Episode Transcript
[00:00:03] Speaker A: Life is about the moments that make your heart tick. And we're here to keep it ticking strong. I'm Dr. Barry Bertolet, and this is where All Heart, where we dive into the latest cardiac care with the experts who live it every day. From breakthrough procedures to the most cutting edge treatments, we're putting heart health front and center. We're All Heart is brought to you by North Mississippi Health Services in partnership with Cardiology Associates of North Mississippi. Let's get to it.
Hi there. Welcome back to We're All Heart. And Today we have Dr. Baker Boller with us, who's going to be talking to us about hypertension, which is high blood pressure. So welcome. Dr. Boler, would you like to introduce yourself to the audience?
[00:00:52] Speaker B: Yes. My name is Baker Boler. I'm a general cardiologist with Cardiology Associates.
Been here, I guess, about two years now, and so really enjoyed my time here. And I thank you, Dr. Bertolet, for having me today.
[00:01:05] Speaker A: Absolutely. So today we're talking about hypertension. So what is hypertension? What is that?
[00:01:12] Speaker B: So hypertension is an elevated measurement of our blood pressure. And so blood pressure is the pressure that the heart generates when it squeezes. We measure two numbers, you know, the top and the bottom number. Top number being systolic, bottom number being diastolic. So systolic is when the heart's squeezing, and the bottom number is diastolic is when the heart is relaxed. And so we measure that, of course, with a blood pressure cuff, and we're measuring the pressure in the arteries. And so that pressure in the arteries over time can cause damage to the body, whether that's heart, kidneys, brain. And those are things that we monitor to watch risk for progression of disease.
[00:01:49] Speaker A: And when we're talking about measuring that number that's in the arm, or sometimes people do that at the wrist, what do those numbers mean? We got a top number and a bottom number.
What does the top number mean? What does the bottom number mean?
[00:02:03] Speaker B: So, ideally, the guideline suggests a blood pressure less than 120 over 80 is normal.
We can get away with a blood pressure between 120, 129 over 80 as elevated and not quite meet the diagnosis of hypertension.
[00:02:18] Speaker A: But.
[00:02:18] Speaker B: But we meet the diagnosis of hypertension when the top number is over 130. Stage one is 130 to 139, and then as well as the bottom number of 80 to 89. Now, stage two, a little more advanced stage, is when the top number is over 140 or the bottom number is over 90.
Usually that requires medicines immediately. Stage one. We can kind of get away with lifestyle modification and then medicines if we can't control with that.
[00:02:41] Speaker A: So that's probably going to surprise a lot of people that if you had a blood pressure of 130 over 85, you have high blood pressure and you need to do something about it. So that's not normal anymore. Right. So if 120 over 80 is, is the ideal where you need to be at 130 over 85, we need to start thinking lifestyle modifications and maybe even moving toward medications, is that right?
[00:03:08] Speaker B: That's correct.
[00:03:09] Speaker A: Wow. So that's different. So how frequently do we diagnose high blood pressure in people today?
[00:03:19] Speaker B: So I recommend, you know, as we're dealing with adults, that we start managing people once they reach the age of 18. But every year someone should know their blood pressure and particularly that risk for blood pressure or prevalence goes up once you get to the age of 40. So every age, once you reach the age of 40, you need to be knowing your blood pressure at least once a year. If you do not have a diagnosis of blood pressure, which, but of course if you have a diagnosis of blood pressure, that becomes something we check a lot more regularly.
[00:03:46] Speaker A: So if I had 1040 year olds in the room, how many of them have high blood pressure, do you think?
[00:03:53] Speaker B: The number specifically, I would think would say around like 40 to 50%. Is that about right?
[00:03:58] Speaker A: Yeah. And then as you mentioned earlier, as you get older in life, that prevalence or that chance of you having high blood pressure does go up. So if you're 70 or 80, what do you think about the prevalence or the chance of having high blood pressure then?
[00:04:17] Speaker B: Well, most of my patients over the age of 75 are in blood pressure medicine and I really think the prevalence is closer to that, greater than 80%, so quite common at that age.
[00:04:26] Speaker A: So we know that the blood pressure number that we measure over here is sort of the marker of maybe an internal disease that may be going on that's causing our blood pressure to go up. What are some of the causes that a person may have that creates the high blood pressure?
[00:04:44] Speaker B: I think number one that we see is genetics. A lot of times family history of hypertension will see that carry over to the patient. But I think in Mississippi we're seeing lifestyle choices.
Whether or not that's high salt intake, that's obesity, lack of sleep, stress, sedentary lifestyle, all those are going to be contributing to your elevated blood pressure.
[00:05:07] Speaker A: So those are some lifestyle things. So if we're eating too much Salt. Or for overweight or for sitting too much on the couch. If we undo those things, can we then lower the blood pressure?
[00:05:20] Speaker B: That's exactly right.
Specifically, if you meet certain goals in weight loss, you can see specific numbers of your blood pressure to improve.
[00:05:29] Speaker A: Wow, that's very interesting. And then what about some medical issues? Are there any kind of medical issues that go on that may elevate somebody's blood pressure that we need to be worried about?
[00:05:40] Speaker B: Yes, some of the more prevalent, I would say, you know, with Mississippian obesity is sleep apnea. You know, being screened for. Sleep apnea is a common cause of high blood pressure.
Also, there's, you know, more rare cases. There's instances where there's a particular hormone that's elevated and we can do some screening for that. There's a couple different hormones that we screen for.
Also, sometimes if your kidney artery is tight, that can also cause your blood pressure become elevated as well. But again, I think alcohol use, too, is another thing. I don't know if I touched on that earlier. I think it's a big one that I like to make sure I address with my patients.
[00:06:18] Speaker A: Yeah, there was an interesting study that I read that was. It was in England, and they had these guys and they put them in the hospital and they had them drinking beer, pints of ale, as they called it. And when they drank their pints of ale, their blood pressure went up. And when they eliminated their pints of ale, their blood pressure came right back down. So that's sort of a cool story that I read. So if we have that high blood pressure, what does that do to our body? What are, I'm going to say, the consequences of having high blood pressure untreated?
[00:06:48] Speaker B: So that's a good question. So, you know, we're talking about the heart.
Heart disease process, whether that's heart failure, risk for heart attack, even risk for rhythm. Issues like atrial fibrillation is more prevalent. When hypertension exists, there's large arteries that leaves the heart called the aorta. There's risk for dissection with elevated blood pressure.
And then with the brain, there's risk for stroke with elevated blood pressure.
And as we were kind of talking earlier, there's risk for small vessel disease.
That risk can even be linked to dementia with effects of blood pressure on the brain at an earlier age.
And then finally, of course, a big one in Mississippi is kidney disease, elevated blood pressure leading to poor outcomes with kidneys, whether someone has chronic kidney disease or procrastinating dialysis.
[00:07:41] Speaker A: So, as you alluded to and Very aware of.
In 2025, the American College of Cardiology released new hydrogen hypertension guidelines. And there was something surprising and interesting in those guidelines about memory loss and dementia. You want to give us some insights into what you know there?
[00:08:01] Speaker B: I think it mainly goes down to small vessel disease.
And over time, you know, we check our numbers, right. We've had elevated blood pressure and then all of a sudden we have a normal blood pressure. Does that mean everything's okay?
Not necessarily.
Small vessel disease over time can lead to volume loss in the brain, which can lead to dementia long term.
[00:08:23] Speaker A: And so now these new guidelines are telling us that if we keep our blood pressure controlled, that is going to be one of the major ways we can help prevent memory loss as we age and dementia as we age. So if you're interested in that, keep your blood pressure controlled. That's important.
So what about the races now? Is Caucasians the consequences of high blood pressure? Is it different in a Caucasian versus African American population versus Hispanics?
What do we know there?
[00:08:56] Speaker B: Another good question. And there is a significant race disparity with high blood pressure.
There's Data that over 50% of African Americans have elevated blood pressure.
Caucasians, that's probably around 30 to 40%.
In the Hispanic population, particularly Hispanic males, we see a higher numbers of higher elevation in blood pressure as well.
[00:09:22] Speaker A: Yeah, and that's really interesting. I read another study where it showed that at a same blood pressure, African American population was more likely to have kidney problems related to high blood pressure than a Caucasian population. So you need to be even a little bit more diligent if you're African American on that. So if you have high blood pressure, and we know that we got these bad consequences if we lower their blood pressure, can we prevent the kidney failure, the strokes, the tears in the aorta?
Correct.
[00:09:56] Speaker B: Yes, we can lower those.
To give you kind of specific numbers, we have our top number every 20 points that it's elevated from a normal blood pressure of 120.
The risk of an adverse event that we'd hit on earlier doubles and Bob number being greater than 10. So we kind of look at a linear line that every 20 points that our blood pressure is elevated, that risk of those adverse events doubles. And so we have to stay on top of that to of course lower risk.
[00:10:27] Speaker A: Well, so even little changes in that blood pressure number can be big benefits for us, lifestyle wise. That's really. Now what? You know, there's a lot of folks that may not want to take a medication for blood pressure. Are there some non medical Things that a person could do at home, easy stuff that they could do to help lower their blood pressure.
[00:10:48] Speaker B: Yes. And this is what I prefer. You know, as we talked earlier, the stage one class, we actually incorporate lifestyle modification first.
And so that's getting your weight down, particularly trying to get out of that obesity category with your BMI that's increasing your physical activity. I usually say about 90 to 150 minutes of moderate physical activity, where that's just a long walk through the neighborhood. Kind of slow increases in heart rate to kind of get some good cardio in your system, like low salt diet. And particularly, I think if we hit them with races, African Americans are much more sensitive to salt. And so we see a lot larger reduction in blood pressure when they're abiding by a particular low salt diet.
Again, back to alcohol, limiting alcohol. We can see improvements in blood pressure, even stress reduction. There's some more Class 2 indications for incorporating yoga or breathing exercises and even meditation and lowering blood pressure. So stress does have an effect on blood pressure.
[00:11:50] Speaker A: Yeah.
Interesting note, I did some yoga the other day for the first time and that's tough.
That's a hard thing to do. So it is interesting is that fast foods are also high salt. So if you want to avoid a lot of salt, avoid those fast foods there because that can be really tough.
What about medicines? Let's say we've tried those things and we're still failing. What medicines are probably best to lower blood pressure and lower our risk of a bad consequence of that high blood pressure?
[00:12:26] Speaker B: Another good question. So we start off with three medicine classes.
ACE inhibitors, angiotensin and receptor blockers. Most commonly that'd be lisinopril, losartan that you'll see that we'll prescribe. Another class is calcium channel blockers.
Commonly we use amlodipine, nifedipine and then your thiazide. Diuretics, which also help urinate. Salt, which sometimes will do. Some people have some mild swelling in their ankles and some elevated blood pressure. A lot of times you'll see us use hydrochlorothiazide, chlorthalidone.
So after we incorporate those three classes, if your blood pressure is still elevated, we're probably doing some additional test testing to see what else is going on. But you'll see us incorporate different classes, more particularly spironolactone for that resistant case. But you'll see us delve into other categories as well.
And you know, unfortunately, sometimes we have people in 4, 5, 6 blood pressure medicines. Again, rare cases, genetic Cases probably involved. But that is an instance.
[00:13:24] Speaker A: Now you somewhat alluded to that earlier about we could have elevated horizontal levels and aldosterone being one of those. What is the mechanism action of spironolactone when we add that, you said you add that on as the fourth drug when your blood pressure is still elevated. What is spironolactone specifically doing when we look at the hormonal aspect of that?
[00:13:47] Speaker B: So spironolactone blocks a hormone called aldosterone. Aldosterone producing the adrenal glands associated with high blood pressure. We can block that receptor. Sometimes in a workup we can actually find some people actually may have a little tumor that secretes aldosterone. Sometimes we'll find that on a CT scan and even pursue surgery to have that adrenal gland resected and seeing how the blood pressure improves.
[00:14:11] Speaker A: Yeah, so here's a pro tip for you. If your potassium level is low, then you likely have too much aldosterone. So that's sort of the little clue there. So if you've looked at your blood work at home and you got a low potassium level, you might have that. So maybe, maybe something to think about as we move forward.
And are there other, I'm going to say, non medical ways that we can treat high blood pressure? Let's say I got somebody and they have high blood pressure and they're now on three drugs and we still don't have their blood pressure control. What, what are next steps? If we, we don't want to add 4, 5 or 6, what else can we do?
[00:14:54] Speaker B: So, you know, patient discussion, we say where do we go to next?
I think we're fortunate here at cardiologistosage to do a lot of research.
And I think you've kind of delved into that category a little bit yourself. Dr. Berle, is there a particular procedure that you have that you're working with?
[00:15:10] Speaker A: Yeah.
Great segue. So there is now a new procedure that we can use for high blood pressure and this has now been FDA approved for two years. We have been part of the research and the development in the United States of this for the past five years.
And we've now done about a hundred of these procedures. And then this is now a proven technology to help lower the blood pressure. And then what we actually have found is that the brain talks to the kids kidney and the kidney talks to the brain through nerves.
And when those nerves become very excited, then your blood pressure goes up.
That nerve traffic also increases these hormones like aldosterone that drive the Blood pressure up.
And we have found that when we use technology called radio frequency energy, that we can calm these nerves down.
So that radio frequency energy that's using radio waves to treat the actual nerves, it is the same energy that they use in the heart when they make skipped heartbeats go away. It's the same technology that they use the pain doctor will use in your back when your back hurts. And they do that radio frequency ablation there.
And that technique is a pretty easy procedure and it's somewhat similar to a heart cath.
This is a procedure that can be done in 45 minutes, done as an outpatient, and then it does work. So I'll take you to this graphic here.
This is a procedure where we'll go through the leg, we can place a catheter, this blue line, up to the kidney, and we actually go into the kidney arch.
Again, we're using the artery because the artery is here, but the nerves are just outside the artery. And when we send those radio waves through the artery wall, that's how we can affect those nerves.
And so we'll place a small catheter into the kidney blood vessel and then this catheter then will assume a spiral shape that will touch the blood vessel wall. And then there are these electrodes that are on this catheter and then it will send these radio waves through the blood vessel wall to affect these nerves. And effectively this calms those nerves down and then we're able to calm those nerves down. Then we'll see that blood pressure reduction. Reduction.
So what we've seen in our clinical trials is we've seen in the first six months after we do this, we see roughly about a 10 point drop in your blood pressure. And then as we get into years two and three, we're seeing more of about a 20 point drop in your systolic blood pressure. And so this is some new technology that has now become available for us to treat resistant hypertension.
Right now, this is a procedure that is approved by Medicare for Medicare patients. And we're working with the private insurance companies to assure that they cover a procedure like this.
[00:18:40] Speaker B: I think that's a great solution. Instead of adding that 5th 6th medicine to your medicine list.
[00:18:44] Speaker A: Oh, yeah. Certainly helps a lot. And, and may even get you off a few blood pressure medicines.
So if somebody watching or listening has high blood pressure and they've been working with their primary care provider in not getting those blood pressure numbers down, where can they go to get help with their blood pressure?
[00:19:06] Speaker B: Well, come to Cardiology Associates and we can Evaluate again, kind of making sure we touched on secondary causes as well as kind of reinforcing lifestyle modification. I feel like that's a big factor that I like to address with patients is we can lower blood pressure without adding medicine, but again, a secondary workup can be involved. And now that we have a new option like this, it's always great to have that in our arsenal to further lower blood pressure without add additional medicines.
[00:19:39] Speaker A: Right? Yeah. I mean, that's. That's the key. You'd like to get control without that. So one of the things that we've been asking in the slogan for north Mississippi is that you are our true north.
So here's a question. I'm going to toss it back to you.
What is your true north? What brought you to north Mississippi? What do you look to look forward to maybe doing in your career here in Tupelo?
[00:20:03] Speaker B: Well, I guess I could take that question long, literally being my true north. I'm from Greenwood, did really most of my training in Jackson, was there for about 12 years.
So I came north to Tupelo.
And so what I've really found is, you know, Tupelo is an easy place to live, easy to raise a family, have all the amenities you need, also have a great sense of community.
And so I guess everything that kind of ties together for me a great opportunity is have such an advanced healthcare system with a small town feel. So I guess that's my true north in a literal sense.
[00:20:41] Speaker A: That's a wonderful summary, and I think that's almost part of what this podcast series was all about to introduce in our small town of Tupelo.
What a fantastic medical system that we have here. So thank you so much for spending time with us today, educating us about hypertension, high blood pressure and what we can do to make that better.
[00:21:05] Speaker B: Oh, well, thank you for having me. I feel like I'm here to fireside chat with a historical figure.
[00:21:11] Speaker A: All right, we're out.
We're All Heart is brought to you by North Mississippi Health Services in partnership with Cardiology Associates of North Mississippi.
