Steps To Lower High Blood Pressure

High blood pressure is typically symptomless, can quietly damage blood vessels and leads to serious health problems. While there is no cure for high blood pressure, it is important for patients to take steps that matter, such as making effective lifestyle changes and taking BP-lowering medications as prescribed by their physicians. In turn, those changes can enhance their quality of life and reduce their risk of heart and kidney disease, stroke and more.

The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.

Here is a to-do list for patients drawn from this series on what doctors wish patients knew about addressing—and managing—high blood pressure, a condition that nearly half of adults in the United States have. Hypertension was the primary or contributing cause of death for more than 670,000 people in the country in 2020.

Measure your BP at home

Many patients with high blood pressure don’t have their hypertension under control. But when patients measure their BP regularly, and share those measurements with their doctors, they are playing an important role in their care. Here is what patients need to know about taking their own blood pressure measurements outside of the clinical setting, also commonly referred to as self-measured BP.

Make appropriate lifestyle changes

There is a growing need for people to commit to making lifestyle changes to help prevent chronic conditions such as type 2 diabetes and heart disease, yet patients are often uncertain of what changes they should make to improve their health and well-being. This article outlines some of the key changes patients should make.

Eat healthful food when you can

What you eat plays a leading role in your health and well-being. When someone eats healthfully, it helps to protect against many chronic diseases such as heart disease, type 2 diabetes and obesity. But with so many fad diets and food recommendations out there, it can be hard for patients to navigate what to eat and what not to eat. Two physicians offer realistic, tested advice on healthful eating.

Avoid unhealthy alcohol use

Disrupted routines combined with the uncertainty of the pandemic have led many people to feeling isolated at home while experiencing greater stress. As a result, some people became their own bartenders and progressed into heavier drinking patterns to cope with pandemic anger, stress and anxiety. Learn when drinking is a problem, and what can be done about it.

Use medications to reach BP goals

While “lifestyle change is very beneficial for reducing blood pressure, many patients need medication to reach their BP goal,” according to Neha Sachdev, MD, a family physician who is the director of health systems relationships at the AMA. “Your doctor and you should talk about what medications are being prescribed and how the medications work to lower your BP.”

Watch your sodium consumption

While sodium is an essential nutrient, most people consume too much and are not even aware they are doing so. Excess sodium can increase a person’s risk for developing high BP. That is why it is important to understand where most salt intake is coming from and how to lower it. Learn more about where sodium resides and which choices to make to avoid it.

Be mindful of your cholesterol

High cholesterol and high blood pressure tend to run together. But, while one does not necessarily cause the other, it is common to see both in an individual. Nearly 94 million adults over the age of 20 have what could be considered borderline high cholesterol, yet as with hypertension many patients are unaware of it until they visit their doctor. Sorting through the good, the bad and the ugly about high cholesterol can be confusing. One family physician explains what to keep in mind.

The AMA has developed online tools and resources created using the latest evidence-based information to support physicians and care teams to help manage their patients’ high blood pressure.

These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association.

Another great resource from the AMA is the US Blood Pressure Validated Device Listing (VDL™). The website details which of the thousands of BP-measurement devices have been validated for clinical accuracy in the United States.

What Doctors Wish Patients Knew About Loneliness And Health

Even though people are becoming more connected through social media and other outlets, the great irony is that many people still feel lonely. That loneliness, in turn, can have far-reaching implications on a person’s health and well-being. Loneliness as a public health issue has been intensified during the COVID-19 pandemic. Knowing how to recognize loneliness and what can help patients overcome feeling lonely is key.

There’s a gap in feeling connected

“Loneliness is essentially the feeling of being uncomfortable or in distress when someone feels that there is a gap between the connection they would like and the connection they actually have,” said Dr. Bell Washington, adding that “you can be in a crowd full of people, you can know all of them, and you can still feel lonely.”

“So, you might have a lot of superficial social connections, but what you really want is something deeper—someone to know you on the inside,” she said. “It’s really based on perception of the difference between the relationship you’d like and the relationship that you have with others.”

Younger people are feeling lonelier

“Loneliness was already an epidemic of its own, but the global COVID-19 pandemic caused loneliness to increase substantially over the past few years,” said Dr. Bell Washington, who took a course during the last year of her MPH program at Harvard T.H. Chan School of Public Medicine where she learned the serious complications of loneliness. “A 2021 online survey found that 36% of all Americans—which includes 61% of young adults and 51% of mothers with young children—feel ’serious loneliness.’”

Additionally, the Centers for Disease Control and Prevention (CDC) “found 63% of young adults also suffer significant symptoms of anxiety or depression,” she said. “That means we have a generation of young people hungry for deeper connection who often do not have the skills or opportunities to achieve it.”

“One’s 20s are filled with countless social expectations including separating from one’s nuclear family, finding a partner, developing a career and finding a ‘tribe,’” Dr. Bell Washington said. “For many this time is complicated by unrealistic social media lives which are often unattainable. That only amplifies the loneliness that young adults feel.”

Social isolation can play a role

“An individual experiencing loneliness will often describe feeling alone. This is distinct from social isolation where there is a paucity of social connectedness,” said Dr. Clark. “Social isolation can be a sequela of loneliness, but there are plenty of individuals who experience loneliness and are still socially connected.”

Additionally, “there are some people who I would consider socially isolated, but they feel perfectly fine with it,” said Dr. Bell Washington. “The pandemic revealed that though some people considered themselves loners, when they truly had to be alone all of the time (due to quarantine or isolation), they found out that they actually do value social connection, and would have preferred to be with other people.”

Social media affects loneliness

“We get these dopamine surges when someone likes our status,” said Dr. Clark, referring to a social media posting. Many, conversely, feel “sad or upset when they do not receive a certain number of likes or have over 1 million followers on their social media accounts.

“And if you’re having an identity crisis—and if you’re letting social media dictate who you are—that can create some loneliness,” he added. “We must be mindful of the psychiatric sequelae of loneliness. These include depression and anxiety.”

Everyone is at risk for loneliness

“We’re all at risk for loneliness in our lives,” said Dr. Clark. “There was a report that came out from the National Academies of Science, Engineering and Medicine. It revealed that more than one-third of adults 45 or older reported feeling lonely and about a quarter of adults 65 or older were considered to be socially isolated.

“Social isolation in itself was associated with a 50% increased risk of developing a neurocognitive disorder and other serious medical conditions,” he added. “No one is immune to loneliness and social isolation, but there are certain groups who are at increased risk.”

“When we think about historically marginalized groups in terms of immigrants—as well as the LGBTQ+ community—those are groups that have been shown to be at high risk for loneliness and social isolation,” Dr. Clark said.

“Anyone can suffer from loneliness and the highest risk is for those who are not able to remedy the loneliness when they feel it,” Dr. Bell Washington echoed. She added, “The fear of being alone in your loneliness only makes the isolation worse. It is easy to feel you’re the only one who needs social connectedness, but that is not true. There is no shame in being lonely. We were built for connection.”

It’s linked to health complications

“There is some evidence to note that people who are experiencing social isolation and loneliness are at increased risk for premature death,” said Dr. Clark, adding that “social isolation and loneliness were associated with a 29% increased risk of heart disease and a 32% risk of stroke.”

“Now, I’m a romantic and a poet, and there’s something to be said about the broken heart—literally and figuratively speaking,” he said. “If you’re already feeling lonely, that’s going to impact your heart. If you’re feeling socially isolated, that’s going to impact your heart.”

Discrimination is also a factor

Looking at “immigrants and the LGBTQ+ group, why do these groups feel so isolated and lonely? Well, discrimination is a factor that can be a barrier for them being able to feel socially connected,” said Dr. Clark. “The other thing would be language barriers if we’re talking about immigrants where English is not their primary language.”

“It can be difficult to form relationships with others when historically marginalized groups continue to be stigmatized,” he said. “We have to acknowledge our implicit and explicit biases if we hope to seek to embrace humanity in the form of diversity, equity and inclusion.”

Acknowledge how you’re feeling

“Sometimes we are in denial. When we’re in denial, it’s easy to avoid those feelings that we know are bubbling on the surface, but we just try to continue to suppress them,” said Dr. Clark. “If you are feeling lonely, the first thing is, acknowledge that, and then ask yourself: What is contributing to my loneliness?”

“Loneliness is not your fault. Social isolation is not your fault,” he said. “Because, again, there are probably precipitating and perpetuating factors that are contributing to these states of being.”

“We have to remember that we are enough and that we belong,” Dr. Clark said.

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Everyone needs a support system

“If we’re wanting people to live longer, healthier lives, we have to be better about investigating how loneliness is impacting our communities,” said Dr. Clark. “Everybody needs a support system. Even the person who says that they have a shy temperament and they’re more introverted—they still need a support system.” “When we’re looking at our AMA declaring this as a public health issue, it speaks to the importance of advocating for connectedness for all communities that will enable them to flourish,” he said. “For example, supports systems are a positive, prognostic factor for individuals who are suffering from mental health conditions, substance-use disorders and personality disorders.”

“We have to make sure people have the available resources that will allow them to cultivate connectedness,” Dr. Clark said, adding that “these resources must be diverse, equitable and inclusive.”

Don’t minimize anyone’s struggle

“People assume if someone is doing well, making money and has a family that they can’t be lonely, but that is not true,” said Dr. Bell Washington. “We all benefit from having a deeper connection with others, no matter what stage of life we’re in.”

“We really can’t minimize anyone’s struggle, because we all have different difficulties that we’re coping with,” she said. “We are human, we have needs and we have a right to express those needs. We should always be kinder than necessary because you never know the hidden battles that people are going through.”

Take loneliness seriously

“Loneliness is something to be taken seriously,” said Dr. Bell Washington. Loneliness “can have serious mental and physical complications that worsen if ignored.” She added that, “social isolation and loneliness lead to higher risk of high blood pressure, heart disease, obesity, anxiety, depression, memory issues and even death.”

“It is not a sign of weakness. You do not have to be a superhero. You don’t have to be strong all of the time and there’s nothing wrong with desiring or seeking connections,” she said. “The same things we needed as little kids; we need as adults too. So, of course you need sleep, healthy food and physical activity, but you also need connection.”

“That connection looks different for different people. For some, it may be connection with a higher power,  family or friends,” Dr. Bell Washington said. “I advise all patients to make sure you are taking care of yourself and seek help if you need it.” Washington

Reach out to your physician for help

“If you notice that you are sad or worried more days than not, that would be a sign that you probably should check in with someone,” said Dr. Bell Washington. “In addition to confiding in a trusted family friend, I’d recommend reaching out to your personal physician.

“They can make sure you are not suffering from depression or other mood issues as a result of your loneliness,” she added. “Your doctor would be a great person because they can be sure to provide you some help as well.”

“Then obviously if you get to the point where you’re feeling so lonely and so isolated that you start feeling hopeless or suicidal, you should reach out to your doctor immediately,” Dr. Bell Washington said, noting “there’s also a new 988 mental health hotline. Whatever you do, don’t suffer in silence, please get help!”

(Two psychiatrists, AMA members share their thoughts on what patients need to know about loneliness as a public health issue. These AMA members are:

  • Tiffani Bell Washington, MD, MPH, an outpatient general, child and adolescent psychiatrist working with Centurion and also in private practice in North Carolina. She is an American Psychiatric Association delegate to the AMA Young Physicians Section, alternate delegate to the Section Council on Psychiatry and a member of the AMA Ambassador Program, which equips individuals with the skills and knowledge to confidently speak to the AMA’s initiatives and the value of AMA membership.
  • Frank Clark, MD, an adult outpatient psychiatrist at Prisma Health in Greenville, South Carolina, and associate clinical professor at the University of South Carolina School of Medicine-Greenville. He is also an American Psychiatric Association delegate to the AMA Section Council on Psychiatry.)


Dr. Vivek Murthy Urges Nation To Act Together To Address Physician Burnout

Physicians and other health professionals on the front lines of COVID-19 care have experienced so many unknowns during the pandemic. They’ve also put their own health and the well-being of their families on the line to provide care. Fortunately, though, the country is in a better position than it was a year ago. Despite the rise of the Delta variant and increases in cases and hospitalizations, the three available COVID-19 vaccines have helped save lives. But the fight isn’t over yet. Another battle remains: burnout within the exhausted physician workforce.

“It’s felt hopeful to me, especially in the early parts of the pandemic, to see many people in the public recognizing the role that clinicians were playing and the sacrifices they were making,” said U.S. Surgeon General Vice Adm. Vivek Murthy, MD, during a discussion with AMA CEO and Executive Vice President James L. Madara, MD, at the American Conference on Physician Health 2021.

But “I also worry about what’s happened to our clinicians. Yes, they have been absolute heroes, but that’s coming at a cost,” said Dr. Murthy. “The question that we have to ask ourselves as a country is: Are we willing to finally step up and do something?

“This is a time where we have an opportunity, but also an obligation, to address some of these deeper challenges of clinician well-being,” he added.

“We know that in order to address burnout, this isn’t about one organization or one sector—we all have to act together,” said Dr. Murthy. The “government has got to play an important role here. Health care systems have an important role to play.”

Also, “we know educational institutions, training institutions have an important role they can play,” he said, adding there’s even “an important role for policymakers and the public.”

How to promote physician well-being during a pandemic and beyond

The federal government has a unique opportunity and power “that is critical to highlight the issue for the general public and to lay out a national strategy around” physician burnout and well-being, said Dr. Murthy.

Don’t focus solely on the individual

“The bottom line with all of this, though, is … you can’t assume that solely focusing on equipping individual physicians with individual tools is going to be the solution to burnout,” said Dr. Murthy. “This is not just about enrolling physicians in a CME around self-care that they take for three days. … The problem is it is so much more systemic, and it’s deeper than that.”

Bringing “the right people together—the right sectors together—to commit to … both the systemic and process changes, but also the cultural changes that need to take place in an institution is going to be extraordinarily difficult,” he said.

Educate the public about burnout

“All of this cannot happen sustainably without us bringing the public in. And I don’t mean the broader health care professional,” Dr. Murthy said. “I mean the general public outside of health care because I don’t think that the general public fully appreciates how the problem of physician burnout is already impacting the care that you’re getting or not.

At pandemic peak, 1 in 3 resident doctors in NYC experienced burnout

“We know that when clinicians drop out of the workforce, it’s not just that there are fewer people that care for COVID patients at hospitals, but our ability to provide primary care, hospital-based care and other clinicians across the board also is compromised,” he said. “There’s so much more we need to do to help the public understand why clinician well-being is not just an issue for clinicians.

“It is a national priority, and it has to be treated with the urgency that it really deserves,” Dr. Murthy added.

The AMA offers resources to help physicians manage their own mental health and well-being during the COVID-19 pandemic and provides practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.

6 Things AboutCOVID-19 Vaccine Card

Social media has been flooded with images of people proudly displaying their COVID-19 vaccination cards—and the impetus for doing that is understandable. While that little white card has helped bring a sense of normalcy to people across the country, one question remains: What should your patients do with their COVID-19 vaccination cards? One physician explains what to tell patients to keep in mind after receiving their vaccine card.

Get the latest COVID-19 vaccine updates

Scientific integrity and transparency secures trust in COVID-19 vaccines. Stay informed on vaccine developments with the AMA. More than 140 million people have been fully vaccinated against COVID-19, according to the Centers for Disease Control and Prevention (CDC). Whether a person has received the Pfizer-BioNTech, Moderna or Johnson & Johnson COVID-19 vaccine, everyone should receive a vaccination card. This card includes the data, location and which COVID-19 vaccine the person received. AMA member Purvi Parikh, MD, an allergist and immunologist as well as a vaccine researcher in New York City, shares what patients should know about their COVID-19 vaccination card.

Cover personal information

Many people have already shared photos with their COVID-19 vaccine card. But Dr. Parikh explained that it is important not to take a selfie with a vaccination card “because there’s actually been a lot of counterfeit cards being made.” Instead of taking a selfie with the vaccination card, Dr. Parikh recommends taking a photo while receiving the vaccine, which is what she did.

If a patient does want to take a selfie with their card, she recommends covering up personal information as well as the lot number and manufacturer because “someone could pretend to be you and copy the card—the same way someone can steal your identity for credit cards and other financial information.”

Have a backup copy

People who have received two doses of Pfizer or Moderna, or one dose of the Johnson & Johnson vaccine, should consider having a backup copy of their vaccination card, says the CDC. One way to keep a COVID-19 vaccination card safe is to “make a copy of it,” said Dr. Parikh, noting that this can be done by “taking a photo on your cellphone—that way you have it easily accessible.” Additionally, “make sure all the information on the card is correct and up to date,” she said. If it is not, inform the vaccine provider of the incorrect information.

Skip card lamination

“We recommend not laminating especially because we don’t know yet if booster shots are going to be needed,” said Dr. Parikh. “We also don’t know if additional shots and information will need to be added either.” Instead, “keep the card in a plastic covering like those plastic holders for IDs at conventions to keep it from getting ruined, because once you laminate it you can’t write anything on it again,” she said.

Replacement can be complicated

“You don’t want to lose your card, but if you do lose it—that’s why the photo is helpful,” said Dr. Parikh. But if a card is lost, “you could always request another one from where you received your vaccine, which can be complicated, especially if you did it in one of those pop-up vaccine sites. “But the best way to go forward is to get another card,” she added, noting that “if you’re in the system they can verify that you did receive a COVID-19 vaccine.”

There’s no easy access to the data

The vaccination card is a patient’s personal proof of immunization. Their information is also recorded in their state’s immunization registry. And while it may currently be difficult to access data on who is vaccinated and who is not, Dr. Parikh is “hoping that improves as we get more people vaccinated.” “Our primary goal is to get people vaccinated—period,” she said. “As more people get vaccinated against COVID-19, we’ll be able to organize the data better, the same way we do for flu shots and other vaccinations.”

“Once we get to a place where infection rates are low enough, where it’s not a public health threat, we may not need to do all of these things,” said Dr. Parikh. “But for the foreseeable future, we will have to be prepared to follow precautions and maintain records of our vaccine cards.”

Share vaccination status with doctor

It is also important for patients to share that they have received a COVID-19 vaccination with their doctor to “enter into the electronic medical record or paper chart in their office,” Dr. Parikh said. This is similar to what “we do with other vaccines, so it becomes part of your medical record as well.” Sharing that you have been vaccinated against COVID-19 and having it entered into the EHR also helps “in the event a card is lost, or documentation is needed,” she said.