Hypertension specialist at University of Miami Comprehensive Hypertension Center, Maria Delgado, MD talks about a new way to check your blood pressure.
Interview conducted by Ivanhoe Broadcast News in December 2023.
What is hypertension?
Delgado: Hypertension is a huge public health problem in the United States and worldwide because it’s a genetic and social disease. It grows with us; it perpetuates with us. You only need a parent; a grandparent and you almost guarantee that 75 percent of your children in future generations will be hypertensive. It’s social because it depends in many ways on who we are, how we behave, what we eat, and what we do. In summary, it depends on our lifestyle in many ways. But the hardcore is genetics, which is strongly transmitted in families. The problem that we have in the United States and across the world is that even though we’re diagnosing more and more hypertensive patients, the treatment is becoming a problem. This is because only one out of four is controlled. We have many people walking around with uncontrolled hypertension. We’re growing into the understanding in the community why hypertension is, but still, hypertension in many eyes is something like a blood pressure cuff and you put it in your arm and that’s the story. You take a pill, and you forget about it. But it’s a systemic disease. It’s a disease that attacks every single organ in your body. It’s the number one risk for heart disease and stroke. It makes sense, we are the majority hypertensive. We are dying from heart disease and stroke as the primary cause of death. It’s a huge problem that we have right now. Understanding and controlling blood pressure is a huge deal in the United States.
Are there some exciting new treatments for it? Let’s talk about the patch.
Delgado: When you put a cuff around your arm, you know that you’re taking your blood pressure. You feel the pain against your skin and your muscles and then you’re looking at that machine and see it’s going up or it’s going down. You cannot prevent yourself from being aware of the measurement and your brain your feelings and your sensations will also affect that reactivity, because blood pressure is vital to you. You’re alive because you have blood pressure. The patch is a very interesting technology in which by light a sensor, goes and transmits light to the aorta. It’s the main artery of the heart, transmits light, the light pounds back to that sensor and it’s measuring your blood pressure without you knowing. You go through a 24-hour measurement, and you don’t have any sensation that the blood pressure is being measured. The result is a very accurate measurement of the physiology or the behavior of your blood pressure in 24 hours. The big deal about 24 hours is that we are beings, but it happens in animals and plants and everything. We move with the circadian rhythm. That means our cells function the way we behave. Everything in our body follows that night and day cycle. The blood pressure does the same thing. In hypertension, many patients have problems controlling their nighttime blood pressure. This patch will help us understand what is happening to you while you’re asleep. Also, if there is an interruption in that rhythm that increases your risk for cardiovascular events or problems.
Do you have any pictures or videos that you could share with me about this patch?
Delgado: Yes. How to put the patch is something cute. Historically, the 24-blood pressure monitor has been done for many years. That’s the most accurate way to establish a diagnosis and even treatment for blood pressure, knowing and understanding what happened in 24 hours. It’s just that instead of buying and singing, instead of using something that you’re affecting, you’re using a past that doesn’t get affected by your thoughts or your feelings over that monitor that you’re having at that time.
I think everybody gets scared to go to the doctor if they don’t find something wrong.
Delgado: That’s a good point because many will tell you, ‘Doctor, you don’t understand. At home, my blood pressure is 120/70. It’s just when I come here, it goes very high.’ That’s an important observation because natural reactivity to the environment, to being concerned about what a doctor is going to tell you, and what’s going to happen can increase momentarily your blood pressure. What is bad is to react to that, to tell the patient, okay, your blood pressure is 170/100, I’m going to increase your treatment. You can’t do that. You need to establish what is the behavior because in terms of cardiovascular risk, it’s not that single number. It’s the average. If your average during the day is 170/100, you have a problem. If your average is 120/70 and you had two readings in the 150, it doesn’t matter, we all have it.
Now, let’s move on to renal artery denervation.
Delgado: Yes. If you look at blood pressure treatment, non-pharmacological or where we normally do the lifestyle, by the way, it’s one of the most important pillars, then how do you treat that patient with medication? We usually have what you see commonly is non-pharmacological lifetime changes and pharmacological treatment. Now, we have a treatment that is a procedure, meaning that is something that we do that will decrease the blood pressure independently of the medication.
How does that work? How do you do that?
Delgado: Let’s imagine that you must look at your kidneys. You have two kidneys, two renal arteries that go to the kidneys, and the big artery in the middle which is the aorta. Your brain, your central nervous system has something called the sympathetic nerve system. That gives roots everywhere, and of course, to the renal arteries. These renal arteries have little nerves here from the sympathetic nerve system when their tone is increased it will affect blood pressure. It happens that many hypertensive patients have a sympathetic tone increase. Meaning that this sympathetic nerve is activated more than it needs to be activated. What we do, is make these little terminals in the renal artery go to sleep. We can either do it by heat or by ultrasound. You disable these terminals in that renal artery. We go through a catheter. If we were going to do a cardio cap, the catheter goes through your groin, goes to the aorta, which is the main artery, and then goes to the first renal artery. Disabled these little terminals by heat or by ultrasound on one end and then goes to the other side. That procedure itself is ambulatory. It is with very mild sedation. The patient goes in and later four to five hours later, they go back home. But it translates between nine and 50 millimeters of mercury decreasing blood pressure independently of medication. Many patients are on two, or three drugs that are still in control, or even those on three drugs are controlled, but they don’t want to take that many medications. You can start dropping blood pressure medication on this patient. This is an extraordinary treatment because it’s something that you do biologically, and you do it only once. To this day, the lasting duration that we know of is three years and beyond. The blood pressure drops are maintained for at least three years.
If you don’t change your lifestyle after you take it or do it, are you going to get the hypertension right back?
Delgado: Lifestyle is critical because you’re affecting volume, you’re affecting salt, where most of us, most of the hypertensive population is salt sensitive. Meaning that if they eat salt, their blood pressure goes up and they get puffy. Everybody tells you that my hands, my legs. But anyway, this is interesting because it’s a biological intervention, so a very bad lifestyle, especially eating a lot of salt, will activate your sympathetic nervous system. By doing this procedure, you’re cutting that information that goes to the renal artery. Does that give you a path? No. Still, you need to improve your lifestyle because there are things independent of what you’re doing that will get worse over time, and that’s your cardiometabolic risk. You’re going to still have a heart attack if you don’t change your lifestyle. Do you see what I’m trying to say? But this, in terms of biology, this is something that you’re disabling. These nerves are hyperactive and then you tell them to shut up. But you still have the rest of your life and the rest of the things that you need to do to get better.
Could you talk a little bit about Desire?
Delgado: Desire is a very interesting patient because she’s a female. We know that when worldwide, or let’s not go world in the United States, the population, of women is more in different states. What do you call their position in terms of health is different from that of men? We get diagnosed later in life; we get complications in more amounts than men. If we have one, we get treated later than the men. That’s a statistic that still happens. But moving forward you’re still yourself. She’s a woman, she’s postmenopausal, and when I met her, she was obese. There were a lot of things going on in her hypertension, and cholesterol. There are a lot of things going on for her and I want to get a better doctor. They start with blood pressure. When she came and saw me for hypertension, she also understood the ramifications, what hypertension is, and what lifestyle is. It’s not just taking a pill. That’s where the hypertension story starts. I told Desire, not just a pill, you need to modify your lifestyle. You need to decrease this type of food, especially salt intake. You need to do more exercise because everything is interrelated. What you eat affects everything. What you do, and how you sleep affects your body. And affects your aging, your biological aging. All of us, especially when women transition to petty menopause and menopause. She starts thinking, oh my God, I’m getting old. What do I do to get younger or not too old? To get old that fast. It’s all about biology. We tend to go into plastic surgery, but seriously aging is more about biological age. She was able to understand that. This woman on her own, decided to be in charge at a postmenopausal age. Because this is very easy when you’re 20 or when you’re in your early ’30s, but not when you’re in your ’60s. She was able to lose weight, she was able to change her sleeping habits, and her stress management. You see what I mean? It’s all about lifestyle. Something interesting that she did and continues to do, is nocturnal fasting. When I talk about fasting, I need to explain to the patient, this is not a fat diet. This is not something that you do for two weeks or two months. You lose 20 pounds and it’s over. Initially, the animals including us, should have a time where they rest. That also means the resting of your metabolic capacity. The problem that we have in our country is that we don’t have a limit in eating, you eat, eat, and that includes eating before going to bed. That alone is a big problem because it activates your pancreas. It increases your risk for diabetes. Your cholesterol is not well metabolized. Most of all that process that your body reserves to burn the calories that you radiate during the day stops. Because you’re eating at night. She understood very well that I wanted her to do nocturnal fasting as a physiological protection of her cardio-metabolic state, that this is not a fat diet, and that she will lose weight. Everybody who stops eating before going to bed and protects that period, between 12 and 16 hours. Everybody who does that, will lose weight. There’s no question.
By doing that, what will that do for your body?
Delgado: You need the nighttime. We’re going back to the circuit and rhythm that I explained to you about the blood pressure. Nighttime is a time when cells rest, especially your vascular cells. Your brain is resting. But it’s also the time of cell regeneration, which decreases inflammation. Where you metabolize whatever, you have in terms of energy. Energy is being used, but the keywords here are inflammation and cell regeneration. You get to clean your body during that time when you’re not eating. The nocturnal fasting for 12 hours protects the pancreas. The pancreas mainly gets less activated, and inflammation decreases. Cell regeneration happens only during that time, not during the day. Biologically you’re protecting yourself. You’re protecting, it’s like the reset, if you think about it, you reset your body during sleep. That’s why it’s so important when you hear even from the American Heart World Health Organization, that sleep is important. You need to sleep and not during the day. You need to sleep during the night because you follow your circuit and rhythm, and that’s another story when people sadly must work shifts and then they don’t sleep at night. That’s what she’s doing. She’s improving her metabolic profile by doing fasting. Cells are not working the same way that when you were 18, when you were a child when you were a young adult. Sadly, they’re not working the same way. But what you do, environmental-wise, affects even more of those functions. That’s why changing your lifestyle and trying not to eat too much, especially at night, is our key. But look what I’m saying about changing lifestyle. To the last publication of the American Heart Association regarding hypertension and cardiovascular prevention. You know what it focused on. It focuses on the social determinants of health. That’s how deep it goes. Social determinants of health are who we are literally at one point where we sleep, how we work, how we go to work, and how our environment is around us. Worldwide, we all come to realize that heavy responsibility for health, longevity, and quality of life relies on us. No pill tells you, to take this so you can change your lifestyle and no, it’s you.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Kai Hill Joanna Palmer
khill@med.miami.edu Joanna.palmer@med.miami.edu
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