THIS PROGRAM IS MADE BY MPT TO ENRICH ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

*] >> JEFF: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION."

>> Jeff: GOOD EVENING WELCOME TO YOUR "DIRECT CONNECTION".

COMING UP TONIGHT, NEW GUIDELINES FOR HEALTHY BLOOD PRESSURE WE WILL GET THE LATEST ADVICE.

BUT FIRST TONIGHT THE NATION'S BLOOD PRESSURE SPIKING WITH ANOTHER THREAT OF A GOVERNMENT SHUT DOWN.

JOINING US NOW FROM CAPITOL HILL IS MARYLAND'S THIRD DISTRICT CONGRESSWOMAN, SARAH ELFRETH THANK YOU FOR JOINING US.

>> THANKS FOR HAVING ME ON.

>> Jeff: AND I UNDERSTAND YOU WERE JUST BACK FROM A CAUCUS MEETING.

WHERE DO THINGS STAND?

>> I SPRINTED BACK TO BE ON IN TIME I APOLOGIZE IF I'M OUT OF BREATH I WANTED TO TALK DIRECTLY TO PEOPLE.

WHERE THINGS STAND IS DEMOCRATS ARE READY, WILLING AND ABLE TO WORK WITH REPUBLICANS ON A BIPARTISAN BUDGET THAT ACTUALLY ADDRESSES THE REAL AFFORDABILITY AND IN PARTICULAR, HEALTHCARE AFFORDABILITY CRISIS TO MANY AMERICANS ARE LIVING WITH ON A DAY-TO-DAY BASIS.

YOU MIGHT KNOW, JEFF, THE ACA TAX CREDITS THAT KEEP PREMIUMS DOWN ARE SET TO EXPIRE ON DECEMBER 31.

WITHOUT CONGRESS ACTING IN MARYLAND PEOPLE'S HEALTHCARE PREMIUMS WILL GO UP BY 13% IF YOU GET YOUR HEALTHCARE ON THE STATE EXCHANGE IF CONGRESS DOES NOTHING.

WE ARE ASKING FOR BIPARTISANSHIP HOW CAN WE WORK TOGETHER TO SOLVE THIS SOLUTION AND KEEP THE GOVERNMENT RUNNING.

>> Jeff: THE REPUBLICAN SPEAKER OF THE HOUSE WAS ON "CNN" SAYING THEY HAVE A CLEAN EXTENSION READY TO GO.

AND THAT THE DEMOCRATS HE SAYS ARE HOLDING IT UP TRYING TO GET FREE HEALTHCARE FOR ILLEGAL ALIENS HIS TERMS.

WHAT DO YOU SAY TO THAT?

>> I THINK THAT IS UTTER FOOLISHNESS.

UNION WHERE THEY ARE GETTING THAT PARTICULAR TALKING POINT.

WE ARE TALKING ABOUT ACA TAX CREDITS THAT DON'T GO TO ANYBODY WHO IS NOT A CITIZEN OF THESE UNITED STATES.

SO I THINK THEY ARE USING FEAR TACTICS FRANKLY TO DIVIDE THIS NATION WHEN DEMOCRATS ARE TRYING TO LITERALLY KEEP PEOPLE INSURED KEEP OUR RURAL HOSPITALS OPEN, KEEP FOLKS WITH DISABILITIES ON MEDICAID THAT IS WHAT WE'RE WORKING FOR RIGHT NOW.

WE ARE WORKING NOT AGAINST THE REPUBLICAN CR WE ARE WORKING FOR THE AMERICAN PEOPLE.

SO, I AM I DON'T BUY WHAT THE SPEAKER IS SELLING.

>> Jeff: YOU ANNOUNCED LEGISLATION THAT WOULD PROTECT FEDERAL WORKERS AND CERTAINLY WE HAVE A LOT LIVING IN MARYLAND FEWER THAN WE USED TO.

HOW WOULD THAT WORK?

>> GREAT QUESTION.

SO WE'VE HAD UNFORTUNATELY TOO MANY SHUTDOWNS AND WE SEE WAYS TO FILL THE NEEDS AND FILL THE GAPS WITH EVERY SHUT DOWN.

SINCE THE 2018, 2019 SHUT DOWN A DIFFERENCE IS FOLKS WILL RECEIVE BACK PAY WHICH IS REALLY IMPORTANT.

BUT WE FOUND A LOOPHOLE IN PROTECTIONS FOR FEDERAL EMPLOYEES AND I REPRESENT 44,000 FEDERAL EMPLOYEES IN THE THIRD DISTRICT.

IF YOU ARE DEEMED ESSENTIAL AN F.D.A.

2347ER, INSPECTING FOOD QUALITY AND SAFETY YOU YOU ARE AN AIR TRAFFIC CONTROLLER OR A FIREFIGHTER, YOU WILL BE DEEMED ESSENTIAL AND YOU HAVE TO WORK AND YET NOT GET PAID AND YOU ARE NOT ELIGIBLE TO COLLECT UNEMPLOYMENT INSURANCE.

BUT IF YOU ARE FURLOUGHED YOU COULD COLLECT THAT UNEMPLOYMENT INSURANCE.

AND YOU'RE PAYING INTO THAT UNEMPLOYMENT INSURANCE WITH EVERY PAYCHECK.

TOO MANY AMERICANS I DID NOT KNOW THIS HALF OF AMERICANS ARE LIVING PAYCHECK TO PAYCHECK INCLUDING OUR FEDERAL WORKERS.

THERE IS NO SAFETY NET IN CASE OF A SHUT DOWN FOR THE ESSENTIAL EMPLOYEES.

OUR BILL IS GOING TO FILL THAT GAP AND I'M GRATEFUL TO BE WORKING ON THAT BILL WE HAVE A GREAT NUMBER AND COALITION OF COSPONSORS ON THAT BILL.

I'M WORKING HARD TO MAKE IT BIPARTISAN AS I DO, THIS IS AN ISSUE THAT OBVIOUSLY IMPACTS THE THIRD DISTRICT AND THERE ARE FEDERAL EMPLOYEES WHO ARE ESSENTIAL AND ALL 435 DISTRICTS AND THEY DESERVE THE PROTECTION.

>> Jeff: OBVIOUSLY WITH CONGRESS CONTROLLED BY THE REPUBLICANS, THE WHITE HOUSE CONTROLLED BY THE REPUBLICANS, LEGISLATION IS A LONGSHOT.

YOU ARE TRYING TO MAKE IT BIPARTISAN.

HAVE YOU SIGNED SOMEBODY UP?

>> I'M TALKING TO MY FRIENDS ACROSS THE AISLE EVERYDAY.

PARTICULARLY THE ONES WHO HAVE FEDERAL EMPLOYEES.

THE FIRST BILL I FILED IN CONGRESS, IS THE PROTECT OUR PROBATIONARY EMPLOYEES ACT IN RESPONSE TO DOGE'S SUMMARY FIRINGS OF PROBATIONARY EMPLOYEES AND I'VE BEEN ABLE TO GET FIVE REPUBLICANS ON THAT BILL.

I'VE GONE TO MY PARTNERS IN THAT AND FRIENDS SINCE WE FILED THAT BILL TO ARGUE THE CASE THAT MAYBE WE'RE NOT GOING TO AGREE ON A SHUT DOWN BUT CAN WE PLEASE AGREE THAT FIREFIGHTERS RESPONDING TO FIRES IN OUR MILITARY INSTALLATIONS DEEMED ESSENTIAL THEY SHOULD HAVE A SAFETY NET THAT THEY PAID INTO.

THAT IS THE ARGUMENT I'M MAKING SPENDING TIME TRYING TO GET BIPARTISANSHIP ON THAT BILL.

>> Jeff: THE WHO GETS BLAMED CALCULATION, EVERY TIME THERE IS A SHUT DOWN, BOTH SIDES ARE TRYING TO MAKE THEIR CASE TO THE AMERICAN PEOPLE.

REPUBLICANS HAVE CONTROL OF THE HOUSE AND THE SENATE.

BUT THEY DON'T HAVE ENOUGH VOTES IN THE SENATE TO SHUT DOWN A FILIBUSTER.

THEY CAN MAKE THE CASE THAT THIS CLEAN CONTINUING RESOLUTION IS BEING BLOCKED BY DEMOCRATS.

CAN THEY NOT?

CAN THEY HAVE REPEATED VOTES TO SHOW DEMOCRATS BLOCKING IT?

>> YES, I DON'T BUY THIS ARGUMENT IT'S DEMOCRATS.

WE ARE THE ONLY ONES ASKING FOR A BIPARTISAN BUDGET THAT YOU ARE NOT HEARING SPEAKER JOHNSON THEY ARE ASKING US TO VOTE FOR A CONTINUING RESOLUTION THAT IS GOING TO KICK THE CAN SEVEN WEEKS DOWN THE ROAD.

SEVEN WEEKS CLOSER AGAIN TO THE ACA TAX CREDIT CHALLENGE THAT IS HAPPENING ON DECEMBER 31.

AND BY THE WAY, INSURANCE COMPANIES AREN'T WAITING FOR CONGRESS TO ACT THEY ARE SENDING OUT NOTICES ABOUT INCREASING PREMIUMS FOR HUNDREDS OF THOUSANDS OF MARYLANDERS AND MILLIONS OF AMERICANS ON OCTOBER FIRST.

WE DON'T HAVE THE LUXURY OF TIME HERE WE NEED TO SOLVE THIS NOW AND THAT IS WHAT DEMOCRATS ARE ASKING FOR.

>> Jeff: YOUR ADVICE FOR CONSTITUENTS WHO MAY BE WATCHING WHO KNOW THEY HAVE AN OPEN ENROLLMENT PERIOD COMING UP, HOW MUCH TIME DO THEY HAVE?

>> THEY SHOULD GET THINKING ABOUT IT NOW AND WATCH THE MARKETPLACE.

I AM AN OPTIMIST I COULDN'T BE IN THIS WORK IF I DIDN'T BELIEVE WE COULD COME TOGETHER AND ADDRESS THIS HEALTH INSURANCE CRISIS.

I'M HOPING WE CAN MAKE THIS IN TIME.

BUT I WOULD CAUTION PEOPLE PLEASE LOOK AT THE EXCHANGE AND SHOP AROUND CALL YOUR MEMBERS OF CONGRESS TO SEE IF WE CAN PROVIDE CONSTITUENT SERVICES DURING THE TOUGH TIME OF A SHUT DOWN MY OFFICE WILL BE OPEN.

WE WILL BE ANSWERING EVERY PHONE AND RETURNING EVERY E-MAIL.

REACH OUT TO US IF WE CAN BE OF HELP AND WE'RE WORKING HARD ON GETTING THE BILL INTO LAW SO PEOPLE HAVE THAT SAFETY NET THAT THEY DESERVE.

>> Jeff: LET ME ASK ONE OR TWO OTHER QUESTIONS IF I MAY.

OVER THE WEEKEND GOVERNOR MOORE COMMITTED TO REDRAWING MARYLAND'S CONGRESS AT DISTRICTS TO COUNTERACT WHAT IS HAPPENING IN REPUBLICAN STATES WHERE THEY ARE REDRAWING MAPS TO ADD MORE REPUBLICAN DISTRICTS.

I UNDERSTOOD THAT MEMBERS OF THE MARYLAND DELEGATION WERE BROADLY AGAINST THAT.

WOULD YOU SUPPORT THE GOVERNOR'S PLAN?

>> WELL, WE DON'T HAVE A VOTE IN THE GOVERNOR'S PLAN.

THAT GOES TO THE GENERAL ASSEMBLY IT DOES NOT COME TO MEMBERS OF CONGRESS.

I WILL SAY THAT WE HAVE NEVER EXPERIENCED THIS TYPE OF MID-DECADE REDISTRICTING PURELY FOR POLITICAL PURPOSES AS WE'VE SEEN IN TEXAS AND OTHER STATES, FLORIDA IS A BIG ONE THAT IS COMING UP.

IT IS DISASTROUS FOR OUR DEMOCRACY.

IF LINES CHANGE EVERY TWO YEARS BASED ON HOW MANY SEATS ONE PARTY OR ANOTHER CAN PICK UP FOR THE NEXT CONGRESS.

IT IS A GAME TOWARDS ZERO.

AND IT'S NOT HEALTHY AT ALL.

AT THE SAME TIME I'M NOT SURE HOW STATES CAN SIT HERE AND NOT RESPOND TO WHAT'S HAPPENING IN TEXAS.

SO, I'VE SPOKEN TO THE GOVERNOR AND MADE CLEAR I WILL SUPPORT WHAT THE GENERAL ASSEMBLY DECIDES TO DO AND I WILL RUN AND SERVE IN ANY DISTRICT THAT MY CONSTITUENTS ASK ME TO.

>> Jeff: THE LATEST ON THE KEY BRIDGE, I BELIEVE THE THIRD DISTRICT ACROSS CENTRAL MARYLAND RUNS RIGHT UP TO THE KEY BRIDGE SITE.

IT'S BEEN A YEAR-AND-A-HALF.

WHAT'S THE LATEST ON THAT?

>> GREAT QUESTION.

I SPENT SOME OF MY JULY TOURING THE DEMOLITION.

THE GOOD NEWS IS THAT DEMOLITION IS MOVING FORWARD.

THE FEDERAL FUNDING MY PREDECESSOR AND SENATOR CAR DEN WORKED HARD TO MAKE SURE WE HAD BIPARTISAN SUPPORT 100% FEDERAL FUNDING FOR THE KEY BRIDGE DEMOLITION AND REBUILD.

I KNOW THERE'S BEEN A LOT OF POLITICAL FOOTBALL NONSENSE WITH THE PRESIDENT SAYING THINGS.

BUT THAT IS IN LAW.

AGAIN BIPARTISANLY PASSED LAST YEAR IN THE BUDGET.

NOW IT'S ABOUT MOVING FORWARD.

HOW ARE WE MEETING OUR BUDGET, MEETING OUR SCHEDULE, BEING AS AGGRESSIVE AS POSSIBLE AND MAKING SURE WE ARE EFFICIENT TO MEET THE NEEDS OF REBUILDING THAT BRIDGE.

THE FASTEST WAY AND SAFEST WAY POSSIBLE AND THAT IS WHAT I'M FOCUSED ON IN WASHINGTON KEEPING THAT FEDERAL MONEY AND MAKING SURE THE STATE IS DELIVERING ON TIME AND ON BUDGET.

>> Jeff: CONGRESSWOMAN SARAH ELFRETH JOINING US FROM CAPITOL HILL THANK YOU FOR DASHING BACK TO YOUR OFFICE FROM THE CAUCUS MEETING TO JOIN US.

>> I CAUGHT MY BREATH.

THANK YOU SO MUCH.

>> Jeff: GOOD TIMING.

WE HAVE AN INTERVIEW REQUEST OUT TO THE OFFICE OF MARYLAND'S LONE REPUBLICAN MEMBER OF CONGRESS ANDY HARRIS HOPE TO BRING YOU THAT CONVERSATION IN THE NEAR FUTURE.

WE WILL BE RIGHT BACK.

>> Jeff: AND JOINING US TO TALK ABOUT YOUR HEALTH IS SDR JEREMY POLLOCK A CORDOLOGIST AT THE UNIVERSITY OF MARYLAND ST.

JOSEPH MEDICAL CENTER.

DOCTOR WELCOME BACK TO MPT.

>> THANKS FOR HAVING ME ON AGAIN.

>> Jeff: IT'S GOOD TO HAVE YOU.

WE ARE HERE TO TALK ABOUT BLOOD PRESSURE.

FOR THE FIRST TIME IN EIGHT YEARS WE HAVE NEW RECOMMENDATIONS, WHAT'S CHANGED?

>> WE ALWAYS LOVE WHEN NEW GUIDELINES COME OUT BECAUSE WE CAN RECESS THEM AND WHAT IS THE DIFFERENCE AND WHAT IS THE SAME AND TALK TO OUR PATIENTS AGAIN.

NEW GUIDELINES NOW THERE WAS A LOT OF EMPHASIS ON THINGS THAT WERE OLD FROM THE OLD ONES AND A COUPLE NEW ONES.

THE BIG THING I LOVED IS THE EMPHASIS ON PREVENTION IN A HOLISTIC APPROACH TO YOUR HEALTH NOT MUCH DIFFERENT THAN EIGHT YEARS AGO.

>> Jeff: I NOTICE THE NUMBERS DID NOT CHANGE.

THEY DIDN'T GIVE EVERYBODY 10 BONUS POINTS.

>> THE NUMBERS ARE THE SAME WE LOOK AT NUMBERS AND THINK OF WHAT IS NORMAL BLOOD PRESSURE.

ON AVERAGE LESS THAN 120, THE TOP NUMBER OVER 80, THE BOTTOM NUMBER WE CONSIDER NORMAL.

PREHYPERTENSION IS UNDER 130.

BETWEEN 120 AND 130 RANGE.

ABOVE 130 WE ARE TALKING ABOUT STAGE ONE BETWEEN 130 AND 140.

AND 140 STAGE TWO THAT IS THE SAME AS EIGHT YEARS AGO.

NOTHING DIFFERENT.

>> Jeff: AND AT THE TOP OF THE CHART THE CRISIS.

WHICH WE SHOULD TALK ABOUT BECAUSE IT IS AN EMERGENCY.

>> YEAH, HYPER HYPERTENSIVE CRISIS WE CONSIDER ABOVE 180 WITH SYMPTOMS.

SYMPTOMS OF HIGH BLOOD PRESSURE VISION CHANGES, HEADACHES, CONFUSION, SHORTNESS OF BREATH OR CHEST PAIN WHERE YOU ARE PICKING UP THE PHONE AND CALLING 911.

>> Jeff: THE THING ABOUT BLOOD PRESSURE MOST PEOPLE HAVE NO IDEA BECAUSE YOU DON'T FEEL IT.

YOU WOULD BE 100 OVER 70 OR 150 OVER 90 AND NOT FEEL ANY DIFFERENCE, RIGHT?

>> RIGHT.

WE CONSIDER HYPERTENSION HIGH BLOOD PRESSURE SIMILAR TO CORONARY DISEASE TO BE THE SILENT KILLER BECAUSE YOU DON'T FEEL HYPERTENSION IF YOU FEEL IT IT'S TOO LATE.

SAME AS CORONARY DISEASE.

FOR HYPERTENSION IT'S ABOUT IDENTIFICATION EARLY, KNOWING THAT YOU ARE AT RISK FOR IT AND PUTTING A FOUNDATION AND STRUCTURE IN PLACE TO TRY TO PREVENT IT FROM PROGRESSING.

>> Jeff: WHAT IS IT DOING TO OUR BODIES WHILE WE DON'T KNOW IT'S DOING IT?

>> KEEP IT SIMPLE.

IT IS A PLUMBING SYSTEM.

SO IF YOUR PRESSURE ON YOUR ORGANS IS HIGHER YOUR KIDNEYS YOUR EYES YOUR HEART, LUNGS, BRAIN ARE SEEING A HIGHER PRESSURE OVER TIME, OVER TIME, YEARS, DECADES THAT CAN CAUSE DAMAGE.

IF WE CAN IDENTIFY THAT HIGHER PRESSURE THAT THOSE ORGANS ARE SEEING EARLIER IN THAT PROCESS WE CAN CHANGE THE TRAJECTORY OF THE DISEASE SO IT DOESN'T AFFECT YOUR ORGANS.

>> Jeff: TWO NUMBERS BECAUSE THE HEART BEATS AND THAT IS THE TOP NUMBER.

>> I LIKE TO KEEP IT SIMPLE.

WE CAN GET INTO THE WEEDS AND TALK ABOUT THE TOP NUMBER SIS TOLLIC OR THE DIASTOLIC.

WHAT I COACH PATIENTS ON FOCUS ON THE TOP NUMBER BECAUSE THAT IS THE PRESSURE THE ORGANS ARE SEEING.

WE WANT THE TOP NUMBER ON AVERAGE TO BE LESS THAN 130.

>> Jeff: VIEWERS IF YOU HAVE A QUESTION ABOUT BLOOD PRESSURE, BLOOD PRESSURE MEDICATIONS, YOU CAN SEND US AN E-MAIL LIVE QUESTIONS AT MPT.ORG.

WHAT IS THE RELATIONSHIP YOU MENTIONED SOME OF THE ORGANS AFFECTED.

RELATIONSHIP TO HEART DISEASE?

>> SO HYPERTENSION WE CONSIDER ONE OF THE EIGHT RISK FACTORS FOR HEART DISEASE.

IF YOU HAVE HIGH BLOOD PRESSURE THAT INCREASES INFLORIDA NATION AND PRESSURE THAT THE HEART IS SEEING OVER TIME AND IT CAN CAUSE ACCELERATED DEVELOPMENT OF CRUD OR BLACK IN YOUR ARTERIES.

KEEPING YOUR BLOOD PRESSURE UNDER CONTROL IS PART OF THE EIGHT THINGS I'M RECOMMENDING ALL MY PATIENTS DO TO PREVENT HEART DISEASE LONG-TERM.

>> Jeff: WHAT ARE THE OTHERS?

>> IT IS A SOFTBALL.

AGAIN, THE TREATMENT FOR HYPERTENSION HIGH BLOOD PRESSURE IS SIMILAR TO THE TREATMENT FOR HEART DISEASE AND I CUT IT INTO TWO GROUPS.

GROUP ONE IS WHAT WE CARE ABOUT THE HOLISTIC INTERVENTIONS.

PEOPLE DON'T LIKE TAKING MEDICINES.

PEOPLE LOVE TO HEAR WHAT CAN I DO ABOUT MEDICINES TO IMPROVE MY HEALTH.

NUMBER ONE, THE KEY TO LONGEVITY IT IS NOT A PILL OR A MAGIC CLINIC IT'S EXERCISE.

DAILY EXERCISE.

AND WE CAN ALL EXERCISE, RIGHT?

NOBODY HAS AN IMPEDIMENT TO IT.

EXERCISE CAN BE AS SIMPLE AS WALKING.

30 MINUTES, FIVE DAYS A WEEK, YOU ARE DOING BETTER.

IF YOU CAN DO 30 MINUTES FIVE DAYS A WEEK YOU CAN LOWER YOUR BLOOD PRESSURE.

NUMBER TWO IS WEIGHT.

WE ALL WANT TO BE AT A HEALTHY WEIGHT AND I AND MANY OF US WISH THAT EXERCISE COULD LOWER OUR WEIGHT.

ONCE YOU ARE OVER 25, 30 YEARS OLD IT'S HARD.

WEIGHT LOSS IS CAL LOWERRIC INTAKE NUTRITION AND WHAT WE'RE EATING.

NUMBER THREE IS THE NUTRITION.

LOW SALT DIET TALKING ABOUT HYPERTENSION.

HIGH SALT AVERAGE AMERICAN IS TAKING IN FIVE GRAMS OF SALT, TWO GRAMS A DAY WHICH IS HARD IT IS NOT JUST POURING SALT ON FOOD, THE SALT CONTENT IN OUR FOOD YOU CAN LOWER YOUR BLOOD PRESSURE.

THOSE THREE BIG THINGS, WEIGHT MANAGEMENT, NUTRITION AND EXERCISE AND NUTRITION CAN BE A HOLISTIC APPROACH TO OUR HEALTH.

>> Jeff: THE DIFFICULTY OF GETTING AN ACCURATE MEASUREMENT?

SOMEBODY COMES INTO YOUR OFFICE AND THEY ARE IMMEDIATELY ON EDGE, NOT YOU, THE WHITE COAT HYPERTENSION.

SO WHAT DO YOU DO IN THE OFFICE SHOULD SOMEBODY DO AT HOME TO MAKE SURE THE NUMBERS ARE ACCURATE?

>> IT IS AN IMPORTANT POINT I WANT TO GET ACROSS TO YOUR VIEWERS.

THERE'S TWO GROUPS OF PATIENTS.

GROUP ONE, THEY'VE NEVER SEEN A BLOOD PRESSURE CUFF THEY DON'T KNOW HOW TO CHECK THEIR BLOOD PRESSURE.

THAT IS A GROUP OF PATIENTS TALKING ABOUT HOW TO CHECK THEIR PRESSURE AT HOME.

GROUP NUMBER TWO CHECK THEIR PRESSURE TWO, THREE TIMES A DAY.

THEY COME IN WITH A LOG THAT IS THIS BIG THEY ARE EQUALLY AN ISSUE AS THE PATIENTS THAT DON'T CHECK IT.

WHAT I COACH PATIENTS ON HOW CAN YOU ACCURATELY CHECK YOUR PRESSURE.

IT IS NOT ACCURATE IN A DOCTOR'S OFFICE.

I ACTUALLY WOULD PREFER US NOT CHECK IT IN A DOCTOR'S OFFICE AND THE GUIDELINES TODAY 2025 REITERATE THIS.

IT'S AT HOME.

I TELL MY PATIENTS AND THIS TALKS TO BOTH GROUPS I ONLY NEED YOU TO CHECK IT ONCE A WEEK.

NOT TWICE A DAY, ONCE A WEEK.

IT HAS TO BE SEATED AT REST NOT WATCHING THE RYDER CUP OR THE RAVENS GAME.

NO STRESS NOT IN PAIN.

FEET ARE FLAT.

YOU ARE AT REST.

YOUR ARM IS AT HEART LEVEL AND RELAXED AND DO IT THREE TIMES OVER FIVE MINUTES AND YOU WRITE THE THREE NUMBERS DOWN AND WE CARE ABOUT THE TOP NUMBER.

IF YOU GET 150, 140, 130 YOU ARE WRITING THE LOWEST NUMBER DOWN AND YOU WILL GET ME A RUNNING AVERAGE OVER THREE MONTHS.

I DON'T CARE WHAT ONE NUMBER IS BLOOD PRESSURE CHANGES BY SECOND TO SECOND.

I WANT TO KNOW OVER 12 WEEKS WHAT IS YOUR AVERAGE BLOOD PRESSURE.

AND FROM THAT WE CAN MAKE AN ASSESSMENT.

>> Jeff: YOU WILL BE POPULAR.

WE WILL THROW OUT THE HIGH NUMBERS AND CONCENTRATE ON THE LOW NUMBERS.

WHAT IS IN THE TOOLKIT IF SOMEBODY HAS DONE EVERYTHING YOU ASK AND THEY ARE DOING EXERCISE MAYBE IT'S WALKING THEY ARE LIMITING THEIR SALT AND THE NUMBER IS STILL TOO HIGH?

YOU HAVE A HUGE ARRAY OF BLOOD PRESSURE PILLS?

>> AGAIN, OUR 2025 GUIDELINES ADDRESS THIS.

IF WE HAVE DONE OR HOLISTIC INTERVENTIONS AND MAKING EVERY EFFORT SOMETIMES WE CAN'T CHANGE OUR GENES OR AGE.

AS WE GET OLDER OUR ARTERIES GET STIFFER, BLOOD PRESSURE GOES UP AND IT'S NO LONGER CONSIDERED NORMAL.

WE HAVE LOTS OF CLASSES OF MEDICATIONS WE CAN HELP OUR PATIENTS TO GET THINGS TOLERABLE AND CHEAP AND CAN MILWAUKEE A DIFFERENCE AND THAT IS FINDING THE RIGHT COCKTAIL AND WHAT YOU CAN BE ON AND HAVING A GOOD RELATIONSHIP WITH YOUR PHYSICIAN SHORT-TERM AND LONG-TERM.

>> Jeff: DO THESE HAVE SIDE EFFECTS.

WHEN YOU GIVE THEM THE MENU OF OPTIONS AND ONE OPTION IS GO TO THE GYM AND THE OTHER IS POP A PILL SOME WILL CHOOSE THE PILL?

>> PILLS WORK ONLY SO FAR.

WE HAVE TO MAKE LIFESTYLE CHANGES TO REALLY MAKE THE PILLS WORK THE BEST.

YES, EVERY PILL HAS A POTENTIAL OF SIDE EFFECTS.

BUT THE GOOD NEWS IN 2025 IS WE HAVE ABOUT 100 YEARS OF DATA AND SCIENCE AND OVER 100 DIFFERENT DIFFERENT MEDICATIONS WE CAN CHOOSE FROM.

THE GOAL IS LOOKING AT THE PATIENT WHO IS IN FRONT OF ME WHAT ARE YOUR GOALS AND VALUES AND WHAT CAN WE GIVE TO YOU TO MAKE A DIFFERENCE FOR YOU.

>> Jeff: HOW MUCH IS THIS IN THE PURVIEW OF CARDIOLOGY VERSUS PRIMARY CARE?

>> THAT IS A GOOD QUESTION.

I THINK IT'S BOTH OF US.

A LOT OF MY DAY-TO-DAY PATIENT CARE IS HELPING THE PRIMARY CARE DOCTOR.

AGAIN OUR PRIMARY CARE DOCTORS ARE STRESSED OVER BURDENED THERE ARE NOT ENOUGH OF THEM.

THERE ARE NOT ENOUGH CARDIOLOGISTS.

WORKING HAND IN HAND WITH PRIMES IS UNBELIEVABLY VALUABLE FOR OUR PATIENTS.

IT TAKES MANY OF US WITH DIFFERENT CONTACTS TO MAKE A DIFFERENCE.

>> Jeff: I READ IF YOU CAN LOWER THE SYSTOLIC BY 10 POINTS, 20% DROP IN YOUR CARDIAC EVENT RISK?

>> YOU HAVE TO ASK GPT THAT ONE.

EVERY FIVE POINTS YOU CAN GO DOWN YOU HAVE A SUBSTANTIAL DECREASE IN YOUR LONG-TERM CARDIOVASCULAR RISK.

>> Jeff: WHAT IS THE FRONTLINE MEDICATION?

IS THERE ONE THAT EVERYBODY'S GO TO PILL?

AND HAS THAT CHANGED OVER TIME?

>> 2025 GUIDELINES ARE NOT DIFFERENT FROM 2017 IT DEPENDS ON THE PERSON.

THERE IS NOT A ONE-SIZE-FITS-ALL.

FOR MOST OF MY PATIENTS THAT COME IN WITH HIGH BLOOD PRESSURE THAT TRIED THE LIFESTYLE CHANGES THE THING THAT THE 2025 GUIDELINES ARE ASKING US IS A COMBINATION PILL THAT IS ONE PILL THAT HAS TWO DRUGS.

ONE IS A MILD DIURETIC IT MAKES YOU URINATE AND ONCE IS A DILATER THAT MAKES YOUR ARTERIES LESS PLASTIC.

THAT WORKS WELL WITH LITTLE SIDE EFFECTS.

>> Jeff: HERE IS A QUESTION WHAT ARE THE ISSUES WITH CHRONICALLY LOW BLOOD PRESSURE?

DOES THAT HAPPEN ABSENT SOME OTHER ISSUE?

>> I LOVE THAT QUESTION MORE FOR THE TWO GROUPS OF PATIENTS WE'RE TALKING ABOUT.

THE PEOPLE THAT CHECK THEIR BLOOD PRESSURE TOO MUCH AND THOSE THAT DON'T CHECK IT ENOUGH.

HIGH BLOOD PRESSURE IN THE SHORT-TERM IS NOT GOING TO HARM YOU.

I'M COACHING MY PATIENTS CHECKING THEIR BLOOD PRESSURE.

140-160.

RIGHT NOW THAT IS NOT GOING TO HURT YOU.

IN THE NEXT 10, 20 YEARS WE NEED TO FIX IT.

BUT IF I OVERSHOOT GIVE YOU TOO MUCH MEDICATION AND I LOWER YOUR BLOOD PRESSURE I CAN HURT YOU TODAY.

I CAN MAKE YOU DIZZY LIGHT HEARTED, LOSE CONSCIOUSNESS.

LOW BLOOD PRESSURE IS A PROBLEM ESPECIALLY WHEN WE OVERMEDICATE WE HAVE TO BE VERY CAREFUL HOW WE CHOOSE THE MEDICATION AND HOW WE MONITOR IT.

>> Jeff: SUSAN AS A QUESTION ABOUT THE DIFFERENT BRANDS DIFFERENT TYPES OF TESTERS.

I FIND IT DIFFICULT FIGURING OUT WHICH ONCE TO USE, HOW TO USE IT GET STRESSED TRYING TO FIGURE IT OUT.

DO YOU HAVE RECOMMENDATIONS?

>> I HAVE NO RELATIONSHIP WITH THE BLOOD PRESSURE CUFF MAKERS.

I TYPICALLY RECOMMEND OMRON.

THERE IS A WEBSITE, I THINK IT'S BLOOD PRESSURE CUFF.COM.

BUT IF YOU HAVE A WEBSITE I CAN GIVE IT TO YOU WHERE YOU CAN MAKE SURE THE CUFF YOU CHOOSE IS ONE THAT IS ON THAT LIST AND IS VERIFIED BY THE AMERICAN HEART ASSOCIATION.

THEY ARE GOOD.

YOU LIKE THE AUTOMATIC ONES.

AND THOSE ARE TYPICALLY RANGE BETWEEN $40 AND $50 THEY LAST FOR A LONGTIME AND ARE VERY ACCURATE.

>> Jeff: QUESTION FROM CAM WHO TAKES BLOOD PRESSURE AT HOME ONCE A WEEK.

LOWEST OF THREE AVERAGE OF 12 WEEKS WHEN UPON WAKING UP?

BEFORE OR AFTER A MEAL?

IS THERE A TIME OF DAY.

>> A GREAT QUESTION.

THE REASON WE DO IT 12 TIMES I WANT YOU TO DO IT RANDOM TIMES.

I DON'T WANT YOU STRESSED.

YOU DON'T WANT TO BE WATCHING THE RAVENS GAME OR HUNGRY OR JUST EXERCISED.

TRY TO DO IT AT DIFFERENT TIMES SO WE CAN GET AN AVERAGE WHAT YOU'VE BEEN RUNNING OVER THREE MONTHS.

>> WEARING A FANCY WATCH THAT SOMEBODY WOULD DO A HALF MARATHON CAN THAT DO BLOOD PRESSURE IT CAN DO A PULSE?

>> THERE ARE DEVICES NOW THAT CLAIM THAT THEY CAN GET BLOOD PRESSURE WITHOUT ACTUALLY GIVING PRESSURE ON THE ARM.

I DO NOT RECOMMEND USING THOSE YET.

THOSE ARE NOT READY FOR PRIMETIME.

THE DATA FOR HOW ACCURATE THEY ARE IS NOT OUT THERE.

THIS IS AN APPLE iWATCH THEY DON'T HAVE BLOOD PRESSURE YET BUT THERE ARE DEVICES AND I DON'T RECOMMEND THEM.

>> Jeff: BOTTOM LINE FOR PEOPLE WATCHING WE'VE ESTABLISHED IF IT IS AN EMERGENCY LEVEL YOU GOT AN EMERGENCY, OTHERWISE YOU WANT PEOPLE TO FOCUS ON WHAT?

>> AGAIN, IF THERE'S ANYTHING YOU GET FROM THIS IT'S FOUNDATIONAL LIFESTYLE CHANGES.

HEALTHY WEIGHT, EXERCISE EVERYDAY.

TRY TO EAT WELL.

CONTROL YOUR STRESS.

SLEEP WELL AND WE MISS SOCIAL FITNESS HAVING HAVING HOBBIES AND FUN THOSE THINGS ARE MORE IMPORTANT THAN ANY PILL I CAN GIVE YOU.

>> Dr.

JEREMY POLLOCK UNIVERSITY OF MARYLAND ST.

JOSEPH MEDICAL CENTER THANK YOU FOR STOPPING BY.

THAT IS "DIRECT CONNECTION" FOR THIS WEEK WE'RE BACK FRIDAY WITH "STATE CIRCLE" AND THE LATEST ON MARYLAND POLITICS JOIN US FOR THAT FRIDAY EVENING AT 7:00 P.M.

YOU CAN SEE PAST EDITIONS ON-LINE AT VIDEO.MPT.TV.

AND ALSO ON THE FREE VAN.

FOR ALL OF US AT MPT THANK YOU FOR WATCHING "DIRECT CONNECTION" AND HAVE A GOOD NIGHT.

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