I have recently been told that I have high blood pressure. While my doctor recommends that we work towards keeping my blood pressure at 140/90 mm Hg, my kids did some research on the internet, and they say I should really aim toward keeping my blood pressure at 130/80 mm Hg. So, is 140/90 mm Hg the ideal rate for blood pressure, or should it be lower?
–Deborah from Sheffield

This is an interesting question as the answer is not entirely straightforward. While the traditional treatment for hypertension, or high blood pressure, has been to set the target blood pressure at 140/90 mm Hg, a recent study called the SPRINT trial has provided more evidence that supports a target systolic blood pressure of less than 120 mm Hg. This study concluded that setting the blood pressure goal lower actually resulted in a 43% lower risk of death from cardiovascular causes and also a 25% less chance of incidents such as myocardial infarction (also known as a heart attack), acute coronary syndrome, stroke, acute compensated heart failure. While part of the study is ongoing, there is a theory that a lower blood pressure even results in better cognitive function of the brain and a smaller risk of developing dementia.

This being said, suggesting a recommended blood pressure rate is not a simple task. It is complicated by the fact that, in most cases, hypertension is accompanied by additional health problems. Also, there are disagreements as to the best blood pressure goal for patients of different ages and of different races.

The SPRINT trial study showed that the target of 130/80 mm Hg is optimal especially for those over the age of 50 with uncomplicated hypertension. Those under the age of 50 with uncomplicated hypertension, however, are recommended to stick to a goal of 140/90 mm Hg in order to prevent stroke and other cardiovascular events. If you have other health problems, such as chronic kidney disease, your doctor may be well-advised to recommend a blood pressure goal of 140/90 mm Hg. Hypertension accompanied by cardiovascular and coronary artery disease also have a recommended goal of 140/90 mm Hg. However, keep in mind that there are exceptions in both of these cases where 130/80 mm Hg might be a better goal. In the case of patients with type 2 diabetes, there is not a standard agreement of how to treat patients who have hypertension accompanied by this condition.

Based on the results of the recent SPRINT trial study, pharmacological treatment for hypertension also varies depending on age and race. In cases of uncomplicated hypertension, the study recommends using angiotensin-converting enzyme inhibitors (or ACE inhibitors), an angiotensin receptor blocker (ARB), a calcium channel blocker (CCB), or a thiazide diuretic as the medication of choice. Additionally, the European Society of Hypertension encourages the use of beta blockers as the medication of choice in many cases of hypertension. The SPRINT trial study recognizes the importance of using combination therapy, or the use of two medications at the same time, in most blood pressure related cases as it usually takes a combination of medicine to effectively treat hypertension.

If you want to learn more about hypertension or discuss your heart health, call the Cardiovascular Institute of the Shoals at 256-766-2310 to schedule an appointment.

My mother’s doctor told her she is at risk for congestive heart failure. What is congestive heart failure, and what are the causes and symptoms that we should look out for? What can we do to prevent it?
–Todd from Lexington

Congestive heart failure is a medical condition that occurs when your heart does not effectively pump blood as it should. This condition occurs when the function of the heart’s left ventricle is reduced.

Ejection fraction is the percentage of blood that the left ventricle pumps to the body with each beat. Cardiologists determine this by a number of tests – such as Echocardiography, Nuclear Stress Ejection Fraction, and Cardiac Catheterization. When this percentage is significantly reduced, you are at a risk of congestive heart failure.

Causes of Congestive Heart Failure

So what are some of the causes of congestive heart failure?

One cause is a Myocardial infarction, or rather, a heart attack. If you experience a heart attack, your heart loses some of its ability to pump. The muscle that is damaged by the infarction is permanently scarred and does not contract as it would normally, which can lead to congestive heart failure.

Cardiomyopathy, or cardiac muscle weakness, is one type of viral condition which weakens heart muscle and reduces the heart’s ability to clear an amount of blood that it usually does with each heartbeat. This reduced clearance function can again lead to congestive heart failure.

Another condition that reduces the efficiency of your heart is high blood pressure. High blood pressure leads to a thickening of the muscular wall of the heart, and eventual decreased muscle function can also be a cause for congestive heart failure.

Another cause of congestive heart failure is rheumatic fever. As a result of rheumatic fever, one of the four valves of the heart may be affected by an infection or scarring of the valve.

Symptoms of Congestive Heart Failure

So what are the symptoms of congestive heart failure?

Someone with congestive heart failure is easily short of breath, and as the failure worsens, the shortness of breath worsens as well. People with this symptom have difficulty completing tasks that used to be ordinary. Someone experiencing congestive heart failure may even feel short of breath while lying down. Some people even forgo the bed and sleep only in a chair at night, or sleep with many pillows underneath their heads.

Swelling, also known as edema, is also a common symptom of congestive heart failure. Usually, the first noticeable swelling occurs in the legs (known as peripheral edema), and it may progress to swelling of the stomach as fluid builds in the body.

Treatments for Congestive Heart Failure

The mainstay of treatment for congestive heart failure primarily involves medicine such as beta blockers (which control your heart rate), ACE inhibitors (which control blood pressure), or diuretics (which eliminate extra fluid by encouraging urination). In addition to these options, there is a new medication called Entresto, which has shown significant clinical improvement in many patients. Treatment such as coronary artery revascularization and certain types of pacemaker placement may offer relief. Along with pharmacological treatment, it is also mandatory to restrict salt in your diet and avoid all prepared foods with high sodium amounts. If a single food has over 400mg of sodium, you should avoid it and make the food with fresh or frozen vegetables. Usually canned vegetables, canned soups, canned meats, packaged lunch meats, or snack foods do not contain less than 400mg of sodium per serving. Your total daily sodium intake should be less than 2g of sodium.

To treat congestive heart failure, we need to first identify the cause. If you are experiencing any swelling in the feet, ankles, and legs, along with a sudden shortness of breath, you should visit a doctor immediately. Before the next day, you should have your symptoms evaluated as this could be a serious and dangerous problem. There are many therapeutic interventions that can improve your symptoms and extend your life.

If you want to learn more about congestive health failure or discuss your heart health, call the Cardiovascular Institute of the Shoals at 256-766-2310 to schedule an appointment.

My doctor told me that I have a problem with the blood supply to my heart and that I need a coronary angiogram. He said he is going to stick me in the groin, but I’m really uncomfortable with this. I’ll have to lie down for six hours afterwards, but I have frequent back pain. I also heard that there can be a lot of complications with this procedure. Are there any alternatives? If so, what are they?

You’re correct in that you have to lie down for about six hours after a traditional coronary angiogram. Coronary angiograms require that cardiologists introduce a catheter – a thin tube inserted in your artery and guided near your heart – to determine blockages near the heart, typically using the femoral artery in your groin. This is called a transfemoral catheterization.

However, there are many complications that can arise from inserting a catheter through your femoral artery. For instance, you could develop AV fistula, aneurysms, or a hematoma with the transfemoral approach. Also, because the transfemoral artery is a large artery, there is even a risk of death from exsanguination, or blood loss. Elderly and obese patients are at an especially increased risk of bleeding complications from transfemoral catheterization.

So are there alternatives to this method? The simple answer to your question is yes.

Minimally Invasive Angiogram

By inserting a catheter through the radial artery in your wrist, a coronary angiogram can be a minimally invasive procedure. Using the radial artery to insert a catheter is called transradial catheterization.

Most people you know have probably had a coronary angiogram via a femoral artery catheterization. In 2008, when I first started practicing in Florence, less than 3% of angiograms in the United States were done via the radial artery. According to a study from 2015, now almost 30% of angiograms in the United States are done this way. All over the world, 70% of these angiograms are performed via the radial artery, and in some countries, this percentage is more than 90%.

Why? Well, there are actually many benefits to using the radial artery instead of the femoral artery.

Benefits of Transradial Catheterization

Studies show that using the radial artery means fewer chances of complications occurring. Because the radial artery is smaller than the femoral artery, there is less risk of bleeding, AV fistula, aneurysms, or a hematoma. Also, the risk of death from exsanguination is virtually eliminated with a radial artery catheterization. In fact, studies report that the recovery is quicker when using the radial artery. You are able to walk immediately after the procedure – as opposed to the femoral artery catheterization which requires you to lie down afterwards. This is especially good news for patients with back pain, and this ultimately leads to a much shorter hospital stay, a lower cost to the patient, and less discomfort overall.

If you want to learn more about angiograms or discuss your heart health, call the Cardiovascular Institute of the Shoals at 256-766-2310 to schedule an appointment.