Share The Pressure - Understanding Blood Pressure



This on-demand teaching session provides important knowledge of high blood pressure (BP) and how it disproportionately affects people who are Black African or African-Caribbean. Participants will gain insights from session facilitators Michaela and David, who have worked together for many years to lead community initiatives and training. Through this session, medical professionals will learn the basics of BP and how it can influence cardiovascular disease, as well as understand strategies to increase health literacy. An important part of this project is the live evaluation process, so all participants will be encouraged to provide feedback. Join us now to be part of a project that aims to reduce BP among the African and Caribbean communities.
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Learning objectives

Learning objectives: 1. Understand which populations are more likely to be affected by high blood pressure 2. Learn how COVID-19 has increased risks associated with high blood pressure 3. Acquire knowledge of how to use the shared decision-making tool to address high blood pressure monitoring 4. Gain an understanding of how to simplify complex medical principles for different patient populations 5. Identify ways in which healthcare professionals can encourage patient engagement with healthcare initiatives such as Share The Pressure.
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

Swelling round and round. Yeah. And I never quite know from the swell to the go live bit when we're actually live, but we're definitely read now, David. So we are definitely live. Welcome everybody this morning to another of our sessions. This one is around understanding BP. It's part of the share the pressure project, which I'm going to tell you about a little bit more. Um This is David's first time using medal. So I'm just gonna walk him through it briefly and the same for you guys who are watching live at the moment. Um So for everyone watching live, you've just got the comfort of sitting here of watching and listening to myself and David, you, uh this style that we do on these webinars at the moment means that you don't get to put your camera, you don't get to put your audio on. So you can really stay quite nice and relaxed. But you do get to use that chat function. So please do you use that chat function that's there? I'm just going to pop a high in it and let us know where you're from, what your role is and really what you want to get out of today's session. I've got a couple of slides that I'm going to share and I just remembered I needed to upload them in advance, but whilst I'm uploading them, which will take a few seconds. Now, I just want to tell you a little bit more about some of the upcoming sessions that we have. Well, actually, more for the people who were going to be joining us on demand. Actually. So David, the way we're winning this now is it's live and people can see that alive and it gets recorded and then people will have the opportunity to watch it another time. Now, when people do watch it on demand, they will not be able to see the chat in the chat box. So if we ever do get a question, then we have to read it out. Otherwise it will look a bit weird if we've got some chat and we've already got some people saying how some, some, some hellos in the chat. We've got Balbi a who's a practice nurse and we've got Laura who is a healthcare assistant. Uh ball beers from Greenwich. Fantastic, Greenwich because that's where we've got. And Burton on Trent is Laura. So, and we're here and we're ready to start now. So, um this is a project and um we've got more, Tanya's A HCA from South End. So lovely to have lots of people here with us today. Mynatal care. Not or you're gonna learn a little bit more about David and myself in a vein mint. But for now, I'm just going to let you know a little bit about our project or initiative actually. So it's called Share The Pressure. And it's a collaboration between a variety of organizations, the race equality, Foundation, smart Health Solutions, which is where David and I are from younger lives and BP UK. And the whole of this initiative wouldn't be around um if it was the bed Tetris for nursing, who uh we were successful in winning a grant for this one. And this initiative was really about exploring and trying to address high BP amongst people who are Black African and Caribbean using what we call a shared decision making tool. And you'll learn more about that on some of the other sessions. That's our heart age session that you'll be able to look at. But for this one, we're looking at the um at another little bit. So we're doing the BP too, training side and these are the trainers. So there's myself and Joe and David and we deliver all of the training, Dave. I'm going to get you to say a moment who you are once our next life comes up, but he's there. David and I have worked together for years on different projects and I did say David come and do this and join in and you got a wing it and I'm going to ask you some questions that you might not be expecting because I haven't thought them up yet. That's my freestyle way and, and David gets to do this same as well. So this section is all of that really going back to the very foundations of understanding what BP is. That's what we're aiming for. So as I said, my name is Michaela and the founder at Loma Nurses and I'm also the Directorate, smart Health Solutions. But David, I want you to say a little bit about you and why you're involved in this project and why it's important to you and why are you excited to be here? Yeah, of course. First of all, good morning, everybody. And thank you for taking time out of your busy mornings to listen to Mikayla. And I talk about a really important topic which is BP and understanding BP. So who am I? My name is David Okoro, obviously. Um I live in London originally from Liverpool, which is the world's greatest city as we all know. And um I am a associate for smart health Solutions working on the share the pressure program. Outside of that. I am a leadership coach. I'm also an education and training consultant and the founder of um of leadership academies in London, South London, and also Northwest London, which are uh West side Young Leaders Academy and Lewisham Young Leaders Academy. And it's a real pleasure to be here. Today. Um As I said before, to talk about a very, very important topic. Um most of us understand the issues around BP. But I think that we have a lot of work to do in our communities, especially in the African and Caribbean communities. And that's what our role will be and my role in particular in terms of raising awareness and encouraging more people to get tested and take Axion. Brilliant. Thank you, David. Now, if you see some panicky text, ignore them because my internet crashed briefly. And so I said, oh my gosh, carry on without me. But then I managed to get back and you were still going so absolutely perfect. So hopefully nobody noticed it. And whilst, whilst it was there, we've got quite a few more people who said hello. So I've got so many she had a practice nurse in or there practice nursing so that we've got Maziya who's a nurse prescriber in chills field. Now, one thing I will say our target um for this project that we're initiative is Southeast London. But we've made this training available to everybody. So you can all come and learn a bit more. But occasionally we might make reference to things in Southeast London. So it's brilliant. It's even more brilliant to have people from South East London here. So I'm gonna jump right in with the end now, um particularly for people who are alive and for people who are watching on demand. Don't forget to do your evaluations. They are really important to us. It's also how you get your slides and your certificates. But this allows us to collect everything you say. So say whether it's good or bad, let us know because that's how we improve. But of course, we have to go back to our funders to be able to demonstrate what we've done. And of course, we want this project to roll on. So the more that you can give us feedback, the better we can make it. But let's jump straight in now with a bit of BP, with a bit of BP. And this is what we're going to look at. Oh, that's the medal. So why is it important? Well, it's so important in this initiative in really, in this community because we know that and David, did you just say this when I was offline or I briefly touched on it, briefly, touched on it? Okay. So I'll come in a little bit more. But you know, we know more than ever now that when it comes to cardiovascular disease, people's ethnicity, how can greatly influence it and people who are black African or African Caribbean. And then then, you know, hybrid pressure will disproportionately affect them with much higher incidences of stroke worsening kidneys that renal failure. And actually, when people do get finally diagnosed, more likely to have high BP because of potential delays in in coming forwards and that's not blaming people and coming forward often. It's the system that it's not really open for people coming forwards. Now, we do know then almost whatever ethnicity men, David, you are responsible for all men. Now, you're a bit plants at coming forward for screening programs. Are you going to answer for all, you're going to answer for all men men are terrible when it comes to health generally and you know, particularly this, this issue as well. Yeah. So you're right. Can I just, I almost feel like I want to run to say in our bathroom. Now, this is where I go off. Peace David. And I never know. I'm going to say things so, but in our bathroom is that you're not old enough yet for that poop scrape thing. You know, the bowel screening one week, had it since about last summer for my husband sitting in there and I do get cross with him because I say, you know, it's up to you to decide if you want to or not. I have been well insured, but the NHS spends more money on trying to get him to come forward. So I said, well, come forwards and anyway, that's going off pieced, but there you go. And we all know that Neil needs to feel on a stick. Now, the other bit coming back to here is, um, COVID and there's no escaping what's going on with COVID. It has made things so much worse and it wasn't really good in the first place. So, um so this is why I'm really excited with this project and this project is we're going to go right back to basics. So, David, you might hear some things now that you think. How do you, how do you teach healthcare professionals in this way? Well, for me, because I'm gonna use some weird ways of get the same thing says I'm a great believer in taking things that are complicated and making them as simple as possible, maybe turning them into little stories or little phrases. And I find from me that sticks in my brain and if it sticks in my brain, I can remember it and if I can remember, I can tell it. And therefore I also tell it in a way that there's no use to need to use complicated long language. You know, it's about breaking down those barriers. And you know, we've really got to think of health, health literacy who were engaging with. So I often think that the more easy to understand we can make something, the better it is for everything. And that's sounds good to me. That sounds good to me. Yes, brilliant. So brace yourself, strap yourself in and away. We go and same for you guys, everybody that's there on the call now and people who are joining us, some of you that have maybe done this before, you might have seen some of the bits I'm going to come up with. But here we go. But before I jump into the, you know, the novelty stuff and let's just remind ourselves the BP is a really big issue. And certainly if we just think of the, if England one in four people have high BP, one in four and that prevalence is going to be even higher in people who are black because we know it's even worse. They're um, we know that in the England alone, it's the third British risk factor for death. If we think about the world, it's the first biggest risk factor. And for people who are in the more deprived areas, they are 30% more likely to have high BP than those in the richer areas. And, you know, we've already mentioned the issue around ethnic ethnicity, but also at least half of all the heart attacks that are out there as, as kidney disease and heart failures all happen as a result of high BP. So it's really important and that's why it's really good that you guys are here now, if I could just add to that as well, Michaela, I was astonished to read that half of the adults with BP have not been diagnosed. Oh, yeah. So, so it's getting a little better now. But, you know, we call it the rule of haves and I remember the rule of huh passed many years ago. So of all the people we know with hypertension, only half of being diagnosed, of all those that are diagnosed, only half are treated of all those who were treated. Only half get to target. So it's got a little bit better, you know, we're not quite the rule of half, but I remember that rule of half, 20 years ago, the thing we've got is there's more and more people with hypertension in there we've ever had. So we've got so many more to find as well as fast as we keep finding it more. Keep happening. So you never stop looking for hypertension, you know, never stopped looking for it. So, um, let's think about them. What is our BP? Why do we need it? And what does it do? So this is the circulatory system and circulatory system is how blood moves around the body and it moves around the body because it carries lots of goodies. It carries oxygen nutrients. You know, it's one of the transportation systems that we have and, and those, you know, when our heart beats, it pushes blood out into the arterial system. So, David, if you ever watch a horror movie, I don't know if you watch horror movies and it squirts up on the ceiling. Yes, that it's an artery, okay. And arteries under really high BP, a vein, it seeps. So if you've had your blood taken to take it from a vein, yeah, you don't take it from an artery arteries, food, they're the ones that hit the ceilings and that circulatory system is there. And lots of stuff is designed around that circulatory system to keep that going, to keep it open to keep the blood moving around. So, what is BP, the actual nitty gritty? What is BP? And I'm gonna ask you, were you, did you, when you were first, you know, when people started first talking to you about BP, did they explain what it is? No, not really. I was, I was given a diagnosis. I was told I had high BP but it wasn't really explained to me what was causing the high BP. So I had to do my own research. Really. I didn't get that information from a doctor. It was all very, uh, you know, let's have a test yet. You've got high BP. Um, here's a prescription for your medication. Yeah. See, you see you in six months. Wow. And that's unique and that's what happens because, you know, everywhere is busy and it's about to get through. Let's get that, of course, but it doesn't make it right. Doesn't, it doesn't make it right. And so, um, so I'm going to talk to us now again, right? That just what is BP and why do we need it? So you remember those archers? I mentioned the one that squirts the blood up. Well, they need to stay open okay because they're quite muscular and we need to keep them open, we keep them open to let the blood flow around. And so that is to do with our BP are BP keeps them open. We didn't have BP, their clothes, you know, and we'll just be flat on the floor. Now, this BP. So when you have your BP taken and if you have a cuff on your arm, that's feeling the pressure that's exerted from the inside by the blood, from the inside of the artery wall on the artery wall. That's what we're measuring. And that's controlled by two main things. One, something called cardiac output. So when your heart beats, boom and art is sitting here beating away. So each time it beats, it's pushing blood out into that circulatory system, every beat, it's filling it up with another, uh you know, the chamber full of blood, of course, at the same time it's, it's coming back in. Okay. It's coming back into, it's pushing it out and it's coming back in. So that's one way of controlling BP. The other way is down on our peripheries. So imagine your artery goes bigger. It goes smaller, smaller, smaller, smaller, smaller, smaller that is down to your arterials here. Okay. They're not just in your fingers. It's just I want to show them being smaller. Okay. You know, that's not just that. Um And they can do this, they can expand and contract and they either create more volume or less volume in that circulatory system. Yeah, we got that. Yeah. Yeah. Lovely. Okay. Now, when I was a cardiac rehab nurse, many years ago I used to talk about BP about our arteries like these rigid hose pipes because there wasn't any of youse little expandable, contractible hose pipes out there. And so now I want you to think about our arterial system like this thing that can expand and contract. That's what it's doing. More volume, less volume, that's there for a reason. We need that system involved. Okay. So, and when we take a BP, we get two numbers. So the top number is when the heart pumps and pushes blood out into the circulatory system. So out into those hose pipes that's called the systolic, that's the top number. And then we have the bottom number and the bottom number is when it relaxes and feels okay there, the top number, the top and bottom number and there is a dream BP, one top over 70 an absolute dream BP. Okay. Not many people have got it, but that's our dream BP. Now, there is something else that we should think about when we're looking at BP and this is called the afterload. And I'm guessing they never mentioned afterload to you. Absolutely not. So the afterload is, and it's not something that we discussed a lot really. So the afterload is, imagine, imagine that heart muscle, so your heart's and muscle, it's got to work to overcome the pressure in the system. There's already a pressure inside those, inside those hose pipes inside those arteries. So when that heart contracts, it's got to overcome the pressure already in there to get that out. Yet, it's going to be higher than the BP in the system. And we know that also has an effect going down. So remember this one because I will come back to the afterload as we go through now, we weren't designed to live this long. Okay. We really weren't designed for most of the time, for most of the time. But our bodies have been around and we've been around for, you know, hundreds of thousands of years. Then we lived for about 20 to 30 years and, and, and we have system, I mean, we used to die in those days, prom infections, blood loss, starvation, you know, we, we, we didn't survive, we didn't thrive and survive in the same way. Now, back in a couple of 100 years ago, we've got really good at vaccinations, immunizations, antibiotics, modern medicine, blood, all of those things. And that's what making us live longer. We go back to all those years ago. There were systems in our bodies that were designed to look after us all those years ago. So, and those systems that were designed to look after us are now working against us and we're having our bodies alive a lot longer. Right. In an environment that it wasn't supposed to be. You know, we weren't designed to have delivery on our phones. Well, I shouldn't say names, should I? Well, I say them all. Uber eats on the whole lot than it doesn't matter. But, you know, we were designed to go out and hunt and gather and worked really hard for a small bit of food. We didn't go, darling. No. So, um, I've said, I've said loads of them now, so none of them can be across. It's about us having too many of them. Jesus is going out and it's been recorded. I'm so sorry, everybody. Yeah, we're just not designed to expend the energy that we should be doing to gather the food stuff that we have. Okay. Have that system, have that, that, that systems there. So how is our BP maintained? What is this system we have? Well, it's a really complicated system. So I make it easy, easy. And the way I make it easy, easy is like I'm thinking about dinosaurs. It was from that long ago. And dinner ladies. Okay. And there's actually a book called Dance or Dinner Ladies, Joe found it and sent it to me. So I like to think I was unique but clearly and I must have copied it. And so when I was growing up and David and I are both from the Northwest, so do you remember dinner ladies when you were growing up? Oh, yes. They were more like a playground monitor. What did they, do you remember what they did, David? And I was going to ask him anything like this. Well, our dinner ladies used to serve as food at lunch time. Yeah. And then when we were playing, playing in the playground, they would be watching us when we were playing in the playground as well. So they had to purpose or served two purposes. Yeah. Well, these ladies are in the playground. They're those ones. And you said exactly they were observing you, they were keeping an eye out and that's, and that's what we've got in our bodies. We've got dinner ladies that hang around in our bodies. Now, I'm guessing your dinner ladies probably went where there was more likely to be a bit of trouble, more likely to be a lot of football, more likely to see things. They didn't go to the quiet bit of the place. Exactly when there, where the boys were playing football or something. You know, that's what our dinner ladies in our bodies do is we have things in our bodies that hang around looking for trouble. Ok. That's what we have. And they are called bala receptors. Okay. This is another one. Now, I used to be dead, scared about receptors. I never understood them for ages till out to teach about them. I said at all. So for anybody from Southeast London, you'll know Debbie Brown. She said, Michaela come and talk about high protection and just debunked by receptor. Everyone's scared of them. So I thought, oh, so I turn them into dinner ladies. They're no longer scary. So right there you go. You got piglets when you're lying flat. Okay. When you're lying flat, gravity does nothing to your body. Really? Not a lot to your body. You go upright, gravity pulls the blood down. So this is where the dinner ladies kick in and they push the blood back up to our brain. They make things happen in our body. So our dinner ladies would have blown a whistle and the teachers would have come running. That's what the dinner ladies in our bodies do. The barrow receptors, they blow chemical whistles and make things happen. So yes, the barrow sectors are a chemical know they are. Wait, now, wait, wait, wait, I'm jumping the gun. Just a little observer. Imagine they're just a little observer. Okay. Just a little observer. Okay. Just imagine them. They're just a little cluster of something hanging around. Yeah. Now this is because we need to keep, you know, we need to look for lots of things. But now this is a big test. A but what is the most important organ in your body? Um, your brain isn't it? Exactly. So if there was going to be a system that had to look after something, what would be the most important thing to look after the vessels that pump blood to the brain. Exactly. Well, the brain itself this, of course, do. Yeah. So you can live with that. A leg. You can live without an arm. You can have a heart transplant. You can cut your liver in half, but you don't get your head cut off and survive. You know, we don't have a brain. So there's a lot of things in our body that's about protecting this brain and we keep it in a hard shelf. You know, it's not dangling off the end of our elbow's, it's in a hard shell for a reason. And so our barrel receptors are there to really keep our brain profused. Okay. Do have some people who have different health conditions that, that means that, that the BP goes low when they stand up and that's all the, all the, all the static hypotension, the blood comes down. That's pots postural tachycardia syndrome. The blood comes down doesn't come back up in the same way, but we're going to stay with it coming up right here. You are out one day playing with your favorite dinosaur. Okay? You're out one day. I want you to think about your favorite dinosaur cause it was that long ago. Okay. Playing with your favorite dinosaur and it's got you by the leg. He's got you by the leg and he's bit your leg off. Okay. He's bit your leg off. And David doesn't seen these. So it's not complicated, is it, it's bit your leg off and uh, and you're losing a load of blood. Okay. Now, when you lose blood, your BP goes down, you haven't got that volume. You just don't have that volume. So it goes down. This is where the dinner ladies kicking the dinner ladies are hanging around parts of your body that notice that BP, they notice that blood flow and that BP and that's things like in your heart, in your top of your kidneys and in your neck. And that's what they do is they then blow a chemical, blow a whistle. Okay. We're just going to keep it easy. They blow a whistle a bit like the dinner ladies in uh in the classroom, in the, in the schoolyard. And what they do is they tickle. You can tell I don't use complicated stuff. They tickle your autonomic nervous system. Now, your autonomic nervous system is the things that uh we do without having to think about doing it. So David, I'm going to get you to do some things. David, can you scratch your nose? Please write that is not to do with the autonomic nervous system. David, could you make your heart beat faster? Please not sitting down know, could you dilate your people's, please? Could you maybe produce a bit of adrenaline, please? You see that's your autonomic service system. Does that sort of stuff? Okay what your body does without you. There are different systems that play and that's what these barrow receptors do. They tickle elements of your autonomic nervous system. So, one bit is, and we're not doing in any particular order, but they'll talk, they'll talk to the heart and they'll say to the heart. Right. Come on, it's not that this fella's that is led bitten off by a dinosaur. We've got to do something about it and what it does is it says, right, let's get more blood around, let's get more blood around. It's called about increasing cardiac output. Cardiac output is a formula and it says we either push more blood out with each beat or we make the heart beat faster. Right? Yeah. Now, when people are having surgery, that's what we look for for sign of bleeding. We look for dropping BP and we look for an increase in heart rate. You know, we have an operation. That's what we look for. Okay. That's a sign of bleeding. It's a sign of blood leaving the system. That's one thing it does. Another thing it does is it tickles the adrenal medulla. Now give me one second. I just have to do this. Uh, you know, I got my timing one this morning, um, 15 minutes late. I'm just letting my 10 o'clock know it's quarter past me. I thought it was 10 o'clock this morning. Nine o'clock this morning, everybody. Okay. So then it goes to the next thing to adrenal medulla. Now your adrenal medulla. So, are sitting on top of your kidney, your kidneys, David, you know where your kidneys are? Yes. Ok. So the easy way to explain to people get things like that. Do this okay. Do that make them into fifth. Everybody can do that. Took them around the back of your body and sort of just where you were under your rib cage, that kidneys are okay. It's always easy. That's where your kidneys that easy. Right? So they tickle the kidneys. Now, the kidneys produce a chemical, they do lots of different things, but one of the chemicals they produced is something called aldosterone. And aldosterone helps your body do this with salt and water. And you know, if you've ever read something really salty kind of makes you want to drink more. That's right. That's what happens inside your body. Your body will keep salt in and we'll keep more fluid in to try and balance it out. Okay. Yeah, cool. Now this is what's going to get, you know, this is where you're going to really have some fun. Hopefully. So this is ignore this bit for now. This is the eldest ear. Oh, okay. There's your adrenal. Damn. Sitting on the top of your kidneys. Looked up here and they produce, they tickle. Remember the dinner ladies? Chemical whistle? They, this allergist e around the salt and water and all that helps to increase our BP. Yep. Helps to increase all the pressure. Right. They also work directly on the kidneys as well. Now, the kidneys, they're over here, these fellas here and they are involved because they produce a chemical called Renan. Now, you don't have to remember what Renan is, but they produce a chemical called Renan. So, your liver, okay. You've got a liver. We've all got a liver and our liver, it's like a factory doing lots of different things and one of the things it does, it produces something called angiotensinogen. And angiotensinogen is quite a, well, I think of it like a Wimpy Disney princess. You know, Disney Princesses nowadays are really kick ass the old days. Snow White. Remember her? She was just passive sitting there waiting for prints. Charming to turn up. She didn't do a lot, did she? So, to me and your 10 Synergen it's snow white. She's a bit wimpy. Okay. They're a bit wimpy that one. And it's just so we've all got angiotensinogen hanging around in our bodies waiting for who to turn up. Do you know who turns up for snow white testing? You're now on your Disney Princess, charming, charming, of course, charming print shops. So, Renan is Princess Charming. Okay, when it is Prince's charming. So he only turns up occasionally right there right there all the time. Prince's charming turns up. So together and your 10 Synergen and Renan print's charming and snow white. They are full of potential. Okay. So they make a chemical called angiotensin one. It's full of potential, doesn't do anything but it's full of. Now, the reason why I'm telling you this, so we can understand how the medication works in a minute. Okay. So, angiotensin one full of potential. And it's only when it gets turned into angiotensin to buy something called an ace and angiotensin converting enzyme, then it turns into angiotensin two, which is full of Axion. It does something. So it goes from provincial doesn't do anything to Axion. And that Axion makes our blood vessels constrict up, making the volume in our system, in our circulatory system less pushing our BP. Remember when I talked about those arterials can expand and contract. Yeah. So this is making them contract up. So does that contracts up? It's gonna put your BP because it's Oh Yeah. Yeah. So that all leads to put your BP up that also. But, and your attention to full of Axion makes those adrenal glands. Well, a bit more producing the eldest ear. Oh Put in your BP up. It's all going on. Okay. It's all going on there, right. And then of course, there's peripheral. So down in the, down in the ends, that's what your fingertips. That's the small vessels vasoconstriction there. Now, is this new to you, David? It actually is, is it making sense? It does. Yeah, it does. So, now what we're going to do is overload the medications. We do have a session coming up about which, you know, how we're not different ones. That's, that's coming up later. But I'm just going to now we under no, this bit. How do the different medications work? Well, even before that, I wanna, I must change this one. It comes blurry because we have to PDF people. I'm so sorry. But have you ever wondered about the implications of high BP date? Yes, I have. And it was a question I wanted to ask you really, you know, what, what are those implications of people who have or what are the applications for people who have high BP? Yeah. So now I don't want to scare you, David. Okay. I don't want to scare you but, and I know you well, can I say I know your BP is fine uh now, but um, but if it hadn't stayed, if it hadn't been fine, then the higher BP and the longer the BP was raised for, uh the more likely it is to have these complications and I'm gonna start at the top. Okay. We're going to start with the eyes and everybody realizes when people come for a hypertension checkup. We always should look in their eyes and every year look in their eyes. And what you're doing is looking at the back and there's these really little tiny vessels and what we're looking for is these little cotton wool spots. Okay. It's called hypertensive retinopathy and it's where those little blood vessels have been damaged. Now, some people only get this diagnose when they go to the opticians, they go to the opticians who look in there and they say we've got high BP and they don't even know. So opticians is a really good place and we don't want, I mean, ideally you don't, that you should be having your BP found sooner. Your hypertension found sooner than this damage because this is called target organ damage. That's what we're looking for here. Target organ damage. So looking in your eyes, now we're going to come around and then we'll go to the middle. Now this is your heart and when your heart has to pump blood out, doesn't it to overcome what pushes blood around the body? But it also has to overcome that afterload. Remember the afterload, the amount of course, the harder that heart has to work. Not like when you're exercising, that's a good way to exercise. That's a good way to make our heart work harder. But when it has to work harder to push blood into the system, then that left ventricle, which is a muscle here becomes thick, becomes flabby. It's not good for it. And we develop something called left ventricular hypertrophy. And that's why people have an E C G regularly because we're keeping an eye with, with hypertension, we'll keep an eye on what is that left ventricle doing ventricular hypertrophy on the. Now, we now have people have got left ventricular hypertrophy and hypertension. It's much worse. More your kidneys. Your kidneys are precious little creature's. And imagine you. So you got two of those kidneys. Each one of them has got about 750,000 nephrons inside. Now, we won't talk about net phones today. But imagine they're gonna be tiny, aren't they? You've got high BP, it's going to be doing inside those nephrons, what it's doing up your eyes, it's going to be damaging them. So it's part of hypertension management. We keep an eye on those kidneys and we get the BP down and we know for people who are black then that chronic kidney disease and that advanced stage of kidney disease is even worse, even worse for lots of people. So that's why we have very aggressive targets when it comes to CKD. Um, now we have problems with strokes, we have problems with heart attacks. We have problems with aneurysms where there's all sorts we can go on and have transient ischemic attacks and dina, there's lots of conditions we can have as a result of hypertension and then untreated hypertension. So now we're going to spend the last five minutes looking at very quickly how the medications were and what can lifestyle do. And I know you might have a question about lifestyle. Sorry, I'm, we've been through these, I'm so used to doing it. But now for people in Southeast London, you have all got a set of guidelines. Okay. But each for your different area and if you want to know where they are, you can come and get them from our website from the share the pressure from where you registered for this. They're also part of Southeast London Clinical Effectiveness Group. So Kessel and um so here we go. Now this is all based on nice guidelines and the nice guidelines say you've got your hypertensive. Okay. Let's imagine you've got to be hypertensive to get in here. If I don't know why this is Shane blurry. We have two PDF it David and then it makes it go blurry when I get pain, isn't it? I know I'm going to speak to Medal and say, why does this happen? Because I don't know how to make it any better. So I'm so sorry, everybody, but I will put the link in the chat later on where you can directly go and get these guidelines from. So you've got hypertension, you've either got type two diabetes and if you've got type two diabetes, you follow this route. If you haven't got type two diabetes, you follow this week. So what we're going to do, um is we're going to go through down this route because you've got type two diabetes or you're over 55 or you're under 55. And if you are not Black African or Africa rib Ian, then you follow this route. So for everybody else, we're going to be talking about in this project in this initiative for people, a Black African or African Caribbean, you follow this route and we start with a medication called a calcium channel blocker. That's like an amolodipine. So let's have a look at how that medication works. Oh, we're going to go back to this phone. So we're going to go back to this fellow and it works down here. So remember Snow White Print's charming potential Axion. We allow the whole of that pathway to happen and it gets to this where that Axion would normally work on the arteries to make the arteries constrict up instead of constricting up, they just relax a little bit, creating more volume, they relax a little bit there and they do that by poops. They do that by and the movement of calcium in your, in your, in your cells. So it does it in the heart. So to, to make your heart beat when we're back to this autonomic nervous function to make your heart beat, there needs to be electrical impulse and that happens by the movement of calcium in every Hartsell. So it makes the heart beat but it's less strong. So which is, which may sound like it's not a good thing, but it is because the, the harder our heart beats, the more oxygen that heart muscle needs. We can just have a little bit more relaxed when it's beating, it's still pushing the same amount of blood out is it needs less blood and it needs less oxygen. So it takes some demand out of the system. Yeah. So you still get the same output, but with less effort, it also does it in our vessels. So for our arterials to expand and contract each cell with the calcium instead of its magic and chatting through the quite hard. It just does it a bit more relaxed. So it creates so it just takes the pressure off the system. Yeah, which all allows more volume and allows the BP to go down. The next thing we might then do so most people's BP doesn't get managed with one tablet. I don't know if you knew that most people need at least two, if not more. Oh, really? Yeah. Yeah, absolutely. So the next thing we would add in is traditionally we do an ace or an ARB and I'm going to tell you what that is or Thiazide like diuretic. But down here it says what we should be doing is going for something called an ARB and angiotensin receptor block up. And that's what called the start. And like the Candesartan is the Losartan. Where do they work? Well, let's go back to this process. Snow white print's charming potential gets turned into Axion and then, and your sense and your attention receptor blocker blocks the Axion from happening, stops that Axion from going into the vessels, making that contraction happen, it reduces it down. So while vessels don't contract up as much, creating a bit more given the system. Yeah. Now sometimes we do give an ace inhibitor as well. So the ace inhibitor works in a different place. What that does? Snow white prints charming angiotensin. One potential. It stops the potential, turning into actions we blocked. So this is why we need multiple tablets because it blocks different parts of the system. It's not that one tablet fails. It's just we try a bit, we try a bit, we try a bit and we add them all together. Now, that is really interesting because I was only given one, one tablet. But that yes. So you only need to have one tablet if it works if you get my point. So you don't keep giving all the tablets and then the blood pressures in your boots, you have to keep an eye on the tablet, the BP, the tablet, the BP. So it's a, it's the way we add them in. So if you, if your BP wasn't controlled, then we would add it in your right. Another one, you know. Ok. That's what makes sense. Yeah. And often the messaging is oh, that, you know, that one's failed. Well, actually add another one and then if we haven't got that messaging right? People can really feel like a failure or they feel like they gave me the wrong tablet in the first place. And it's not, it's just blocking different systems. Then the last one I'm going to talk about is something called a fireside like diuretic. There are more tablets that can be used, but that's the only one I'm going to mention here and that just works here. It makes, it's called a water tablet. And your, we out more fluid, your we out more fluid. So there are the three main types of tablets that we use when we're coming to do BP and those people probably need three of them, you know, and it just depends who you are. Depends where we start. Now, Joe's going to do a session on hypertension and medication in a different way. She's going to like not start at the beginning like I did and pick it up here where she'll start to talk about, you know, dose titrations, changes, monitoring all of that. Oh, before I get to that one, David, was there anything you wanted to ask me? Yeah, I wanted to try and squeeze in a couple of questions before we finished. I wanted to ask a question on behalf of fighter, you know, you know, we've talked about the Sorry Fizer. Is that nurse prescriber at Chelsea field surgery? Thank you pfizer's for your question. And pfizer's States or asks, are we also over diagnosing? So, are we over diagnosing BP? What's, what's your opinion? On that, please. I was and I would suggest that in some ways we might be, but probably we're not. Um, and the reason why we worry about over diagnosing is because we often, we've had people who were diagnosed maybe in the clinic setting, but they might have this white coat hypertension and that white coat hypertension means that yeah, when you're in the clinic, it's higher than when you're at home. So the ones we might worry about a little bit, but that we're missing so many people with hypertension that we're, you know, we might be over diagnosing in a couple of people, but we're certainly under diagnosing across the whole of the population, across the whole of the population because that's, that's, yeah. Okay. I definitely understand. Now another question, how do you know if you have high BP? How do you know you don't, you don't, most people don't, it's called, you know, it's called The Silent Killer for a reason. That's right. Yeah. And now sometimes, and there is a big, there's a lot of myths around there about you have to have all of these symptoms. You know, you got to have headaches, you've got to have this, uh, most people don't have any symptoms with biting sometimes if your BP is like, really, you know, you're just minutes away from a stroke. It's that high, you might have symptoms. But if you wait for symptoms, you're gonna, your BP is going to be so, yeah, it's gonna be so fine. I'm so high. It's bad. So we certainly don't wait for symptoms. Um, so the only re weigh, you know, if you've got high BP to get it checked is to get it checked. Final question from me this week is how can you check your BP at home? Oh, great question. And that's part of where we are with this budget because we're working with BP UK on this. And they've got some great guidance. I'm checking your BP at home. And if you, if anybody wants to look at that, just go back to our, where you, where you watch this from. We've got links for patient's, we've got links from number of staff to say for healthcare professionals to all of these organizations. Now checking at home is brilliant, but the most important thing to know is have you got the right kick and are you doing it properly? So there are really skills involved in doing that and maybe David, we're going to put a session on about that because that would be useful. Yeah. Yeah, let's do that. Let's do a section on that in that way. Um So I've just got a few more slides. Now, pfizer's also said, do you raise the tablet to the max dose? But now, rather than answering that pfizer because uh my colleague, Joe is gonna do medications and hypertension. So I'm uh whilst I know the answer, I'm just gonna suggest that you go join that session. Um Because, because that's her space and she's going to be doing that now, we are running them live, but you can also catch these upon catch up. So I'm gonna tell you a little bit more about our projects about the bits. So we do have what we call our community of practice and that is in our website and I'll pop that in, in a moment because I'm going to let David do a last little quick roundup for me. Um And in there, we've got some webinars, we've, we got some podcasts that we're going to keep adding to. And of course, we've got the resources and this is where I spoke about that the links for the hypertension guidelines for the particular areas. Now we do also, I'm just going to say this final bit about, you know, before I get you to say something, David about how I am that, that this is only one part of our hypertension germy, you know, that basic understanding at the beginning is only one part of it and that it's about seeing all the other elements together that's there. Um So share the pressure, the website is around pop that up in the chat as well. I didn't like to say it, but when it was there last night and there was one of those, I think they were doing a bit of maintenance on it. So it's up and working now, which is fantastic. So, David, if, if that's all right with you, well, I go and get the links to everything. Can I get you to just summarize your experience today? And you didn't know I was going to ask you to do this? But what was it like hearing what I had, what may be how I said things in a way of. No, that's fine. And first of all, thank you to you for your explanation as to what BP is. Um as I mentioned before, I've never received an explanation like that. And it was really informative. I never thought I would find out about BP by watching a presentation where a dinosaur bite a man's leg off. So yeah, that is definitely a first for me as well and it was, you know, good to hear about the barrow receptors and all of the other um um functions that your body does. Um and all of the, all of the defense mechanisms that kick in when your BP is too high or is too low. So I found it really informative and helpful and I have information now that I can share with with other people. And I think that's really important that lay people like myself and people who want health practitioners can find out about BP in a, in a simplified way that they can share with family and friends. So for me. It was really, really, really helpful. Thank you very much. Thank you, David. Well, with quarter past now just gone. So I've popped in the chat, the link to be able to pick up those resources. I'm also going to pop in the chat as well. The feedback form. We will be here for another couple of moments for any questions. Ah, Valbe A she's just said, or they just said when you do three readings, which one should we note? Right? You do your first one, if that's raised, been it. So you do your second to now. It depends. You're either going to do the average of the second two or the lowest of the second to look at your local guidelines for which one? That's really interesting. Yeah. Yeah. And David, we're definitely going to do testing, measuring BP as I look forward to that were definite will do absolutely okay. So I'm going to, so we'll, so, so this is our first time. So for when I click leave now, David, we'll go off land, we'll stop going live. We'll be still be able to see the chat and we can pick up some questions, but I could, as you know, I could talk forever, but I won't. So David, I will see you soon. Thank you so much for joining me and for being part of this project. Thank you for letting me just throw your random questions. We do have more sessions coming up. We've got lifestyle and if you think, you know, medications of the answer it so isn't lifestyle, got us into hypertension. Lifestyle will get us out. That's what I will say for anyone that come and listen to the lifestyle sessions as well. All right, then I'm going to click the leaf button. We're going to stop going live now and yeah, I will speak to you soon. Thank you everybody. Thank you very much. Take care.