Diet and Lifestyle in Hypertension Prevention and Management–Lawrence Beilin

Diet and Lifestyle in Hypertension Prevention and Management–Lawrence Beilin


– Hello, I’m Peter Wilson. I’m the Chair of the Lifestyle on Cardiometabolic
Health Council at the American Heart Association, and I’m here in San Francisco with one of our keynote lecturers for this meeting, Dr. Lawrence Beilin. Welcome! – Thank you. Very pleased to be here, I’m really honored to be invited to give this David
Kritchevsky Memorial Lecture. It’s pretty exciting to come here again. – And you’re from Australia, right? – That’s right. From Perth
in Western Australia, yep. – Oh, that’s a long way, as you certainly have a good chance to win the distance award this year. – Yeah, okay. – Tell us about what
you plan to address in, generally about your research that you’ve been conducting in Australia. – Well, I’m going to talk about lifestyle, and diet, and high blood
pressure and it’s importance and also something about the
search for the elixir of life. That everybody seems to be demanding. – Well, one of the questions, I think, comes up in our Lifestyle Council is the relative comparisons
of what might lifestyle do versus a blood pressure medicine. I have patients I put
on a thiazide diuretics, calcium blockers, and others. Give me some sort of
relative way of what works. – Well I must say, I got into this also because as a physician I was frustrated with the side effects people
were getting from tablets, the fact people didn’t want to take drugs. And so over the years we’ve been studying and trying to found
out actually what works and what works if you
add to effects of drugs, or if you can substitute for drugs. And I think the answer to your question, as to what’s the equivalent, it depends, it depends whether you
can get people to change their lifestyle adequately. And in terms of what really works, there are a number of things we know that will reduce blood pressure and what I would call
Proof of Principle studies. In addition to sodium restriction, which of course has long been there, is weight reduction,
increased physical activity, moderation or reduction in
heavy alcohol consumption, and eating the right kind of foods. So all of those things independently will reduce blood pressure in somebody whose got high blood pressure by about 5 millimeters
of mercury systolic. Which is about half of what you might get from a single drug therapy. But if you combine two of
those lifestyle factors, particularly anything
added to weight control, if you add weight and sodium restriction, or weight and exercise, or
weight and alcohol moderation in heavy drinkers, then you
can get something like a 10 milimeter mercury plus
blood pressure reduction. Which is equivalent to that of a drug. If you take the so-called DASH diet, increase fruit and vegetables, and all the reduction of
heavy meat consumption, reduction of saturated
fats, then in hypertensives just from that DASH combination diet they got 11 millimeters of
mercury blood pressure reduction. So there are a lot of different things that will work together, which
in mild hypertensives will give you the equivalent of a single drug. The problem is, of course,
getting people to stick to these regimes and when you
get out into the community, you don’t get usually as big an effect as you do with single drugs. But, at a population level, of course, you can get major effects,
major shifts in population blood pressure which can
have enormous effects on the outcomes in terms of stroke
risk and heart attack risk. – So it’s interesting, in the
American Heart Association we have Life’s Simple 7,
it’s part of our 2020 goals and as I was counting in my head, I think you have 4 or
5 of our 7 key factors in blood pressures, feeding into blood pressures so to speak. I’m going to ask a question, that you may say you don’t want to answer, but if I were to
prioritize with my patients and I typically have somebody who’s 10 or 20 pounds overweight, and they have many of these issues. Where should I start if
I was going to work on 5, is there any way to prioritize? – Well again, it depends on your patient If they’re a smoker, my
number one priority would be to get them to stop smoking. Now that may not have a very big effect on blood pressure acutely, we still don’t quite know about that. But in terms of reducing their
overall cardiovascular risks, and of course their risk of
cancers and lung disease, smoking secession, I think, is still the number one priority. But of course if you do
that, in a hypertensive, you’ve then got to stop
them putting on weight. So almost at the same
time, you have to get them into some way of increasing
physical activity and balancing their calorie consumption, so that they won’t put on weight. And once they’ve got off smoking, then you focus on the other priorities. So if you come to the nonsmoker, again I think it depends
on the individual. If they’re overweight, I would probably put
getting weight under control as the number one
priority by a combination of increased physical activity
and eating more sensibly and initially cutting
down those portion sizes. There’s no way, if you eat the standard portion
you get served in a diner in San Francisco, or
elsewhere in the States, or even in Australia now, that
you’re going to lose weight. And you’ve only got to do
that 2 or 3 times a week and all your attempts
that carry a restriction the rest of the week will go out. – So – But I’ll just bring you another one, because I said it depends
on the individual, I don’t know about here currently, but there are a lot of
heavy drinkers in Australia, and I think there are
quite a few in America. If they are heavy drinkers, getting their alcohol intake down will substantially lower
their blood pressure. We’ve got very good evidence for that. And of course it’ll also reduce their risk of a number of cancers. Which people don’t realize
is a major risk of alcohol. – So, one of the things
I think we grapple with in taking care of patients, and taking care of the population, is who should be the message
bearer and who should be the person trying to lead them. For instance, it sounds like
you’re especially emphasizing the patient health
practitioner relationship, rather than trying to
change sodium in the diet and other issues. – No, no, no. – What is your flavor, or maybe it’s all, and you’ve largely focused on the… – No, I focused on it because
I answered your question. You said what should I
do if a patient came in, what would be my priorities. No, I think you’ve got to
have a multipronged approach to this, and I think, a major role for the
doctor as an advocate. – Okay. – To the public, to health agencies, and to politicians in particular, to try and develop
measures that will make it easier for the community
to deal with the cultural and social issues we have
that are putting weight up, keeping blood pressure up,
and enabling a lot of people, not enabling, but in
particularly developing countries encouraging smoking
rates to increase still. So I think yes, you know,
the political, the social, the industrial side of
this, is absolutely crucial. There’s a very limited
extent to what we can do with patients, and there was
a wonderful paper presented by one of the young
investigators this morning, showing the difference
between what you gain by a population wide
approach compared with an individual patient approach. In fact, you’re getting more
with a population approach, but you’ve got to have a dual approach. – Right, well thank you very
much. Thank you for your time, and we certainly enjoy having you here at our meetings though and
look forward to hearing you tomorrow morning when
you deliver your lecture. And I’m still hoping to find out exactly what this elixir of a long life and less hypertension
for me and my patients, really might be. So this is Peter Wilson from
the American Heart Association, thank you for being with us.