Despite years of public health efforts, most U.S. adults with high blood pressure are still not meeting current treatment targets, a gap that new national data continue to highlight.

Jason Trager, DO, a cardiologist with OSF HealthCare in Bloomington says the findings underscore why recent hypertension guideline changes were necessary and why controlling blood pressure remains one of the most effective ways to prevent serious cardiovascular events.

Under updated guidelines, the long-standing 140/90 mm Hg is now considered stage 2 hypertension, and a blood pressure of 130/80 mm Hg is considered stage 1.

“Which is a fairly low goal yet, when you compare 130/80 to the 140/90 and you treat these people, it resulted in about 15% risk reduction in all-cause mortality. So again, there’s good data to back it up.” 

Dr. Trager says lowering the threshold for diagnosis of high blood pressure can make a difference in preventing heart attacks and strokes. However, in the National Health and Nutrition Examination Survey (NHANES) 2021-2023 data, 79.1% of adults with hypertension did not have their blood pressure within the 130 mm Hg systolic and 80 mm Hg diastolic threshold recommended by guidelines.

Trager said the reasons are complex and often overlapping.

“Well, it’s a little bit difficult to tell,” according to Dr. Trager. “And sometimes it could be access to the care where the patients aren’t getting in to see their primary care docs and doing the primary care prevention type of stuff. Sometimes it could be related to the cost of the medications that are required, or some people just have high blood pressure, but they don’t know it.” 

Lifestyle changes can make a big difference

He adds that lifestyle factors also play a major role in whether patients achieve control.

Smoking cessation, he emphasizes, could have the single greatest impact.

 “Quitting smoking decreases your risk of having heart attack and strokes by 50%. I mean, it’s almost better than any medication that I can give you, it’s just, it’s just not to smoke.” Dr. Trager adds, “The other thing we see a lot is sleep apnea and treatment of the sleep apnea – that can really reduce someone’s blood pressure significantly too.” 

For many patients with stage 1 hypertension, medication is not the first step. Instead, Trager believes in introducing lifestyle changes that can significantly reduce blood pressure.

“If someone decreases their salt intake, and there’s this DASH diet, we can see about a 10-point blood pressure reduction,” Dr. Trager says. “If someone starts exercising, we all see about a five-point reduction in blood pressure. If someone ends up losing, you know, just 10 pounds, you would also see about a five-to-10-point blood pressure reduction.” 

Even among patients taking medication, control remains elusive. Trager point out that half of people with high blood pressure are unaware they have it, and even among those treated, only about half reach current targets.

Check blood pressure regularly

“With these newer guidelines, about one in five people will be controlled,” he says. “So, in other words, come in, bring in your blood pressure cuff, see your primary (care provider), or see your cardiologist, because you will probably need to do some tweaking of the medications now.” 

Trager recommends taking a blood pressure reading once a week at home. And he stresses the importance of accurate blood pressure measurement, including proper cuff placement and body positioning. He suggests avoiding wrist cuts because he says they can be notoriously inaccurate. Also, make sure you are placing the cuff high enough on the arm – about where your heart is and ensure you don’t have arms or legs crossed and you’re in a relaxed state.

Because hypertension often causes no symptoms, regular monitoring is key. For patients with a history of cardiac disease, he says it’s really important to treat anyone close to the 130/80 range. Hypertension is often referred to as the “silent killer” because someone might not have any symptoms until it’s too late.

With a family history of cardiac disease, he also recommends getting a calcium score test or coronary artery calcium scan which is a non-invasive CT scan that detects calcium-containing plaque in the coronary arteries. It measures the risk of heart disease or future heart attacks. It takes 10–15 minutes, involves low radiation.

Here is more information about getting that test.

Video Clips of Dr. Jason Trager

Nearly half of all U.S. adults live with hypertension, making it one of the nation's leading risk factors for cardiovascular disease and premature death. Despite its prevalence, both accurate diagnosis and effective long-term management of hypertension remain clinical challenges.

As one of only 42 health systems nationwide participating in PCORI’s Health Systems Implementation Initiative, OSF will use the project to strengthen patient-centered strategies for hypertension care in 123 adult primary care practice sites and over 100,000 patients. Over the next four years, key areas of collaboration include:  

•          Integrating proven, evidence-based strategies into care models
•          Leveraging digital tools to better engage patients in their care
•          Address barriers such as social determinants of health
•          Provide advanced training for care teams
•          Enhance data analytics to support improved health outcomes

“We are excited to collaborate across OSF and other national colleagues through this initiative, leveraging our collective resources to improve the care and experience of those we serve.” said Melinda Cooling, DNP, MBA, FAANP, chief nurse and advanced practice provider executive for OSF HealthCare. “It is our goal to provide team-based care for our patients with a digital component through OSF and to work with a multidisciplinary research team of physicians, advanced practice nurses, an anthropologist and Mission Partners within OSF to help patients better manage their blood pressure, reduce risks and improve their overall well-being. By translating research into practice, OSF will continue to demonstrate our commitment to innovation, exceptional clinical care, and delivering the highest quality support to those we have been called to serve.”

Building on the success of a recently completed capacity building project also funded by PCORI, this project will  improve hypertension management by implementing findings from a PCORI-funded comparative clinical effectiveness research (CER) study showing the comparative clinical effectiveness of clinic and telehealth-based models of hypertension care.

This funding award has been approved pending completion of PCORI’s business and programmatic review and issuance of a formal award contract.   

Learn more about the work between OSF and PCORI through the OSF HealthCare Accelerated podcast.

The United States Food and Drug Administration recently approved the first treatment for people with liver scarring due to fatty liver disease. It's welcome news for people battling the disease.

How did we get here?

In some ways, it goes back to the obesity epidemic in the United States. Obesity brings an increased risk of fatty liver disease, an ailment that’s treatable but could mean serious complications. Moreover, health experts say isolation during the pandemic led may to increase alcohol intake, another risk factor for fatty liver.

David Rzepczynski, MD, a gastroenterologist at OSF HealthCare, describes the liver as an “extremely important” factory for the body. It performs many functions, like detoxifying medications, aiding digestion and making cholesterol, proteins and amino acids that help the body function. And have you ever missed a meal? You can thank your liver for releasing glucose and giving you energy.

All those “factory functions” make it critical to be watchful of fatty liver disease. As the name suggests, the disease describes an accumulation of fatty cells in the liver. Dr. Rzepczynski says it takes just 5% of cells with increased fat to make a diagnosis, but some obese people have 100% of cells with fat.

Hepatitis C and excessive alcohol use can cause fatty liver disease or are at least linked to it. But you can still get fatty liver if you’re not a heavy drinker, and that’s where your weight comes into play.

“The big driving force of fatty liver disease is what we call the metabolic syndrome,” Dr. Rzepczynski explains. “There are five factors: obesity, diabetes, hypertension [high blood pressure], high cholesterol and insulin resistance.”

Dr. Rzepczynski adds that fatty liver disease may cause pain in the upper abdomen, but it mostly comes without symptoms. So if any of those five risk factors apply to you or if you’re a heavy drinker, don’t wait. Talk to your health care provider about getting your liver looked at.

A doctor will likely start with a blood test, Dr. Rzepczynski says. An ultrasound or biopsy may also be needed. The next step: lose weight.

“It doesn’t have to be getting back to your ideal body weight,” Dr. Rzepczynski says. “Losing 5% of your weight can reduce fat in the liver. Losing 7% will help reverse some of the inflammation associated with fatty liver. And some studies have even shown that losing 10% or more might reverse some of the scarring.”

While it may be a bit alarming, left unchecked, fatty liver disease can lead to a serious condition called cirrhosis, or scarring, of the liver.

“You have normal liver tissue replaced by scar tissue,” Dr. Rzepczynski says. “When that occurs, you have a loss of liver function. You have less liver cells performing their duties.”

Cirrhosis of the liver can cause the organ to fail, making a transplant necessary. Liver issues can also mean an increased risk of heart disease, stroke and cancer, particularly breast and colon cancer.

Learn more about fatty liver disease and other gastroenterology care on the OSF HealthCare website.

Interview clips

Do you really need that extra shake of salt on your fries? Because sodium is not your friend.

That’s according to a study published in the Journal of Internal Medicine that showed any significant reduction in the consumption of dietary salt can improve hypertension.

“Hypertension is high blood pressure, or where our arteries are experiencing too much pressure with the blood flow to our organs, and this can lead to things like end organ damage, and some things that are really serious like stroke and heart attack," says Lauren Hargrave, a physician assistant with OSF HealthCare." 

According to the American Heart Association (AHA), nine out of 10 Americans consume too much sodium and they don’t even know it. The average person eats more than 3,400 milligrams (mg) of sodium a day – the AHA recommends no more than 2,300 mg a day. Ideally, it would be less than 1,500 mg a day, especially for adults with high blood pressure.

Reducing sodium by just 1,000 mg a day can improve blood pressure and decrease the risk of cardiac issues. The study also found that lower sodium consumption reduced symptoms of depression and anxiety in some study participants.

“Hypertension is a very big issue," says Hargrave. "It affects a lot of people across all ages. And it really is something that is not always recognized because people can be asymptomatic or not have any symptoms until they come in and see us.”

Still, sodium is important to the human body. It helps control your body’s fluid balance and is important to nerve and muscle function. But too much sodium can cause your body to retain water increase puffiness, cause weight gain and can lead to high blood pressure.

The ideal blood pressure for adults is a systolic pressure (top number) of less than 120 and a diastolic pressure (bottom number) of less than 80. According to the AHA, Hypertension Stage 1 is when blood pressure consistently ranges from 130-139 systolic or 80-89 diastolic, Hypertension Stage 2 is when blood pressure consistently ranges at 140/90 or higher, and a crisis occurs if your blood pressure readings suddenly exceed 180/120.

“A lot of times the first time people hear that they have high blood pressures is in an office visit after we take vitals," says Hargrave. "They don't always know that they have high blood pressure at home and we call it the silent killer because a lot of times it is something that's not presenting with symptoms. We’re telling people that they have high blood pressure and explaining the importance of treatment. It is very treatable with medications with lifestyle changes, but if it's not recognized, that's when it can become dangerous.”

The best way to reduce the sodium in your diet is to stay clear of prepackaged, processed and prepared foods. Pay close attention to food labels – foods that have the most salt are breads, pizza, sandwiches, cold cuts, soup and tacos.

Other foods that have “hidden” amounts of sodium are cheeses, canned vegetables, frozen dinners, snack foods, and condiments such as ketchup and mustard.

If you’re cooking at home, avoid adding table salt to foods, flavor your meals with herbs, spices, lemon and lime. Opt for chicken, fish and lean meat rather than canned or processed meats, and rinse canned vegetables and beans to reduce the amount of sodium.

Restaurant meals are another source of high sodium. Study the menu before ordering, choose fresh fruits and vegetables when you can, ask for salad dressing on the side and request that your meal be prepared without added salt.

Exercise helps with overall heart health, which can help lower blood pressure. It also helps with weight reduction, which can also improve blood pressure. The key, according to medical experts, is paying attention to what you eat and make modifications when necessary.

“It can be potentially serious but it's treatable and manageable if you watch your salt intake and exercise and have a conversation with your doctor," says Dr. Tianyu Dong, a family practice physician with OSF HealthCare. 

For more information about hypertension, visit OSF HealthCare. 

 

Interview Clips 

Television host Carson Daly is the latest celebrity to try what some call sleep divorce. Couples who sleep in the same bed but are not getting that coveted seven to eight hours of shut eye will slumber with some degree of separation: in the same bed but with separate blankets, in separate beds in the same room or in separate rooms.

Daly called the move the “best thing” for his marriage during a summer episode of the Today Show.

“We both, admittedly, slept better apart,” he said.

The concept is one worth exploring for couples who are kept up by snoring, restlessness, differences in sleep schedule or other nighttime issues, says Nadeem Ahmed, MD, a pulmonologist at OSF HealthCare in Alton, Illinois.

But let’s get one thing straight.

“I don’t like the term ‘sleep divorce’ because it tends to blame other people. It’s not a good word. It brings anxiety,” Dr. Ahmed says.

“I like to use ‘sleep alliance.’ They’re working together. They’re working things out. They want to make sure it’s healthy for both bed partners and the sleep disturbances don’t affect the other partner’s life,” he says.

Have the discussion

Dr. Ahmed says he encounters sleep issues, like snoring, in his practice “almost every day,” and many people are shy about it.

Every case is different. Dr. Ahmed says couples should first talk out their sleep issues and try to find a solution. The partners could try sleeping in separate beds during the week and in the same bed on the weekend so intimacy is not completely lost. Some mattresses have different firmness, temperature and slant on each side, which can help.

If needed, the partners should talk to a pulmonologist or psychologist.

“A lot of psychologists will do similar things that a physician will do. It’s just the comfort level of the person,” Dr. Ahmed explains. “Sometimes they don’t want to go to a medical doctor for the sleep problem. They would rather talk to a psychologist.”

“The idea is to discuss it with some type of professional,” he says.

Dr. Ahmed adds that sleeping separately should be a short-term solution.

“Tell your bed partner this is an issue, and we need to address it. As opposed to just getting mad or feeling crummy or sleepy the next day,” Dr. Ahmed says, “Because it can affect your job, like if you’re a machine operator or have to drive a truck.”

A major cause

Dr. Ahmed says a big cause of the restlessness that leads to sleep alliance discussions is sleep apnea, when people stop breathing during sleep. This can lead to loud snoring or body movement in bed and crabbiness or grogginess the next day.

Dr. Ahmed says there are two types of sleep apnea: obstructive and central. Obstructive sleep apnea is a product of obesity. Central sleep apnea is associated with neurological deficits like a stroke.

“[Sleep apnea] is not fatal because our brains are hard-wired to let you go to a certain time, and then it triggers you to take a breath,” Dr. Ahmed explains.

But, if the condition is left untreated, there is a litany of possible issues: hypertension, cardiac arrhythmia, diabetes, dementia, headaches and frequent urination.

Diagnosis of sleep apnea would involve a sleep study, either in your home or at a hospital.

Treatment options include a mask and machine combination known as a CPAP or BiPAP, a mouth guard or a small device that’s implanted in your body in outpatient surgery. All those options aim to help you breathe normally and sleep peacefully.

“Along with that, we have to stress lifestyle changes,” to rid oneself of sleep apnea, Dr. Ahmed adds. “Eating healthy. Losing weight. Getting exercise.”

Over-the-counter options for better sleep include melatonin, an eye mask, earplugs, thick window curtains, a plush mattress and sheets and a white noise device like a smart speaker. Don’t eat or drink, aside from water, a couple hours before bedtime, Dr. Ahmed also advises.

Learn more

Learn more about healthy sleep on the OSF HealthCare website. If you’re having sleep problems, especially if it’s impacting your daytime life, talk to your primary care provider, a pulmonologist or a behavioral health provider.

Interview clips

Previous coverage

TikTok trend deemed dangerous
Catch your ZZZs
Getting a wake-up call
Chronic fatigue is nothing to sleep on
Slumber hours slump
OSF HealthCare blog entries on sleep
 

From Elon Musk to TikTokers, ongoing social media chatter claims drugs like Ozempic, Mounjaro and Wegovy are the magic way to weight loss.

There’s good news, says Aminat Ogun, MD, a family medicine physician at OSF HealthCare in Champaign, Illinois. Those drugs can help you lose weight when prescribed by a doctor under specific circumstances and paired with diet and exercise.

The more important bad news? There’s no magic, one-size-fits-all drug that will by itself cause you to shed pounds. And if someone on social media is claiming so, they’re wrong.

Dr. Ogun says Ozempic, Mounjaro and Wegovy are from the same family of medicine. They are usually prescribed to people with Type 2 diabetes.

“It increases the insulin in the body, which helps bring glucose into the cells,” Dr. Ogun explains.

The medications also slow food leaving your stomach and suppress appetite.

Once the drugs became more well known, Dr. Ogun says people found, not surprisingly, that weight loss was a side effect and began prescribing them for that purpose under specific circumstances. She says the patient should have a body mass index (BMI) greater than 30 or a BMI greater than 27 with a chronic condition like diabetes, hypertension or hyperlipidemia.

But even if you meet those guidelines, Dr. Ogun says you should talk with your doctor about whether a weight loss drug is right for you or whether simply changing habits can get the results you want.

For one, Ozempic, Mounjaro and Wegovy are expensive and may not be covered by insurance.

Also, the U.S. Food and Drug Administration reports a shortage of Ozempic and Wegovy. So Dr. Ogun says doctors may be less likely to prescribe the drugs for weight loss when diabetics may have a more critical need.

And like any other medication, there is a list of side effects.

“Abdominal pain, nausea, vomiting, diarrhea and constipation are possible,” Dr. Ogun says. “There are also hypersensitivity side effects like angioedema and an anaphylaxis reaction. It’s also been known to cause kidney injury or pancreatitis.”

Lately, the term “Ozempic face” has been trending on social media, describing a hollowed-out appearance due to quick weight loss.

One last piece of advice you’ll hear doctors give over and over: don’t rely on social media for health tips. If you find a tip that might benefit you, talk to your doctor before starting any treatment.

“The good thing about social media is that it allows a lot of people to receive a variety of information all at once,” Dr. Ogun says. “The downside: is it a credible source?”

Find a primary care provider on the OSF HealthCare website.

Interview clips

The Medicaid Innovation Collaborative (MIC) – a partnership between Peoria-based OSF HealthCare and four Federally Qualified Health Centers (FQHCs), celebrated its one-year anniversary by highlighting a long list of milestones achieved. MIC provides a variety of digital care services and personalized support for Illinois Medicaid patients through programs developed by OSF OnCall.

The state-funded, five-year initiative is designed to transform health care delivery to improve outcomes, decrease disparities and reduce costs using sustainable programs.

The FQHC partners in the program include Heartland Health Services (Peoria, Illinois), Chestnut Health Systems, Inc. (Bloomington, Illinois), Eagle View Community Health System, Inc. (Oquawka, Illinois), and Aunt Martha’s Health & Wellness (Danville, Illinois).

To date, MIC has been able to stand up several programs to expand services by:

• Providing pregnancy and postpartum support 24/7 to enrolled patients; featured on this Health Accelerated podcast.
• Offering remote patient monitoring for chronic disease management including asthma, diabetes hypertension, COPD and heart failure.
• In a collaboration with Illinois Central College, training OSF digitally-enabled health navigators to be embedded within communities across the state and FQHC community health workers; within their facilities and co-located in community-based organizations, including homeless shelters. 
• Expanding breast cancer screenings through digital outreach, making it easy for patients to schedule this important test
• Extending health and wellness education with the goal of reducing chronic disease risks associated with diet and nutrition, exercise, unhealthy weight and smoking
• Launching culturally sensitive, easy-to-use communication tools.
• Developing a systematic approach to assessing social determinants of health and tracking data to prioritize patient outreach, optimize workflow and to identify which patients might fit into specific programs. Future work will integrate all information with a patient’s electronic record for providers to have a holistic view of their patients.

Jennifer Junis, senior vice president for OSF OnCall who also chairs the MIC Governance Council, says community health workers embedded in vulnerable communities also screen individuals for social service needs and they’re connected with local resources to provide support for food, transportation, child care and affordable housing, among other factors that contribute to improved health and wellness.

During a day-long session earlier this week, FQHC leaders and frontline employees reviewed progress toward goals outlined for the first year.

Chestnut Health Systems in Bloomington:

•  Began work on a building renovation and hiring for a new dental clinic that will serve Medicaid participants. 
•  Collaborated with a local homelessness service provider/food pantry to organize and implement a Food Pharmacy. Providers at Chestnut screen patients for eligibility criteria and prescribe use of the food pharmacy services. The pharmacy provides fresh and healthy food options often worth hundreds of dollars.
• The CHW program has solidified co-locations for staff at six partnering agencies.

Heartland Health Services in Peoria:

• Built a new team within HHS and the framework to support digital care programs and to provide virtual primary care in homeless shelters.
• Began building trust with leaders and residents of homeless shelters through food and clothing drives and providing COVID-19 rapid kits.
• Hired a digital support manager and community health navigators who have also been trained on tele-diagnostic equipment that can be used to support virtual visits.
   

Aunt Martha's Health and Wellness in Danville: 

•  Trained and hired community health workers.
•  Established monthly Healthy Behavior meetings at the YMCA and Public Library.
•  Educated more than 100 people in the community about resources and how to take control of their health.
•  Expanded training for CHWs on cultural diversity, domestic violence and sexual assault.

Eagle View Community Health System in Oquawka:

• Deployed CHWs who are providing services in three locations in the community.
• Implemented a new electronic health record system (Epic) that allows for better data collection and reporting on health outcomes.
• Hired a new transportation van and hired a transportation director.

Junis says these efforts are designed to wrap a 24/7 digital safety net around patients that is available 365 days a year

“So if you have a question in the middle of the night, you don't have to go to an emergency department, or you don't know who to call. You can reach out to us and it's through text messaging or calls and we're available. So that's really the transformation piece. Is that we're not episodic but we're really meeting patients where they are and where they need us the most, at the times that they need us.”

The effort is expected to lower health care costs by keeping people out of the emergency department or the hospital, the most costly point of care. Savings can also be created by scaling the effort with telehealth providers overseeing care for many patients at a time.

MIC will continue into year two with goals of improving dental care for patients, providing virtual health to residents of homeless shelters, and enrolling new patients in existing MIC programs. Junis says it’s also about improving based on feedback.

“Year two is about optimization, and coordination and collaboration, and really continuing to work together to understand all of our different components of the holistic care of a patient and how we all play such a big role in that.”

Video Clips with Jennifer Junis, Senior Vice President for OSF OnCall Digital Health