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The Far-Reaching Grasp of High Blood Pressure

David DeRose

Description

Objectives

1. Articulate at least four fundamental aspects of hypertension epidemiology in the United States. 

2. Provide an explanation for the relatively poor compliance with blood pressure management approaches. 

3. Describe a ten-step approach to controlling blood pressure utilizing non-pharmacological strategies. 

4. List three key dietary strategies that can help individuals control blood pressure. 

5. Enumerate three common classes of beverages that tend to foster high blood pressure-- along with the mechanisms responsible for their blood-pressure-raising effects. 

 

Approximately 90% of Americans are destined to have hypertension, "the leading risk factor globally for mortality" according to the WHO. Nonetheless, conflicting guidelines and issues with medication side effects and non-compliance have left many clinicians searching for better strategies. In this presentation we'll cover data supporting optimal guidelines and lifestyle and strategies for non-pharmacologic blood pressure optimization, suitable for clinical practices and church-based health ministry. 

Presenter

David DeRose

President of CompassHealth Consulting

Conference

Recorded

  • October 26, 2018
    2:00 PM
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Father in heaven thank you so much for the privilege we have of coming apart and studying really the crowning act of your creation on this planet the human organism and yet we're in a world of sin and things go wrong and yet you want your children to be ambassadors of your good news not only the gospel as far as the saving power of Jesus but also how you want to save us from ourselves and our poor lifestyles and the environment that we find ourselves in please help us to that and give us things that we can take away that will not only change our lives but change the lives of those we touch we ask in Jesus' name amen Well we truly are in the midst of what we call a pandemic it is a worldwide epidemic when it comes to high blood pressure sometimes we think these chronic diseases are just happening in the United States but earlier this year I was invited to speak at a. Division wide conference in Europe the European division was hosting a Health Conference and I said I got to look at data throughout the world is it just a US problem are we dealing with high blood pressure worse than other nations Well I looked at data from the World Health Organization and it is amazing using guidelines some people it's a little bit older guidelines we'll talk some about changes in guidelines as we go through the C.M.E. event this afternoon but historic guidelines for high blood pressure up until fairly recently. Greater than or equal to 140 for the systolic number greater than equal to 90 for the diastolic number or on blood pressure lowering medication the World Health Organization looked at this across nations throughout the world what did they find this is the prevalence the percentage of the population with high blood pressure and you can see it doesn't matter where you go whether it's a developing nation or developed nation about 30 to 50 percent of the population have high blood pressure say well that's just the A.B.C.'s Dr DROs What about the other countries it's the same wherever you go it includes China and Denmark it's Germany it's she lay gonna Iran Israel 30 to 50 percent across the board as you look at the rates of high blood pressure Mongolia That's right Mongolia Poland doesn't matter 30 to 50 percent with high blood pressure so we want to look today at some key messages 1st about epidemiology and the 1st key message is this is a pandemic an estimated one point 4000000000 people worldwide with high blood pressure and the number continues to climb so let's look at 7 key messages that especially relate to the epidemiology but also give us some special insights that can help us when we reach out to our patients and to our communities 7 key messages the 1st one we've already had were in the midst of a pandemic but here's the 2nd one the 2nd one it's not just someone else's problem it's not just someone else's problem if you don't have high blood pressure today it's likely waiting for you down the road did you catch that. It's likely waiting for you and for me that's what the data shows if we look at what happens as a population ages the rates of hypertension increased dramatically this is even with older data older cut off for high blood pressure we'll see what they look like with newer guidelines but what I want you to notice is once we get into our sixty's our age is roughly the percentage likelihood that we have hypertension I know we just ate so let's make this a little bit interactive Let's say someone is 65 years old and a less a 68 or 68 years old what is the likelihood that they have high blood pressure That's right 68 percent how about if they're $75.00 What is the likelihood 75 percent now roughly that's a rule of thumb that is remarkable this is what happens worldwide if you look at the World Health Organization that it's the same worldwide as we get older our likelihood of having hypertension dramatically increases and if you look at some very good data that we have from here in the United States the data suggests that only about one in 10 of us these are the newer guidelines you can see just shifts things up a little bit higher but only about one in 10 of us if we're like the average American will evade the grasp of hypertension about 90 percent of individuals look at this statistic you're 55 or 65 years of age they have no hypertension 90 percent chance that before they die they will have a diagnosis of high blood pressure I think that's just a just astounding. So if you're talking about high blood pressure you're basically talking about a problem that relates to every single person whether we realize it or not we either have high blood pressure or it's likely waiting for us they say as being quite pessimistic Well not really because we want to try to look at some of the reasons why that's the case and some of the things we can do or some of the things we can help our patients do so that they don't develop high blood pressure Well I don't want to spend a lot of time with the obvious high blood pressure is extremely dangerous even though it is underappreciated as such by most people who have high blood pressure. Here's how the World Health Organization put it really in a very impressive monograph if you're interested in worldwide risk of non-communicable diseases chronic diseases very very nice monograph your published in 2011 by the World Health Organization Here's what they said common preventable risk factors underlie most non-communicable diseases these risk factors are a leading cause of the death and disability burden in nearly every country says Dr De Rose You can't even read right it says nearly all countries same message regardless of economic development look at this what is the leading risk factor globally for mortality elevated blood pressure so high blood pressure is not just a risk factor that we. Get concerned about it is really a worldwide problem that is cutting millions of lives short you know many of the complications that go along with high blood pressure we won't take a lot of time with this but I will highlight a couple more and more data really underscoring just how compelling the link is between even relatively mild levels of blood pressure elevation and dementia. Men often don't realize that it's not just agents that are sometimes used to treat prostate problems that actually lower blood pressure it's true with one class of drugs you know the alpha agonists But prostate problems are increased if you have high blood pressure but of course the leading concerns stroke heart attack kidney failure blindness if you have diabetes you're dramatically increased risk of just about everything on this list at high blood pressure to the equation and it increases your risk even more so here's the 1st take home point from these 1st 3 epidemiology points and that is if we're interested in ministering to our patients that we're interested in ministering to our communities and if we're interested in preserving our own abilities to minister effectively we need to be concerned about high blood pressure do you think that's a fair conclusion to draw just from what we've looked at OK Some of you are alert enough tonight you're heads others of you aren't sure you're like may be more non-committal and I appreciate that I don't want I'm not one of those preachers who like to get people saying amen get them into you know work them up into a fervor so that they will assent just to about anything that the speaker says so you're doing very well to have your critical regard and your critical faculties honed even after a lunch on a warm day Well here's my story and how I got involved being especially interested in public health approach to high blood pressure I'm from Northern California outside of Sacramento. Our health director there Dr Gordon botting about 6 years ago 67 years ago came up to me and he said in so many words our Adventist churches are not doing anything to help people with high blood pressure we don't have a specific program to deal with high blood pressure why he thought this was a concern as he went throughout the conference he saw that we would often do these health screening events and he noticed there was one common denominator at every health screening event that he attended and what was it a blood pressure checks or identify all these people with high blood pressure and then he said what are churches don't have any program to invite them to so he invited me to. Actually film a series of presentations so we filmed 31 hour presentations we called it reversing hypertension naturally we partnered with a number of ministries like we mar an amazing facts in the production and that's been available like I said for about 6 years we said though something more is needed especially churches that are interested in this and for health professionals and a couple of years ago Greg Steinke Dr Greg stanky Trudy Lee and myself came out with this book 30 days to natural blood pressure control now some of you are here because you have a special regard for Dr stanky as I do you saw in the program that he was going to be here with me unfortunately he's actually not able to be here so I'm pressing forward without him he recently requests relocated from the northwest to the college D.L. Tennessee area and he's keeping busy on the home front we said we could limp along without him and of course they accuse me and out if you don't like something that happens in the seminar I'll just say well that's because Dr stanky was in here OK More recently. There's been a change in the blood pressure guidelines we're going to get to that in just a minute but I'm going to tell you one other obvious thing about epidemiology I say obvious because I'm speaking to health professionals It seems that many laypeople don't seem to realize that it really does make a big difference to get their blood pressure numbers down after all they feel the same whether their blood pressure is $170.00 over 100 or whether it's $130.00 over 80 but it makes a huge difference just one example to illustrate the obvious and that is regardless of our age getting our blood pressure down will dramatically increase our risk of a stroke decrease Yes thank you for correcting me that's why I like audience participation yes will dramatically decrease your risk of stroke OK OK Message Number 5 now this is something that a lot we we could spend all day talking about this I don't think would be particularly useful but I want to give you some insights into why I think there is controversy in the medical world about what guidelines should be for high blood pressure so we'll try to give you a really a quick overview but here's the key message that I want to give you I actually think the confusion about blood pressure guidelines is an opportunity for us to educate people about high blood pressure in fact I believe it's priming lay people and professionals for messages about non drug therapy for high blood pressure so follow along with me over the next few minutes if you can understand this rationale and it makes sense to you this is something that you can use in your educational efforts So let's step back to the joint National Committee report back in 20 was effective through 2013 we called GNC 7 so they would have these panels that would convene and put out these guidelines we had Jancee 1234 all the way up through Jancee 72013 Jancee 8 came up a chance to see 7 guidelines it pretty much for accepted worldwide. For a decade and you can see the guidelines that they were using So basically they wouldn't call someone hypertension hypertensive until their blood pressure reach 140 systolic or 90 diastolic So those were the cut offs that were being used you can see they had a category that they called pre-hypertension they said normal blood pressures were here less than 120 systolic less than 80 diastolic Well things have been gradually changing this is even the World Health Organization this year I didn't look recently but they were still using the 140 over 90 cutoff but many expert groups have been pushing these criteria downward it's true in Europe it's true in the US you could see European guidelines pushing things lower especially for certain populations this was a few years ago then the big change came out about a year ago now and 2017 when. To argue as ations American College of Cardiology the American Heart Association along with a number of other organizations came out with a new set of blood pressure guidelines and they basically were going to label everyone as elevated if they were over this normal range OK hypertension Frank hypertension begins at $130.00 over 80 and there's been a lot of dialogue a lot of discussion about whether it's because some expert groups some specialty groups are saying no we're going to keep it 140 over 90 others say no we need to lower it so why is there controversy and I actually before coming in today I was looking at some different articles and and this debate is still playing out today and different groups taking sides here's why this is why I believe there's controversy to some extent and the elevation beyond your physiologically lowest attainable blood pressure is harmful OK. Once you reach a certain blood pressure level though lowering your blood pressure with medications can introduce more problems than it solves let's look at some data that underscores this this is actually the World Health Organization again remember they're sticking with a guideline of 140 over 90 as a cutoff but they will they will put right in the same publication that you begin to increase risk as your blood pressure goes up beyond 115 over 75 we've had data that really has. Indicated this for decades literally really suggesting that if we want to have the lowest risk we probably want to systolic blood pressure of 110 or lower diastolic 75 or lower one of the datasets that you may have heard of is the multiple risk factor intervention trial or mr fit this brings us back a number of decades and you can see here I mean very good data the asterisks actually are showing you differences that are not statistically significant and so the point here just to make it practical if you can't read the fine print by the way this is an advertisement for doctors of a Tama tree that are here if you can't see that you're supposed to make friends with one of them and schedule an appointment but look here this is looking at this is desk so it's divided the population into 10 percent pieces if you will and you can see those with systolic blood pressure is less than 112 that's the darker red bar you can see by the time you get up to a blood pressure of 118 you're increasing your risk of heart disease death by 30 percent and that is statistically significant So going from 112118 you're dramatically increasing your risk of heart disease death. I mean I think that's quite stunning when you think about where we're looking so you start looking at stuff like this and you say well we want to get our blood pressure as low as possible no some of you realize we walk down the same path with diabetes right and if you look at the population the lower your hemoglobin A one C. that average marker of blood sugar the less risk you have of things that go along with diabetes the better off you are but the problem is we don't give people insulin and oral medications or other injectable medications to get their hemoglobin A one C. down to 5 Why don't we do that because it increases complications it increases deaths so just what is good in a natural state is not necessarily good when you're medicating people so adding medication changes the equation when J. and C. 8 came out they did not take the position that the expert panel took last year and one of the reasons why is for data like this this is actually one of the studies it's quoted in J N C 8 and what you're looking at here are 2 of the very best tolerated classes of medications when it comes to high blood pressure the angiotensin receptor blockers and the ACE inhibitors one drug from each of those classes and what you look at here is yes if your blood pressures in the one sixty's getting it down will decrease your risk this is about it there's a logic to the study following people over a span of about 5 years and you can see they're looking at end points that include cardiovascular death heart attack stroke or hospitalization for heart failure what do they find they find that with medication therapy as you lower blood pressure you lower your risk of these events until what happens once you get down around 130 then what happens your risk of these endpoints actually increases. This is not a unique study I was just looking at a recent paper a few weeks ago same kind of data you increase medications in certain segments of the population at least and actually they increase risk now you say well how does this help us what I'm trying to help us see is the reality 2 realities one the better we can get our blood pressure naturally the more desirable but adding medications to the equation medications seem to lose their benefits around 140 over 90 at least for some people and surely and most people by 130 over 80 OK that's that's kind of my take on where we're at today and say I've got some of end stage renal disease we're trying to keep their systolic blood pressure under 120 and OK I mean individualized things but if you look across the board this is what the concern is so if that's one rationale for why we can tell people yes why there's confusion why you're confused why this one doctor said one thing and someone else is telling you something different if your primary care provider like me an internal medicine specialist and someone comes as a patient confused you can explain to them Well here's why The lower you get your blood pressure naturally the better but if we add drugs they can increase problems in the controversy as well where does that balance send you know if they walk in with a blood pressure 170 over 100 There's no question you need to get those numbers down if they're 135 over 85 and I'm probably not going to increase your medications and how about if they walk in one town over 60 and we see this a lot in primary care practices people are getting over medicated because they walk into the doctor's office and their blood pressure goes up. They're not measuring their pressures at home but that's a whole other story so we really encourage people to get those measurements in a home setting or ambulatory blood pressure monitoring but that's a little bit more than we're able to surround today let's look at this 6th key message from epidemiology Why are people not doing well when it comes to high blood pressure control because that's what the data indicates just let's look at it for a minute this is us data and you can see we're doing a whole lot better than we were doing in the seventy's late seventy's into the eighty's were only 10 percent of Americans had their high blood pressure controlled it's up to 50 percent but no one would say that's good would you we wouldn't say 50 percent is good I mean some of you may be too far divorced from your medical school years but I was never happy with a 50 percent on any test right Will we be happy with that is the score in our population right worldwide it's even worse I mean we're actually doing you know relatively well you could say in the United States worldwide if you look at the higher income countries it's around 30 percent so not only is it a worldwide pandemic not as being redundant of course but it's a pandemic when it comes to the incidence in the prevalence of hypertension it's a pandemic when it comes to the lack of control we've got all these powerful drugs you say well you know they might not be able to get them in Tanzania we're not talking just about lower income countries we're talking about the high income countries of the world still very low rates of blood pressure control and so as a clinician is if just in my own practice and as you look at the literature it's pretty obvious what's going on it's the medication side effects that are keeping people from embracing our typical approach to hypertension which is medication based and you know this stuff common symptoms of high blood pressure medications what do you see. Yes if they're on a diuretic they're going to be going to the bathroom more often fatigue is common on many blood pressure medications dizziness uncontrollable cough exercise limitations sexual dysfunction and depression and when you compare that with typical symptoms of untreated high blood pressure what are you looking at on that side of the equation that's right there's nothing I remember a woman some years ago she came into my practice she knew that we had a reputation for getting people off medications for high blood pressure she had been diagnosed about 6 or 8 months earlier she was seeing another physician and every drug that she was put on she had side effects from she felt fine Do you understand she felt fine with her diagnosis of high blood pressure but every medication added it's complications and so after about 6 medications she was in to explore non-drug approaches to high blood pressure some really interesting statistics if you look at medications that are used to treat high blood pressure this data from the journal Circulation if you put someone on a beta blocker to control blood pressure now these are not considered 1st line drugs for blood pressure anymore if you're not aware but if you put them on a beta blocker the only reason you're putting putting them on atenolol or metoprolol is because they have high blood pressure the odds are less than one in 3 that they will still be on that medication for their high blood pressure a year later so even the best tolerated drugs the ACE inhibitors the N.G. Tensen receptor blockers What do you see you see that just over about a year's time a 3rd to a half of people are not going to still be on those medications so the message is that we are. Identifying important risk factor we screen for high blood pressure most of the people that we screen especially a screening event they feel fine then we put them on medications that make them feel worse is it no wonder that we're not doing too well when it comes to high blood pressure control so the question is is there a better way is there a better approach and really what I'm arguing for is that there really is a no pressure solution type blood pressure and of course we're not talking about no pressure trying to get them to 0 over 0 right that's not our goal I have no interest in the mortuary business but no pressure is I'm no monic that we've been using in our educational efforts to try to help people remember 10 areas that can help them with blood pressure control so here are the 10 you could say well this looks like other acronyms that we've seen nutrition choices beverages physical activity or exercise rest environment stress management social support natural agencies that can be used refraining from pressers excesses and exercising faith in God So this is a construct that we've been using for a number of years now in especially in community efforts but also with individual patients now I've been making a case for a huge amount of interest in this I'm telling you that the public is anxious to have this and so to look at some actual data hard data where do you find hard data as far as what the public is interested in when it comes to blood pressure is there any way that we can put our finger on the pulse of what people want to know if they have high blood pressure well one placing goes to Amazon What are people purchasing if they have high blood pressure right. So I went early this week on to Amazon here is the Amazon high blood pressure best sellers and what you'll notice about them what you'll notice about them is every single one of them is a lifestyle book and so you might even say Well that's a blood pressure book I don't know how Amazon Amazon changed how they rank books in the hypertension category I've been watching that being a hypertension book author but Why We Get Fat will definitely there's a connection between obesity and high blood pressure but how they categorize it under high blood pressure or the Kito genic diet or Sugar Busters The Case Against Sugar yes we would agree all those things have a role in hypertension but a lot of them are using the DASH diet Dietary Approaches to Stop Hypertension that's this this and this book these are all based on the DASH diet but all of them you can see are lifestyle books it's not the Mayo Clinic guide to choose the best blood pressure medications so the populous is saying we want we want natural strategies for high blood pressure and we as physicians are trying to do what we're trying to give medications right now say no we're trained to educate and lifestyle we're 7th Day Adventist health professionals but the problem is on those short visits sometimes we feel our only option is to give a medication I'm not saying it's wrong I medicate people of if someone walks him a blood pressure of 200 over 120 I don't tell him that change their diet and go out and exercise you understand so I mean we need to get those numbers down especially if they're dangerously high but lifestyle is really what patients are wanting so. Let's look at these 10 steps before we do so you might be saying OK well this is all interesting. I'm supposing And again I'm putting myself in your position hopefully you're supposing that there really is evidence base for all of these points and there are but you say does this approach really work and so I want to just look look with you at that question briefly. Our book came out a couple years ago we have 4 D.V.D.'s a compliment and so we have community groups and churches that are using these resources to put on a 48 week program and we've tried to make the barriers for participation very low people don't have to go through a training they don't have to be in any kind of formal database so we rely on people sharing data with us in order for us to draw any conclusions but this is a small series These are 3 different community programs that have shared their data with us using the curriculum that we're talking about and what I want you to notice is if you look at the individuals who had blood pressures systolic of 140 over greater There were 25 in those 3 programs their average blood pressure at the start of using these that natural pro-choice 157 and a half and you can see at the end of the 4 to 8 week program it's a 30 day program but some churches and community groups stretch it out over 8 weeks because there's 8 modules in the program you can see here an average drop in blood pressure of 17 points to stock and about 8 points diastolic so. If you do much in the public health arena so I have a master's in public health I'm also boarded in preventive medicine and Lord willing in a few weeks I will be at one of my regular stops during the year which is the American Public Health Association meetings actually they're meeting not far from here in San Diego this year so I will be there and I'll be talking a lot about public health and about translational research so if you're not familiar with that concept there's a lot of basic science research there's a lot of clinical research that happens but what people in the public health field are saying is we don't really care if if you can lower blood pressure you know on this and this example with this drug we want to know if people actually use that drug and here too it will make a difference in the population will providers actually prescribe this medication so you know come up with this new magic drug X. Some people are experimenting with things like we call them poly pills maybe you've heard about this because what we know about hypertension is the more pills you're on the less your compliance will be and so if you're on 5 drugs for high blood pressure the likelihood that you're going to take all of those 5 blood pressure drugs is incrementally decreased relative to if you were just on one or 2 drugs so one of the solutions one of the strategies now is let's put you know 43 or 4 drug classes in a single pill and we've been doing it for years with diuretic so put a diuretic in with the beta blocker or a diuretic and with the ACE inhibitor or whatever but now they're wanting to put multiple drugs in and it may make it here it's better but it actually makes it much more difficult to do what we call step down therapy because what we're seeing is if you can get people to get on a better lifestyle then you can start backing off their medications you put them on a single pill that has everything in it well how do you do that. Anyway so Translational Research says how do we take what we know. And put it into effect of this and what I'm saying is really transition transit translational research if you will takes place maybe not formal research what takes place in your clinic in your office because what you do what works for you what can help your patients what can help your community get these numbers better than just visiting with a number of you here at these meetings I've heard terms like the blue zone some of you were at the A.C.L. our meetings earlier this week and actually one person was saying they were there and. Dr A T. Cullen Campbell who many of you know from the China die at China Study He was extolling Ellen way before the audience and he's not a 7th Day Adventist I was last week actually up until yesterday we flew out of Denver I was at the National Congress of American Indians and believe that even believe it or not even in that venue Seventh-Day Adventists actually have a very high profile the this is the largest. Political body of Native Americans and it's the oldest They had their 75th anniversary meeting it's still going on in Denver but there's been a very strong Adventist lifestyle presence in their community because of some some proactive 7th Day Adventists and the past president of the National Congress of American Indians is a 7th Day Adventist Brian Clough to speak but my point is simply that the world is turning their attention to the admin is telephone message they're interested in what God has given us and I don't think that in our lifestyle approaches we have to be a shame that we're 7th Day Adventists are feel that we have to hide that well you say has a C.M.E. event so why would we look at something that Ellen White said years ago. Well because we're talking about putting things into practice and I believe some of the best insights into how to practically implement things actually come from the Spirit of Prophecy in medical ministry Ellen White is quoted saying this she of course didn't write medical ministry it's a compilation she said I am concerned because so many things engage the minds of our physicians which keep them from doing the work that God would have them do as what evangelists who thought about that one lightly Actually I've been thinking a lot more lately and even though I guess a lot of people would say I've done a lot of health of evangelism over the years Laura has been impressing me that I'm I'm there's still more that I need to do in these lines and. I'm actually in the process of stepping away from the clinical practice where I've been working for those of you that know where I've been at I submitted my resignation a week or 2 ago and as of December I'm trying to free up more time to do health of Vangelis in the service and I will this is really strange Are you trying to say we all should leave our practice is no I don't think you all should leave your practices but I'm saying corporately we have a calling and why I'm telling you this when it comes to high blood pressure I'm going to show you some preliminary data that suggest that what we have spiritually to offer also can increase the efficacy of what we're doing when it comes to high blood pressure I'll speak about it more in the next hour but really I want to give you a challenge. We don't you just leave with a little bit better grasp of epidemiology as it relates to hypertension worldwide but I'd like to challenge you that before next year's Amen conference which is scheduled for Colorado that you somehow become more active in health of evangelism OK you know let me challenge you that way so you may feel you're already engaged enough will pray and because I think we're I think we've got an opportunity as a church and as believers to do something the world is more primed I think than ever before to hear what we have to say. We've got a bunch of things that can help you do that that are FREE OK compass Health dot net is my website and if you go there some even taking pictures of the slides many of these slides are available free compliments not only of compass health but also of the North American division compass Health dot net slash health Sabbath if you can't get to it through some of the clicking if you just actually take a picture of that I don't know did you know this every year the North American division has a health Sabbath and maybe maybe the General Conference we have you sponsors it but we have a health Sabbath it's in February and every year they provide resources and scripts so that a pastor or health professionals in a church could do a health sermon and so the featured topic for health Sabbath in 2018 was on heart and high blood pressure and one of my co-authors Trudy we she actually adapted our materials and provided power points and scripts so much of what we've been looking at and much much more is available free of charge compass Health Net slash health Sabbath will redirect redirect you there to health ministries they want to you just tell us just go to the end of the website because when I tell people to go to the any of the website they can find it. OK so. But if you can navigate Either way through through my website or through health ministries and just trying to give you tools if you want to give a presentation yourself the slides are all there there's no charge for it you say well I don't have time to talk with pay with patients or lecture patients much I am I'm not in a specialty that really lends itself to that we've just put up this year free videos 30 day program they don't need to buy a book they don't need to watch any videos in a church setting or community setting we called 30 Days to natural diabetes and high blood pressure control and a little bit more history one of the things I'm doing in Indian country that's how we speak about working with Native Americans in Indian country I have a grant right now that's working with diabetes among Native Americans and what we're finding is that the same messaging that relates to high blood pressure relates to diabetes and so we have these 5 or 6 minute modules 30 of them on You Tube you can access them through You Tube or you can go through Facebook and it's basically me giving some encouragement to people to improve their lifestyle so those are some free resources to help you and your health of Vangelis and resources in Your Health of evangelism outreach OK So we've got a lot more stuff in our free materials section on the compass Health website but we will hasten on to give you some of the high points. Of the 2 topics that lead off these are the videos that are used and by the way since it's a C.M.E. event we're not just talking about one approach what I'm trying to help you see is that Adventist lifestyle programs and we look at admin as lifestyle programs whereas the one that I've been working with or whether you look at the complete health improvement project that Dr Deal launched in that now is under the umbrella of sanitarium in Australia with a look at Dr net lease program whenever we look at the data from programs that use our advocates health message that it's compelling I mean that the Lord gave us stuff that is cutting edge material and some people say well Dr Drew yes you could show us all this data but there's recidivism you know people are going to follow this and I'll go through a lifestyle program at the church or we'll even do a something in our in our our medical office and then some of the patients will continue to follow and you know it's very interesting to me as a public health professional that I don't hear people using that argument much when it comes to medications no one talks about recidivism we put them on a beta blocker for high blood pressure OK so why would we withhold the best treatment just because we think a lot of people will follow it some of them will some of them will. Now this is still in the realm of continuing medical education we can speak more about this because people say well the spiritual I mean you don't talk about that in a C.M.E. event because that really doesn't relate that's that's how we try to bridge people from the health of vent to to Jesus went to Bible study. Well we have 2 resources that we use in the hypertension series to help bridge people to spiritual interest this spiritual health neglected dimensions is a series that Greg stanky and I did and we'll talk about that in the next hour if you're interested in it if you're not interested in it I'll still talk about it the next hour OK You just probably won't be here but then we also have this series called Healing insights from the Gospel of Mark you so you know how does this relate to efficacy of programs just let me give you this is a manuscript that we recently submitted to a journal I won't mention the journal name and we entitled it spirituality is a component of complimentary approaches to high blood pressure control does the nature of the spiritual intervention make a difference report from a case series Why found out that this particular journal didn't like a series and they rejected it really all I could figure out was for that reason they were very upset that we didn't do a case a prospective study but this is an observational study it wasn't something that we designed a couple of years ago my wife and I were invited to go to one of our administration centers in the Czech Republic Very are in the process of translating the book into Czech and they wanted us to do a couple of one week programs at their facility this is their facility but an hour outside of Prague the Czech Republic so as we were there we delivered the program twice but and I may tell more about why we did it this way but we actually use the spiritual approach in our book for the 1st week and the 2nd week we used a different spiritual approach that was more based on the great controversy the 1st virtual approach was based on the Beatitudes. And this is data from the 2 programs combined It's really similar only a one week program you can see statistically significant changes in systolic and diastolic blood pressure this is without increasing medications and you can see about a 10 point drop in systolic 7.6 point drop in diastolic blood pressure but what was really interesting is when we looked at this be attitudes based model which is what we used in the book and we compared to what you say maybe a great controversy might also is another spiritual biblical model was there a difference and you can see it was amazing difference the differences were statistically significant about an 18 point drop in blood pressure average blood pressure and those who did a model spiritual model based on the Beatitudes those who did the other spiritual model you can see here much less remarkable changes and you say whoa that's very interesting we'll talk more about that in the next hour but I put it up here because a lot of us have gotten in this mindset that the spiritual dimension really doesn't. Necessarily have all that much to do with the physical dimension as far as the outcomes and the reason why some of you might be saying no I don't agree with you but really if you think about it all of the data that we look at in the literature almost always has the Spirit has no spiritual component to it right so you look at an exercise intervention it's not combined with exercise and prayer I mean there are journals and there are sources that are looking at the spiritual element but I'm just saying we can't let the spiritual element slip off the screen say this isn't medical This isn't something that we need to be looking at I think it does and I definitely think it needs more research but our interventions we do them in the advantage sure I think one of the things that gives them efficacy is not just not just the fact that we're basing them on sound physical and physiologic principles but we're also bringing a spiritual element in both in our praying for our patients praying for a community members praying for participants and also the spiritual elements of the intervention Well let me look with you just some examples in our last few minutes we did start a bit late and since the next speaker has graciously allowed me to run a little bit late yeah for those who didn't realize that is me will run just a few minutes late because I want to give you some high points from the 1st 2 we're going to be covering some of the other elements in the next hour so nutrition What in the area of nutrition can help us with our blood pressure we in our efforts have focused primarily on 3 areas and I want to highlight mainly the 1st one which is plant food consumption most of you are already directing your patients in to adopt more plant food choices some really amazing data I would say from the admin is tell a study this is a graphic from the current admin to health study H S 2. Some 90000 individuals in this data set that is being projected here and what I want you to notice if you haven't seen this particular graphic I mean it is worth a picture it's worth it by the way this is one of the free slides that we're offering you but feel free to grab that I think it's actually worth the whole hour that you've spent here or the 15 minutes however long you've been here because patients have been motivated by this single slide to change your lifestyle and what it is is basically showing you as you eat less and less animal products now this is what we call cross-sectional data so it's at a point in time but if you look at people who are on a vegan diet they have about one 5th the likelihood of having either diabetes or high blood pressure as compared to those who are on the average American diet so typical dietary practices make a huge difference it's huge you say well that's cross-sectional data there could be all kinds of things that are interfering with that that are confounding those relationships but a review a few years back you just look at any of the research out there and as you add more plant products to the diet and as you subtract animal products from the diet consistent finding blood pressure goes down whether someone is labeled as nor Motown's of or whether they are labeled as hypertensive and remember the goal is to try to get our blood pressure as low as possible naturally that's what the data is suggesting now the big biggest question I think in a lot of people's minds is why are plant food so powerful what is it that's helping to affect blood pressure lowering Well we could look at micronutrients magnesium calcium potassium and what we've done is looked at these things in some detail you look at the U.S.D.A. database you look at some of these things especially relative to the number of calories. Purser Ving and you'll see that whether it's magnesium whether it's potassium whether it's calcium you say you're going by that too quickly all those slides are by the way there in those free resources we have for you but. What it's showing you is the champions when it comes to micronutrients per calorie are plant foods that's right even with calcium it's not dairy products what about fight a chemical this to me is extremely interesting I would say fascinating many of the drugs that we have for high blood pressure work on this Renan angiotensin aldosterone system and whether this conjures up nightmares from medical school or nursing school or dental school or whatever discipline you're in where they've never seen it before and you're just here because your spouse wondering why you stuck your head into a class it's got a teacher is doing something that every speaking coach says never to do and puts up such a busy slide Well the reason the busy slide is there is to appreciate help you appreciate just how busy this system is if you don't remember but what's so interesting is one of the key components is this angiotensin converting enzyme that we tend to block with drugs are you aware that we now know that there are drugs if you will using the phrase lightly in quotes that are put in the in our plant foods by the Creator these ace inhibitory peptides with blood pressure lowering properties are found in soybeans and mung beans and if you like a graphic maybe better than looking at just a quote Here's a graphic here with some of the foods that have been identified as having aces inhibitory proteins so when you're eating spinach you're helping to lower your blood pressure when you had that peanut butter was lowering your blood pressure the garlic the rice the wheat the chippies these foods all have these compounds that help lower your blood pressure. And you don't have to worry about going into shock from eating too many of them really get too much of pharmacologic agents but not too much of these well weight control sodium control very important from my work with Native Americans it's been underscored many times the community impact and social determinants of health a big topic in the public health community really what I'd like you to think of yourselves as Don't just think of yourselves as practitioners don't just think of yourselves as church members think of yourselves as agents of change in your communities what the research is showing us and we'll look at some more of this in the next hour is that actually some of the most powerful things that affect chronic disease risk in communities are community values community practices and this is why we need churches to be citadels if you will of healthy living in their communities and we'll talk more about that in the next hour or so. We're going to hasten on their salt is controversial but most of data is pretty compelling that for a significant percentage of hypertensive salt restriction can dramatically help them and dramatically decrease their risk of cardiovascular complications and of course the good news is or tastes change if you're looking at your watch we're going to take you know we're going to do we are going to take our official break I know it is. Right on time and what I'm going to do I'll start with beverages in the in the next segment so we're going to give you a 10 minute break or an opportunity to graciously leave if you have any individual questions I'm happy to talk with you and let's close with a word of prayer though OK Father in heaven we want to thank you for the privilege you give us of being your children. And you are have been so anxious for decades yes for what over 150 years to shine a light on our path to try to help us help our communities help our patients help our families of why the ravages of diseases that you're wanting to mitigate Please Father help us to understand better what you want to do for individual patients for our communities and for the world and most of all help us to know how best to do it in a way that ultimately results in souls in your kingdom we ask in Jesus' name in this media was brought to you by audio verse a website dedicated to spreading God's word through free sermon audio and much more if you would like to know more about audio verse or if you would like to listen to more sermons leader Visit W W W audio verse or.

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