, which tells us which Med has the best ratio of COSC- and tolerability. It's based on the more familiar number needed to treat the number needed to harm. Here's what they found Larussa. Don La. Tuta rose to the top in nearly every category. The, categories were based on different side effects. When we're talking about ethics, we were talking about one thing treating depression, but side effects are many, so they measured the likelihood to be helped or harm in several categories of side effects, weight gain, extra parameters, symptoms, fatigue, academia, and nausea as well as dropout dude at any adverse effect, which might be the most important of the bunch. I should note here that the study was sponsored by Sylvian, the maker of Larizza Don, but I have reviewed the data in other less biased sources and agree with the general consensus. They're Larizza Don is one of the better tolerated and psychotics, and with the number needed to treat of five. It stands comfortably alongside OFC and Qu Taya Pain. Those two are high on C., but they're lower on tolerability. Zipping Fox teen combination was actually a close second to Loretta Don in most categories except weight gain. Quantify opinion on the other hand sank to the bottom and most of the categories, although Kotite, typing ranks for both short and long term efficacy in bipolar depression and mania. It's also the typical that patients are most likely to quit in the short term and it side effects like fatigue and hypertension or often the reason. What about the newest on the block curric- present very lar- it's basically the less effective cousin Laura Zone, the to have never gone head to head, but careens number needed to treat indicate. It's about half as effective as Laura Zone. It does have two advantages. However, it works in Mania, which Larizza Don is not been tested in, and it's among the most tolerable of the atypical anti psychotics. Laura Zone as I said does not have any studies in mania, but it did work for mixed states and a new poster presentation, also sponsored by the industry brought some reassurance to those of us who worry that it may make mania worse like so many other anti-depressant therapies do. They re analyze Larizza domes main clinical trials again. None of these were done in mania, but they looked at manic symptoms and found that they did tend to improve with Larizza don and did not get worse.
Changes in thinking about blood pressure
"Or high blood pressure is a common condition. It's the most common reason that adults visit their doctor's office. There is considerable debate about what constitutes normal blood pressure, and depending on whose data is cited roughly half the people with high blood pressure. Do not have adequate blood pressure control, but in part this is because in 2017, the American Heart Association lowered the threshold for. For what defines hypertension from one forty over ninety to one thirty over eighty before the new definition, thirty percent of Americans had high blood pressure after the new definition, the number jumped to forty six percent, the same population of people, just a new definition of what constitutes the disease. This is an additional thirty. One Million Americans labeled as diseased for a total of one hundred and three million Americans with high blood pressure. It used to be that the ideal blood pressure was simply the average of all adult blood pressure's, but then came autopsy studies of soldiers who died in the Korean War those revealed that about two-thirds of these young Americans already had early signs of heart disease. Then the Framingham study revealed that there was an association between elevated blood pressure and heart disease, and then came studies showing that if you lowered blood pressure, you also lowered the risk of heart disease, and that sort of where we are today. Hypertension is more common in older people compare to younger people, which brings me to an interesting article published in Jama. The so-called optimize study included only people older than eighty who were being treated for high blood pressure with at least two different medications. We know that older people who take more than one blood, pressure, medicine, or prone to dizziness and falls and other side effects, so do these people really need this cocktail of different high blood pressure pills, so these researchers asked when people stopped taking one blood pressure medicine did they have dangerous increases in blood pressure? Half of the group had one medication de prescribed in other words discontinued the other continued on with their usual medications. They were followed for about three months for those who had one medication stopped. It turned out that eighty six percent of the patients blood pressure remained under control now in contrast, eighty eight percent of people who had no changes made to their blood pressure also had their blood pressure under control, so there really was no difference between the two groups. The study lasted only three months, which is too short to see if the changes in the drugs had any impact on the length of life or the quality of life, but reducing unnecessary, second or third blood pressure medications may both decrease dangerous side effects, which can lead to decrease, falls and fractures and head injuries and reduce the cost of medications for the elderly.
Santa Clara County officials push to declare racism a public health crisis
"Santa Clara county supervisors are considering resolutions that would declare racism a public health crisis Casey this is Kerry who dissect reports that the effort is meant to support the black lives matter movement while problems of inequity aren't new in Santa Clara county board of supervisors president Cindy Chava says a recent black lives matter demonstrations have fueled them to take action what is good about this moment is heighten the consciousness of a nation this is a modern reflection of that movement and and I think more importantly what it just reaffirms is that we weren't done considering racism as a public health crisis she wants more resources to go toward public health and early child care one of the things we know is that the African American community has a much higher level of diabetes hypertension and infant mortality and a lot of that we believe can be really tied back to to racism the goal is to address these inequities for communities of color from birth this is asking that the county start using an equity lines in terms of its funding your zip code shouldn't determine how soon you die or whether not you go to college in San Jose Kerry had a sack
Practice Guidelines and racial disparities
"Delivery is racist in many ways from insurance to hospitals to admission rates, and in other ways through implicit bias this week. The New England Journal of Medicine Points Outweighs that Ray sneaks into medical practice in ways we don't even realize. Is Skin color really a proxy for health risk factors we'll. geneticists argue that racial background is important to identify specific genes that are associated with specific diseases. Social scientists argue that racial differences in diseases are not due to genetics or skin color, but due to social disparities and inequities. Well, let's look at one example. A study shows that black and Latino ex people with heart disease. We're less likely to be admitted. Admitted to the hospitals heart service than white people. Some doctors argue that those differences aren't really racially biased. Because doctors used a computerized flow chart to calculate a person's risk of death from heart disease, and so they did well. There are dozens of these flow charts for all sorts of medical conditions. Many share a common problem. Let's look at the one used to predict risk of dying of heart disease. You'll see that the practice guideline directs more intensive resources to white people then to black people the way the American Heart Association's guideline does this is by putting together a number of risk factors for heart disease, history of diabetes, hypertension, family, history, and the like. Each risk is associated with a point. When it comes to race. If someone is not black, they get three additional risk. points sounds like AAC. Good thing right? Blacks have lower risk. Right will what happens is the black person get a lower risk or so? They are less likely to be admitted to the hospitals, heart service, and less likely to get all the heart care they need why those three extra points well. Nobody really knows and this isn't the only example by far. There are guidelines for heart surgery. Dialysis, organ, transplants, vaginal births, lung, disease, and cancer treatments when any of these specific. Followed seems that doctors are directed away from providing people of color with the route to more aggressive care, so is the risk really skin color. What do we do with the risk factor for someone with one parent who is white and one is black. We know that people of Color have different health outcomes than whites and Asians, and for public health reasons it is important to keep track of data by race and ethnicity and other social parameters. Why well just look at the rates of Covid in different communities? Communities. We need to know this the difference though isn't about skin, color or race. It's about poverty and housing and education, toxic stress and type of employment. There are very likely examples of diseases that do track to certain subgroups of people, but let's look for the specific gene that causes the disease and not the color of someone's skin. We do need to look at racial disparities, but that's very different than using raised to develop guidelines for doctors to
"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 Surgery 101
"Let's talk about treatment. Women with persistent postpartum hypertension should be treated because the risk of stroke or seizure is still high patient that need anti hypertensive therapy or are those with severe hypertension on those non sphere hypertension with pressures above one forty over ninety patients with prejudge stations. Diabetes should have the pressures Kapitolo one thirty thirty over eighty the Beta law. Fifteen extended release hydrology in Massell. Dope are the most common agents us. It's inhibitors such as capital. Prell and analysis krill though contraindicated in pregnancy can be used postpartum. All of these options were saved for breastfeeding liberal. which is a Beta blocker should be avoided in women with asthma or heart failure and can be given either orally or through an IV Philippine can only be given orally rallying can be prescribed the IV or intramuscularly muscular early mental Joepat can only be given orally absorbed signs of pre ECLAMPSIA? ECLAMPSIA are or help syndrome. Magnesium sulfate is given for Niro protection. Finally Wanna I treat for causes and consult other specialties. If there are signs of an organ damage most importantly patient education is required. Patients should be given teaching on how to take take a proper blood pressure at home. A blood pressure log should be given so patients can keep track of their blood pressures and cut off values on when they need to visit our family physician or present to hospital should also be given. Okay let's get back to our case you've already ordered lobs by regardless of technical diagnosis patients. Hypertensive before you had offered that c-section Russian you ask the nurse to give her Bagel and to call you urgently for pressure goes above one sixty over one ten on either systolic diastolic or develop any new symptoms dining hugo reassess. Alana her has gone away. Fenner pressures are back to normal. She's feeling much better. Her labs are also normal. And you deamer safe to go home before discharge her. Get her educational teaching on how to take our pressures you ask her to schedule a follow up appointment with her obstetrician one week from now interfere pressures go above one forty over ninety dollars diastolic. To Call Her outside attrition if it goes above the one sixty or one ten mark on other systolic or diastolic. She should come to the hospital right away. She agrees with the plan to summarize. Hypertension in pregnancy including postpartum is defined as systolic blood pressure. One forty zero grader and or a dialogue pressure ninety a crater on tour marcation at least fifteen minutes apart severe hypertension systolic pressure when sixteen greater or a diced olic pressure one hundred ten or greater signs or symptoms include a severe headache altered mental status blurry vision visual. Oh field defects pulmonary Dima right upper quadrant or stomach. Pain nausea vomiting and swelling in the legs hands for face mobile hydraulic the Filipina and method doper for the most common agencies. Thank you for listening to a podcast..
"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..
"hypertension" Discussed on Surgery 101
"So that's intra hypnotic portal, hypertension, pre hypnotic and post hypnotic causes are a lot more straightforward when we think about pre hypnotic portal, hypertension. This would be equivalent to someone stepping on the garden hose proximal to the outlet of those again, any resistance apply to the anatomical path flow proximal to deliver can cause pre hypnotic portal. Hypertension portal or splitting vein thrombosis split omega Lee or split. Nick, atrial Venus. Fistula are three important causes of pre hypnotic portal, hypertension, moving onto post paddock port, hypertension. This is a source of resistance that is distorted liver thus the causes can be well, categorized. Into paddock means the inferior Vena Cava or the heart. So as we mentioned earlier, but Kyari syndrome can cause thrombosis of the paddock veins or the inferior Vena Cava and therefore can lead to post. Paddock portal, hypertension, cardiac diseases such as constrictive pericarditis or restrictive cardiomyopathy result in decreased filling of the right atrium ventricle this ultimately translates to an increase in pressure in the IB see in the portal Venus's system by section. So that concludes the structural changes of portal, hypertension. If you're still with me, let's briefly talk about the dynamic changes, which is still an area of active research. The dynamic changes occur from increased production of Vasil constrictors such as Endo theologians agile tense into nor Ephron as well as decrease secretion of endothelial basil dilates such as nitric oxide in the liver. This causes contraction of smooth muscles of the paddock vascular to make things more complicated. The splaying blood flow, which is the circulation of the GI tract increases because of local release of vascular endothelial girl factor at Nick oxide, this alternately causes spanked Nick Vasil dilation angiogenesis increased basketball permeability and systemic Hypo tension the systemic hypertension results in activation of the Renan agile Johnson dos strong system, resulting in increase. Fluid retention which combined with the increased vascular permeability of displaying Nick circulation as well as the low albumin that is typical of nutrient deficient psoriatic patients ultimately contributes to the development of the site. He's all right. So let's simplify that the dynamic changes are caused by secretion of compounds that ultimately caused basil constriction in the and basil dilation in the slang circulation digitally, low albumin creates a low on Kartik pressure. Promoting sites development, which is worse. Invite inflammatory factors causing an increase in vascular permeability of despite Nick circulation. So that concludes our podcast on the path of Yala. The of portal, hypertension. Thank you so much for listening. Here's a summary of the key points. Number one. The portal vein is a large main that's applies liver with seventy five percent of his blood flow at about fifty percent of his oxygen. Number two sites of Puerto systemic collateralisation include cabinet Medusa, the Sauvage VERA sees gastric fair. Sees rectal. Vera sees or hemorrhoids the retro peritoneal Baynes and the veins of sappy. Number three causes of portal. Hypertension can be broken down into pre hypnotic intra paddock and posted paddock. Number four, intra paddick causes can then further be broken down into pre sign associate soil and Paul said. Number five, the most common cause of Puerto hypertension in the western world is liver cirrhosis and finally number six the dynamic changes of Puerto hypertension include Vasil constriction of deliver Vasil dilation of split Nick circulation and increased vascular permeability of the split Nick succession. I hope you enjoyed this podcast and tune into our next one on Pertile, hypertension, as we work through patient presentation of the disease. Thanks again for listening. Thanks air for this. Excellent. Overview of what can be a complicated, and sometimes confusing topic. I'm looking forward
"hypertension" Discussed on Surgery 101
"Risk number three rectal, viruses, or hemorrhoids these occur from the anastomosis between the inferior Mezin teric vein to the superior rectal vein. And then lastly to the middle and inferior rectal James causing hemorrhoids. Number four gastric. Vera sees these occur from the anastomosis between the portal vein and sledding gain, which sent an ASOs. He's to the short gastric lanes. Number five, the retro peritoneal veins or the veins of recipes these occur from the anastomosis between the inferior Mezin teric main on the veins of Retzias. And lastly, number six the die for Matic veins or the veins of sappy this occurs directly from the anastomosis between the portal vein and the veins of sappy. Okay. So far, we've covered the anatomy of portal, hypertension. The definition of portal pretension and the concept of porta systemic collateralisation. Now, let's address the causes of Puerto hypertension. So Ohm's law defines pressure as the product of volume of blood flowing through a system and the resistance of that system to flow in portal, hypertension. There is both an increase in the volume of blood flow Annan increase in resistance, and this is due to both structural changes as well as dynamic changes. Let's talk about the structural changes. I you can classify portal hypertension, into pre hypnotic intra paddock or post about it causes. Let's begin with intra paddick the most common intra hypnotic cause of portal. Hypertension is liberty roses liver cirrhosis is defined by paddock fibrosis which causes a distortion of cell architecture. A ceramic liver has increased resistance of imagine that the portal vein is a garden hose. Intra hypnotic portal. Hypertension would be analogous. Someone pressing thick piece of cheesecloth to the outlet of the hose the hose becomes pressurized proximity. And we will see less output from those when we look at intra paddock causes of portal, hypertension. We can further apply cheesecloth analogy to specific locations within liver. Simply put the cheesecloth could be located anywhere along the anatomical path flow. Remember, the paddock science soy's mentioned earlier as you now know they are essentially small canals which allow for. Passage of blood from the portal triads to the central veins in broad terms are cheesecloth can be located before the paddock sides. It can be located within the paddock sinus olds or it can be located after paddock sides, respectively referred to as precise oil, sinus oil or poll side Soto. Precise soil portal, hypertension, develops proximal to deliver sinus waves and can be due to number one congenital malformations such as polycystic liver disease number two year diseases such as primary bilious roses or primary Slough rose in college Itis, number three neoplasm such as them Volmer or Colegio carcinoma number four granular liver lesions such as sarcoidosis or she still foam ICES. Sinus oil portal, hypertension, develops due to a problem with the liver, sinus oil itself or the surrounding structure of that sign swayed the space of this is the common culprit, this is the space between the sinus, Lloyd and the hip paddle sites, which is actually where the exchange of nutrients into the liver actually occurs. Fibrosis of the space of this is an important cause of sinus sorrel, portal, hypertension, and this can occur from metabolic causes such as non alcoholic fatty liver disease inflammatory causes such as viral hepatitis. She still so myositis cytomegalovirus or chronic. Uber and drugs are talks in said his EMMY odor on methotrexate, alcohol, vinyl, chloride or copper. Lastly post sinus, oil portal, hypertension, develops distant to deliver sinuses. Causes include a sinus Loyd obstruction from vino Occlusive disease, but Kyari syndrome, which is the clues in of the paddock veins or the inferior Vena Cava can also be considered posted Babic as well as primary vascular malignancies such as epithelial you'd Emmanuel Indo THEO while that's a mouthful, okay..
"hypertension" Discussed on Surgery 101
"The paddock artery proper flowing inward as well. As the car. Unbowed duct flowing outward after entering deliver the left and right portal vein. Contribute to portal triads which made a portal vein branch had a gain anabol- duct. These portal triads make up part of the functional unit of deliver known as agonize or lobbies, and the labile is made up of several portal triads arranged around the periphery of a central vein blood flows from the terminal Puerto vein in the portal, triad to the central through a structure called a sinus lining the outside of these signs are Pata sites, which absorb nutrients from the blood as flows through the sinus sinuses to the central vein, the central vein, then go on to form left right and middle hypnotic veins, which then flow into the interior via cable now that can be quite complicated to visualize. So I suggest looking at a diagram online of the labeled anatomy, if the billiards system would also be helpful to look at a labeled cross-sectional view of deliver to get a sense of the portal triad. Adds a assign a soybeans and the central veins. All right. That's nothing Adamy for now. So how do we define portal? Hypertension portal. Hypertension is technically defined by portal vein pressure that is higher than five millimeters. Mercury. However pressures of eight to ten moments of mercury are usually required for the development of Puerto systemic collateralisation. So what is that what is part of collateralisation while let's break down Porto systemic means that it involves both the portal circulation as discussed above, and this is stemming circulation collateralisation means that there is development of collateral flow or an alternate flow, Pat for the blood under normal circumstances. The blood in the portal circulation does not make the blood in the systemic circulation. However, a basic understanding the laws of physics tells us that flow tends to follow the path of least resistance. So if we create resistance in the portal circulation, we will see elevation portal pressure and the flow of blood will. Preferentially pass through areas of low resistance, hence the term porting systemic collateralisation porta systemic collateralisation occurs, where the Puerto Vena system Nassim sees with stem Akina system as the pressure in the portal vein increases, these anastomosis become engorged dilated Enin some cases become a concern for bleeding. There are six major sites of Porto systemic collateralisation, which are highly pimple. They are number one captured Medusa recalculation of the Bill Bain and engorgement of the para umbilical veins this occurs from the anastomosis between the left portal vein and the obliterated umbilical vein. Which runs inside ligament Terry's number two is often you'll Veira sees this occurs from the anastomosis between the portal vein and the coronary thing, which is also known as the left gastric way this drains into the Asaf Venus plex side as mentioned. Earlier bleeding from an esophageal disease is associated with fifteen to twenty percent mortality.
"hypertension" Discussed on KIRO Radio 97.3 FM
"Thing which is what you talked about where you're increasing your fitness and the the byproduct is happiness but if your main goal is happiness than doing a little bit hopefully will then lend itself increase i was getting a lot of anxiety because i've shared this story i felt like one day i was just gonna have a heart attack and i was two hundred thirty pounds and got my cholesterol numbers back yesterday here i am fifty one year old dog assure my cholesterol numbers were there they were to eleven they were high and that's when i decided one hundred four days ago that was gonna change my diet drastically that i was going to go plat base stop eating meat along the way very limited dairy i was going to drink a salad in the morning which is what i do i'm going to exercise sixty to ninety minutes a day i'm gonna take my fitness outside i'm not going to be locked into a gym somewhere i'm not gonna limit alcohol i'm gonna quit alcohol which is what i did one hundred and four days ago and i got my numbers back from my doctor yesterday and michael cholesterol numbers plummeted to one hundred thirty six i had hypertension where sometimes i would come to work in my hypertension might numbers my top number on my blood pressure be between one forty and one sixty so i take a hypertension medicine for that and i recently went to see my doctor after making these changes and my blood pressure was one oh five over sixty eight so i share this with you because your body really can't heal it so if you take the time no matter how much you've abused your body if you really take the time and take care of it and think about what you're putting into your body and it doesn't mean you have to be planned base it doesn't mean you can't eat meat it doesn't mean you can't have a beer but you just pay more attention you pay more attention and you wake up with intention just wake up with intention pay more attention your body will heal itself and you can live a great life time for texts it's all right here we go at tax time nine eight nine seven three tracey's here brought to you by wrench mobile mechanics will check the cars here in a moment but right.
"hypertension" Discussed on 1150 AM KKNW
"'cause you do oh i know my wife at least twice a week looks at me when i'm asleep going at kill you retina i know she won't do it because you'll get caught she watches a lot of i am married to a marriage and family therapist imagine that combo platter i feel your pain i laugh at your pain when the kids went off to college she joined them because she was in college for therapy we had to take therapy i did not want to take therapy because i handle my problems the old fashioned way you hold them internally and you express them in all sorts and hypertension that's the way i deal with it so put my foot down i said no therapy here's what i learned about therapy pretty much every conversations going on man woman goes like this why do you keep trying to solve my problems because you're talking to me tried to solve my problems quit talking to me and this is why my wife will never be out of work i got to tell you when she was in school all the test we had to do i would actually dreading her becoming a therapist but compared to the people that she deals with now on a daily basis i look fantastic hulan i wish you would have done this years ago save me so much trouble i can do whatever i want carte blanche because she can't horse me it'd be bad for business her business cards would have to read do as i say how do you get any driver's license to man the last time you've done that got new drivers license.
"hypertension" Discussed on WDRC
"Been to a couple daca than indicated that they need the fog you know the evening actress thaw ldl though fat then of the weird a health warning what who is it is a bit where but you know uh we tend to demonize salt you know everybody's must have been an ultra low sole diet and yes that the big since people with congestive heart failure and a certain percentage of people not all but a certain percentage of people with high blood pressure they benefit from a low sodium diet however it's actually have been shown that uh for some peop people with high blood pressure uh you get a paradoxical reaction like a backwards reaction from restricting sodium you've actually can sometimes send your blood pressure up uh when you're sodium declines so uh for some people who have hypertension or low blood pressure or weak adrenal function uh they may require more salt and sodium to maintain their fluid volume uh and in the absence assault they feel low weaken can woosie and so i am a partial myself to salt consumption by part of it has to do with my genetics and part of it has to do with the fact that i don't have any conditions which cause you to have to avoid salt i don't have hypertension uh but also exercise lawn they when you exercise on you do lose sodium you sweat and so you need to replete that and and and at just the way is for some people so i i would say uh that's not necessarily a problem so we're going to convert a potential problem into a nonproblem and i should reassure your friend the uh you know as long as everything's okay as sodium consumption has not been shown to be uh a problem in of itself a one way to mitigate the effects of taking a lot of sodium is makes you taking a lot of potassium it's more about the a sodium to potassium ratio uh because americans consume much too much sodium and not enough potassium from fresh fruits and vegetables a gave of sodium from salty foods junkfood snack foods uh and you know that is what creates the problem but if the ratio of sodium to potassium remains good then it's less of a problem as a nonproblem for worry about it keep on consume an assault or eight uh this item if you're suffering from fatigue uh let me suggest.
"hypertension" Discussed on AM 870 The Answer
"More than twenty percent for you to qualify and this that one luke well i sometimes don't understand how things happen but they happen in a very miraculous way and i became a kidney dr because i'm supposed to come here on this radio and say i love you and i know how to protect your kidneys so ckd is the area of my attention and i know how to stop its chronic kidney disease is a very scientists these most patients who end up on dialysis have no clue about their kidney disease according to alatas studies one third of patients who end up on dialysis until d us and another thirty percent until a week both four initiation other dialysis have no clue that anything is wrong with their kidneys civil coming from the rest in modern medical world i have this question what has happened why is that so that so many people are getting on dialysis we have about seven hundred thousand people on the other series and of course many of them have gone that way because diabetes because diabetes is the number one cause of kidney failure in our country and the second most titled an cause is hypertension a lot of times diabetes and hypertension are together and her you have to stop diabetes hypertension if you wanna stark kidney disease and this is why we are conducting this study on the six self march next tuesday and i want to see all of you and i want to make sure that you all come people who don't want to get on they the alice's who don't want to go there out that everybody else has hey can i want you to be there because your haning dancing doctor no said it all so between eleven and twelve on tuesday he had the registration time and i wanna see everybody in chester please make sure you ask about your egf are if you're a number is less than thirty more than fifteen you are in stage four if it's less than fifteen you are in stage five ckd.
"hypertension" Discussed on KQED Radio
"Where most of our providers are and so from children all the way up to our seniors and really we see a lot of adults and chronic diseases hypertension diabetes um north carolina still has a lot of smoker so we see a lot of uh chronic upset djoric pulmonary disease and asthma so those folks would lose the access to that and trying we do a really good job with our um with our diabetics we have you know sixty over sixty percent of our diabetics of hemoglobin a 1 sees that measures other diabetes are doing london under seven i wish was really difficult for folks of low income and your it sounds like you're their lifeline in a in a in a very serious way and so i'm curious if if this funding does not come through and i know that is not the purpose of this programme to predict that it's not going to come through its to say that this is up in the air were in limbo but if it does not come through our eu facing closures of some of the clinics that you're running oh absolutely um we are we would end up closing at least two clinics um and that also would then mean also lane off a significant portion of our staff and so that would billy be a hardship especially four roanne county where there is not as much access i wanna share some more of what you are listener said about this issue here's what one of you left in our inbox my name is dr george garo i'm a chief medical officer or federally qualified health centre in western pennsylvania i wanted to talk with you about community house center mission.
"hypertension" Discussed on Code Switch
"Rain and we've been experienced and racism didn't get i want to go back to your agenda metaphor really quickly so you said it weathering is like a game agenda in which you know you routinely have these blocks removed from one level moved up to a different tear into everything becomes more and more unstable in a lot more tenuous to stay with metaphor for a second is there any way to put the bloc's back it it's it's it hard to say but i don't think it's sort of the complete gun repeal i certainly don't believe there isn't anything that can be done one thing that can be done is done and it you know benefits in particular people who are weathered but in the middle class or more highly educated is access to healthcare so you might be hypertensive from weathering fight if you have good access to healthcare you get it diagnosed early you get it treated you know you learn what you need to do with your diet to make it a little less likely to be turned into its most pernicious and lifethreatening formed a we've seen evidence for instance in some of our studies were we've compared lax in very highpoverty areas too lax in more middle class neighborhood and what we've seen is that those in the higher class neighborhood do have much longer life expectancy than those in the poor neighborhood but they send most of that extra life with chronic conditions and possibly disabled there with a variety of morbidity uh than whites with the same incomes and education floating in the same neighborhood so certainly having the longer life expectancy in averting death and averting the worst versions you know of hypertension or diabetes or or their complications you know avoiding educations and strokes et cetera those are good things fight without dealing with the kind of more structurally routed factors that lead to weather across class.
"hypertension" Discussed on KPAM 860
"Oh the booklovers heart his two healthy for words and the nature leprous heart it flies high return but the heart of some pulmonary hypertension often misdiagnosed as as is unbearably stressed in can fail at the former neary hypertension association we onepage nations a high mass foreign live including our heart into finding a cure here png association dot org that's ph association dot org two two two.
"hypertension" Discussed on Road To Ripped
"The american culture house the station to reduce heart disease patient's lives the incidence of hypertension and diabetes or talent they actually get reduced as you go higher higher and turns to restrict what about so this is a the cause asian thing what about calories sufficiently low calorie sell on to talk about the what about being active excise say what about you know what about being at and healthy weight food quality a so nutrient you're the one thing we know is that when they do these studies these big sample size studies with thousand people those that eat more meat tend to be the looking at a lot of times of fastfood meat processed me those eat more meat smoke cigarettes though the more likely to not excise the more likely be over way the more likely to over conceicao is more likely to go on bayala's pop and so they try and use that meat as the link they could pick anything has the lake any figure rigs like so many different variables in that study yeah use son and those that are that are tend to be vegan there are more likely to be more healthconscious they'll be doing though magazine more abiyan calorie yeah though they won't be exactly they'll be slimmer leaner and then it's like get a controlled study will you have you know two dietrich of two people want other being dr for seen calories or whatever went on macronutrients on a diet with some meat yes saint that you know and then excising doing all that and see the how the bloodmarkers change and author even really that different i wouldn't think there would be like you had the same mac rose and you had very similar people that were going in with similar blood work unless they get unless there all on do a gin the protein from soy protein because that independent berlin's of estrogen yahya i'll outside but if they were doing something like rice protein it probably be just fine right and because i don't think vegans alpha gets necessarily like a terrible diet for you we're trying to be antivehicle but i just think that the way that they bash they do like these totally bad straw man arguments all anal is cool they did a documentary which actually pretty good called fat head.