HOW TO HAVE A HEALTHY THANKSGIVING

Thanksgiving has been one of the most anticipated occasion every year.  Busy people are around the corner because of the preparation for a grand night feast. Turkeys, dessert, and stories fill the whole room. But before you get overwhelmed by all those memorable moments, let yourself be reminded that health is one of the best things you have to be thankful for.  With that, here are some helpful tips that will make your thanksgiving unforgettable and HEALTHY! 

Mindfulness, Meditation, and Your Blood Pressure

Can mindfulness and meditation strategies be a useful alternative to popping pills to lower blood pressure? While conventional wisdom suggests a simple and evident link, the clinical application of mindfulness and meditation to treat hypertension is more complicated than it first appears. As such, we approach the role of meditation in blood pressure management by asking more detailed questions. Can meditation help reduce blood pressure in those that already require antihypertensive drugs? Could meditation enhance the effects of medication therapy, yielding a greater reduction in blood pressure than either would produce on its own? 

Let’s dig deeper into this attitude of mind, and the possible effects it can have on cardiovascular health.

Reducing SBP by just 3 mm Hg in the general population has the potential to reduce stroke mortality by 8% and coronary artery disease mortality by 5%.10, 11 The published findings of the InterStroke Study, one of the largest studies of its type in the world, concluded definitively that uncontrolled HTN is the single most influential risk factor for stroke. 12

Transcendental meditation and mindfulness involve entering into a state of concentration, contemplation, and reflection. It has been practiced in various forms for thousands of years, with the goal of improving “well-being.”

What does that mean? The practice promotes inner calmness, physical relaxation, and reduced anxiety and depression. It involves progressive muscle relaxation that can lead to the reduction of blood pressure as well as heart rate variability. Other benefits include improved insulin sensitivity, lipid profiles, and hormone levels that affect heart health. It stands to reason that these effects could have a real impact on heart disease—caused in part by high blood pressure—which is the leading cause of death worldwide.

How does it work? Recent discoveries in neuroscience indicate that the thoughts and emotions we hang on to—our mental baggage if you will—can cause significant changes in our neural wiring. Since meditative practices often involve practicing “letting go” of troublesome thinking, the links between meditation, mindfulness, and clinical outcomes would seem to be self-evident.

Designing a study that elucidates these links and describes their actual effects can be quite challenging and costly. Further, the difficulty substantially increases when we attempt to determine whether the results we see are actually due to meditation and mindfulness, or whether something else is doing some of the heavy liftings.  For example, the placebo effect can account for as much as 30% of the effects seen in any treatment.  Some studies support meditation to reduce blood pressure, while other studies contradict those findings. After reviewing the available research, we’ve found a few things that allow us to recommend meditation only as an adjunct to care provided by a medical doctor for the treatment and management of hypertension:

1. There are no extensive peer-reviewed studies available.

 The majority of available studies show there can be significant benefits to lowering blood pressure using various mindful breathing exercise though their remains a few studies that contradict their findings. 

The strongest studies are in peer-reviewed journals and are usually conducted over several months or even years. Good research design includes having a large number of study participants—at least 100 people, and ideally a lot more—as this helps to show the results are real and not just a one-time fluke. Further, a study should not be funded by an organization that can profit from the results, as that can introduce bias to the study findings.

Finally, while good research can provide revolutionary results, it’s wise to adhere to the old maxim: “if it sounds too good to be true, it usually is.”  While a lack of peer-reviewed science doesn’t mean that meditation and mindfulness aren’t useful in the fight against blood pressure, it does mean that it’s a little early to swap in all your medications for meditation and that you might at the very least be able to reduce the quantity and dosage of your medications.

2. Blood pressure is influenced by genetic, ethnic, and biological factors that cannot be easily influenced by meditation.  

                                                    Photo Courtesy of  geraldoswald62  via Pixabay

                                                   Photo Courtesy of geraldoswald62 via Pixabay

The risk of developing a chronic disease involves a complex mix of genetic, behavioral and environmental factors. If there are many paths to a chronic disease, managing that disease will necessarily require different approaches and strategies as well. In other words, no one activity will be the be-all, end-all of cardiovascular disease; there are simply too many contributory factors to be taken down with one silver bullet. If such a silver bullet existed, the world would hear about it, and a massive study (or some large studies) would back it up.

3. In all likelihood, a combination of mindfulness, meditation, medication, and lifestyle management is the key to lowering blood pressure, but that story is not new.

Good health comes from a combination of a healthy diet, exercise, and stress management. Anyone can learn these things, though some have an easier time than others. There’s no magic in this story. Just the mere notion that with the addition of mindfulness, meditation and proper adherence to blood pressure medication, your blood pressure may improve to the point that your doctor can lower the dose of your medications. It’s not a miracle, and it certainly isn’t an instant cure; however, mindfulness and meditation do show real benefits in many areas of life, especially if practiced regularly over time. Even a few minutes a day can be helpful.

What can you do?

Practice mindful and meditative methods to help you manage your blood pressure. As your ability to control your mind increases, mental well-being is improved, which can lower blood pressure over time. For more information on blood pressure monitoring and education, get to know Cardiowell.  

Practicing self-selected relaxation techniques can have an immediate impact on your mind and perception of stress. Being conscientious of the signs of stress will help your health, as this awareness will help you determine when you need to apply these relaxation techniques. Understanding the different types of triggers for your anxiety and stress—and their associated side -effect high blood pressure—can help you re-map your brain to be more stress-resistant. Resilience against the damage of in-the-moment stress through continual self-assessment and a focused approach can reduce anxiety and chronic stress; in turn, can be helpful in preventing the onset of chronic diseases related to high blood pressure.

Are you ready to increase your ability to cope with life’s challenges? Here are nine surefire ways to manage stress and help you manage your blood pressure:

1. Take charge of your schedule.

Include time in your schedule to take care of yourself. Use a calendar to map out your activities, events, and time for self-care. Plan ahead and walk through your schedule mentally. If your calendar is too full and you feel anxious about following through on all of your tasks, it’s time to approach them one-by-one, identify them, and break them down. Your heart will thank you.

2. Organize yourself.

                                            Photo courtesy of  Pexels  via Pixabay

                                           Photo courtesy of Pexels via Pixabay

Spend time each day getting ready for the next day. Organize your task list into “must do,” “should do,” and “could do” sections. Push as much as you can to the “should do” and “could do” items, so that your full focus is on as few “must do” items as possible. Then, start with the most important “must do” items, and approach the other sections as time and energy permit.

3. Don’t be afraid to say “no.”

If your plate is full, say “no” to requests for your time and energy. If “no” doesn’t work in a particular situation, find a compromise by letting people know what’s on your plate and when you could reasonably expect to meet or have something done, his can be a powerful tool in reducing your overall stress and anxiety.

4. Express your feelings.

Feeling overwhelmed? Talk about it! Let a trusted friend or loved one be there for you; that’s what they’re there for! People with hypertension are known to bottle up their emotions. As you practice expressing yourself, you’ll increase your ability to find and express the emotions you’re feeling and reflect on them. Annoyance and frustration, for example, are forms of anger. When you notice you’re feeling these emotions, ask yourself what is causing them and whether those things warrant the negative energy. Then, decide what you can do about it! Adjusting your expectations and your response to the expectations placed upon you can do wonders for your stress level.

5. Evaluate your stressors.

                                         Photo courtesy of  ciao_triana  via Pixabay

                                        Photo courtesy of ciao_triana via Pixabay

Have a heart-to-heart with stress, and what you can do about it step-by-step. Make a list of your stressors and create your plan to either cope with them or remove them. Go one by one. Determine what you can’t change, avoid, or eliminate; then get creative about handling them! If traffic causes you stress, leave an hour early and finish your last hour of work at home. If you have a family member that creates stress for you, respectfully decline frequent social situations that include them. Taking a moment to look at your stressors and what you can do about them can yield positive results, and you’ll get better at it each time you practice.

 

6. Eat Healthy

                        Photo courtesy of  Chris Lawton  via Unsplash

                       Photo courtesy of Chris Lawton via Unsplash

Focusing on healthier snacking and eating has been shown to reduce blood pressure and improve cardiovascular health.  Stress wears down your ability to make healthy choices. Irrational decisions stem from being tired. Your resistance to sugar-filled foods and crunchy salty chips is worn down by exhaustion, studies say. Getting an energy fix from healthy choices such as honey-crisp apples, crunchy nuts, carrots, celery, dehydrated fruit, or popcorn can steer you away from further emotional distress. Avoid all sugary drinks, especially those with artificial sweeteners.  A recent study published in Stroke, by the American Heart Association Journal showed that artificially sweetened drinks could increase your risk of stroke by up to three times. 

7. Take care of you first.

Eat three healthy meals a day and prepare for them before you do anything else for anyone else. Get 8 hours of sleep nightly, exercise for at least 30 minutes every day, and take the time to reflect on your feelings before prioritizing anything else in your life. Taking care of yourself makes you stronger, which will put you in a better position to help others!

8. Manage technology.

Gain control over your cell phones, computers, and iPads. The distractions of online interactions like social media and emails can rob you of valuable minutes throughout the day, making you less productive and more stressed-out about your “must do” list. Setting boundaries can help! Practice “unplugging” from your electronic devices at the end of the day, or at least putting them in a “time-out” for a while. Do your life a favor: don’t let devices run it.

9. Avoid competitive thinking.

Do you create our stress? Envy and jealousy can build up stress and resentment, neither of which is beneficial to your health. Adjust your expectations. Focus on humility and gratitude for the little accomplishments and joys in your life. Positive thinking perpetuates itself when practiced in a mindful fashion.

De-Stress with Relaxation Techniques

Practicing the strategies listed above will help you to get a handle on your stress level. For additional stress-busting techniques, there are many things you can do to promote relaxation and good health. Combining stress management and relaxation techniques is a powerful way to reduce the impact that stress and anxiety can have on your physical and emotional well-being. If you set aside 10 – 20 minutes daily for relaxation techniques, you can reduce your risk for many stress-related conditions, including insomnia, cardiovascular disease, accidents, and even cancer.

It can be difficult, especially in the beginning, so don’t get discouraged! Relaxation doesn’t always come easy, but with practice and some experimentation, you can find methods that work for you. Remember: there isn’t a right or wrong way to relax! Rather, relaxation involves finding and practicing activities that are enjoyable or complimentary to your daily life.

Here are a few activities that can help you relax, reduce stress and lower blood pressure:

1. Exercise

                     Photo Courtesy of  Curtis Mac Newton  via Unsplash

                    Photo Courtesy of Curtis Mac Newton via Unsplash

Exercise improves mental and physical health, releases built-up stress in the body, and increases circulation by getting your blood pumping. Aerobic and group exercises–such as kayaking, rowing, walking, cycling, skating, and swimming–can be a way to keep things interesting and challenging for those who tend to get bored. Exercise also promotes good sleep which is essential for the heart.

 

2. Meditation

                         Photo Courtesy by  Alfonso Coutinho  via Unsplash

                      Photo Courtesy by Alfonso Coutinho via Unsplash

Meditation involves your mind and your body and includes focused breathing with thoughtful relaxation techniques that can improve tranquility and reduce stress. Find a comfortable, quiet place and sit in a comfortable position. Then, close your eyes, relax your body, and focus your concentration on relaxing from your head slowly down to your neck, and then down through every muscle until you reach your toes. Meditating, and putting the body in a restful “pause,” can block out a significant amount of negativity, and lead to you feeling more relaxed and capable of handling the stresses of the day. There are many apps available to help you master meditative methods. Try one today!
 

3. Visualization

Visualization, or guided imagery, is a variation of traditional meditation that requires you to employ not only your visual sense, but your senses of taste, touch, smell, and sound as well. Engaging all the senses doesn’t happen by accident. It takes time and focused energy to submit to your senses completely.

Find a quiet place.  Close your eyes.  Imagine that you are in a peaceful place. Try to imagine all the details – what do you see, smell, hear, feel?  The more information you visualize, the better this works.  You can choose whatever imagery you want.  For instance, if you imagine you are walking through the park you would:

 

·         Hear the birds chirping

·         See the birds flying from tree to tree

·         Hear children playing

·         Feel the sun on your face

·         Notice the shadows on the ground

·         Smell the foods cooking on the grill

How visualization works:

As you imagine being somewhere else, your mind is focused on the details of the imagination and not on the stress or anxiety that you were feeling. You may lose track of where you are in your peaceful place – that is normal. The idea is to let your mind go somewhere tranquil and focus on relaxation for a while. There are many other techniques you can use to help you manage your stress – the important thing is to practice some form of relaxation.

4. Deep breathing

Breathing mindfully at six breaths per minute has been shown to reduce blood pressure. Breathing at six breaths per minute helps to synchronize the heart and lungs and send extra oxygen through your body that helps promote relaxation and reduce stress. Focus on full, deep, cleansing breaths, a simple and powerful technique which is the cornerstone of many other relaxation and meditation practices. Combine with scented candles, aromatherapy, music, massage, or a warm bath for more great results!

Deep breathing from the abdomen allows you to get as much fresh air as possible in your lungs. When you take deep breaths from the abdomen, rather than shallow breaths from your upper chest, you inhale more oxygen. The more oxygen you get, the less tense, short of breath and anxious you feel. Here’s how to deep breathe:

• Sit comfortably with your back straight. Put one hand on your chest and the other on your stomach.

• Breathe in through your nose for FOUR counts. The hand on your stomach should rise. The hand on your chest should move little by little. Hold that breath for SIX counts.

• Exhale through your mouth for NINE counts, pushing out as much air as you can while contracting your abdominal muscles. The hand on your stomach should move in as you exhale, but your other hand should move slightly. Practice 4-6-9 breathing for three cycles.

• Continue to breathe in through your nose and out through your mouth. Try to inhale enough so that your lower abdomen rises and falls. Count in a deliberate manner as you exhale.

Learn how the Cardiowell App can help improve your breathing.

5. Positive thinking

Self-talk that increases stress needs to stop! Negative thoughts eat up good energy that can be spent getting more done and helping others. Typically, positive thinking leads to the positive energy that can be contagious to those around you. Positive-thinking exercises like positive self-talk suppress the release of cortisol from the adrenal glands and can help you feel calm and peaceful.

6. Deep muscle stretches

Stretch your muscles out, or get a massage or both. Doesn’t fit your schedule? Here’s how to do it now, right at your desk! Tense all your muscles for 10 seconds and then let go. You can also purchase a foam roller to do “self-myofascial release,” which is just a fancy term for self-massage.

7. Yoga

                         Photo Courtesy of  Matthew Kane  via Unsplash

                        Photo Courtesy of Matthew Kane via Unsplash

Break the cycle of stress and high blood pressure by trying yoga! By combining breathing, meditation, and physical poses--also called postures--yoga can increase strength and flexibility while promoting mindfulness and relaxation. Yoga poses vary in intensity: some require nothing more than your attention and a mat to lie on, while others will stretch your physical limits. A practical yoga session involves a number of different postures, conducted in a sequence designed to provide a workout that involves your whole body and focuses your mind.

While there are many books, videos, and internet resources devoted to this practice, beginners will find yoga more safe and approachable if they find a trained instructor to guide them. A good instructor will encourage you to explore your physical limits without exceeding them, maximizing the effect of yoga while keeping it safe for you. Research your local providers to determine which yoga teachers have experience with your health conditions and concerns; then, find a class that fits your schedule and go for it! Individual classes may help you progress more quickly and refine your technique; however, many beginners locate the camaraderie and support offered by group classes increase both their enjoyment of yoga and their motivation to continue doing it. Yoga can be strenuous, so it's wise to check with your health care provider before starting the practice, but almost anyone can practice--and benefit from--some form of yoga.

A recent article published at the 68th Annual Conference of the Cardiological Society of India in 2016 showed hatha yoga could decrease blood pressure by as much as 4.9mmHg.  According to the author Dr. Angrish “Although the reduction in blood pressure was modest, it could be clinically very meaningful because even a 2 mmHg decrease in diastolic BP has the potential to lower the risk of coronary heart disease by 6% and the risk of stroke and transient ischemic attack by 15%”8

8. Tai Chi, Qigong

A Chinese martial art that uses slow movements, tai chi is sometimes described as “meditation in motion” because it promotes serenity through gentle movements—connecting the mind and body. Originally developed in ancient China for self-defense, tai chi evolved into a graceful form of exercise that’s now used for stress reduction. It aids in a variety of other health conditions. Qigong is related to tai chi, and also involves meditative activities that combine mind, body, and breathe control. 

9. Acupuncture

Small needles are placed at specific acupuncture points around the body with the goal of improving health and wellness. During a typical acupuncture treatment, the needles are left in for about 20-30 minutes. During this time the body temperature may lower; organ systems, heartbeat, and respiration may slow down; and muscle tension dissipates. In most cases, the patient will sink into a very relaxed state.

Research shows that acupuncture causes the body to release neurotransmitters such as endorphins and serotonin. Endorphins are the body’s natural opiates, which relieve pain and increase the patient’s relaxation response.

Endorphins and serotonin also stimulate the adrenal gland, which secretes cortisol. Cortisol is the body’s stress-fighting and anti-inflammatory hormone. It helps regulate immune functions, blood pressure, and glucose metabolism. Over the course of treatments, patients experience a heightened sense physical, emotional and mental well-being.

10. Take a time-out

Remove yourself from a stressful situation for a few minutes to get your thoughts, emotions, and perspective together. Taking a few moments to de-escalate the stress and improve your ability to focus and think creatively will help you navigate stressful events more effectively.

11. Music

                        Photo Courtesy of  NeONBRAND  via Unsplash

                       Photo Courtesy of NeONBRAND via Unsplash

Listening to music has a calming effect. Try putting together a selection of music that you find calming and play it during stressful times of the day, such as during a daily commute. Music can also help you make your mind before stressful events.

12. Hobbies

                          Photo Courtesy of  Kahar Saidyhalam  via Unsplash

                         Photo Courtesy of Kahar Saidyhalam via Unsplash

Hobbies can be relaxing, but it’s important to ask yourself if you honestly feel relaxed or if your hobby sometimes becomes stressful for you. Avoid leisure activities that are competitive, involve a lot of running around, or that can become frustrating. For relaxation, focus on non-competitive hobbies, such as painting, photography, gardening, bird watching, reading, cooking, dancing, model building, car restoration, creative writing, scrapbooking, woodworking, fishing, knitting, jewelry making, collecting, billiards, and astronomy.

13. Games

                            Photo Courtesy of  Pascal Swier  via Unsplash

                           Photo Courtesy of Pascal Swier via Unsplash

Choose games that allow you to relax and enjoy yourself. If the games you enjoy are frustrating or competitive, you may want to choose a different relaxation tool. Examples of games include cards, bridge, chess, darts, mahjong, Scrabble, bocce, croquet, board games (such as Monopoly), dominoes, and craps.

14. Baths

Taking a long, hot bath can be relaxing. Consider adding Epsom bath salts for added relaxation. The magnesium found in the salts can improve the relaxation of blood vessels, which may lower blood pressure.

15. Pets

                             Photo Courtesy of  Aidan Meyer  via Unsplash

                            Photo Courtesy of Aidan Meyer via Unsplash

Pets can lower stress levels and relax you. Before deciding to get a pet, consider the type of pet you would enjoy and whether or not getting a pet is right for you.

16. Walking

Walking can be a great way to shed stress, and it’s good for your physical health too! Consider different routes such as walks in the city or countryside, by the water, with a beautiful view, or at sunrise or sunset, to add to the relaxing effects.

17. Sleep

                      Photo Courtesy of  Meaghan Smulders  via Unsplash

                     Photo Courtesy of Meaghan Smulders via Unsplash

If you are stressed, you may need extra rest. Consider heading to bed a little earlier if you feel particularly stressed or, if you can find time during your day, try to fit in a quick power nap. Chilled cucumbers placed over your eyes can add to the relaxation effect.

18. Sports

If you follow professional sports, consider going to a few games versus watching them on TV.

19. Comedy

They say laughter is the best medicine, and there’s an abundance of research that supports the health benefits of laughing. Tune into a comedy channel on TV or radio, or check out a local live comedy show.

The type of relaxation method is not important; rather, it’s taking time to relax and unwind that produces the benefits. Relaxation takes practice. If you can master the art of mindful relaxation, you’ll reap both physical and mental benefits, leaving you better equipped to handle life’s stressors without spiking your stress level and blood pressure!

 

REFERENCES:                                                                                           

1.      Bai, Z., et al. "Investigating the effect of transcendental meditation on blood pressure: a systematic review and meta-analysis." Journal of human hypertension 29.11 (2015): 653-662. View Article.

2.      Blom, Kimberly, et al. "Hypertension analysis of stress reduction using mindfulness meditation and yoga: results from the harmony randomized controlled trial." American journal of hypertension 27.1 (2014): 122-129. View Article

3.      Zawadzki, Matthew J., et al. "Absorption in self-selected activities is associated with lower ambulatory blood pressure but not for high trait ruminators." American journal of hypertension (2013): hpt118. View Article.

4.      A Barnes, Vernon, and David W Orme-Johnson. "Prevention and treatment of cardiovascular disease in adolescents and adults through the Transcendental Meditation® program: a research review update." Current hypertension reviews 8.3 (2012): 227-242. View Article.

5.      Meditation alone doesn’t lower blood pressure: study. Reuters. Health News. Oct 4, 2013.View Article.

6.      Schneider, Robert H., et al. "Long-term effects of stress reduction on mortality in persons≥ 55 years of age with systemic hypertension." The American journal of cardiology 95.9 (2005): 1060-1064. View Article.

7.      Labarthe, Darwin, and Carma Ayala. "Nondrug interventions in hypertension prevention and control." Cardiology clinics 20.2 (2002): 249-263. View Article.

8.      Angrish, Ashutosh. Yoga reduces blood pressure in patients with hypertension. presented at the 68th Annual Conference of the Cardiological Society of India (CSI). (2016). View Article.

9.      Matthew P. Pase, et al.  Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia. A Prospective Cohort Study. American Heart Association Journal. (2017). View Article.

10.  StamlerJ, RoseG, StamlerR, et al. INTERSALT study findings. Public health and medical care implications. Hypertension 1989; 14:570–7. View Article.

11.  AppelLJ. Lifestyle modification as a means to prevent and treat high blood pressure. J Am Soc Nephrol 2003;14:S99–102. View Article

12.  O'DonnellMJ, XavierD, LiuL, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112–23. View Article.

 

Adapting to Consumer Driven Healthcare in a Digital World

Digital health is empowering patients like never before forcing healthcare systems to market directly to patients.  This focus on the patient is being sped in part by the increasing cost of healthcare and changes in health insurance coverage models.  This change is forcing many consumers who opt for high deductible emergency coverage to take greater responsibility for their health and to seek care options.  When developing solutions for patients, it is imperative that healthcare providers adapt in at least three ways:

1. Provide solutions at the patient’s location,
2. Provide tools that empower self-care while giving autonomy, 
3. Provide solutions that develop social connectedness and engage consumers with their social network.

Consumers are the drivers of change today, and the healthcare system needs to adapt and meet their demands.  The days of health systems dictating and institutionalizing care are being replaced by meeting the needs and catering to the patient.  

Here are three ways healthcare systems must adapt to the consumer: 

1. Delivering solutions to where patients live requires meeting patients at their location, and not expecting them to come to you.  

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An example of this is the trend towards delivering medications directly to the patient's home. This will result in improved adherence, compliance and outcomes.  Another example is providing routine and urgent virtual care visits using teleconference technologies. As much as 70% of care can be provided remotely from the comfort of a patient's home.  Allowing the patient's existing primary care doctor to care for their patients virtually will enable them to treat and diagnose most health conditions.  Virtualizing primary and specialized care services will allow for better care coordination while ensuring a patient-centered focus.   

Virtual care will help contain costs.  Currently, 44% of people don’t go to the doctor when sick or injured because of the cost burden, and 40% don’t get necessary tests or treatments.  This results in people getting progressively sicker until which time they are forced to urgent care centers and emergency rooms where the cost of care skyrockets.  The cost of an in-person doctors visits may cost $125, compared with less than $50 for a telemedicine visit.

As more care is provided virtually both using passive monitoring technologies and active virtual care visits, digital health technologies will allow the healthcare system to evolve from two to three 20-minute clinic visits a year to 24/7, 365 days of continuous care and management run by nurse practitioners and clinical pharmacists.  Only in the event of emergent, acute care events will patients need to go to a facility for care.  

In anticipation, health systems are already decentralizing their services from large hospitals to smaller more geographically spread micro facilities to serve patients and lower operating costs.  These new facilities allow patients to get their blood tests and x-rays at a fraction of the cost of going to the hospital.

Large employers such as Apple and Amazon are taking the employee's healthcare into their hands by developing their private provider networks and allowing care to be delivered directly in the workplace.  At the same time, pharmacies such as CVS are merging with healthcare providers to provide primary care in local communities ensuring patients are not lost to competing healthcare providers.  These changes are resulting in more care being delivered to patients at their location.  

2. Provide tools that empower consumers to self-care while giving them autonomy from the health system.  

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Photo from the Ottawa Heart Institute Telehome Care Program

New digital health tools are allowing consumers to learn more about their medical condition and treatment options.  A new class of ‘drugs’ called digital therapeutics is being developed that would enable patients to self-manage and treat diseases such as diabetes, hypertension, depression, and COPD.  Coupled with IoT devices and mobile apps, patients will increasingly self-track and monitor their health while simultaneously being remotely monitored by sophisticated predictive machine learning analytics to prevent complications.  

Wearable heart rate monitors like the Apple Watch are already saving lives by allowing the detection of pre-diabetes, atrial fibrillation, and deteriorating health conditions days in advance by measuring changes in heart rate.   

Today’s health system struggles with prevention and managing chronic disease.  This is evident by the fact that chronic disease accounts for over 80% of all healthcare expenditures and 70% of all deaths in the USA. The health system needs to bring the cost and responsibility of treating and managing chronic conditions in focus.  “Over the next 10-15 years there will be a scientific wellness industry in contrast to the disease industry and the market cap will far exceed that of the disease industry,” said Leroy Hood, Chief Science Officer at Providence St. Joseph. “  The contrast between 20th and 21st Century medicine is striking, 21st is proactive, focused on individual wellness, creating medicine that is preventive, personalized and participatory, and reverses rising cost trends.

New reimbursements experiments are underway and chronic care monitoring payment models continue to emerge. Reimbursement is increasingly being redirected from fee for services models that reward providers for delivering more services to value-based care that reward providers with incentives that keep their patients healthy and reduce visits to traditional medical facilities.  Today, approximately 30% of all healthcare payments are tied to such alternative payment models.  Additionally, employers are increasingly offsetting the cost of healthcare to their employees.

In a move that will put more control in the hands of consumers, CMS is changing ‘meaningful use’  EHR requirements to ensure patients have access to their medical data by requiring providers to equip patients with access to their electronic health records on the day they leave the hospital.  CMS also requires increased transparencyto cost and quality of treatment options.  This isn’t being lost by the likes of Apple who just recently empowered consumers with access and control of their medical information from their iOS devices.  Despite the challenges faced in creating personal health record solutions, Google with over 80% of the smartphone market is sure to follow.   This is giving patients control of their medical record by providing them the ability to share their information with any healthcare provider they wish.

Data collected from a patient in a hospital is only valuable for predicting readmissions during the seven days that follow their discharge from the hospital.  Similarly, a single blood pressure measurement in the doctor’s office or hospital is not reflective of the patient's life.  Recent data points to 30% of patients being diagnosed with white coat hypertension, where their blood pressure readings are artificially high when taken in a doctors office versus at home.  A study of over 64,000 patients over five years showed that blood pressure taken at home was a stronger predictor of cardiovascular deaths then doctor’s office readings. Other studies have shown that hypertension can be controlled remotely as well, if not better, then when done face to face in a doctor's office.

Patients must continue to be monitored from their homes to predict better and prevent rehospitalization. Solutions must be user-friendly and fit into their daily routines as much as possible.  The fact is that life happens outside of traditional care settings and to better understand and intervene, patients must be monitored and cared for in their environment.  

3. Provide solutions that engage consumers with their life, friends, and family – not with the healthcare system.  

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The healthcare system wants to engage their patients, but patients are not necessarily interested in engaging with them.  Instead, patients want to learn more about themselves and engage with their loved ones.  They want to get the most out of life and ‘disengage’ from the healthcare system.  As a result, healthcare providers need to enable solutions that allow their patients to be more socially engaged.  The AHA recently launched a patient-centered strategy focused on addressing the specific needs and preferences of the aging population.

Mental health is essential and in many cases more important than our physical health.  Today 18% of people have a mental health condition.  Loneliness is at epidemic rates.  Recent research shows lack of social connections is more dangerous than smoking 15 cigarettes a day and worse than obesity - increasing the chances of early death by as much as 50%.  Suicide is now the second leading cause of death for people between the ages of 10-34, and the 4th leading cause of death for people between 35-54 years old, after accidents.

People’s behaviors and choices in life are the most significant contributors to the development and progression of most chronic diseases.  With less than 3% of American’s living a ‘healthy lifestyle’, most people are kicking the can down the road. They say they will follow a diet next year or begin exercising soon, but fail to follow through. They don't see the immediate consequences of their behavior.   Controlling chronic diseases can only be done by empowering patients to better care for themselves.  By giving immediate feedback on how behavior is affecting their health, they will better understand and be motivated to make improvements in their lifestyle.

For example, a continuous blood pressure device that informs a smoker that after just half a cigarette their blood pressure increases to 180/110 will more likely cause a change in behavior. Likewise, providing feedback to a patient with heart rhythm problems that indicates that after one drink that their heart rhythm is adversely affected, will cause them to quit drinking sooner. 

Research by the United Health Foundation shows that so-called social determinants of health, including poverty, unstable housing and lack of social support, influences 50 percent of health outcomes.  Healthcare systems need to develop solutions that connect patients with their family and support networks while still being able to unobtrusively monitor changes in a patient’s health.  The IoT revolution, the use of Amazon’s Alexa and similar interactive digital assistant solutions will significantly change the way patients interact with their healthcare providers and support networks.  

When focusing on medication adherence, providers need to identify the personal issues that contribute to nonadherence.  Several studies have shown that reminding patients to take their medications is ineffective because of secondary reasons such as side effects, cost, and convenience.  Currently, between 20%-50% of patients are noncompliant, contributing to 125,000 deaths per year and costing between $100-$300 billion dollars annually. 

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Photo Courtesy of JESHOOTS.com via Pexels

With increasing consumer care options, healthcare systems need to do things differently by creating solutions that motivate patients to make meaningful behavioral changes.  

Healthcare will be delivered more from an Amazon model, where consumers will have an increasing choice of services with more transparency into price and quality.  Healthcare systems must begin to adapt to the future where consumers will dictate and control the services they receive.  Digital health technologies will help drive the change and force healthcare system and their preferred vendors to work together to empower consumers with choices that delight and engage them as passive recipients in the care and management of their health.  Because more then anything, we want a health system the works for us, allowing us to live longer and more fulfilled with the people in our lives.

 

This article was inspired in part by Hugo Campos who spoke at the Quantified Self Cardiovascular Health Conference in San Diego CA.

Accurate Blood Pressure Readings Are Critical For Your Health

HOW TO TAKE YOUR BLOOD PRESSURE CORRECTLY

Having and maintaining a healthy blood pressure is the result of numerous factors such as genetics, attitude, age, education, urbanization, obesity, alcohol, tobacco, mindset, diet, and cardiovascular fitness.  Research has proven the benefits of exercise, healthy food, and mindfulness, but many are still unaware of the proper guidelines when taking blood pressure and will not be correctly diagnosed with hypertension. 

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It is well understood that as many as 30% of people whose blood pressure is taken at a doctors office is artificially high (white coat hypertension), while about 12% of people have their blood pressure measured artiffically low (masked hypertension).   Masked hypertension had been considered most dangerous because the high blood pressure is not picked up at the doctors office and is thus not addressed.  Recent research published in the New England Jouranl of Medicine shows people with white coat hypertension are twice as likely to die then those who have normal blood pressure in the doctors office.  The reason is that people with white coast hypertension are found to have a natural tendency to have their blood pressure affected by stress.  

This is one reason it is important to take your blood pressure at home, as it has been found to be much better predictor of death then measurements taken at a doctors office.    

A diagnosis for hypertension is best made after numerous home and office measurements taken over multiple days and times. Getting accurate blood pressure measurements can be difficult.  Blood pressure changes throughout the day - rising between 6am-12pm, and lowering between 12pm-6am.  Measurements are also significantly affected by taking blood pressure incorrectly. The best way to diagnosis and manage blood pressure is by taking readings up to twice a day, at different times of they day and under proper conditions.

May is  High Blood Pressure Education Month and serves as a great reminder of the importance of taking accurate blood pressure readings and to refreash yourself on the AHA guideliness.  It is essential for you to know the guidelines for proper blood pressure measurements in order to have accurate readings and better manage your medication use. So the next time you measure your blood pressure take note of these DOs and DON’Ts. 

Choosing a Blood Pressure Monitoring Device

                                              Photo Courtesy of  BPGuideHQ.com

                                             Photo Courtesy of BPGuideHQ.com

Consumers now have access to high quality and accurate automatic blood pressure deivces.  They are also increasingly being used by medical professionals.  Not all blood pressure devices are equally accurate, and the FDA has recently raised concern and stepped up their approval process due to a number of innacuate devices being sold.   Consider these factors when selecting a blood pressure device to ensure you get accurate results:  

  • Purchase the device from a reputable vendor and ensure it meets FDA Class II requirements and has a CE mark.  Some studies have shown that some blood pressure monitors can be inaccurate 70% of the time.
  • IoT digital blood pressure devices are on the rise in the healthcare market. Consider devices that store and track the results on mobile devices to allow you to track your blood pressure over time and allow you to share it with your doctors. One example is the Cardiowell cellular enabled blood pressure device* and its digital therapeutic App.   
  • New devices that use pulse transmit time calculations are convenient as they can be taken seamlessly from the wrist,  but as of yet have not proven to be as accurate.
  • Select a device that measures blood pressure from the arm (brachial artery).  Devices that measure on the wrist, or finger are not as accurate.  Ensure you are using the proper size cuff for your arm. Too small a cuff can add 2-10mmHg. 
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Behavioral Guidelines

  • Take measurements at the same time every day. 
  • Take measurements as much as twice a day.
  • If one of your readings appears abnormally high or low, take two additional readings 3-5 minutes apart from each other.  
  • Take your blood pressure the same way each time.
  • Share the results with your doctor.  

Before taking your blood pressure

DO NOT

  • Have a big meal, exercise, drink or eat caffeine, take alcoholic drinks and decongestants. If you do any of these things, wait for at least 30-minute before taking your blood pressure.

DO

  • Use the bathroom and empty your bladder.  A full bladder can increase your BP by as much as 10mmHg.
  • Sit calmly and comfortably for 3-5 minutes without crossing your legs and ankles. Crossing your legs can increase your BP by 2-8mmHg. 
  • Support your back while sitting and keep your feet flat on the floor. Not doing so can increase your BP by 5-10mmHg.
  • Read instructions on how to use your blood pressure monitor.


While taking your blood pressure:

DO NOT

  • Talk or actively listen.  Doing so can raise your BP by as much as 10mmHg.
  • Read, Text, Watch television or use your smartphone

DO

  • Wrap the cuff over your BARE arm and above your elbow.  Look at the palm of your hand up and let your arm muscles relax. Taking your BP over clothes can increase by your blood pressure by 10-50mmHg
  • Rest your arm on a flat surface or table at heart level.  It should remain stretched out and relaxed. Not supporting your arm can raise your BP by up to 10mmHg.  Having your arm too high lowers your BP, while having it too low can raise your BP. 

Here are the seven most important steps are recommended from the American Heart Association:

                                    Photo courtesy of  American Medical Association

                                   Photo courtesy of American Medical Association

Know your numbers

The AHA just increased its categorization of hypertension to anything greater then 120/80.  Learn more about the importance of the guideliness from article "The New Normal: Why Accurate Monitoring is Important with the New Hypertension Guidelines"

Two numbers make up your blood pressure.  The top number data is the systolic blood pressure (most important), the lower number is the diastolic blood pressure.

Record and track the results manually if your device doesn't already do it for you.  Share with your doctor regurlarly to ensure you are receiving optimal blood pressure management.

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* The Cardiowell IoT blood pressure device is currently being evaluated by the FDA and is only available for research today.

 

Why Stress is Bad for Your Health

KILL STRESS THIS NATIONAL STRESS AWARENESS MONTH BEFORE IT BECOMES YOUR JOY KILLER

No one is exempted from stress but everyone has the power to manage it. April is a reminder of how dangerous stress is on our body. Stress Awareness Month, celebrated every April, is a national cooperative effort in the United States to educate people about the harmful effects of stress to people.  

Researchers have been studying the link between hypertension and stress for years. The human body produces an increase of hormones when you’re in a stressful state that it can increase the risk of heart attacks and strokes. Such hormones can temporarily cause a spike in your blood pressure resulting in increased heart rate and narrowed blood vessel.  As of 2018, there is no conclusive proof that stress can make a person hypertensive. But these short-term stress-related blood pressure increases, added up over time, can contribute to high blood pressure in the long run.

Here are different ways to beat stress before it robs your health:

                                    Photo Courtesy of  Sarah Diniz Outeiro  via Unsplash

                                   Photo Courtesy of Sarah Diniz Outeiro via Unsplash

                                                                 Photo Courtesy of J enny Hill  via Unsplash

                                                                Photo Courtesy of Jenny Hill via Unsplash

1. Develop Relaxing Breathing Techniques. Many Americans underestimate the effects of breathing. Deep and slow breathing techniques can help remove tensions all over the body that helps you relax. Especially, learn to breath at six breathes per minute to achieve the best results.

2. Get that Body Moving. Diseases hate exercise. Find the best physical activity for you, it might be jogging, brisk walking, team sports, running or dancing. But ensure to consult to your doctors before doing an intense physical activity.

3, Mindfulness and Meditation. According to Mayo Clinic, meditation activities such as Yoga can help lower systolic blood pressure by 5 millimeters of Mercury or even more. Moreover, it can strengthen your body as well as release tension.

Digital revolution apps like Cardiowell available on the Apple App store can help you develop mindfulness techniques. This app not only tracks your blood pressure, weight, and heart rate but also helps you to improve your health.

4. Your Focus is Vital. Where to put your focus is essential to beating stress. Humans have the tendency to complain or feel defeated whenever stressful situations arise. Shift your focus to possible solutions and firmly believe you’ll get through tough times.

5. Organize Your Schedule. Being in a rush is welcoming stress with open hands. Take control of your schedule by organizing tasks and activities earlier.

                                                               Photo Courtesy of  Annie Spratt  via Unsplash

                                                              Photo Courtesy of Annie Spratt via Unsplash

 

6. Sleep is Your Best Friend. You are not a superhero, you need not save the world before bedtime because you need it per se. Setting a definite time for sleep helps you get a comfortable rest. In case you are suffering to get a good sleep, try drinking chamomile tea, dim the lights, decrease humidity inside your room and add aromatherapy to your space.

    Never ever take stress for granted. Start doing things that best help you cope up with stress.

 

 

Turning App Stores to Drug Stores: Redefining Hypertension Treatments

 “The future is now,” is a statement that has been widely used by tech companies in various conferences and numerous product launches. It is a result of rapid advancements in technology that has paved the way for the progress of different industries, particularly in healthcare. Hospitals have become advanced with managing and treating complex diseases.  The rise of the Internet of Things has helped usher in the future of healthcare by innovating and disrupting how treatments and medications are delivered.

Understanding IoT

      Internet of things or IoT is all that is connected to the Internet. IoT comprises devices such as smartphones, wearables, medical devices, appliances and basic sensors that are connected to each other. These connected devices combined with automated systems acquire and process information and can develop treatment recommendations as well as actions to complete a specific task or gain knowledge.

        In simple terms, IoT is all about devices, networks, and the data gathered. It enables devices to create more connected systems around the world.

IoT: Revolutionizing Healthcare

    Healthcare companies are increasingly adopting digital health solutions to increase efficiency resulting in widespread redesigning of business and treatment models.  IoT is revolutionizing health care by allowing individuals to participate in digital health solutions through the network of devices they are connected to.  Using digital health technologies, people are being empowered to take control of their health in an individualized way.  Recently Apple has enabled consumers access and control of their medical information from their mobile devices.  Control of their medical record gives them the ability to share the information with any healthcare provider they wish easily.

 Of Wearables, Smartphone, and Heart health

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According to the latest guidelines, forty-six percent of people in the United States now have hypertension. Hypertension continues to be a significant concern as rates are expected to increase worldwide by over 60% over the next ten years.  It remains one of the deadliest diseases due to heart attacks and strokes.  

Digital health technologies, such as IoT blood pressure devices connected via cellular networks make tracking and managing blood pressure as easy as pressing a button. 

    Patients are increasingly taking more control of their health and transforming the patient-doctor relationship. Research by HealthPartners Institute for Education and Research published in JAMA showed that remote data and home monitoring equipment significantly improve blood pressure control. Researchers of the study compared the usual methods of medication and digital healthcare. Data collected helped the pharmacists and doctors to customized medication, therapy and blood pressure goals. Other studies resulted in decreases in blood pressure by as much as 17 points.

The New Drug Stores: Digital Therapeutics

    App Stores may soon become drug stores. Digital therapeutics are new types of mobile applications that help in treating diseases by reshaping patient behavior while utilizing remote monitoring and communication platforms to improve health. Digital therapeutics target specific conditions and includes personalized health programs such as diet, exercise, and medication. Unlike wellness apps, digital therapeutics are catered to treat or manage chronic diseases such as hypertension, diabetes, and addiction.

    One of the primary investment drivers in digital therapeutics is the data.  Precise data collected from patients are valuable for doctors because it helps develop unique insights into a patient’s behavior and offers insights into improving care and outcomes. Treatment options allowing patients to be part of managing their chronic diseases could result in significant cost savings throughout the healthcare system.  Pharmaceutical companies are primarily interested because it will enable them to continue to track the effectiveness of their medications, long after the clinical trials are completed.  Digital therapeutics designed to be a companion to the medicine can help track long-term results and increase treatment adherence.

   Health and insurance companies are some of the most prominent investors in digital therapeutic companies today.  Clinical results of the newest digital therapeutics show they can either supplement or complement traditional therapies with equal or better results. For health insurance firms, mobile health apps are relatively inexpensive and can prevent the progression and often fatal consequences of chronic disease at the population level.  Digital therapeutics will allow the healthcare system to evolve from two to three 20-minute clinic visits a year to 24/7, 365 days of continuous care and management.

Cardiowell: Empowering Health

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 Not all smart health devices and solutions are equally effective. Cardiowell is uniquely empowering health. Cardiowell is a digital therapeutic designed to reduce the risks associated with hypertension.  It can be download for free and connects with various wearables and blood pressure monitoring devices. Cardiowell gives individuals a holistic view of their heart health— from heart rate variability, pulse, weight and blood pressure to overall wellness. Cardiowell is more than just a platform or application; it helps in developing awareness of the things that cause stress on the body. A lot of people tend to ignore the fact that stress is one of the major contributors to a person’s blood pressure and health. Cardiowell is dedicated to help create purpose, empower patients, redefine health and help people to prevent a heart attack or stroke.

Sources:

https://reachmd.com/news/from-app-store-to-drug-store-digital-health-is-redefining-pharmas-pipeline/1614531/

https://www.philips.com/a-w/about/news/archive/blogs/innovation-matters/how-the-internet-of-things-is-revolutionizing-healthcare.html

https://www.everydayhealth.com/heart-health/digital-health-revolution-in-blood-pressure-control-3208.aspx  

The New Normal: Why Accurate Monitoring is Important with New Hypertension Guidelines

Those who have normal blood pressure might be hypertensive now according to the new guidelines released by American Hypertension Association (AHA). (1)   These guidelines mean that 46 percent of Americans can now be classified as hypertensive in comparison with 32 percent 14 years ago.

What does the new guideline entail? Before anxiety and panic kick in, let’s find out the standards set by AHA:

Cardiowell Blood Pressure Guidelines.jpg

120/80 reading remain as the normal state. The most significant change is the hypertensive baseline which is 130/80 (previously 140/90. Thus, having a blood pressure of 130/80 is now considered as high risk. Pre-hypertension may start above the 120/80 cut-off.

Although the guideline may make millions of people who had normal blood pressure before having high blood pressure now, the good news is that medications are not recommended for the newly classified ‘high risk’ individuals.   However, if the individual has another disease such as diabetes, treatment is essential. 

Lifestyle Changes

Instead of recommending medications, AHA is campaigning for the prevention and management of blood pressure with lifestyle changes. Veering away from the sedentary lifestyle, reducing sodium intake, getting enough rest and sleep, and choosing healthy food can drastically reduce blood pressure. 

“An important cornerstone of these new guidelines is a strong emphasis on lifestyle changes as the first line of therapy. There is an opportunity to reduce risk without necessarily imposing medications.”

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When it comes to lowering blood pressure, a low-salt, a heart-healthy diet may be just as effective as medication. This is the conclusion of a new study recently published in the Journal of the American College of Cardiology.  “What we're observing from the combined dietary intervention is a reduction in systolic blood pressure as high as, if not greater than, that achieved with prescription drugs says Senior study author Dr. Lawrence Appel, Johns Hopkins University School of Medicine (2)

The most surprising result was found for adults whose baseline systolic blood pressure was 150 mm Hg or higher. They experienced an average systolic blood pressure reduction of 21 mmHg with the low-sodium, DASH diet, compared with those following the high-sodium, control diet. (2)

Managing Blood Pressure at Home

Keep in mind that hypertension is not an illness per se, but having high blood pressure puts you at risk of a heart attack or stroke and may result in deadly diseases such as kidney failure, heart disease, erectile dysfunction, and more. 

The guidelines do not intend to scare most people; its goal is to encourage everyone to track accurate blood pressure numbers. This might seem costly to some, but blood pressure management is easy and cost-efficient nowadays. 

Because of various improvements in technology,  low-cost digital therapeutics are now available. Digital therapeutics rely on accurate, clinically proven technologies to replace or supplement traditional medical therapies.  Thus, managing and preventing blood pressure can be easily done using mobile phones. 

Cardiowell, a digital therapeutic mobile application for blood pressure management, is a free application that focuses on recording, tracking, and analyzing blood pressure. Cardiowell aims to help users increase resilience to stress and reduce the risks associated with hypertension.    

Learn more at cardiowell.io

References:
(1) http://hyper.ahajournals.org/content/early/2017/11/10/HYP.0000000000000065
(2) https://www.medicalnewstoday.com/articles/320151.php

Hypertension is the Biggest Cost Center Being Faced by Healthcare Today

Reducing blood pressure is the key to managing the exploding chronic disease crisis in the United States

High blood pressure is a leading cause of death and disability worldwide. Over 33% of people above the age of 65 have high blood pressure.  The rate of hypertension has increased by 23% in the last 13 years1 and is likely to increase by 60% till 2025.2  It is one of the leading cause of stroke and heart attack, increasing the risk by four times.  In the last 13 years, the death rate due to hypertension has increased by 61%.1

It is difficult to treat as in 95% of cases there is no identifiable cause. Only 30% of people suffering from hypertension have it under control.3 Medication management is the most common form of therapy, but unfortunately, it is not entirely effective. Patients are often on more than one blood pressure medication, subjected to unwanted side effects, and have poor compliance.

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It is estimated that the 2008 Per-Member-Per-Month (PMPM) cost of adults with hypertension was about $716 – almost three times the $250 PMPM of adults without hypertension3. Thus there is a great opportunity to save lives.  Dr. John Sotos, a cardiologist and worldwide medical director at Intel, identified that ‘Hypertension is mobile health's biggest opportunity.'4

A study in The New England Journal of Medicine showed that reducing systolic blood pressure from the current recommendation of below 150mmHg Sys to 120mmHg lowered the risk of heart failure by 38%, risk of death by a cardiac event by 43% and the risk of death for any other reason by 27%.5

new england journal of medicine

Because white coat and masked hypertension readings make diagnosis and treatment difficult, regular monitoring of blood pressure readings is needed to manage it properly. Cardiowell works by remotely monitoring and managing blood pressure and medications while empowering individuals to manage their stress and increase their wellness

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Blood Pressure Monitoring Management

Self-monitoring has been shown to reduce BP by 3.4-8.9 mmHg (Sys)6, 7 improve adherence to antihypertensive medication8, and reduce primary care consultation rates at no additional cost. 9

Research also shows that remote monitoring and management of blood pressure by pharmacists can reduce blood pressure by 10.7 mmHg (Sys).10 Other studies that add a telemonitoring component have also witnessed blood pressure drop by as much as 17 mmHg.11-13

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Cardiowell’s ‘always connected’ blood pressure devices and weight scales automate data collection.  Results are sent from the device over a secure cellular network making results immediately available to clinical pharmacists trained to make treatment recommendations. 

Cardiowell also collects additional indicators and predictors of cardiac health such as heart rate and heart rate variability.14 Cardiowell analyses minute fluctuations between each heart beat (heart rate variability) to quantify person’s wellness and provide greater insight into cardiac health. 

Heart rate variability (HRV) is considered one of the best single indicators of person’s health and an early indicator of sudden death.15 By measuring HRV over time, along with other vital signs such as blood pressure, Cardiowell helps to understand when a person is at increased risk.

Stress Management and Increased Wellness

Research suggests that stress plays a significant role in hypertension,16-22 and increases the risk of heart attacks and stroke.22-23 Many studies have shown that biofeedback based breathing exercises can reduce blood pressure by as much as 15 mmHg. 24-50 Meditation which uses breathing techniques have been shown to reduce death by cardiac events in hypertensive patients by 30%.51

Breathing and mindfulness solutions are being promoted by Blue Cross, Etna, and Kaiser because of the known benefits. The American Heart Association also recommends device-guided breathing for anyone with high blood pressure.52

Breathing at six breaths per minute has been shown to increase heart rate variability and strengthen the body’s ability to regulate blood pressure.25, 53 It works by stimulating the parasympathetic nervous system and improves synchronization of the cardiac and respiratory systems. Evidence suggests that it is also very effective in alleviating depression,54-56 a major risk factor in heart disease.

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Normal respiration rate is about 12 breaths per minute (bpm), yet most people breathe at 18 bpm. Fast breathing is known to stimulate the sympathetic nervous system which over time can strain the cardiovascular system. Respiration rate, much like heart rate, is a marker for pulmonary dysfunction.

Using mindfulness principles, Cardiowell increases a person's wellness by helping them breathe slower. Over time with increased awareness and better breathing, people's wellbeing increases and their blood pressure becomes more stable.

Cardiowell Solution

Cardiowell combines remote monitoring and medication management with wellness and mindfulness to lower blood pressure. Cardiowell expects to help lower blood pressure from at least 140/90 mmHg to the newly recommended 120/80 mmHg. Based on research, this is projected to help reduce the rate of stroke by around 25% and heart attacks by 20%.5

The greatest predictor of a second heart attack or stroke is having uncontrolled blood pressure. Cardiowell can also be used by patient-centered homes allowing chronic disease patients and post-acute patients to be remotely cared for. Patients benefit from having to take fewer medications thus decreasing the number of side effects, while at the same time it helps payers reduce population risks and costs.

Cardiowell is available today for employers and consumers as part of a physician-led care plan to help reduce the risks associated with hypertension. Learn more at www.cardiowell.io

 

Download the PDF version of the article here: 

Hypertension is the Biggest Cost Center Being Faced by Healthcare Today (2017)
Reducing blood pressure is the key to managing the exploding chronic disease crisis in the United States
.  

References:

1.      Kung, H. C., & Xu, J. (2015). Hypertension-related Mortality in the United States, 2000-2013. NCHS data brief, (193), 1-8. View article

2.      Chockalingam, A., Campbell, N. R., & Fodor, J. G. (2006). Worldwide Epidemic of Hypertension. Canadian Journal of Cardiology, 22(7), 553-555. View article

3.      Milliman Client Report(2005). The Need for Better Hypertension Control: Addressing Gaps in Care with the Medical Home Model. Milliman, Inc., NYView article

4.      Comstock, J. (2015). Intel's Medical Director: Hypertension is Mobile Health's Biggest OpportunityView article

5.      SPRINT Research Group. (2015). A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med, 2015(373), 2103-2116. DOI: 10.1056/NEJMoa1511939. View article

6.      Uhlig, K., Patel, K., Ip, S., Kitsios, G. D., & Balk, E. M. (2013). Self-measured blood pressure monitoring in the management of hypertension: a systematic review and meta-analysis. Annals of internal medicine, 159(3), 185-194. View article

7.      Fletcher, B. R., Hartmann-Boyce, J., Hinton, L., & McManus, R. J. (2015). The effect of self-monitoring of blood pressure on medication adherence and lifestyle factors: a systematic review and meta-analysis. American journal of hypertension, hpv008. View article  

8.      Ogedegbe, G., & Schoenthaler, A. (2006). A systematic review of the effects of home blood pressure monitoring on medication adherence. The Journal of Clinical Hypertension, 8(3), 174-180. View article

9.      McManus, R. J., Mant, J., Roalfe, A., Oakes, R. A., Bryan, S., Pattison, H. M., & Hobbs, F. R. (2005). Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis. Bmj, 331(7515), 493. View article  

10.  Margolis, K. L., Asche, S. E., Bergdall, A. R., Dehmer, S. P., Groen, S. E., Kadrmas, H. M., ... & O’Connor, P. J. (2013). Effect of Home Blood Pressure Telemonitoring and Pharmacist Management on Blood Pressure Control: A Cluster Randomized Clinical Trial. JAMA, 310(1), 46-56. DOI:10.1001/JAMA.2013.6549. View article

11.  Neumann, C. L., Menne, J., Schettler, V., Hagenah, G. C., Brockes, C., Haller, H., & Schulz, E. G. (2015). Long-Term Effects of 3-Month Telemetric Blood Pressure Intervention in Patients with Inadequately Treated Arterial Hypertension. Telemedicine and E-Health, 21(3), 145-150. DOI: 10.1089/TMJ.2014.0058. View article

12.  Zullig, L. L., Melnyk, S. D., Goldstein, K., Shaw, R. J., & Bosworth, H. B. (2013). The Role of Home Blood Pressure Telemonitoring in Managing Hypertensive Populations. Current Hypertension Reports, 15(4), 346-355. View article

13.  Neumann, C. L., Menne, J., Rieken, E. M., Fischer, N., Weber, M. H., Haller, H., & Schulz, E. G. (2011). Blood Pressure Telemonitoring is Useful to Achieve Blood Pressure Control in Inadequately Treated Patients with Arterial Hypertension. Journal of Human Hypertension, 25(12), 732-738. View article

14.  Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-Analysis. JAMA, 303(1), 47-53. View article

15.  Ogliari, G., Mahinrad, S., Stott, D. J., Jukema, J. W., Mooijaart, S. P., Macfarlane, P. W., ... & Sabayan, B. (2015). Resting Heart Rate, Heart Rate Variability and Functional Decline in Old Age. Canadian Medical Association Journal, 187(15), E442-E449. DOI:10.1503/CMAJ.150462. View article

16.  Linden, W. (1984). Psychological Perspectives of Essential Hypertension: Etiology, Maintenance, and Treatment (Vol. 3). Karger Medical and Scientific Publishers.

17.  Shapiro, A. P. (1996). Hypertension and Stress: A Unified Concept. Psychology Press.

18.  Steptoe, A. (1986). Stress Mechanisms in Hypertension. Postgraduate Medical Journal, 62(729), 697-699. View article

19.  Henry, J. P., Stephens, P. M., & Ely, D. L. (1986). Psychosocial Hypertension and the Defence and Defeat Reactions. Journal of Hypertension, 4(6), 687-688. View article

20.  Markovitz, J. H., Matthews, K. A., Kannel, W. B., Cobb, J. L., & D'Agostino, R. B. (1993). Psychological Predictors of Hypertension in the Framingham Study: Is There Tension In Hypertension?. JAMA, 270(20), 2439-2443. View article

21.  Gasperin, D., Netuveli, G., Dias-da-Costa, J. S., & Pattussi, M. P. (2009). Effect of Psychological Stress on Blood Pressure Increase: A Meta-Analysis of Cohort Studies. Cadernos de Saude Publica, 25(4), 715-726. View article

22.  Tawakol, A., Ishai, A., Takx, R. A., Figueroa, A. L., Ali, A., Kaiser, Y., ... & Tang, C. Y. (2017). Relation Between Resting Amygdalar Activity And Cardiovascular Events: A Longitudinal And Cohort Study. The Lancet, 389(10071), 834-845. View article

23.   American Heart Association (2014). High Stress, Hostility, Depression Linked with Increased Stroke RiskView article

24.  Lin, G., Xiang, Q., Fu, X., Wang, S., Wang, S., Chen, S., ... & Wang, T. (2012). Heart Rate Variability Biofeedback Decreases Blood Pressure in Prehypertensive Subjects by Improving Autonomic Function and Baroreflex. The Journal of Alternative and Complementary Medicine, 18(2), 143-152. View article

25.  Gevirtz, R. (2013). The Promise of Heart Rate Variability Biofeedback: Evidence-Based Applications. Biofeedback, 41(3), 110-120. View article

26.  Reinke, A., Gevirtz, R., & Mussgay, L, (2007). Effects of Heart Rate Variability Feedback in Reducing Blood Pressure [Abstract]. Applied Psychophysiology and Biofeedback, 32, 134.

27.  Wang, S. Z., Li, S., Xu, X. Y., Lin, G. P., Shao, L., Zhao, Y., & Wang, T. H. (2010). Effect of Slow Abdominal Breathing Combined with Biofeedback on Blood Pressure and Heart Rate Variability in Prehypertension. The Journal of Alternative and Complementary Medicine, 16(10), 1039-1045. View article

28.  Schein, M. H., Gavish, B., Herz, M., Rosner-Kahana, D., Naveh, P., Knishkowy, B., ... & Melmed, R. N. (2001). Treating Hypertension with a Device That Slows and Regularises Breathing: A Randomised, Double-Blind Controlled Study. Journal of Human Hypertension, 15(4), 271. View article

29.  Yucha, C. B., Clark, L., Smith, M., Uris, P., LaFleur, B., & Duval, S. (2001). The Effect of Biofeedback in Hypertension. Applied Nursing Research, 14(1), 29-35. View article

30.  Linden, W., & Moseley, J. V. (2006). The Efficacy of Behavioral Treatments for Hypertension. Applied Psychophysiology and Biofeedback, 31(1), 51-63. View article

31.  Grossman, E., Grossman, A., Schein, M. H., Zimlichman, R., & Gavish, B. (2001). Breathing-Control Lowers Blood Pressure. Journal of Human Hypertension, 15(4), 263. View article

32.  Rosenthal, T., Alter, A., Peleg, E., & Gavish, B. (2001). Device-Guided Breathing Exercises Reduce Blood Pressure: Ambulatory and Home Measurements. American Journal of Hypertension, 14(1), 74-76. View article

33.  Meles, E., Giannattasio, C., Failla, M., Gentile, G., Capra, A., & Mancia, G. (2004). Nonpharmacologic Treatment of Hypertension by Respiratory Exercise in the Home Setting. American Journal of Hypertension, 17(4), 370-374. View article

34.  del Paso, G. A. R., Cea, J. I., González-Pinto, A., Cabo, O. M., Caso, R., Brazal, J., ... & González, M. I. (2006). Short-Term Effects of a Brief Respiratory Training on Baroreceptor Cardiac Reflex Function in Normotensive and Mild Hypertensive Subjects. Applied Psychophysiology and Biofeedback, 31(1), 37-49. View article

35.  Elliott, W. J., Izzo, J. L., White, W. B., Rosing, D. R., Snyder, C. S., Alter, A., ... & Black, H. R. (2004). Graded Blood Pressure Reduction in Hypertensive Outpatients Associated with Use of a Device to Assist with Slow Breathing. The Journal of Clinical Hypertension, 6(10), 553-559. View article  

36.  Bertisch, S. M., Schomer, A., Kelly, E. E., Baloa, L. A., Hueser, L. E., Pittman, S. D., & Malhotra, A. (2011). Device-Guided Paced Respiration as an Adjunctive Therapy for Hypertension in Obstructive Sleep Apnea: A Pilot Feasibility Study. Applied Psychophysiology and Biofeedback, 36(3), 173-179. View article

37.  Nolan, R. P., Floras, J. S., Harvey, P. J., Kamath, M. V., Picton, P. E., Chessex, C., ... & Talbot, D. (2010). Behavioral Neurocardiac Training in Hypertension. Hypertension, 55(4), 1033-1039. DOI: 10.1161/HYPERTENSION-AHA.109.146233. View article

38.  Viskoper, R., Shapira, I., Priluck, R., Mindlin, R., Chornia, L., Laszt, A., ... & Alter, A. (2003). Nonpharmacologic Treatment of Resistant Hypertensives by Device-Guided Slow Breathing Exercises. American Journal of Hypertension, 16(6), 484-487. View article

39.  García-Vera, M. P., Labrador, F. J., & Sanz, J. (1997). Stress-Management Training for Essential Hypertension: A Controlled Study. Applied Psychophysiology and Biofeedback, 22(4), 261-283. DOI:10.1023/A:1022248029463. View article

40.  Parati G, Izzo JL Jr, Gavish B., Third Edition. JL Izzo and HR Black, Eds. (2003). Respiration and Blood Pressure. Hypertension Primer (Ch. A40, p117-120). Baltimore, Lippincott Williams & Wilkins.

41.  Hering, D., Kucharska, W., Kara, T., Somers, V. K., Parati, G., & Narkiewicz, K. (2013). Effects of Acute and Long-Term Slow Breathing Exercise on Muscle Sympathetic Nerve Activity in Untreated Male Patients with Hypertension. Journal of Hypertension, 31(4), 739-746. View article

42.  Modesti, P. A., Ferrari, A., Bazzini, C., & Boddi, M. (2015). Time Sequence of Autonomic Changes Induced by Daily Slow-Breathing Sessions. Clinical Autonomic Research, 25(2), 95-104. DOI:10.1007/s10286-014-0255-9. View article

43.  Joseph, C. N., Porta, C., Casucci, G., Casiraghi, N., Maffeis, M., Rossi, M., & Bernardi, L. (2005). Slow Breathing Improves Arterial Baroreflex Sensitivity and Decreases Blood Pressure in Essential Hypertension. Hypertension, 46(4), 714-718. View article

44.  Elliott, W. J., & Izzo Jr, J. L. (2006). Device-Guided Breathing to Lower Blood Pressure: Case Report and Clinical Overview. Medscape General Medicine, 8(3), 23. View article

45.  Wang, S. Z., Li, S., Xu, X. Y., Lin, G. P., Shao, L., Zhao, Y., & Wang, T. H. (2010). Effect of Slow Abdominal Breathing Combined with Biofeedback on Blood Pressure and Heart Rate Variability in Prehypertension. The Journal of Alternative and Complementary Medicine, 16(10), 1039-1045. DOI: 10.1089/acm.2009.0577. View article

46.  Brook, R. D., Appel, L. J., Rubenfire, M., Ogedegbe, G., Bisognano, J. D., Elliott, W. J., ... & Rajagopalan, S.  (2013). Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure. Hypertension, 61(6), 1360-1383. DOI: 10.1161/HYP.0b013e318293645fView article

47.  Benson, H., Marzetta, B., Rosner, B., & Klemchuk, H. (1974). Decreased Blood-Pressure in Pharmacologically Treated Hypertensive Patients Who Regularly Elicited the Relaxation Response. The Lancet, 303(7852), 289-291. View article

48.  Irvine, M. J., Johnston, D. W., Jenner, D. A., & Marie, G. V. (1986). Relaxation and Stress Management in the Treatment of Essential Hypertension. Journal of Psychosomatic Research, 30(4), 437-450. View article

49.  Patel, C. (1975). 12-Month Follow-Up of Yoga and Bio-Feedback in the Management of Hypertension. The Lancet, 305(7898), 62-64. View article

50.  Howorka, K., Pumprla, J., Tamm, J., Schabmann, A., Klomfar, S., Kostineak, E., ... & Sovova, E. (2013). Effects of Guided Breathing on Blood Pressure and Heart Rate Variability in Hypertensive Diabetic Patients. Autonomic Neuroscience, 179(1), 131-137. View article

51.  Schneider, R. H., Alexander, C. N., Staggers, F., Rainforth, M., Salerno, J. W., Hartz, A., ... & Nidich, S. I. (2005). Long-Term Effects of Stress Reduction on Mortality in Persons≥ 55 Years of Age with Systemic Hypertension. The American Journal of Cardiology, 95(9), 1060-1064. View article

52.  Brook, R. D., Appel, L. J., Rubenfire, M., Ogedegbe, G., Bisognano, J. D., Elliott, W. J., ... & Rajagopalan, S.  (2013). Beyond Medications and Diet: Alternative Approaches to Lowering Blood Pressure. Hypertension, 61(6), 1360-1383. DOI: 10.1161/HYP.0b013e318293645fView article

53.  Lehrer, P. M., & Gevirtz, R. (2014). Heart Rate Variability Biofeedback: How and Why Does it Work?. Frontiers in Psychology, 5, 756. View article

54.  Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., & Fawcett, J. (2010). Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-Analysis. JAMA, 303(1), 47-53. View article

55.  Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Med, 5(2), e45. View article

56.  Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. New England Journal of Medicine, 358(3), 252-260. View article