High Blood Pressure in Menopause & Midlife: The Estrogen Connection with Dr. Alex Verge, ND

If you recently had a  checkup and were a bit shocked to see that you’re blood pressure was up-(perhaps for the first time), and are feeling a bit panicky, you’re in the right place. First things first. Take a deep breath and let me assure you, this is not your fault!

High blood pressure is very common in midlife, and there is a lot you can do to support your heart health. Naturally, I invited Dr. Alex Verge back on the show help us understand where to focus our efforts when it comes to supporting heart and blood pressure health.

The everchanging hormone soup of midlife has a big impact on our cardiovascular health.  And like many other aspects of health in midlife, the answers are far more complex than simply “eat less and move more”.

Hypertension in midlife isn't just the result of declining estrogen and progesterone; it's a complex layering of factors, with things like stress and sleep playing pivotal roles. Many women in midlife can easily list sources of stress in their lives. While stress may feel impossible to avoid, Dr. Alex reminds us that recognizing the signs of stress and practicing relaxation techniques can help us manage high blood pressure and so much more.

Challenging common myths about sodium consumption was a key focus of this conversation too. The idea that 'healthier' salts like Pink Himalayan salt offer a silver lining is just one of the myths we debunked. Sodium chloride, regardless of its source, is still salt and can still impact your blood pressure. Dr. Verge did point out the potential benefits of potassium as a mitigating factor against sodium's effects. This is just another reason building balanced plates is always a great choice! 

 We also touched on the impact of movement and exercise on high blood pressure. And, as we always say around here, all movement counts, especially walking! Dr. Verge noted the significance of the DASH diet and fiber intake, pointing out that while individual food choices matter, systemic changes in the food industry are essential for collective well-being.

But even if you are already implementing all these suggestions, there’s a chance you might not be seeing the changes you’re looking for. When this is the case, secondary hypertension, arising from underlying conditions or medications may be at play. We also wanted to destigmatize the use of medication in managing blood pressure, because the ultimate goal is better health outcomes. It doesn’t matter if that’s achieved through diet, exercise, or pharmaceuticals.

To learn more about Dr. Alex and her work, check out her website at www.kuraclinic.ca and follow her on Instagram at alexvergend.

Links Mentioned: 

• Hypertension Canada’s List of Recommended Devices - https://hypertension.ca/public/recommended-devices
• US Blood Pressure Validated Device Listing - https://www.validatebp.org/
• Stride BP (Joint Initiative with European Society of Hypertension) Validated Blood Pressure Monitors - https://www.stridebp.org/bp-monitors/

Episode 39: What Every Woman Needs to Know About Heart Health, Cholesterol, and Menopause with Dr. Alex Verge, ND

TRANSCRIPT

Jenn Salib Huber: 0:00

Hi and welcome to the Midlife Feast, the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Salib Huber. I'm an intuitive eating dietitian and naturopathic doctor and I help women manage menopause without dieting and food rules. Come to my table, listen and learn from me trusted guest experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. And if you're looking for more information about menopause, nutrition and intuitive eating, check out the Midlife Feast community, my monthly membership that combines my no-nonsense approach that you all love to nutrition with community, so that you can learn from me and others who can relate to the cheers and challenges of midlife. 

Hi everyone, welcome to this week's episode of the Midlife Feast. So I'm going to share a scenario with you, and if you can relate to it at all, then you are definitely going to want to tune in. So imagine that you have always had low blood pressure and you go for your annual checkup. Maybe you're in perimenopause, menopause, postmenopause, whatever it is and all of a sudden it has jumped. It is now high. Maybe it's really high. Maybe you are starting to feel a little bit worried and maybe you left that appointment in a bit of a panic and you start to wonder what have I done, what can I do, what did I do wrong? And it can feel very urgent when the conversation comes around to blood pressure. So if that is you or if you know someone, make sure that you listen to this episode with Dr Alex Verge. 

So Alex was on last year talking about cholesterol and it was one of the top five episodes of the previous year, and I know that this one is going to be equally well loved because she delivers her no-nonsense, yet compassionate and informative way of looking at blood pressure in the bigger picture of our overall health, especially in midlife. 

Hi, alex, welcome back to the Midlife Feast. Hi, jen, I'm so pleased to be with you again. Yeah, so let's talk about the first time you were on the podcast, which was last year. We were talking about cholesterol and that was one of the top five, most popular episodes of the last year. The cholesterol one hands down had more people sending me messages saying, oh my goodness, I learned so much in that episode. Thank you so much. So I knew that I wanted to have you back to talk about blood pressure and menopause.

So I'm going to relay a story that I feel comes up a lot, which is it starts like this it says oh my goodness, jen, I went to see my doctor, my nurse practitioner, my naturopath, for whatever, and for the first time my blood pressure took a jump and it was high. It's never been high. I've always had low blood pressure. What is going on? Yeah, you're not in your head, because you hear this all the time too. So walk us through. What's happening kind of like with cholesterol, like blood pressure changes Is menopause. Is that the cause?

 The Real Cause of Surging Blood Pressure in Midlife

Dr. Alex Verge: 3:10

Well, it's definitely a component. Let's not yeah, absolutely, it's definitely not the be all and und all. But of course, what happens is that people often aren't checking their blood pressure and, like the cholesterol story, women maybe were not paying attention to our cardiovascular health in the same way, and so we don't think about watching blood pressure, asking a bit of cholesterol, seeing where things stand. And again, through the last three or four years we haven't had the opportunities, maybe anyway, and so we're getting back into the swing of things. 

Maybe we're going through that mid lifetime, we're seeing the doctor, blood pressure gets checked and it hasn't been checked in a while and it's like, oh hey, this is now a problem. And so part of it is because the blood pressure actually genuinely has gone up. Part of it is because maybe it hasn't been checked for a while, so the change is noticeable, and part of it is that there are other factors, particularly that come home to roost a little bit at midlife, that may also impact blood pressure. That has nothing to do with the hormonal transition. So it's really common that this is the time when people are surprised with this information.

Jenn Salib Huber: 4:26

OK, so let's talk about some of those other things that come home to roost and I love that, by the way.

Dr. Alex Verge: 4:31

It's a visual, isn't it? So I mean, we often talk about how, during midlife, we may have not competing interests, but we're that sandwich generation pressure. So often we're starting maybe some supportive or caregiving roles or just some concerns about older folks in our family we may have if we have kids. Our kids are going through, as is always the case, but different types of transitions and you're just helping them along as well and supporting on that end, and then you may be seeing changes in your career. You may be working towards retirement and having questions around that, or having job changes or discovering that things aren't where you want them to be in that regard and spending some time thinking about that. 

And it's more and less busy of a time of life than others in different ways. And I think that stress levels and this isn't to suggest that there aren't stressors at other times of life, but I do feel like they land a little bit differently and certainly the folks that I'm talking to feel pulled in way more directions than at other times and because blood pressure is certainly stress reactive in a way that something like, say, alcohol isn't, you're going to see these changes, particularly around this time.

Jenn Salib Huber: 6:01

And I mean stress is. It's the thing that, like, I love and hate talking about stress because in some ways it feels like so dismissive, right, you know, if somebody is like having all the symptoms you know, like, and how's your stress level, like sometimes I feel it's a good thing I'm on the other side of a screen because I feel like they might punch me. But you know, it is relevant, you know, and it is in some ways something that we can have a little bit more input on. So maybe we can't control the stressor, but we can learn to have an impact on the response. Would you agree?

Why We Can't Ignore the Impact of Stress on Blood Pressure

Dr. Alex Verge: 6:35

I would totally agree. Yeah, and I would say I feel very similarly about the. When I ask about stress and I sort of cringe a little bit because, because you do feel that people mention it all the time, it's like, oh, I'm stressed, oh you're must be stressed, in a way to explain some really legitimate feelings and symptoms, but in a dismissive way, and I think that happens a lot, as in the medical fields, right, I think we it happens a lot, and so people are going to be leery of, oh, it's just stress related. 

And so I'm always trying to be clear that when I'm asking about stress, I'm not there to say, oh, it's just stress related. I'm there to say, actually, stress can have a big impact here, and if we can identify that this is having the impact we think it might be, we can start to find ways that are going to work for you to mitigate some of that, and so we may segue into a conversation what I like to call like relaxation training, which may be the wrong word, but I think of it as developing a skill set, and so that's why I constantly use the word training. right Like you wouldn't jump into running a marathon without some training. And why would you expect to have all the like stress management skills down pat without having tried them before? Yeah, yeah.

Jenn Salib Huber: 7:57

And the relaxation training too. I don't know kind of what kinds of things that you recommend doing, but for people who have the ability to measure their blood pressure at home, it can be, so, I think, reinforcing and rewarding for them to see the difference in just like 10 deep breaths right, that biofeedback can be amazing for showing them like, oh man, wow, that really makes a difference and if I do that three times a day, that can have meaningful impact on your blood pressure.

Dr. Alex Verge: 8:33

Yeah, and like, how empowering is that? To allude back to your comment around being able to do something ourselves about that right, it's something we can take complete control of and work at and practice that and train at and see those impacts, and it can work both ways. And a couple of things I wanted to mention there. It's leading me into all these directions, but the first is big advocate for at home measuring of your blood pressure. 

Absolutely, I think you know, if everyone could be blessed with a machine at home, a validated machine at home, I would be so happy. And maybe in the show notes and I don't know if we did this for the cluster wall, because we just briefly talked about blood pressure then but particularly in Canada, the US and I'm sorry I don't have something for Europe, but I have a couple of websites where there's lists of validated home blood pressure machines. So yeah, we can totally share that in the show notes.

Jenn Salib Huber: 9:32

That's a great resource.

The Value of Monitoring Blood Pressure at Home

Dr. Alex Verge: 9:33

Yeah. So people ask like, yes, I'd like to do that, but I'm not sure what machine I should get, and there's no, there's no right answer. But just the important thing is that it's a validated machine and so these resources will will get that information. So, with those validated machines on hand and doing your blood pressure once you get over the hump of being worried about it, which is a perfect example of how stress response impacts your blood, pressure that white coat, hypertension, that anticipatory anxiety of what the number is going to be when you press the button, and then you'll notice that that first measurement is higher than a second or third measurement. 

That's that stress response, and so so I use it in that way particularly, you know, like let's monitor it, let's take those deep breaths or do the exercise and see what happens, and getting that absolute connection to that. But I'll flip that on its head a little bit and say did you just get off a stressful phone call with someone, or you know a particular meeting, or something like that? Do you have access to your blood pressure machine? Why don't you see what the connection that way is, so that maybe we can identify some real triggers that you really that you weren't aware of, in in how it's affecting you, in that way and the anticipatory stress.

Jenn Salib Huber: 10:55

I just want to share my own little story from that. So 13 years ago now, when I was pregnant with twins, I developed preeclampsia and pregnancy induced hypertension and I was someone who struggled to have a blood pressure above 100, over 60, before that pregnancy and all of a sudden found myself hospitalized with blood pressure on the day they were born and I think it was like 180 over like 110 or something, and there was I'm going to call it like a small T trauma in that process. For me that resulted in developing white code hypertension, Like, honestly. And so now I always have to and we're talking like 13 years later, right, and I have one at home and I you know like I'm so, like I can psych myself out of it. And yet in a healthcare provider setting I always have to tell them don't freak out, okay, the first one's going to be high. Then they're always surprised Like I've had it come down 40 points in, like three readings over a five minute setting, like that's how significant my white code is, and it's crazy, right, but at home, at home, I can still get like 124 over 68. But you put me in a healthcare setting, I'm like 160 over 100. It's wild.

Preeclampsia and White Coat Hypertension

Dr. Alex Verge: 12:22

Yeah, yeah. And so the the multiple things I have to piggyback there is. It is astounding, firstly, how much of an impact that anticipation can have, that white code hypertension. I will also mention that I also suffer from white code hypertension, and back in the day we used to think that this was 100% benign thing. Right, it's just a standalone thing. It comes down, you're all good. 

And this isn't to say that it's. It's not. I don't want people to panic, but the evidence is moving towards that, the idea that people with white, white code hypertension are more likely to develop hypertension later in life. So so it's just sort of a maybe a signpost that things could go in a different direction later on. And so I always tell them yeah, so if they're sort of dismissing it, I'll say for sure it doesn't mean you have high blood pressure today, may not mean you have high blood pressure tomorrow or ever, but as a group of people, myself included, who have white code hypertension, we don't want to ignore the possibility that this can go up later in life.

Jenn Salib Huber: 13:37

I think that's really good information. It's like a check engine light, right. It's kind of like, hey, if this comes on, just keep an eye on your engine. It doesn't mean that you have it now or that it needs to be managed or treated, but I think that that's a really great reminder, especially since I had pregnancy, induced hypertension and preeclampsia and I have a family history Like, the more check engine lights I can have, the better off. I'll be right, it doesn't need to be something that we fear.

Dr. Alex Verge: 14:04

Yes, and I'm glad you pointed that out, because certainly when I'm doing cardiovascular screening, especially with newer patients, we are talking about pregnancy history, even if that was decades ago, to be totally honest. Especially if I'm seeing someone in midlife for the first time and their last baby was 20 years ago. I'm still asking were you diagnosed with preeclampsia, Was there hypertension and pregnancy, Among other things? We go through other things as well because those will increase the chance that during midlife or later on, that diagnosis will come back around, even if, as it usually does, it resolves after pregnancy.

Jenn Salib Huber: 14:46

Okay, so we've talked about those things that have come home to Roost, so we've talked about stress, and that led into that side discussion. Oh my God, hypertension, with some great info. What are some of the other things that converge with this age and stage?

Why Estrogren Can Impact High Blood Pressure

Dr. Alex Verge: 15:02

Well, certainly the hormonal piece, I think, is where something is near and dear to both our hearts, and I would say the change in estrogen, which is confusing most of the time, is a major factor here. There's a variety of ways that estrogen is protective to the cardiovascular system.

So blood pressure and its impact on blood pressure is certainly not the only thing, but it will be part of the puzzle, and so one of the ways that estrogen, as it naturally shifts, can change blood pressure relates to its impact on the kidney and things around sodium retention, and it turns out, whether it's related to estrogen or not, we also think that women are more sensitive to the impacts of sodium on blood pressure in contrast to men, and it's not it's again not to be all an end, all, but recent studies have started to really clarify that, if we're talking about sodium restriction, which has become, I think, maybe unnecessarily controversial in the online space, one of the people who feel extremely strongly that the data is abundantly clear that sodium is a thing for blood pressure and it's particularly a thing for women, and so if we're watching our sodium, I mean, I think that's an important thing for anyone with hypertension, but I'm going to be particularly mindful of that in women and particularly during midlife, because of that additional change of the impact of the lowering estrogen on the sodium retention at the kidney level.

Considerations for Adjusting Your Sodium Consumption

Jenn Salib Huber: 16:45

Yes, yeah, I want to echo that the conversation that's happened online, primarily around sodium, is not unlike the conversation we had about fat and cholesterol. It's like saturated fat. So I mean the data is really clear that saturated fat and LDL are very closely related, and it seems like the relationship between salt, especially for women, is not as insignificant as some influencers would lead you to believe, and I often see people who will say that they're intentionally adding salt to things like water or believing that Himalayan sea salt is a better type of salt and anything that has sodium chloride is salt, whether it comes from the Himalayas or your backyard. It is salt, right, and it's going to have the same effect. There really is no evidence that I know of I'm willing to be wrong, but that there is a better salt. Am I right about that? Yeah, you're right.

Dr. Alex Verge: 17:50

Yes, absolutely, and it doesn't mean that there aren't. If you take certain salts and compare them, that there aren't some modest differences. But when we're talking about salt in the context of hypertension, we're talking about the sodium content, and what makes salt salt is the sodium content, whether there's additional bells and whistles or not, and so that's really what it comes down to in this consideration. Every once in a while, you'll hear someone make the argument that, while these additional minerals are going to buffer and it's almost borrowing a half truth, or not a half truth, but borrowing from the understanding that potassium intake can mitigate to some degree the effects of sodium. 

So we talk about how, if someone has a high potassium-containing diet, which is typically rich in fruits and vegetables, in particular a high potassium diet those people will have less of an impact of a high sodium diet on their blood pressure. But they don't cancel each other out and I think that's important to understand as well, and you need extremely meaningful amounts of potassium. So whatever is found in an alternative salt type, let's say, is never going to be enough to make a difference in that regard. But I definitely would push that.

Potassium Chloride Substitutes

Jenn Salib Huber: 19:10

What are your thoughts on the potassium chloride salt substitutes? Are those a good thing?

Dr. Alex Verge: 19:15

Yes, absolutely, although I would caution with this potassium a conversation that there are people who aren't going to be well-served by intentionally adding potassium. So the two big groups although that's something if someone is going to intentionally work on increasing their sodium, I'm encouraging, talking with their healthcare provider but the two groups in particular were most concerned about would be people with chronic kidney disease and people, in fact, who are on a variety of blood pressure medications. Not all of them, but many of them will end up impacting potassium levels and if you're adding more to the mix, that could get people into trouble. So those are the two people we're really worried about, absolutely.

Jenn Salib Huber: 20:02

And I just want to clarify. I think you meant to say intentionally increasing potassium and you said intentionally increasing sodium. So I picked that up and I'm just going to clarify that you should not be intentionally increasing sodium.

Dr. Alex Verge: 20:15

No, you should not, but thank you very much for catching that.

Jenn Salib Huber: 20:20

That's okay, yeah, and some people often ask me about the potassium salt and they'll say like, hey, why don't you talk about this more? And I'm like because it's not a one size fits all answer. It can be a great option for some people, but it really does need to be made in that, like in a conversation with your healthcare provider, to make sure that you don't have contraindications to it. So please don't anyone run out and buy it, especially if you're taking medications.

Dr. Alex Verge: 20:46

Yes, absolutely, and that is in all the places that I'm extremely enthusiastic about the potassium concept. I am very clear that that requires some vetting for lack of a better term because although it can be so useful, it can be really problematic in certain situations and sometimes we don't know if we're in one of those situations. So, a great thing to check in on. But the salt, the potassium substitutes or the salt substitutes that are potassium based, are extremely helpful in the right scenarios. 

They're also not that tasty, and so they have sort of a like bitter flavor, so you rarely see them as being like a complete substitute, but even a proportional substitute. We have this massive study that came out a couple of years ago doing exactly that, and I think it was a 25% substitution with some really meaningful reductions overall. So, yeah, so there's a lot of enthusiasm for that in the field. Just with those specific cautions, yeah, no, that's great.

Jenn Salib Huber: 21:51

Okay, so we've talked about kind of estrogen and sodium and stress. Is there anything else that plays into this blood pressure conversation, because there's so much fear around it? Right, I mean changes happen or health changes as we get older. There are some things that are just I call them part and parcel of just getting older. Is blood pressure one of them?

Dr. Alex Verge: 22:16

Yes, and you'll notice I hesitated a little bit there and that's because we do believe that in general people are seeing little optics in their blood pressure in like midlife and up a little bit, although there's often a decrease in those quite later years, interestingly, for a variety of reasons. But if you look at certain populations where maybe lifestyle factor like I'm going to call it the modern and I hate using that term but certain modern lifestyle, modern diet, access to certain things we do see certain populations probably having a more level blood pressure throughout age. So there's a lot of discussion about how it's not an absolute and it's probably our larger lifestyle that is in part contributing to that. But I want to be really clear when I say larger lifestyle that we're often talking about our food supply in general, not personal choice.

Jenn Salib Huber: 23:19

Yes.

Dr. Alex Verge: 23:22

And we talked about versions of this with the cholesterol story right that these changes can happen, and it's not because you did something wrong. And that's not to take away from the changes we can make within our sphere of responsibility or action, but a lot of the discussion, particularly around sodium, relates more to the general food supply and how there's not a lot of appetite from industry to make certain types of changes and that those would actually be the biggest changes, the most meaningful changes that could happen in regards to, say, the sodium content.

Jenn Salib Huber: 24:02

Yeah, that's a great point. So let's try and flip it around to like what are some of the things that we can add in? So we can add in some relaxation, learning, we can add in reduced sodium, we can maybe add in potassium. What are some of the other things, either food or lifestyle, that we can focus on bringing into this conversation?

Fiber and Exercise: Things to Add In to Managing High Blood Pressure in Menopause

Dr. Alex Verge: 24:28

Well, I can't believe it's taken me until this point to say how important exercise is.

Jenn Salib Huber: 24:33

Oh, I thought you were going to say fiber. I thought you were going to tell me something new about fiber.

Dr. Alex Verge: 24:39

Well, fiber, I love fiber. As you know, fiber is everything and, in fact, if I just do a little segue to come back, that you know things that we talked about for the cholesterol story in terms of background eating patterns that are great for heart health, and sometimes, with more specificity to those things, that will include things like Mediterranean diet style patterns of eating and, in particular, although there's a lot of overlap here, there's a dietary pattern called dash, which stands for dietary approaches to stop hypertension, and the guidelines are around the same, right. So, very plant forward, lower sodium, higher potassium, lower saturated fat all the things that are going to also be helpful for generalized heart health can be really specifically helpful for blood pressure. So, yes, there's these sort of general pieces, which includes high fiber, right? So the fiber is there for sure.

Jenn Salib Huber: 25:42

Alex and I are co chief defenders of oatmeal, so yes, oatmeal influencers here.

Dr. Alex Verge: 25:51

But the exercise brings like some pretty unique stuff to the table and that's true for heart health in general. But a lot of that is facilitated through the blood pressure impact of exercise and it's most basic level and that's sometimes you'll hear about that with the weight piece or whatnot, and that that may be a separate piece, but independently of that, the vasodilating so the sort of blood vessel relaxing, quality of regular activity and sort of cardiovascular fitness, if you will has a huge impact on blood pressure, huge. And so the biggest changes of course are going to be in people who may go from a quite sedentary lifestyle to becoming regularly active. You know, like really seeing that big change. But any additional activity we believe is going to lead to some improvements. The bigger the activity change, the bigger the improvements.

Jenn Salib Huber: 26:57

And all movement counts. Right Like that, you know, we don't have to be signing everyone up for CrossFit, right?

Dr. Alex Verge: 27:03

No, no, not at all. And you know, a mix of activity is going to bring different things to the table, right, so I'm encouraging different things. But I will absolutely say and it's in some of my notes, actually my EMR notes for a different scenario is that some is always better than none and walking is just fine.

Jenn Salib Huber: 27:27

Yeah, walking has the largest body of evidence for pretty much every health outcome and the bar keeps getting lower, which is great. Like you know, this 10,000 steps, which we know is just like a made up number, like that number, is much lower than that. You know, I've seen, I think I saw one study that was like 2,600 steps. I saw another one that was like 6,500 that can have like really meaningful impacts on, you know, not just your cardiovascular health but like your overall longevity.

Dr. Alex Verge: 27:57

Absolutely, and what? Where it would add to that, though, is if someone has just recently been told their blood pressure is high and they think well, I am already walking 10,000 steps a day. First is, I think, to know that you are doing your overall health lots of good already. It just so happens that this thing probably has some other pieces perhaps to it, and exercise can still be helpful, but you may need to layer different things on top right. The add in, not the take away, yeah, but if someone is like I, you know that 10,000 steps takes me this amount of time. I don't know that I I'm in a position to add that anymore, or add more time or whatnot. We may talk about different intensity, we just may talk about different strategies altogether.

Jenn Salib Huber: 28:45

So, again, coming down to finding the right fit for, for different people and there's not going to be one thing like very rarely, you know, do you find one thing Right. What about coffee? What about?

No Need to Eliminate all Caffeine Intake

Dr. Alex Verge: 28:59

caffeine. So lots of studies about coffee in general for lots of different conditions that we're concerned about certainly has gone the way. You know we don't worry about that in the same way anymore, but there's always nuances, right. So caffeine at higher amounts is acutely going to increase blood pressure. So if you, if you walked into the doctor's office let alone your white coat hypertension, if you walked into the doctor's office and you've just shot back three espressos, even if your blood pressure typically is not high, it's probably going to be higher than usual in that instance, right. And so there there can be an impact. 

And if you happen to be one of those people who's a huge, huge caffeine person and is starting with coffee and then moves on to energy drinks and so you've got this caffeine load throughout the day, you may which is also the case with tobacco or nicotine. Excuse me to be clear that we see these acute increases in blood pressure, but if you have two cups of coffee and it comes up and then it goes back down and it's down for the rest of the day at its normal baseline, that's a consequence of the caffeine, but you don't have hypertension. If you're having a nicotine hit or a caffeine hit really regularly. You're going to be seeing these increases that are just your new baseline, basically because it's coming up all the time. 

So that's a slightly different answer to your question. But we're not worried about coffee intake. Generally speaking, there is a dose response and there's an acute response which may, may or may not be problematic, but we're we're not worried about it and certainly we have research that in midlife and post-menopausal, that that caffeine intake doesn't increase the risk of a hypertension diagnosis like that, that there's no link there.

Jenn Salib Huber: 30:59

Okay, yeah, so that is gonna be a big take home, folks. You do not have to cut out your morning coffee. You know, because this is I feel like this is another myth that like, really permeates the internet. It's like oh, if you have high blood pressure, you gotta give up your coffee. No, I think it's reasonable to see what the relationship is for you individually, and if you're someone who has six cups of coffee, maybe there's a room for change there. But I have never seen one cup of coffee make a meaningful difference in someone's blood pressure reading.

Dr. Alex Verge: 31:33

No very. Yeah, I would agree with that. But if someone is worried about their blood pressure because it's been flagged as high and the only time they take it is after those three espressos, I would just advocate for trying to measure at other times to see what the truth of the matter is.

Jenn Salib Huber: 31:50

Yeah, yeah, oh, my goodness, this has been really, really helpful. I know it's gonna be another favorite one. Is there anything else that you would like to add to this conversation? I?

The Role of Secondary Hypertension

Dr. Alex Verge: 32:02

would. I have lots to say, but I'll leave it with one last thing, because this is something I feel quite passionate about actually is the idea that although primary hypertension, or essential hypertension, which is when we think it just happens and you know there may be the stress impact and the sodium impact and so on, but that's the bulk of what we talk about there's what we call secondary hypertension, which means that blood pressure increases are coming from some other cause and not stress and too much, too many espressos and that sort of thing, but either a condition or a drug or something else is going on. 

That's fueling that increase and it's a very real increase. You know people are seeing these higher numbers like it's a, it's legitimately hypertension, but the where it comes from is different than what you might expect. And if no one's doing a little bit of digging there, the natural course of the scenario is maybe you try some relaxation stuff, you try some sodium, like watching your sodium, you're exercising a little bit more, it doesn't really change. So then you get put on medication, which I certainly advocate for to control blood pressure, if it's not being controlled otherwise, because it's really important to have your blood pressure in a nice place for your long term.

I want everyone's short and long term health to be well served and that is required. But if even with the addition of the medication in particular it's not going that well, maybe a second medication is recommended. So you have this difficulty controlling that blood pressure. There's a really good chance that there's probably a secondary cause and, like I said, that can be medication and it's not as rare as you might think. So some a really common scenario. 

There might be someone who starts taking Advil three times a day for their arthritis and they never taken it regularly before, and then three months later where they're going to see the doctor about the joint pain and their blood pressure is flagged and then said medications will increase blood pressure. So that's a perfect example of a really common scenario that can occur. There are other conditions that may not even be that rare that can do that. It really is something that if it comes out of the blue, if it comes at a younger age, if you try and make light like meaningful lifestyle changes and or take medication and it doesn't seem particularly well controlled, those would all be flags to consider that maybe there's something else underlying it and the best way to control your blood pressure or get on top or understand. It would be to figure out what that secondary cause is and and horn.

The Impact of Hormone Therapy 

Jenn Salib Huber: 34:57

But and hormone therapy is is one of those potential causes too, right.

Dr. Alex Verge: 35:04

Yes, and thank you for saying that, because that's where we are here. So, despite the fact that hormone therapy has, you know, the whole midlife hormonal change is going to have some impact on the cardiovascular system, like we talked about with the cholesterol, like we just talked about with hypertension. But estrogen is a complicated being, like us all, and hormone therapy can sometimes lead to these. The estrogen particularly can sometimes lead to these increases. So, although the decreasing levels through that peri and postmenopausal time can lead to increases, hormone therapy can as well, and so it's important to keep your eyes open for that potential, for sure.

Jenn Salib Huber: 35:52

Yes, and this actually sometimes comes up because people will go to their health care provider to have the HRT conversation and at that appointment find out that their blood pressure is high and be told that they can't start HRT until they figure out either why it's high or how to get it down. So that's another kind of common scenario that I think surprises people, right, Because they don't expect that to happen. And there's a lot of like I wanted hormones and now I can't have them and my blood pressure is high, Like it's a whole lot of panic all bald into one. But I hope that anybody listening who maybe relates to any of these many pieces that we've touched on takes away that it is not one thing, it is not your fault and that it requires, you know, maybe some investigations and digging. But there really are a lot of things that you can do, whether that's foods that you add in, movements that you add in, relaxation that you add in, you know, educating yourself around, like those dietary kind of connections with sodium and potassium. There's so much that you can do but that ultimately, the most important outcome is that your blood pressure comes down by whatever means right, and so that's kind of, I think the take home that I always tell people is don't you know? If a healthcare provider has recommended medication and you really feel like you have done everything within your means to do, that's fine, Like there is no shame in that. That is going to have a better outcome than not managing the blood pressure.

Dr. Alex Verge: 37:25

Yes, that is a great summary, because I don't. That's a conversation I have. A lot about people who are feeling defeated or to blame for ending up on medication, and really what I'll always say and this is true with cholesterol as well is we just want those numbers, we just want better numbers, and we have lots of strategies to work towards that, and they're all in my mind. We just use the tools we have and sometimes some tools don't work so we use other tools. They're just all tools.

Jenn Salib Huber: 37:59

And just to kind of bring in my diet culture conversations. You know, the thing about diet, wellness, culture with health conditions in particular is that I think we often have been led to believe, falsely, that everything can be controlled or managed or prevented with diet and exercise. But I can't. That's just how it is. I have patients who are in their 30s who are objectively healthy by all means and they are on medication for blood pressure because they have a strong family history and their high blood pressure showed up before they turned 30. 

That's not their fault, it's nobody's fault ever. But I just mean that like we have to recognize that it is so multifactorial and that all cause mortality decreases. If we keep your blood pressure down, like that's the thing, at the end of the day I feel like it actually has more benefit than almost anything else. But yet people are so I think I don't want to say hung up, because that's the wrong word but they get so focused on not taking medication for it when the worry around the blood pressure and is it going to come down Am I doing the right thing Really just kind of evaporates almost when it's managed through many different means. That can and sometimes needs to include medication.

Dr. Alex Verge: 39:18

Yeah, I couldn't have said it better myself.

Jenn Salib Huber: 39:22

Another great conversation with you. Thank you so much for bringing your time, your wisdom, you are. You are a joy to speak to, and I know that everyone loves to hear from you. So I don't know if you have a different answer, but what? Any ideas on the missing ingredient in midlife this time around?

Dr. Alex Verge: 39:39

Oh no, I was not prepared again, I'm going to just go a little bit personal. I think we get caught up with all of those things we're juggling and sometimes the missing ingredient is finding a bit of fun. It's just a bit of insight into my life right now that I'm trying to recognize that and get a little bit more back. But I think it's really important to recognize if it's missing and to find it.

Jenn Salib Huber: 40:07

Yes, I 100% agree. Thank you so much, and we will have all the links to you and your things in the show notes and people can also follow you on Instagram at Dr Alex Verge Andy. Did I get that right? Yes, alex Verge Andy. Alex Verge Andy. There we go, all right. Well, have a great day and thanks everyone for listening. Thanks, jen, bye everyone. Thanks for tuning in to this week's episode of the Midlife Feast For more non-diet, health, hormone and general midlife support. Click the link in the show notes to learn how you can work and learn from me, and if you enjoyed this episode and found it helpful, please consider leaving a review or subscribing, because it helps other women just like you find us and feel supported in midlife.