Hypertension Education Program

Speaker 1: The material contained in this video presentation provides general guidelines on the management of hypertension. For specific information based on your health condition, Please see your medical provider.

Dr. Damian Hane...: Hello. My name is Damian Hanekom. I am a medical doctor board-certified in family medicine, and today [00:00:30] we're going to be talking about high blood pressure.

A lot of people have a question about, what is high blood pressure?

Now blood pressure by itself is the pressure of the blood against the walls of the arteries in your body. When this becomes high, it can cause damage over time and lead to health problems. And this is known as high blood pressure. As of 2021, the CDC did a survey and found that almost 50% of adults in the United States actually have high [00:01:00] blood pressure. So as you can see, it affects almost one in two adults and is quite common.

Blood pressure is written as two numbers. The top number, also known as systolic, is the highest blood pressure against the walls of your arteries when your heart is beating. The lower number, also known as diastolic, is the lowest pressure of the blood against the walls of your arteries in between heartbeats. Blood pressure oftentimes does not [00:01:30] cause symptoms, which is why it's commonly known as the silent killer. By the time it causes symptoms, oftentimes the damage has already been done.

The definition of high blood pressure has changed over the past several years. Previously, high blood pressure was considered a blood pressure higher than 140 on the top, or systolic number, or greater than 90 on the bottom, or diastolic number. Newer guidelines have now listed the definition of high blood pressure [00:02:00] as a blood pressure greater than 130 on the top, or systolic number, or a number greater than 80 on the bottom, or diastolic number. These definitions were changed after a direct linear relationship was found between lower blood pressures resulting in better health outcomes. And so essentially the lower your blood pressure, the better you'll do as far as your overall health.

Many people wonder how does high blood pressure exactly cause damage? [00:02:30] Over time, if the pressure in your arteries is high, it causes stress and trauma to the blood vessels, which supply blood to all the important organs in your body. This can lead to end organ damage or damage of the organs supplied by your blood vessels, including, but not limited to your heart, your kidneys, your eyes, your nerves, and your brain. Some common things that people are aware of when our blood pressure remains high is [00:03:00] stroke and heart attack. These are two major serious causes of uncontrolled high blood pressure.

Who is at increased risk of developing high blood pressure?

The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65. High blood pressure is particularly common among people of African heritage, often developing at an earlier age. [00:03:30] Serious complications, such as stroke, heart attack, and kidney failure are also more common in people of African heritage. High blood pressure tends to run in families. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood flow through your blood vessels increases, so does the pressure on your artery walls, increasing your risk of high blood pressure.

People who are inactive [00:04:00] tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each beat and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight. Tobacco use, including chewing tobacco, immediately raises your risk of high blood pressure. But the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart [00:04:30] disease. Secondhand smoke can also increase your risk of heart disease and high blood pressure.

Too much sodium in your diet or too little potassium in your diet can lead to an increased risk of high blood pressure. Drinking alcohol, particularly heavy drinking can damage your heart and lead to an increased risk of high blood pressure. Having more than one drink a day for women or more than two drinks a day for men may affect your blood pressure [00:05:00] and lead to a higher rate of high blood pressure. High levels of stress lead to a temporary increase in blood pressure. Particularly, stress-related habits, such as eating more, using tobacco, or drinking too much alcohol, can lead to high blood pressure. Certain chronic conditions may also increase your risk of high blood pressure, including kidney disease, diabetes, and sleep apnea.

[00:05:30] What can you do about high blood pressure?

Get your blood pressure checked at least every two years, starting at age 18. At age 40 and older, get your blood pressure checked at least every year. Try to get at least 150 minutes of moderate intensity exercise per week. Moderate intensity exercise can be determined by a heart rate of 50 to 60% above your resting heart rate. Some common activities [00:06:00] are bike riding, mowing the lawn, swimming laps or playing tennis. Even a brisk walk. Eat a diet that includes foods high in potassium, magnesium and calcium. These are healthy salts. Limit your sodium intake. This is an unhealthy salt. Limit your intake of saturated fats. Foods such as dairy products, red meat, bacon or sausages, fried foods, egg [00:06:30] yolks, and foods made with butter contain saturated fats.

Now you're probably wondering, what actions should you take? Make sure to visit your primary care provider at least once a year to have your blood pressure checked. If you do have high blood pressure, make sure to discuss with your provider what your goal blood pressure should be, how often to measure it, and how often to follow up. Follow lifestyle measures. These [00:07:00] have been shown to prevent high blood pressure and many studies show they are as effective as a single blood pressure lowering medication.

It's important to understand that these are just general recommendations and that you should always consult with your primary care provider or physician about specific health recommendations for you. I hope this has been helpful. Thank you for watching.

Tess Bernstein: Hi, my name is Tess Bernstein [00:07:30] and I am a licensed pharmacist with Lee Health. Today, I will be talking with you about medications for hypertension.

Types of medications.

Types of medications include ACE inhibitors, ARBs calcium channel blockers, thiazide diuretics, combination therapy, and additional medications.

Angiotensin-converting enzyme inhibitors, also known as ACE inhibitors.

The ACE inhibitors allow tight blood vessels [00:08:00] to relax, therefore reducing pressure on your vessel walls. These prevent your body from producing angiotensin II, a substance that narrows blood vessels, which leads to an overall higher blood pressure. Common side effects with ACE inhibitors include: dry cough, dizziness, feeling tired or fatigued, headache, problem sleeping. And some examples of the ACE inhibitors include: lisinopril with the trade name Prinivil or Zestril, [00:08:30] enalapril or Vasotec, benazepril and Lotensin.

Angiotensin receptor blockers, also known as ARBs.

ARBs relax the blood vessels by a similar mechanism to that of the ACE inhibitors. These are commonly used as an alternative to ACE inhibitors and have similar side effects, including: cough, headache, sore throat, sinus problems, heartburn, dizziness, diarrhea, and potential [00:09:00] back pain. Examples of the ARBs include: losartan with the trade name of Cozaar, olmesartan or Benicar, valsartan or Diovan.

Calcium channel blockers.

Calcium channel blockers prevent calcium from entering into your heart and your arteries, which allows blood vessels to relax and open. Common side effects of calcium channel blockers include: drowsiness, headache, upset stomach, [00:09:30] ankle swelling, or feeling flushed or warm. Examples of calcium channel blockers include: amlodipine, with the trade name of Norvasc; or nifedipine, with the trade name of Procardia.

Thiazide diuretics.

Diuretics help your kidneys remove sodium and water from the body. These are sometimes also called water pills. Common side effects include: dizziness, fainting, frequent urination, [00:10:00] headache, and upset stomach. Examples include: chlorthalidone and hydrochlorothiazide.

Combination therapy.

Combination therapy are medications that are made up of two or more different blood pressure medications. Side effects are similar to those listed for each of the generic medications. Examples of combination therapy includes: ACE inhibitors or ARBs, plus diuretics. An example [00:10:30] would be lisinopril and hydrochlorothiazide. ACE inhibitors and ARBs, plus calcium channel blockers and diuretics. And this would include amlodipine, valsartan, and hydrochlorothiazide. And ACE inhibitors or ARBs, plus calcium channel blockers, including amlodipine and benazepril.

Additional medications.

Additional medications can include other diuretics, such as: furosemide, [00:11:00] bumetanide, or spironolactone; beta blockers, such as labetalol, carvedilol or nebivolol. They can include alpha-2 agonist, such as clonidine; alpha-one antagonist, such as doxazosin; or direct vasodilators, such as hydralazine.

Taking your medications.

Look at your prescription dosage carefully. Your healthcare team is likely to increase the dose over time until you reach [00:11:30] the target dose. High blood pressure often has no symptoms, so take your medication regularly to reduce the risk of having serious cardiovascular events. If you did forget to take your medication, take it as soon as you remember, unless it's close to your next dose. If it is close to your next dose, skip it and return to your normal schedule. Utilize a pill box or alarms on your phone to prevent future missed doses.

[00:12:00] Medication therapy management, also known as MTM.

MTM is a service provided by pharmacists to ensure best medication outcomes for our patients. In a one-on-one appointment with the pharmacist, patients will receive: a review of the entire medication regimen, including over-the-counter medications; an updated personal medication list; a medication-related action plan with specific steps to optimize your health; [00:12:30] and any recommendations for medication changes will be sent to your provider. To ask for an appointment, contact Lee Pharmacy at 239-343-2800. Thank you.

Erika Graziani: Hello. My name is Erika Graziani and I'm a registered dietician here with Lee Health. [00:13:00] And today I'm going to be talking with you about hypertension and nutrition.

So objectives for the day. We're going to review what sodium is and how it impacts our health. Sources of sodium and the recommended amounts. We'll look at the DASH diet, a little bit on label reading, and how to achieve a healthy blood pressure level.

Let's discuss how sodium affects your heart and your health. Sodium's a mineral in the body that's regulated by the kidneys. It's needed for normal muscle and nerve function, as well as keeping our body fluids in [00:13:30] balance. Sodium is found in a lot of foods and beverages, usually in the form of salt, which is essentially sodium and chloride. Sodium though can affect the body's ability to self-regulate your blood pressure. When you have extra sodium in the bloodstream, it can pull more water into the vessels, increasing the total volume of blood inside them.

So with more blood flowing through your vessels, the blood pressure increases. You can think of this in terms of turning up water supply to your garden hose, [00:14:00] as the pressure of the hose increases as more water gets pushed through it. So over time, this high blood pressure can actually overstretch and injure the blood vessel walls, which lead to quicker plaque buildup, which can also block blood flow. High blood pressure can increase your risk then of heart attack, stroke, or heart failure.

So what is the recommended intake for sodium? The American Heart Association recommends limiting our daily sodium intake to 2,300 milligrams or less. [00:14:30] However, even limiting further to 1,500 milligrams per day can be even more beneficial depending on your medical history. So what does this mean in terms of real-life measurements? Just one teaspoon of salt contains 2,300 milligrams of sodium. That means just one teaspoon of salt a day, and we've already met a recommended amount of total sodium in a day.

Now let's discuss the different sources of sodium. Of course [00:15:00] we have table salt and different gourmet salts. Now, there are only moderate differences in the sodium content of different types of salts. And this is really due to the volume and shape of the crystals. For example, kosher and sea salts have larger crystals, which means they take up more space. So in theory, they're lower in sodium by volume standards. However, biggest take home point. All these salts contain a lot of sodium, especially keeping in mind that ideally it's less than 1,500 milligrams a day. Just a quarter teaspoon [00:15:30] of table salt is going to give you 575 milligrams of sodium. If you pay attention to the other things up on the slide here, such as cured and smoked meats, canned foods, snacks, chips and crackers, highly processed foods. This is important because more than 70% of the sodium that we consume every day comes from these packaged, prepared, and restaurant foods. So you just want to be mindful of that.

Some naturally low-sodium foods [00:16:00] are going to be fresh unpackaged foods, such as fruits and vegetables, some low-fat dairy products, fresh meats and proteins, as well as nuts and seeds. But you always got to remember, you must read the package. There's going to be more on that just shortly.

So you may be asking, "What about the products that I see saying light salt or salt substitutes?" There are many different types of salt substitutes on the market. However, many of them contain high amounts of other minerals. And so if you're on certain [00:16:30] cardiac or blood pressure medications, or even if you have a history of kidney disease, this actually might be contraindicated. So before you use one of these products, it's best that you check with your doctor and/or pharmacist just to make sure that it's safe for you.

Now let's talk a little bit about the DASH eating plan. Research actually shows that limiting sodium while increasing foods that are rich sources of potassium, magnesium, and calcium, can actually help the body to naturally regulate blood pressure. The name for this eating approach [00:17:00] is the DASH eating plan. And DASH stands for dietary approaches to stop hypertension. This plan requires no special foods, but instead provides daily and weekly nutritional goals.

So just a little bit more detail about this DASH eating plan. The guidelines for DASH include limiting sodium to 2,300 milligrams, though the plan does note that limiting to 1,500 milligrams lowers blood pressure even further. It really emphasizes eating [00:17:30] four to five servings of both fruits and vegetables daily, choosing whole grains most of the time, limiting your low fat, lean animal protein to no more than six ounces or less per day, eating two to three servings of low fat dairy, and at least four to five servings a week of nuts, seeds, or dried beans. Also, they encourage you to minimize high fat meats and dairy, whole fat dairy and added sugars.

Now [00:18:00] let's go ahead and discuss some quick tips on label reading. Reading labels is very important, especially for package and prepared foods. Keep in mind, we get most of the sodium from processed foods, such as soups, canned goods, tomato sauces, and condiments. For foods that are lower in salt or sodium, you might find printed in bold on the package, the words, low salt or low sodium. This can actually help us as consumers to make better choices, but it's important to understand what these terms mean. For example, [00:18:30] sodium free means an item contains a very small amount, less than five milligrams of sodium per serving. Whereas very low sodium indicates 35 milligrams or less per serving. Be careful with the words reduced sodium. That just means that the level of sodium is reduced by 25%, not that it's low in sodium. Also, light or lite, L-I-T-E, in sodium indicates that the sodium has been reduced by at least 50%. So this could be a better choice.

[00:19:00] For a quick tip of reading sodium content on the label, you can use the percent daily value. You'll see on the screen, the yellow arrow pointed to this information. So, as we see, this particular item has 7% daily value of sodium. So what does this mean? We can use these shortcut guides to determine if something's high or low. 5% or less would be considered low, 20% or more would be high. So at 7% we're not low, but we're [00:19:30] also not high. So it's kind of in the middle, but it can give you a quick guide.

Now let's talk a little bit more about how you can make changes to improve your blood pressure. Some things that you can do to change, to help improve your blood pressure, include buying and eating more whole foods, prepare and eat more meals at home. Reading the nutrition fax label to stay informed, as well as research your restaurant menus and options before eating out. Keeping in mind that restaurant meals can likely contribute to [00:20:00] excess sodium intake. You have the most control as to what goes in your food when you prepare it at home. When going out to eat, you can ahead of time, go online and find the nutrition facts, including sodium content on many of the different foods offered at restaurants. If you choose to go out to eat, research the menu ahead of time. Some other ways to keep sodium intake lower when dining out, ask for smaller portions and get sauces, condiments and dressings on the side. Also, you can request that no salt be added [00:20:30] to your food.

Now let's talk about some other lifestyle changes to improve your blood pressure. If you smoke, consider quitting. You can ask your doctor about the many different resources that are available to help you quit. If you consume alcohol, do so in moderation. Moderation means no more than one drink a day for women, no more than two drinks a day for men. Maintain or work towards achieving a healthy weight. Also, when it comes to stress, explore [00:21:00] positive ways to manage it. And lastly, it's really important to stay physically active.

It's very important that you take responsibility. It's important to keep track of blood pressure. Getting it measured routinely and keeping a log is key. If you don't get it measured, there's no way to know if it's actually controlled. Sometimes it can be higher when we go to the doctor, so showing them what your home readings are, may be helpful in determining the proper medication dosages. [00:21:30] Thank you.

Mathieu Knapp: Hello. My name is Mathieu Knapp. I am the supervisor of our Healthy Life Center out at Babcock Ranch, and I have a exercise science background. So I'm going to teach you a little bit about exercise and how it correlates to hypertension.

So to define hypertension from the medical dictionary, hypertension is high blood pressure. Now blood pressure is the pressure that your heart is pumping blood [00:22:00] through your arteries. So it's the resistance it's encountering. It can have higher pressure if encounters plaque or if the arteries are constricted. So the goal is to try and decrease that pressure so the blood pressure comes down.

Now, there are two big players that play a role in hypertension, the first one being genetics. So a lot of times you'll hear people say, "Oh, my family has a long line of history of hypertension." Or, "It's just genetic. That's why I have hypertension." And [00:22:30] the second big player is the environmental or your lifestyle. Now the two are heavily correlated. Dr. Oz put this best, that genetics loads the gun, but your environmental or your lifestyle pulls the trigger. So though you may be born predisposed to get hypertension, your lifestyle can actually make it so you either get it or don't get it, or you can manage it.

One easy factor that you can adjust in your lifestyle [00:23:00] is physical activity or exercise. Now within the Healthy Life Center here at Lee Health, we have five key pillars in our wellness wheel, the five being sleep, behavioral mental health, nutrition, physical activity, and decreasing stress. So one of those being the physical activity, which is the easiest to address. Since physical activity is the easiest component to address, within Lee Health as a health system, we have five key pillars that could also play a role. One [00:23:30] being sleep, second being behavioral and mental health, third being stress relief, fourth being nutrition, and the fifth being physical activity. The physical activity is probably the easiest of the five to kind of change and address, which will help you decrease the hypertension.

Now, physical activity plays a connection with hypertension because if you can increase your physical activity, you're actually increasing your heart strength. Therefore, your heart is more fit to pump the blood, therefore [00:24:00] decreasing its effort to pump the blood out to the arteries and there's less pressure. So sticking with the theme of physical activity or exercise to decrease your blood pressure, we have two key things we can look at. One being cardiovascular exercise, and the second being resistance exercise. So they both carry what we call the FITT protocol, which is how we kind of design your routine. Now, FITT is F-I-T-T. Stands for frequency, intensity, time, and type.

We're going to start with cardiovascular [00:24:30] exercise. So the frequency for this is three to five days per week. So the I for the FITT program is intensity. And so 150 minutes of moderate exercise or 75 minutes of vigorous exercise. Now the difference between the two; moderate is something you can carry on a conversation with someone else while you're doing the exercise, whereas vigorous is something you [inaudible 00:24:54] conversation because you're trying to focus on breathing and you're breathing too hard to talk.

Now with [00:25:00] the first T being time, you want to shoot for either 30 minutes per session of exercise, that'll bubble up into that overall 150 minutes, and it's total for the week, or you can split it down into 10 minute bouts of that vigorous exercise per day that you're working out per session.

Now last one being type. So this can range from anything from gardening to mowing the lawn, to walk. Anything that elevates your breathing slightly and kind of get you moving around. You can get more intense with [00:25:30] this, if you add in maybe biking or running or things of that nature.

So the second thing besides cardiovascular exercise is [inaudible 00:25:38] exercise. This includes some form of body weight or strength machines or free weights that add that resistance. This also carries the FITT protocol. So the frequency for resistance training is two to three times per [inaudible 00:25:53] that's less than cardiovascular exercise because it's more intense typically. So the I in the FITT protocol is for intensity [00:26:00] for resistance training. Now you want to be doing repetitions to where at that last repetition in your set, you are almost too exhaustion. So you couldn't do another repetition if you try. That's your desired weight that you need to be at. This could be as low as one pound or as high as 200 pounds, it's whatever that is designed for you.

Now, the time it takes, we're going to be looking at sets and repetitions. So the time protocol is two to three sets and anywhere between [00:26:30] eight to 15 repetitions. This varies based off the goal you're trying to achieve. If you're looking more so for endurance, you're going to be doing two to three sets of 10 to 15 repetitions, but if you're looking more for strength and/or muscle growth, you're at that lower end of the repetition range at eight to 10 repetitions. For the type, it could be anything from plyometrics, body weight exercises, free weight such as dumbbells or barbells, or you could use machines, resistance bands. [00:27:00] There's a ton of stuff out there for you to use.

The benefits of resistance training or cardiovascular exercise as it relates to your blood pressure is that it can actually decrease your numbers by four to nine millimeters of mercury and/or points. In addition, if you're already at good numbers, say you're at the average of 120 over 80, doctors like you to be lower than that though, is that you can maintain this number by doing resistance training or cardiovascular exercise. In addition to this, these two things can [00:27:30] help you maintain your weight and/or decrease weight, which is another factor that plays a role in your blood pressure. So by doing this over time, it takes about one to three months for you to see the benefits in your blood pressure readings. So please stick with it and be patient. The benefits only last as long as you continue to exercise. So please stick with it. Always remember safety when you're starting exercise, whether it be resistance or cardiovascular, and that you want to monitor your progress as you [00:28:00] go, both your numbers of your blood pressure and your exercise numbers.

So big key factor here is to learn the proper form of the exercises. It could be from walking on a treadmill because it's powered or proper squat form. It is key because if you do it wrong, you could risk injury and then you're moving backwards, not forwards. Another big factor that I hear from a lot of people is to not hold your breath. I see a lot of people doing this. The actual proper form to breathing is [00:28:30] you breathe out at the hardest point. So if we think about maybe sitting in a chair, you want to breathe out as you stand up because that's the hardest point you're exerting the most energy. Whereas on the flip side, you would breathe in as you sit down. That's one little example.

You always want to listen to your body. If something hurts, don't do it. If you're getting too winded, take a break, don't push those limits to where you could hurt yourself. Always remember to warm up before your exercises and cool down after exercises. [00:29:00] This could be an easy five-minute walk on a treadmill or a round outside before you start physically exercising. And the cool down afterwards would be some form of stretching because with exercise you're contracting all those muscles. So you want to stretch them all back out to promote better healing.

Now you always want to stop exercising and seek immediate medical care if you experience chest, neck, jaw, arm pain or tightness, dizziness or faintness, [00:29:30] severe shortness of breath, or an irregular heartbeat. Please remember to monitor your blood pressure and record your numbers so that you can share these numbers with your physician so that they're better able to maybe provide you with more guidelines to help decrease those numbers. In closing, please follow these concepts and/or try them out for an easy way to decrease your blood pressure numbers and improve your overall health. Thank you and have a great day.

Speaker 6: Hi, my name is Bryan Brubaker. I'm a pharmacy clinical specialist focused [00:30:00] on respiratory illness. And today we're going to talk about smoking cessation.

Want to quit using nicotine? If you do, you're not alone. Since 2002, there have been more former smokers than current smokers, and 70% of smokers or tobacco users report that they've either attempted to quit or have considered quitting in the past year.

Benefits of quitting smoking.

Immediately after stopping, the air around you is no longer dangerous to others, including your pets. Within [00:30:30] 20 minutes, your blood pressure and your pulse rate return to normal. After about eight hours, your carbon monoxide levels will drop and your oxygen levels will increase. Over about one to three months, your circulation and your breathing improves, making it easier to walk and do other activities of daily living. At one year, your overall wellness increases, your lungs are able to clean themselves better and prevent infection. And your risk of coronary heart disease is half that of a smoker. [00:31:00] At five years, your stroke risk is that of a non-smoker and your risk for cancer of the mouth, esophagus, and throat are half that of a smoker. After 10 years without smoking, your life expectancy is comparable to a non-smoker's.

Costs of tobacco use.

Everyone knows that there is a health cost to using tobacco, but there's also a significant financial and time impact to your life as well. Over the course of your lifetime as a smoker, you'll spend an average [00:31:30] of $124,000 on cigarettes, $170,000 on healthcare associated with tobacco illness. And you'll lose $253,000 due to absenteeism in wage. If you smoke a pack a day, over the course of a year, you'll lose 15 to 25 days of your time to smoking.

Understand why you use nicotine.

Nicotine is a highly addictive chemical. [00:32:00] When you smoke tobacco, nicotine is taken up into the brain within a few seconds. Once there, it causes the release of mood-altering chemicals that can cause mild euphoria, appetite suppression, and increased alertness. Most people say they smoke for a particular reason. It is a stimulant. So it helps to get them going in the morning or helps to perform certain tasks better. They like handling the cigarette or what we call the ritual of smoking. They feel pleasure or relaxation when they smoke. And cravings [00:32:30] will always reinforce all of these things. When you decide to stop using nicotine, you will probably experience withdrawal symptoms depending on how much you use. This will cause an uncomfortable feeling, especially in the first weeks after stopping.

Nicotine use is a repetitive task and patterns of use develop around other routine tasks that you perform in any given day. These patterns can be very difficult to change once they've been ingrained. Dependence creates triggers and cues that can be [00:33:00] activated by a host of things in your life, including social events, anxiety, stress, or even food items.

Choosing a quit plan.

As with anything in life, to make yourself successful, you should have a plan before you start quitting. You should prepare alternatives to smoking in advance that you enjoy. Avoid temptations whenever and wherever possible, and never allow smoking to be an option. There are many different ways to quit smoking. [00:33:30] Many folks prefer cold turkey, where they feel they don't need assistance or any type of tapering dose. Cutting down gradually can help to lessen the withdrawal symptoms of quitting smoking. And this can also include nicotine replacement therapy, in the addition of online or group counseling. Alternative methods exist as well, such as hypnosis or individual counseling, but you should ultimately select what you feel is most appropriate for yourself.

When deciding to quit using tobacco, it's important to find a motivation, [00:34:00] whether that's your own health, your children or family, the safety of your pets, or to save money. Finding your why, documenting it, and sharing it with others will help to reinforce your plan as you go forward with quitting tobacco. You should choose activities that interest you that you would like to pursue, that will help to replace your smoking habit. Exercise is a great option to smoking. You should also consider the ritual of smoking and come up with some things for you to do with your hands, such as drawing, knitting, [00:34:30] or anything else to keep them busy. You can also focus on rewards, such as pleasure and relaxation events, like a massage or a hot bath, that you can work towards why you continue your quitting attempt.

When attempting to quit using tobacco, it's helpful to tell family, friends and coworkers about your plan to quit. They'll often want to help any way that they can. Telephone and in-person counseling is also available to anyone for free in the state of Florida. They can provide educational material, knowledge and other valuable [00:35:00] experience to help you be more successful. Consider if nicotine replacement therapy is right for you. This will depend on how much you currently smoke, and if you're using any other products to help you quit.

Finally, when you're deciding to quit, you should set a quit date and you should tell other people when that quit date is. I'd also recommend that you write it down, put it on a calendar, put it in your wallet. That will help to keep you accountable when it's time to quit.

Nicotine replacement therapy.

There are [00:35:30] many types of nicotine replacement therapy available. The most two common types are nicotine patches and gum or lozenges. The patches come in 7, 14 and 21 milligram strengths, and your dose will depend on the amount of tobacco that you're using daily. The idea with the nicotine patch is to provide you with a low level of nicotine in your bloodstream throughout the day to reduce cravings. You may still have cravings while you're using a nicotine patch. And in that [00:36:00] case, it may be appropriate to use nicotine gum or a lozenge as well. These provide a small bump in your nicotine levels, which would be comparable to smoking a cigarette and would help to control a craving. This type of nicotine replacement therapy is used in decreasing strength and frequency over time, generally over a period of six to 12 weeks, until cessation is achieved and maintained.

Nicotine replacement therapy by prescription only.

There are two additional nicotine replacement products [00:36:30] that are available with a prescription: the nicotine inhaler and the nicotine nasal spray. Both of these products are used in a similar fashion to the gum or the lozenges with the intention to give you a small boost in nicotine blood levels whenever you experience a craving. Keep in mind that these are generally a lot more expensive than the over-the-counter counterparts, and nasal and oral irritation is a common side effect of both of these products.

Prescription medications.

[00:37:00] Chantix or varenicline is considered by many as the gold standard for quitting smoking. It helps to displace nicotine from the receptor in the brain, which means that you can even smoke when you initially start your Chantix therapy. It may not be appropriate for use in patients with significant renal impairment, serious psychiatric illness, or who are currently undergoing dialysis. Bupropion or Zyban is another prescription medication that was used before we had [00:37:30] Chantix. It also interferes with the dopamine release in the brain that nicotine causes. This medication may not be appropriate for patients with a history of seizures or eating disorder. Most common side effects for bupropion are dry mouth and insomnia, and it's usually started one to two weeks before the quit date.

This slide contains resources to help you quit smoking. I'd like to specifically mention the AHEC Florida Network because they are responsible for distributing nicotine replacement [00:38:00] therapy and providing quick classes. Thank you.

Dr. Brenda: Hi, I'm Dr. Brenda [inaudible 00:38:14], and I'm a clinical psychologist working at Lee Health. I'm here to talk to you about stress and ways to manage it.

Stress can be defined as the physical, mental, or emotional response to any demand that requires an adjustment or response, usually described as feeling tense or worried [00:38:30] about a situation or a stressor that we feel we can't cope with. A stressor might be short term or acute, such as starting a new job, or it can be chronic or long term, for example, caring for someone with complex needs. It is important to note that not all stress is bad or negative, and that stress is a normal part of life, which in some cases can help improve performance.

So what are some effects of stress on your health? In addition to the emotional discomfort we feel [00:39:00] when we're faced with a stressful situation, our body releases stress hormones, such as adrenaline and cortisol into the bloodstream, which prepare the body for the fight or flight response. The body is preparing for an emergency by making the heartbeat faster and constricting blood vessels to get more blood to the core of the body instead of the extremities. A single stress experience is very unlikely to result in long term or chronic medical illness. But when a stressor is negative, can be fought off or avoided, it can take a toll in [00:39:30] our physical health with responses such as heart palpitation, fatigue, sleep difficulties, a decline in sex drive and a weakened immune system. It can also affect our emotions. We can experiment worry, fear, anger, tearfulness, irritability, difficulties with concentration or memory, or feeling overwhelmed. The stress can also lead to behavioral responses, such as social withdrawal and avoidance, unhealthy coping, including overeating, smoking, or [00:40:00] using illicit drugs.

The stress can also contribute to difficulties with adherence, meaning following the medical instructions to treatment and compliance with medications, which are two very important factors in the management of hypertension. The stress can also prevent you from engaging in more helpful activities and can impact the overall degree of involvement in the care of your chronic illness. For example, if the stress level is high, you might not be able to fully understand your medication regimen properly [00:40:30] or clear any incorrect beliefs about medication.

So what can lead to stress?

According to the American Psychological Association 2022 Stress in America survey, two of the most common stressors identified were financial and global uncertainty. But other things including routine or external stressors can be added to this list, including work-related stress, marital stress, natural disaster, or trauma. Another source of stress are internal [00:41:00] stressors. And these can come from unhealthy thinking patterns, for example, catastrophizing or when we blow things out of proportion, or when we jump to conclusion, which is when we make predictions of what's going to happen in the future.

What factors may impact stress in patients with hypertension?

Beliefs about illness, for example, poor understanding of the deceased, and beliefs about the necessity of medications can lead to poor awareness of the need to take medications as prescribed. Feelings that hypertension controls [00:41:30] your life. Having to change routines, having to take multiple medications, all can be seen as time consuming or complex. Health behaviors and thinking can also increase the level of stress for patients with cardiovascular conditions. For example, catastrophic misinterpretation of bodily symptoms can lead to increased focus on the body, which in turn can promote stress and lead to safety behaviors, such as avoiding situations that could trigger any cardiac symptoms. The level of confidence in managing your medical [00:42:00] conditions or levels of self-efficacy can also impact the level of stress.

Now, what are some ways to manage stress?

One of the most important steps when managing stress is to know your triggers. It can be easy to go through your days without taking a step back and identifying what is causing you stress. When we're stressed, it can become habitual to say negative or self-defeating things to ourselves over and over again. Unhelpful self-talk might include things such as, "I'll never get this done." [00:42:30] Or, "Things will only get worse." Negative self-talk can make it more difficult to manage stress. Next time, rather than imagining the worst-case scenario, and then worrying about it, notice your self-talk spiraling and try using helpful calming self-talk such as, "I am coping given with what I have." You can also challenge your thoughts by asking yourself, "Am I underestimating my ability to cope?" You can also switch off your fight or flight response by using breathing exercises, muscle relaxation techniques, or mindfulness-based strategies, [00:43:00] which can also help reduce stress by learning how to focus your attention to the present and moment and become more aware. Problem solving strategies can also be a useful way of clarifying the problem. Brainstorming possible solutions, and then choosing one to put into action after listing the pros and cons of each option.

Other coping strategies include engaging in healthy habits, such as exercise, seeking good nutrition, and having a consistent sleeping routine. [00:43:30] Identify your life priorities, your goals, and aspirations. Also, do you need to change your expectations? Are you taking on too much? Could you hand over some things to someone else? You might need to prioritize things and reorganize your life so you're not trying to do everything at once. Time management strategies can be helpful. For example, setting goals, planning task, or writing to-do list. Sometimes the uncertainty of the future or the regrets of the past can also be a source of stress. Recognize where [00:44:00] you have control and focus on that and accept those situations outside of your control. When life gets overwhelming, we can tend to isolate, and this can be counterproductive. Even when time is a concern, look for opportunities to do something for yourself or connect with others. Expressing gratitude to others can also boost your level of feeling good about life and reduce stressful thoughts.

What are some ways to improve your stress management and adherence?

Increase your knowledge about hypertension [00:44:30] and treatment options. Identify your barriers. What is blocking the progress and what has worked in the past? Also, increase your communication or assertiveness with your healthcare providers to gain a greater sense of control in managing your hypertension. Ask questions. They're there to help. Using these strategies can help increase your confidence in effectively managing your chronic condition.

Now, as a concluding remark, I want to compare stress and anxiety. Determining which one you're experiencing is critical to finding an effective [00:45:00] treatment plan and feeling better.

Stress and anxiety can be both seen as an emotional response to stressors. However, compared to stress, anxiety is defined by persistent excessive worries that don't go away even in the absence of a stressor. If your stress or anxiety interferes with your everyday life, causes you to avoid doing things, seems to be always present or is accompanied by other symptoms such as panic attacks or depression, consider talking to a mental health professional who can help you understand what [00:45:30] you're experiencing and provide you with additional coping tools. It is important to catch anxiety symptoms early to prevent development of an anxiety disorder. Thank you.