Dr. Ellie Campbell discusses the Importance of Checking Blood Pressure - expert tip video(Seattle Study Club)
Video Transcription:
Hi everyone at Seattle Study Club, I am Dr. Ellie Campbell and I am a board certified family physician here to talk to you about oral and systemic secrets for blood pressure success. Because medications are not the only way to manage hypertension and dentists have a huge role in helping me as the primary care provider keep patients blood pressure under control. I have a few disclosures, I've been a paid speaker, I'm a stockholder in a couple companies and I just wrote a book that's going to be released on Amazon November 14th of 2023. So in my opinion, heart attacks are optional, strokes are stoppable, and dialysis is not your destiny.
And we can achieve this only by respecting oral and systemic connections. I'm double board certified in family medicine and integrative medicine. But each of you too is a hypertensive expert because we are all tasked with collecting and reviewing vital signs on each patient we're about to see. Optimal blood pressure control is critical to patient safety in the dental operatory and I checked it wrong for years and you probably are too. So these are our three learning objectives for this little time we have together today.
How you're measuring blood pressure wrong, a couple of hidden root cause contributors to hypertension, and some natural remedies for high blood pressure that you can correct right in the exam room. So remember, I'm not a dentist, but you can still listen to me. Blood pressure control is critical because cardiovascular disease is the number one killer in our country for men and women. Seven times more women die of cardiovascular disease than breast cancer though. That's what we worry about.
But blood pressure is a major contributor to cardiovascular disease for both genders. It's a contributor to all of the number 4 of the number leading causes of death from heart disease to stroke to kidney disease. And of course in our COVID pandemic the last few years, hypertension was a major contributor. So heart attacks are optional if you know how to prevent them and you're willing to do the work. And we have far more power to control our blood pressure than most people believe.
You make the difference for your patients and you can give them at home strategies that will lower their blood pressure. Please don't just send them back to the PCP and forget to empower them with all of the do it yourself blood pressure secrets that you know about. So let's start first with the fundamentals. Do you know what normal blood pressure is? Because it keeps changing.
Certainly. When I was in residency we were allowed 160 over 90 and we didn't even treat that in seniors, but now we call an elevated blood pressure anything above 120 over 80. And notice the change in nomenclature. That used to be called pre hypertension. Now we just call that elevated blood pressure. And stage one hypertension begins at 130 over 80, much lower than it used to be. So did you catch that? Anything? 119 or 79 is too high. A120 80.
Blood pressure is high now. And what if I told you you're measuring it wrong? Well, we have seven rules from the American Heart association and the American Medical association of how to accurately check blood pressure. I wasn't following them because I didn't know what they were. And you probably aren't either.
Inaccurate measurement leads to false diagnosis of hypertension, and nobody wants that. So these are the seven rules. And I think it's kind of a busy slide, so I tried to make it a little simpler. I like mnemonics, so I came up with this one called Equus cvs. These are the seven rules.
Start with an empty bladder. Quiet. No talking. Uncross your legs. Support your feet and back.Use the correct blood pressure cuff size. Put it on a bare arm that's supported. So let's go over each of these a little bit and show how much they can affect your blood pressure. In my office for years, we would tell patients to come in the exam room, get their vital signs, and then go empty their bladder for a urine specimen. And that's wrong.
We do that differently now because having a full bladder can raise your blood pressure 10 to 15 points. And if your bladder is so full that it hurts, that elevation can last for three hours. So we don't want to do that to our patients. We want to make sure that they empty their bladders before we check their blood pressure. No talking, not even active listening, because listening to that very interesting medical conversation that that receptionist is having or that's going on in the next room can raise your blood pressure 10 or 15 points.
So can chit chatting with the medical assistant about how the kids and the dogs are. So no talking, no active listening for at least five minutes before you check your blood pressure or you'll get that elevation of false 10-15 millimeters mercury. Uncross your legs. This is very important. Uncross your legs and your ankles.
Straighten those legs. Keep the feet on the floor or on a step stool, because crossing your legs can add 8 millimeters of mercury. You must sit in the chair with your back to the back and your feet on the floor. Bottom to the bottom, back to the Back feet on the floor. If not using those back muscles can add an extra 5 to 10 millimeters of mercury and no dangling feet.
This is a challenge for those of us who are vertically impaired because on most chairs I can't sit with my back on the back and my feet on the floor at the same time. In order to get my blood pressure measured properly, I have to request a footstool. And never in my life has a doctor ever offered me a footstool to check my blood pressure. But that's the proper way to do it. According to the CDC's new guidelines, if you dangle your feet while you're seated, then you can add 10 to 15 millimeters of false points to your reading.
This means not measuring blood pressure with the patient sitting on the exam table, nor lying vertical. Which is what many dentists will do is put them in the dental chair lying down and then check their blood pressure. That's a mistake. Want to choose the correct cuff size? There's a lot of details about that, actually measuring the cuff until you get used to it because a cuff that's too small can raise the blood pressure 40 millimeters.
Back 30 years ago, we never needed a long adult sized cuff. The extra large cuffs are very wide and many people don't have a wide enough arm to accommodate that extra large blood pressure cuff. But Welch Allyn does make an adult long that fits around the larger girth arms without covering over the humerus. So get that extra blood pressure cuff in your basket. That's adult long size.
Bare arm, not on clothing. If you're wearing a sweater. And check the blood pressure over the top. 40 millimeters mercury arm should be supported at the level of the heart, never hanging at the side. If you fail, support the arm.
You can get 10 millimeters of mercury. If you add two or three of those mistakes together, according to some experts, you could put yourself in a whole other category of risk. So learning those seven American Heart association tricks for you and your staff can get the most accurate data to help you in your care plan. So this is my mnemonic equscbc. Empty the bladder, be quiet, uncross your legs, support your back.
Correct cuff size, bare arm, supported arm, and you are up to date with the CDC 2017 accurate blood pressure measuring guideline. All right, so now you can be a superhero. Because no cardiovascular prevention program is complete without a dentist and a hygienist regularly checking blood pressures. What are some hidden triggers of hypertension? In my practice, the things I see the most are micronutrient Deficiency or micronutrient excess.
Specifically magnesium, potassium and zinc, but also copper, fish oil or omega 3b6, b12, b9, vitamin C and vitamin D, and of course fiber deficiency. Fiber, fiber, fiber. It's lacking in so many people's diets. We need to have that good bowel function. If we tend to run constipated, our blood pressure tends to go up.
Also, micronutrient excess can lead to hypertension. Too much sodium, Too much. Many people are sodium sensitive and that will raise their blood pressure. The cardiologists are very quick to tell everybody they need to be salt restricted. My experience that is not true that there is a select percentage of people who need to be salt restricted.
But many people who think they're salt sensitive become sodium tolerant when they're replete of magnesium, potassium and zinc. Too much calcium, too much selenium can also raise your blood pressure. So there's a little bit of an art to it. But if you as a dentist recommend your patients be supplementing with magnesium, potassium and zinc, a multi mineral supplement, you'll likely improve their blood pressure. So let's look under a rock for the number one hidden risk factor to the number one killer in our country, and that is the mouth oral health.
Oral health is so contributory to hypertension. I missed it for years, that oral systemic connection. And once I started paying attention to this and I started referring more regularly for periodontal disease and endodontal disease, that's when I got to the point where I have had zero heart attacks or strokes in any of my patients in the last six years as long as they follow our protocol. And that includes a very, very aggressive relationship with the dentist. We know that at least 10 different species of oral flora can raise your blood pressure 10 to 15%.
And this includes Campylobacter, bilinella, pro Vitella and others. We know how to balance gut flora will raise your blood pressure. There are stool tests that we can do. I believe every hypertensive patient should have a salivary diagnostic test looking for oral pathogens. A test periodontal disease.
And do not annihilate the healthy flora with chlorhexidine that's been proven to raise blood pressure low. Nitric oxide. The rate limiting step in the production of this miracle mouth molecule is nitric oxide synthase. And while it's made by endothelial cells, macrophage and kidney cells, it's also made by commensal bacteria in the crypts of the tongue. And if you're not supporting the friendly Flora using oral probiotics, you are not going to get enough nitric oxide and the blood pressure is going to go up.
You can even as a hygienist use nitric oxide test strips in the dental chair to check to make sure nitric oxide is adequate. Sleep disorders lead to hypertension so much in my practice. Bruxism, sleep apnea, upper airway resistance syndrome, these can all cause hypertension. And now home sleep testing is easy and can convenient and it can be offered by the PCP and in some states even by dentists. So we know the many roles of nitric oxide.
I focus mostly on the cardiovascular system, vasodilation, platelet aggregation, microvascular permeability. I wanted to share this case with you. The 64 year old black female was referred to me by her dentist who said her blood pressure was too high for them to treat her. She had severe periodontal and caries disease but had not been to a medical doctor or a dentist in over 10 years. So they wouldn't proceed because her blood pressure was 190 over 120 in their office and it was still 183 over 115 in my office with no symptoms.
So I started her on a calcium channel blocker and recommended we start a workup. So I wanted to check her for micronutrient vitamin deficiencies, assess her for cardiovascular disease and chronic kidney disease. I want to do a carotid intimidiate thickness, a coronary calcium score, advanced cardiometabolic lab workup. This is all the routine things I do in my office. But while we're waiting, I wanted her start on Revitin toothpaste and StellaLife mouth rinse because this will help reduce her pathogen load and enhance her nitric oxide production.
I got a portal message from her nine days later and she said, I don't know if you have time to even read this, but my blood pressure is now 131 over 87. That toothpaste and mouthwash really work. Thank you so much. And so I've been using these products more and more in my practice to try to get at least temporary control of things while we work on the big picture and work with the dentist to get that periodontal and caries disease under control because we'll never have long term control if those are not adjusted. So let's go back to blood pressure in your chair.
I need help right now. The patients in my office were at the threshold. Depends on whether you follow the ADA or the aha. American. American Medical association and American Dental Association.
Different thresholds for when you can safely proceed. But what can you do? I'm going to teach it three things that will lower blood pressure by 10 to 40 points in under five minutes. There's breath work, acupressure points and meditation. So breathing like an old fashioned scratched LP radio record for those of you who are old enough to recognize those LPs.
If your patient is stuck in sympathetic nervous system overdrive, they're locked in a fight or flight state, they're going to have high blood pressure. And if you don't kick in their parasympathetic system, you're not going to get that under control. They're running straight into the path of a heart attack or a stroke. And proper breathing can help reboot that and kick in. Parasympathetic control.
My personal favorite is in and out. Five seconds in, five seconds out. Do that for five or 10 repetitions. You can often lower their blood pressure in seconds with that trick. Some experts recommend the exhales a little longer.
Instead of five in, five out, it's five in, six or seven out. And that also improves heart rate variability long term. And, and it's sustained. The better you practice, the longer your blood pressure stays under control. Navy Seals use this box.
Breathing in for five for four seconds, hold for four, out for four, in for four, hold for four. And when we do this in, hold, out, hold dramatically improves both their calmness and their alert status. Main thing is to understand that breath work techniques change blood pressure control control by altering the vagus nerve and up regulating the parasympathetic nervous system. I've also had training in acupressure and acupressure. No needles are required.
Our ancient healers have recognized these meridians that communicate signals from one place to the other. You can use an orange stick or an ink pen to stimulate these pressure points with no needles required. Recognize if your patient's blood pressure is 1, 180 over 120 and they're having symptoms. This is a 911 emergency. Don't try any of this in the office.
Send them on. But pericardium number nine. I call this the middle of the middle. And if you use your orange stick or ink pen to hold pressure for one minute, this will often lower blood pressure. So that's pericardium 9 on the picture or the middle of the middle.
The top of the foot is liver three. This is a little different technique. Deep pressure for three seconds, rest for five. Deep pressure for three, rest for Five. Do that massage for about two minutes on the top of the foot.
I don't know how often dentists take off shoes and socks, but you can use that liver three point if necessary. And then meditation. Five Minutes by Honest Guys is one of my favorites. You can turn on this meditation, turn off the lights, have the patient be quiet, give them five minutes, come back in, and then very often their blood pressure will be 5 to 40 points lower. So Kaiser Permanente has some great meditations.
These are more for home use than in the exam room because they're a little longer than five, but they're very helpful. So I hope we taught you today seven things that the AMA teaches us. How to properly measure blood pressure, two hidden triggers, micronutrient deficiency and oral health. And three rapid remedies to lower blood pressure in your dental office. Breath work, acupressure, and meditation.
That's my team here at Campbell Family Medicine, and I'd love for you to reach back to me and give me all the amazing results for all the things that you've gotten. You can inspire your high blood pressure patients who are struggling to get control and reduce the burden of the number one killer in our country. That's the QR code to order my book. If you want to read the Blood Pressure Blueprint now on Amazon. And we are done.
Thank you for your attention. I'm Dr. Ellie Campbell for the Seattle Study Club. Thank you for watching.