Safeguard Your Heart Health

Joel Kahn, MD, FACC

Great topic today.

Laurie Marbas, MD, MBA

We’re going to dive deep into what uncontrolled hypertension does to the heart. I can think of no one else who I’d rather have this conversation with than Dr. Kahn, because you have been such a lifeline to me, even as a family medicine doctor, to reach out to someone who, if someone has a heart issue, and you were super responsive and gave me the best advice, so listen up, everyone. we’re in. I learned quite a bit today, so we’ll just get the ball rolling. The first question is: How does uncontrolled hypertension directly affect the structure and function of the heart over time?

Joel Kahn, MD, FACC

Great question. There are some estimates that 80% of people know they have high blood pressure based on their doctor’s diagnosis, or maybe their home monitoring is not well controlled. We’re talking about the majority of hypertension patients not hitting 120 over 70 or some reasonable marker. To answer your question, over time, there are acute situations. You can acutely raise your blood pressure to 200 over 130. Terrible diet indiscretions, terrible alcohol indiscretions, anger, emotion, stress, fear, and all. They could put you into it. and it’s called congestive heart failure or pulmonary edema. It could cause a stroke or an intracranial bleed—a bleed in the brain. They could acutely damage your kidneys. These are infrequent and probably emergency room-based acute situations you can cause. I want to mention this. Everybody has a heart beating away, and above the heart is a tube called the aorta. You can tear your aorta—that’s called an aortic dissection—and suddenly feel this massive, sudden pain in your chest. This might occur during gym exercise, during sex, during shoveling snow, or it might be spontaneous. That can be a quickly deadly situation or a slowly deteriorating situation. You’ll be in an emergency room, where you can hopefully make a diagnosis. Those are the acute situations. They’re not incredibly uncommon, but they’re all potentially very lethal. We want to avoid it. There’s a statement I never practiced in Brooklyn or Williamsburg in New York. Still, around the Jewish holidays, when people are eating chicken soup high in salt, the emergency rooms fill up with people having acute, high blood pressure. I’m sure it occurs in many other settings and many other cultures. But my friends in New York tell me you see that around the holidays. Also, that’s another reason I’m big and I don’t make chicken soup. It’s not the chicken; it’s the salt. But don’t do chicken anyway. Chicken has a lot of sodium in it, as many people may know. 

But then there’s more of the chronic. just to the point that over years of blood pressure, 150 over 94. You’ll probably never feel it. You’ll never know your height. You’re not going to be flushed, and you’re not going to necessarily be winded. But versus 120 over 70 slowly impact, scar your kidneys, shrink your kidneys, and cause you to be on your way towards chronic kidney disease. Maybe if you combine that with a little type 2 diabetes, like about 40% of Americans, you might be on your way to even dialysis. Tragic. You will injure your heart and both arteries because we’ve known for at least 50 years that high blood pressure is one trigger of artery-clogging, called atherosclerosis. On your way to a heart attack, stent bypass, or sudden death—terrible things. Or if you don’t have clogged arteries, the muscle of the heart has to work harder. If the blood pressure is 150 over 94, the heart is pumping against more resistance. It’s kind of like putting your hands around the aorta. It’s harder to get the blood out, and the heart muscle thickens. It’s a condition called cardiac hypertrophy. People don’t live as long as the heart muscle thickens. People get short of breath. If their heart muscle thickens, people develop congestive heart failure, and their quality of life probably goes down. Very often, your doctor will say to go get an echocardiogram, or an ultrasound of the heart, because you have high blood pressure and they’re looking for thicker heart muscle. That occurs and it damages the brain. That has to be mentioned. One of the triggers of dementia is chronic hypertension. Those would probably be the biggest ones. High blood pressure ages the body. It’s impossible to talk about wanting to lead a long, healthy life—what we sometimes call a health span. If you’re not focused on your blood pressure, which all equates to getting a home blood pressure cuff, it’s like my number one recommendation to patients: go spend $90. I’d like to give a shoutout. I like Omron Platinum. That’s a brand and a model of a home blood pressure cuff that’s pretty reliable on your arm. Just hit a button and do it about three times in a row, about a minute apart, to get a reasonably accurate result. Blood pressure. If you don’t have a home blood pressure cuff, you are an amateur health advocate.

Laurie Marbas, MD, MBA

That’s great. I agree. The Omron is, I would say, the most reliable brand. If you’re going to. They have some other ones, like Generation 3. That’s also pretty good for those who are looking to be a little bit more cost-conscious. It’s like $35 off Amazon, but just getting back, you touched upon the relationship between high blood pressure and coronary heart disease, or the plaque buildup. Can you describe it a little bit more in detail? What does that mean exactly, and why does high blood pressure cause plaque buildup?

Joel Kahn, MD, FACC

First, there was an observation. Franklin Delano Roosevelt died of hypertension in the 1940s, when therapy was minimal. Then President Eisenhower had a massive heart attack in 1955. I go back because that’s when we started to put major funding into research. What’s the big deal about high blood pressure? That was the National Institutes of Health and the Framingham Heart Study, and probably by 1970, the Framingham Heart Study had concluded that if we take a population of people that have heart attacks and we take a population of people that don’t have heart attacks, high blood pressure is much more common in the heart attack group, and it is a risk factor along with smoking and diabetes. That’s how we learn these things. We observe, follow, do studies, and try to reproduce it. Those things seem so basic nowadays, but they weren’t well known in the 1940s. It took about 20 to 30 more years. Then why does it injure the heart? That’s not as clear. A lot of people think it is mechanical damage. Your heart ejects blood 100,000 times a day. It leaves the heart. There are two holes right above the heart. They’re called coronary artery openings, and they allow blood through the pipes right back to the heart. The force of the ejection is what gets the blood down the arteries. But a blood pressure of 170 over 105 is a bigger smack. It’s like, I just punched my face. I’m not crying. But if I had had 170 over 105, I’d be in a little pain, and I don’t do that very often. I’ve been married for 42 years. I’m used to a little fun and a little pain. That’s a little joke for my lovely wife. Never make a public joke about your lovely wife. But that accelerated biomechanical injury, or at least impact on the lining of your heart, the arteries, also called your endothelium, is believed to be one of the major triggers of atherosclerosis. It gets injured, and then there’s cholesterol, LDL, and lipoprotein A, or high blood sugars. You started the process of atherosclerosis. But high blood pressure is one of the major triggers, as is the front artery of the heart. Some people have heard the name Widowmaker, but it happens to be like the straightest shot from the heart right into the front of the artery. That’s probably why it is one of the three heart arteries. It most commonly gets clogged up with just a straight smack in the face.

Laurie Marbas, MD, MBA

You also mentioned the aortic dissection. I had a patient, just a new patient survived your dissection last Fall. Fascinating story. Very fortunate. Getting back to what you described in the heart, are there any specific heart-related symptoms that hypertensive patients should be particularly concerned about or aware of? They have high blood pressure; maybe this is something they should be looking out for. 

Joel Kahn, MD, FACC

Of course, if they’ve clogged their heart arteries, they might experience—we call it angina—tightness, pressure, squeezing, typically on exertion—that is unusual. I was walking my treadmill uphill a little fast, and I got a burning tightness of pressure. Never ignore that. Report that to your doctor. Go to the emergency room. It could be mainly shortness of breath.

I was doing housework, yard work, and going up and down stairs, and I just didn’t normally feel out of wind. But now that I’m out of breath, maybe the high blood pressure. There may also be a heart muscle thickening, which I call hypertrophy.

Laurie Marbas, MD, MBA

It’s a related story. I had a patient many years ago who was active. He said that mowing his lawn is typically not a problem because suddenly he just can’t. He goes out on energy, and I get shorter. But he had no other symptoms. I’m like, Well, there’s a problem. It is stressful. Sure enough, he had quite a bit of occlusion, ended up with a stent, and went on his merry way. But it was. You do need to be attentive, like I was fine until you weren’t fine. Good things to think about. When we think about not only our heart health, which you’ve done your summit and are doing a summit about. What about lifestyle changes like diet and exercise, is there anything specific they can do to help reduce hypertension? How does that happen? Why is one better than the other? One particular exercise? Anything there?

Joel Kahn, MD, FACC

There are so many. We have a whole variety of prescription drugs for high blood pressure. That’s usually what a family doctor or an internist is going to do. Just in the traditional medical model, you talk about cardiology, and I talk about the root cause. It is a combination of lifestyle and genetics. Briefly, there was a company out of the Mayo Clinic that, with a little cheek swab, you could send in the sample and get an analysis of how many blood pressure-raising genes you inherited from your parents and how potent a factor that was. Even what medicine was most likely going to control your high blood pressure? It was an interesting approach. They seem to have gone on a pause for a minute. They must be regrouping. I hope they relaunch. But until we get that sophisticated analysis and all that, we know that lifestyle is a huge portion, and roughly 70% of Americans are overweight or obese. A big factor. Partly, it’s the food you eat that makes you obese. If there are high-salt foods processed, fast food and frozen pizza foods are very high in salt. You should be reading the label and maybe searching for an article on where salt is hidden in foods like bread and chicken. I fall over in a frenzy when I look at the hospital vegetable soup in my cafeteria, and it has more salt than the Brooklyn chicken soup. I talked about it in the morning. It’s your whole day’s allotment of salt in one bowl of soup, and it’s in a hospital cafeteria with sick people or people visiting their relatives who aren’t necessarily healthy. Weight is a big issue. Salt content is a big issue. Sleep is a huge issue. Very scientific.  We’ve got our iPads and iPhones and our TVs and all the rest of the cable, and we’ve got all those lights going. We have undiagnosed sleep apnea because we’re overweight. You have a poor night’s sleep over and over and over. You have sleep apnea undiagnosed over and over and over. You’ll have high blood pressure; of course, do the opposite: get good sleep hygiene, drop some weight, get a home, study sleep, and treat your sleep apnea. Your blood pressure may come down with that lifelong therapy. Diet: We have plenty of evidence-based science proving that a whole-food, plant-based, brightly-colored diet is the best on the planet. There are a couple of foods, particularly ground flaxseed. I tell my patients that it’s probably the biggest nutritional deficiency on the planet that people don’t know about. You need omega-3 fatty acids in your body, and you don’t make them; you have to get them. One of the best sources is two tablespoons a day of ground flaxseed in your oatmeal, a smoothie, and a salad. There are so many benefits to ground flaxseed. One is that it lowers blood pressure and beats beetroot, leafy greens, watermelons, and pine nuts. They all contribute to more of a chemical called nitric oxide. There’s a blood pressure-supportive diet using plants. There is also a government-endorsed diet for high blood pressure called the Dash Diet. DASH, Dietary Approach to Stopping Hypertension. Some data shows that blueberries lower blood pressure, so there’s a healthier lifestyle. I forgot to mention garlic. Garlic in your diet, garlic as a tablet, garlic as a supplement. All have data for lowering blood pressure, and then there are some other lifestyle things I can’t leave out exercise. during exercise, your blood pressure should go up a little bit. But for the other 23 hours of the day, your blood pressure is, on average, lower. If you don’t have a plan at least hit that 150 minutes a week of moderate exercise that the American Heart Association recommends or 75 minutes a week of vigorous exercise. Those are the minimums. 75 minutes a week is only 15 minutes a day—five days a week of vigorous exercise. You have to hit them. You have to do them. Then there’s Wu who has some evidence. Some data shows that aromatherapy with lavender and frankincense leads to lower blood pressure that’s been studied published data is a good one. Meditation, published study data. We chatted for a minute before we went on about a device that helps you meditate or get a mind-set breathing practice. That’s something called a heartmath.com. People can look up their website. Heart, HEART, Math, MATH dot com. A little device that it’s a breathing practice that may lower your blood pressure. And that’s before we even talk about supplements: nitric oxide supplements, magnesium supplements, coenzyme Q10 supplements, garlic-aged supplements, and many others like Hawthorn Berry and olive leaf. There’s a lot, and there’s a lot that are combinations that help people and work.

Laurie Marbas, MD, MBA

Can we get a little bit into the breathing and the mechanism of why that would lower blood pressure? I have seen patients, like I was with a patient, elevated blood pressure for 70 cycles for four of the four, seven, and eight breathing cycles, the systolic blood pressure, dropped 15 points, and I measured it myself listening with my ears. You describe what’s occurring in the body that allows the blood pressure to drop.

Joel Kahn, MD, FACC

It’s all about what people are more or less in tune with, like a balance between two parts of your nervous system. The nervous system is called the autonomic nervous system. But there’s your fight or flight—the sympathetic adrenaline part of the system. You hear a noise, and it’s dark outside in an alley. You’re walking faster, nervous, and breathing a little heavier. That’s sympathetic fight or flight. Then there’s that aspect called parasympathetic, or your vagus nerve, the longest nerve in the body, and that’s your rest and digest portion of the autonomic nervous system that helps you metabolize your food and sleep and cause your heart rate to go down. It causes your blood pressure to go down. It’s possible now to get a clue about that balance, which from second to second minute to minute is changing. All the time, people wear Whoop Bands, Fitbits, and Apple Watches, and one of the original ones was a ring called the Oura Ring, OURA and it’s still available. It’s very precise, and you can track, what balance you’re in, and what your heart rate variability is. You can alter it by doing breathing exercises, on heartmath.com, and others that are out there. It turns out that when you do this, there are many versions of slow, deep breathing. You are activating your parasympathetic rest and digest system, which helps relax your blood vessels and lowers your blood pressure, and you are deactivating your fight or flight sympathetic adrenaline system, which sends blood pressure up. a four, seven, or eight breathing pattern. What I love is going through your nose for four seconds, holding it for seven seconds, counting slowly now, and breathing out through your mouth for eight seconds. Do that at least four times in a row. Something made very popular by Dr. Andrew Christmas Santa Weil M.D. in Tucson. The guy with the big beard. I don’t know that he created it, but he made it popular. There’s a box breathing in four seconds, hold for four seconds, out of four seconds, hold for four seconds. It is a very relaxing way to breathe. Again, this little device called the HeartMath is another one. These are all tools to activate your parasympathetic and deactivate your adrenaline systems, then? Yes, the proper way to inject blood pressure is to jack up blood pressure. Turn your machine off. Wait a minute. Check it again. Turn your machine off. Wait a minute. Check the third time. I have my patients do that, and they bring me their numbers. 160 over 90 is 140 over 82. The third one’s 128 over 71. That’s, 3 minutes change, and it goes the other way. Do get upset that your casserole in the oven burned because you got distracted by watching something on Netflix, and you get all upset at yourself. Your blood pressure is going to go up. It’s very responsive.

Laurie Marbas, MD, MBA

I just had a question regarding blood pressure medications. Can you speak a little bit? Because I tell patients, a lot of times they’ll come in and say, I don’t want to be on any medications. I’m like, Well, you need to be on some medications because we’re in that place. Maybe we can use it as a bridge, maybe we can decrease medications, or maybe even hopefully stop all of them. But again, medications can be very helpful. Can you describe how anti-hypertensive medications can sometimes support heart health? Are there any specific ones that are more beneficial than others?

Joel Kahn, MD, FACC

There’s strong data. Sometimes I talk about how cholesterol medicines are like different buckets. You’ve got your statin medication and your injectable medications. the same thing with blood pressure. There’s been different classes of prescription drugs for a long time. The first two classes were diuretics, water bills, usually not the ones people have heard of called Lasix, the strong ones we use in congestive heart failure, and usually milder ones like thiazide or hydrochlorothiazide. They’re not bad, they’re inexpensive, and they’re used all over the world. But they can raise your blood sugar a little bit. They can have a slight adverse effect on your blood cholesterol. You have to watch your calcium in your blood and your uric acid gout risk in your blood. They’re good for kidney stones sometimes, but they can trigger other things that are diuretics. Diuretics are now my third or fourth choice, but now my first choice. The other group was beta blockers. Maybe the most well-known is low pressure. Toprol, Atenolol, there’s a newer one that is better called Nebivolol, it used to be called Bystolic. They’re not first-line choices. They are for other things, like after a heart attack, racing heartbeats, or migraines sometimes. But sometimes, at the end of the day, you get to add one in at a low dose and see how that goes. More commonly we’re using, they’re called ACE inhibitors. They’ve been around for a long time. My favorite is Ramipril, ten or 20 milligrams a day, and there’s another group very close by called the ARB blockers, and my favorite is called Telmisartan, TELMISARTAN 20, 40, or 80 milligrams. Well, and then there’s some older drugs we pull in now and then when needed. You can get off medication to lower your blood pressure, go on a plant-based diet, start an exercise program, and get better sleep. I mentioned briefly that if I did an infrared sauna, maybe three times a week, I would have scientific studies at the University of Kansas, Missouri, for lowering blood pressure. If you take a sedative before dropping weight, take a couple of supplements; maybe you can go from two drugs to one drug, one drug to zero drug. It can happen. You go to possibility.

Laurie Marbas, MD, MBA

Thank you, Dr. Kahn, for joining us for this portion of our conversation. But I also want to say to the audience, Thank you so much for joining us today. I hope you found our conversation insightful and engaging. If you’re a summit purchaser, stay right here because we’re about to dive a little bit deeper into this conversation with some interesting questions. If you’re not ahead, click on the button on the blue side and get access to the rest of the conversation. If you’re watching this, thank you for being a valuable member of our community, and let’s continue our conversation. Dr. Kahn, what are the benefits of routine heart health screenings and checkups for those with hypertension? Like, what would you recommend that someone do regularly?

Joel Kahn, MD, FACC

Well, that’s a great question. There’s so much discussion about longevity, anti-aging, peptides, rapamycin, and metformin, and people miss the fact that the number one killer in the world is high blood pressure. They’re taking their metformin and their peptides, and they’re not checking their blood pressure. That doesn’t work. If you want to go to a health evaluation, whether it’s basic or advanced, and you follow certain gurus, I chuckle when I see gurus online about longevity and they never mention heart health in general or high blood pressure checking and normalization; specifically, you’re looking for good long-term health. It’s got to be almost at the top of the list to normalize your blood pressure. The only way to do that is to check it. There’s a home blood pressure cuff. We talked about brands at the beginning of this conversation. I use it regularly. I tell people, don’t leave it in the closet. Don’t leave it in a drawer. Leave your blood pressure cuff on your desk, at work, on your kitchen table, or on an end table, and get an agreement with your spouse, or your significant other. You can leave it out even though it’s not designer-approved. If that’s an issue, you need to use it regularly and do it properly three times in a row, relaxed. I still think there’s some value in things like rushing in from work and checking your blood pressure because, most of the day, you’re not sitting there perfectly relaxed and optimized. You might want to know if your blood pressure is 160 over 90 all day at work when you’re a little more stressed. But we say the proper way to do it is to relax or take time. Number two, there are such things as hypertension clinics at universities. Usually, what they will do is talk to you about a 24-hour ambulatory blood pressure monitor. Many people know that your racing heartbeat skips if you’re having a different problem called palpitations. It’s prevalent to put on a 24- or 48-hour heart monitor to see how many skip beats you have and what skip beats you have. But a lot of people don’t know that there’s a similar device just for high blood pressure, not for skipping heartbeats. The usual version is that there’s a Velcro cuff on your upper arm with some rubber tubing on the belt you wear. It looks like an old-fashioned Sony Walkman. If people are old enough to remember that and you wear that for 24 hours and every 15 minutes, the cuff is programmed to inflate and deflate and that’s during the day. That’s all night long. People often hate that. All night long, your cuff is going up, and your cuff is going down. It’s scientifically proven. You want accurate information on blood pressure that has meaning for how well you’re doing and what your risk of a long life is. What’s your risk of freedom from a heart attack? What’s your risk of freedom from strokes? You want to have a 24-hour blood pressure monitor. Your blood pressure should be good during the day. Your blood pressure should be lower at night. That’s called dipping. That cuff might do that 90 times or 95 times in 24 hours. That’s a lot of blood pressure measurements. In my clinic in South-Eastern Michigan, we imported from Israel a very interesting device called a BioBeat Patch. I’m not an investor or owner, but it’s a pad you wear for 24 hours on your chest. They’ve been patented and verified. You can measure blood pressure through the skin. You just wear the patch. You don’t feel a thing; you don’t know when it’s going on and off. But every 15 minutes, it’s measuring your blood pressure all day and all night. Immediately, when you’re done, you get a report. We’ve seen how it influences the decision to have high blood pressure. Is it white-coat blood pressure, or is it just that you’re in the office and you’re arguing that it’s normal at home? We can prove that it’s normal at home. For example, are you dipping at night, which is a pattern of healthy, more youthful arteries, or are you not? This has, to me, been a real breakthrough, and it’s available out there.

Laurie Marbas, MD, MBA

I’m going to be looking into that. That’s fascinating. Let’s just get a little bit more about, like the stresses of the blood pressure going on all night. What about managing stress for your emotional well-being and its impact on your heart health especially important in the context of hypertension?

Joel Kahn, MD, FACC

It’s a big one. Probably Dr. Dean Ornish gets a big shoutout. The famous lifestyle Doctor, who, for 40 years has been talking about stress and wrote books about stress and heart disease. It’s a big portion of his most recent book called Undo It. He’s not the only one in the field. But it’s nice to have solid science. In 2012, a cardiologist named Robert Schneider, M.D., from Iowa, who’s very involved with the Transcendental Meditation movement, published a randomized study. If I remember correctly, of the 112 men with heart disease who had previous heart attacks, half were trained in transcendental meditation for 20 minutes twice a day. You get your little mantra, you sit quietly, and you let things pass by. The other group just got some health education about stress reduction. At the end of five years, this group of heart patients who were meditating had 50% less risk of a second heart attack, dying, going to the hospital, or going to the emergency room. This is as powerful as almost any medication on the planet, just through some meditation. You know, people say that’s 40 minutes a day. You’ve got over 1400 other minutes a day. How does that 40 minutes a day, 20 minutes twice a day, impact all those other days? It seems there’s a function in the brain. People call it neuroplasticity, but you can, to some degree, retrain your brain. The next time a stressful and unpleasant situation comes up, you don’t react the same way that you did six months earlier. You have a little more gel, and you have less of a sympathetic outpouring and more of an adrenaline outpouring. Stress reduction through breathing practices, yoga practices, Tai Chi practices, and qigong practices is the real deal. You just have to commit to them and stick with them long-term.

Laurie Marbas, MD, MBA

That’s the new prescription for meditation 20 minutes twice a day if you can sit there long. That’s where I struggle. But I’m curious because you’re looking at cutting-edge devices like the product you mentioned earlier. I want to speak to sodium. Let’s just clear that up. Can you just talk about sodium and why it causes elevated blood pressure, like the basic premise of how that works?

Joel Kahn, MD, FACC

It seems to be that it causes the arteries to get stiffer. There is a real scientific concept of our artery flexibility, which includes young arteries, childhood arteries, teenage arteries, and artery stiffness. That’s the term for arterial stiffness or arterial resistance. When your arteries age and become calcified, we call that hardening of the arteries. Arteries get stiffer. They can happen in the heart arteries, the arm arteries, the leg arteries, and the aorta. Your blood pressure is going to go up, and salt can be one of the factors causing increased arterial stiffness. It also, along with salt, tends to retain water. Your overall blood volume goes up. It becomes a little harder to circulate all that blood volume, and your blood pressure goes up. It’s a confusing topic, but there are books out there called The Salt Fix. There are people and functional medicine doctors who recommend big salt, Himalayan salt, Celtic salt, and all the rest. you say, but Doctor A, B, or C says I should triple the salt in my diet, and 99% of hypertension experts disagree and would say that maybe the commonly mentioned 1500 milligrams of sodium a day is a good goal to shoot for on average.

Laurie Marbas, MD, MBA

The last question is, are there any emerging therapies or interventions that are particularly promising for those with hypertension to prevent heart-related complications? Maybe the one product you mentioned before, or are there any others you would like to?

Joel Kahn, MD, FACC

Do all kinds of fine things. This patch that I mentioned is called BioBeat, it’s patented. I’ve researched and found that I don’t have any financial ties to the company. I had to believe it’d be scooped up by Apple or Samsung. We all have. There isn’t a good blood pressure watch right now. There are a couple you can buy. Omron, the company we mentioned, had one, but it was this huge thing, and the actual band would inflate and deflate like a blood pressure cuff. probably not going to wear that down the aisle at your wedding. It’s not a handsome device. There’s another one out there on the market. I’ve had three versions of it. They break. It’s made in China. Not to be disrespectful to everything made in China, but it was just a low-quality product. But one day we’ll have a good blood pressure monitoring watch to alert you, and that’ll be a breakthrough. There is another device that’s very well researched and has been around for around 20 years, called a RESPeRATE. I want to give that a shout-out, RESPeRATE. It’s a device that looks like a blood pressure module with a couple of electrodes you put on. It’s a breathing, relaxing device. They have peer-reviewed science showing that if you’re committed to using it for 20 minutes a day, it’s another breathing approach that some people like. My mother has one, and I have one at home that I will use now and then. Then, just thinking out loud, there’s one other one that comes to mind called Zona, ZONA. And it turns out there was, if I remember right, some NASA astronaut research that isometric exercise squeezing, squeezing, squeezing. When you release, you get some of the sustained low blood pressure effects. It was tested on astronauts. There’s a device pretty pricey, again, maybe three, $400, like the RESPeRATE. The HeartMath is a little less expensive about $225 but the Zona is in that several hundred dollar range. But if you commit to doing your isometric exercises and releasing, it’s a tool backed by science, backed by NASA, that can help some people. If you’re just struggling, the final one, now that you mention it, is a device you can buy for about $85 called POWERbreathe. It looks a little bit like an asthma inhaler, but it’s just a plastic device for $85. It probably cost $6 to make, but you’re breathing in as hard as you can. It’s called diaphragm training, inspiratory training, or inspiratory muscle training. IMT, these things are coming back to me because I didn’t look them up just before this. You do that for just five minutes, twice a day, and they’ve got good published science that IMT, inspiratory muscle training. It’s used for people who have some lung conditions like asthma. Some athletes do it and believe they swim or bike faster because they have increased their lung capacity and strengthened their diaphragm. But it lowers blood pressure, and that’s probably the lowest cost of the four that I just mentioned. I carry the POWERbreathe in my office. A patient this week just went home with the little box and is going to try it, and it works. 

Laurie Marbas, MD, MBA

Would this be the same as the ones we use with hospital patients to prevent anaphylactic,  anaphylaxis infections? 

Joel Kahn, MD, FACC

It’s fair, but it’s not. It looks a little different, but the concepts are the same. The company makes that version too. 

Laurie Marbas, MD, MBA

Well, this has been phenomenal. Dr. Kahn, thank you so much for spending time with us and sharing your wisdom with us today.

Joel Kahn, MD, FACC

Thank you so much. You’re doing a great job.