T HE

Lown Forum
We can learn about high blood pressure and how it should be managed by dissecting an example of a typical encounter between a patient and a doctor.

2011

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LOWN CARDIOVASCULAR RESEARCH FOUNDATION

High blood pressure: A common problem, but often a dicult solution

Charles M. Blatt, MD
answers to both questions impact the patient the same: regular checkups, dietary changes, increased exercise, and possible blood pressure-lowering medication.

The physicians approach

This physician did all the right things. He took a thorough history that uncovered a stressful lifestyle that lacks recreation, has no time set aside for exercise, and a diet that is reliant on cafeteria or restaurant food (which is loaded with salt). In addition he uncovered a family history of hypertension in both parents that emerged at the same time in life as the patient. The blood pressure was taken by two people in the oce, in dierent body positions, at dierent times during the oce visit, and repeated after several deep breaths in order to discern reactive high blood pressure (also called white coat hypertension) from consistent high blood pressure in need of treatment. Planning for follow-up with daily blood pressure checks for several weeks is appropriate, particularly in this setting. The patient was surprised he had elevated blood pressure, and needed time to conrm the diagnosis and come to grips with the new reality of having a medical condition to live with and manage. The treating physician must always be sensitive to, and take into account, the individual circumstances of each patient and adjust the approach to management accordingly. This patient was lucky to have access to daily blood pressure checks at his oce building. Some patients will go to their local re station or pharmacy for blood pressure checks, while others will purchase an automated blood pressure cu. These automated cus are applied to the upper arm and have a large-format digital readout or they print results that can be faxed, emailed, or easily taken in hard-copy to a follow-up visit. Multiple readings of the blood pressure help dene the nature of a patients hypertension or may reveal that no therapy is required.
continued on page 4

At the urging of his wife, a middle-aged lawyer went to a primary care physician. You should have your own doctor and not treat yourself, she had regularly reminded him. Soon after arriving at the doctors oce, a medical technician checked his vital signs temperature (98.6 degrees), height (59), weight (168 pounds), and blood pressure (an elevated 163/89). The patient insisted, Please take that blood pressure again. I never had high blood pressure before. The second reading produced 158/90. Lets try again in the other arm. 162/88. Now I have a problem that I didnt think I had an hour ago, he thought to himself. The physician conrmed the readings after checking the pressure lying down and sitting up, after 20 seconds of hyperventilating, and then again after about 10 minutes of reviewing the relevant medical history. The history included 10 to 12 hour workdays; frequent travel; take-out lunches and several evening meals at restaurants per week; nancial strains with a mortgage and tuitions; little time for exercise; and a family history of hypertension. He had no history of smoking, chest pain, or shortness of breath. His physical exam and electrocardiogram were normal. The check-up was uneventful except for two issues: the weight and the blood pressure. How should the physician approach this patient? How should the patient approach these new developments in his health? In this circumstance, and in most cases, the

The Lown Foundation is grateful to the Max Kagan Family Foundation for their steadfast support of our work for more than a decade. Their contributions have enabled us to advance our patient-centered model of health care here in Brookline, across the country, and around the world.

INSIDE

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Presidents message Meet the Lown Center echo sta Should I switch blood thinning meds? Welcome Andi Brown High blood pressure (cont.)

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Patient prole: Letting go for your health Assessing the value of care among providers A chair as treatment

NewsBeat
Eating healthy

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PrESIDENTS MESSAGE

Attitude and approach

Vikas Saini, MD, President
As the political debate on health care continues to heat up in Washington and on Beacon Hill, there will be a bright spotlight on the cost of care. Despite this increased attention, the cost of care has never been the focus here at the Lown Center. Our emphasis is on attitude and approach. We focus on the human connection between doctor and patient, and we use that as our compass in assessing the various treatment options based on whats best for the patient (whether itd be prevention activities, prescription medicines, invasive procedures, or surgery). Practicing this way, we believe we use fewer resources. Dening the best course of action is never simple since each patient is unique. It seems as though this practice is getting lost with younger physicians. They often seem to do little more than use a checklist when addressing a patients health issues. This is understandable; in the drive to reduce errors and achieve higher quality of care with lower costs the emphasis has turned to protocols, guidelines, and checklists. I nd this unfortunate, not because such tools are not useful or necessary, rather because practicing medicine is much more than a checklist. Caring for an octogenarian, a 40-year-old with kids, an athletic nonagenarian, or a 70year-old couch potato require dierent approaches and considerations. It is the responsibility of the physician to recognize those dierences and administer a course of action that specically addresses the individual patients needs. Because each patient is a unique case, there are times when outcomes are uncertain. If it is unclear whether a test or procedure may or may not be helpful, both the physician and patient have an ethical obligation to consider the cost of a test or treatment when making decisions about the patients care. In the midst of such uncertainty, promoting an attitude among physicians and patients of stewardship of resources requires great thought and care. In a recent conversation with one of my Harvard medical students it became clear that little is taught about this in medical school curricula. However, these conversations are going to increase as we grapple with the challenge of caring for a large, aging population. Here at the Lown Center, we believe that an individualized approach with a generous helping of healthy skepticism towards the latest highly-touted technique is the best path to the goal of cost-eective, humane care.

MEET THE LOWN CENTEr STAFF

Echo testing team

When visiting the Lown Center, your physician may request one or more noninvasive diagnostic tests for you. Many of these tests are performed by our echo testing sta. Mary Lancaster-Pijar is the Technical Director of the noninvasive testing lab here at the Lown Center. Gabe Galambos is a cardiac ultrasound technician who has been with the Lown Center for nine years. His favorite part about working here is conversing with [the Centers] interesting patient population. Outside of work, Gabe enjoys traveling and is a devoted Patriots fan. Deb Lombardo is a registered cardiac sonographer who joined the Lown Center in April 2010. Originally from Cape Cod, Deb completed the echocardiogram program at Bunker Hill Community College and later trained at Mass General Hospital. She is registered through the American registry for Diagnostic Medical Sonography and is a member of the American Society of Echocardiographers. Deb likes being part of the Lown Center team because of the emphasis placed on preventative medicine. Her hobbies and interests include gure skating, reading non-ction, traveling to new places, and spending time with family and friends. Lisa Sharpe is a registered diagnostic cardiac sonographer who has been with the Lown Center just over a year. Lisa earned her BS in Applied Health and Human relations from Colby Sawyer College. One of the reasons she loves working here is because of the compassion and professionalism of the Lown sta. Outside of work, Lisa enjoys cooking, gardening, and spending time with her husband, three teenage boys, and numerous pets.

Annual appeal thank you

As we begin the new year I want to extend my heartfelt thanks to all those who contributed so generously to the Lown Foundation. Your support for our broader mission is a meaningful way of sustaining a community. I would also like to oer a special thanks to Jessica Gottsegen who is responsible for managing the day to day details of our annual appeal, and to Claudia Kenney whose regular input has proved invaluable to this eort. -V.S.

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QUESTION FrOM A PATIENT

Brian Bilchik, MD

I have atrial brillation and I take Coumadin (generic: warfarin), I saw a commercial for a new blood thinning drug called Pradaxa. Should I switch?
Most people with atrial brillation require blood thinning medication, which helps reduce the risk of stroke. Approved in the 1950s, warfarin has been the best option. However, in November 2010, a new blood thinning drug called Pradaxa (generic: dabigatran) was approved by the FDA to be sold in the United States. A tremendous amount of interest is being paid to this potential alternative to warfarin and its easy to see why. Patients are often frustrated with warfarin because it requires frequent blood tests, modication in diet and avoidance of leafy, green vegetables, and it can interact with other medications. Taking warfarin can be timeconsuming and interfere with ones lifestyle. On the other hand, Pradaxa sounds promising. Initial study results show that Pradaxa is not only as eective as warfarin, but it may be slightly safer. Also, Pradaxa doesnt appear to interfere with ones diet and it requires far fewer blood tests. Its the rst time in over 50 years that warfarin has a serious competitor.

falling (often the elderly). Now that Pradaxa is available, there will be many more patients who take it, and in a year or two well have a much better idea of how Pradaxa does in dierent types of patients. Pradaxa has some additional shortcomings when compared to warfarin. Pradaxa is short-acting, which means it must be taken twice a day (warfarin is taken only once a day). Also, the cost for Pradaxa is signicantly higher (approximately $200 a month) and it is not yet clear which insurers will pay for Pradaxa and how much they will cover. Conversely, new advances in home monitoring for those taking warfarin were recently approved and are covered by Medicare and some insurers. This can decrease the amount of blood testing at the doctors oce that is associated with warfarin.

The Lown Groups view

When a new class of medications is developed with signicant implications for our patients, we prefer to wait at least one year before we recommend a transition to the new therapy. What gives us cause to pause for this potentially useful and eective medication is that its predecessor had signicant issues during its trial period. One of the reasons the older version of dabigatran was not approved was because it caused liver problems, however this seems to be sorted out with the new version, Pradaxa. Pradaxa represents the rst of several new blood thinning medications coming to the market. Pradaxa could potentially replace Coumadin, as long as its safe and cost eective. But for the time being, well wait before prescribing Pradaxa until we see how it does now that its reaching a far greater number and variety of patients.

Possible concerns
This is a brand new drug, and it is not clear which populations would benet most and who might be more at risk. Older patients are often not well represented in the testing trials, and questions remain unanswered around patients who are at a higher risk for bleeding and

LOWN FOUNDATION STAFF UPDATE

Welcome Andi Brown

The Lown Foundation is pleased to welcome Andi Brown as our new Director of Development. Since arriving in early November, Andi has put together a dynamic plan to energize our fundraising eorts to support the Foundations work. Andi sees tremendous opportunity in promoting our patient-centered approach. Im delighted to work for an organization that has been such an important player in improving health care for people all over the world. Our model - doctors treating the whole person, not just the

disease - should become the standard of care for everyone. Our philosophy is to recommend alternatives to invasive, costly procedures unless absolutely necessary, and that makes us a bit of a maverick in the current health care climate. We believe were in the vanguard, and with the help of the philanthropic community, were able to promulgate our style of care. Outcomes research and a planned conference on overtreatment in health care are two current projects Andi is working on, and she has several more exciting new activities in the works. Andi looks forward to working with donors, long-time and new alike, to ensure the Lown Foundations continued vitality and leadership position in patient-focused heart health.

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High blood pressure: A common problem, but often a dicult solution

Charles M. Blatt, MD
(continued from page 1) This information is key to management but may be challenging to interpret and represents one of the most dicult aspects of this very common condition. A large study carried out in Paris, France nearly 10 years ago involving 11,000 patients determined that normal blood pressure readings at home on multiple occasions dened a patient who did not require blood pressure lowering medication. The surprising nding in this important study was that a substantial number (11%) had normal blood pressure at the doctors oce, but high readings at home. This group suered most from the serious consequences of untreated hypertension.

The patients response

At rst, he responded as most patients do - with a degree of disbelief and denial followed by repeatedly checking blood pressure measurements. He found that his blood pressure was elevated, often above 155/90, and clearly within the range deserving treatment. Even after modest weight loss, salt reduction, and exercising three days per week, his blood pressure remained too high. The initial approach to treating high blood pressure can vary. His physician tried a low dose of a generic diuretic followed in several weeks by a low dose of a generic ACE-inhibitor. The combination worked well for this patient. The physician had other options to consider. Frequently a third drug, such as a calcium channel blocking drug, is added to a diuretic and an ACEinhibitor. Calcium channel blocking drugs are commonly-used and well-tolerated. One has recently become generic, making it aordable with a low co-pay on most insurance plans. Physicians often use a combination of two or more medications to lower blood pressure because it keeps individual drug doses low and avoids the possibility of side eects that result from an increased dosage of a single drug. Most physicians aim to lower blood pressure to less than 130/80. Lower pressures are welcome as long as side eects attributed to lower pressure do not intervene.

Managing high blood pressure

Successfully treating high blood pressure often requires a multi-faceted approach, and the patient can make a lot of progress by adopting approaches that reduce salt intake and body weight, and increase exercise. 1) Weight loss will help lower blood pressure dramatically in most people. In general, every pound of body mass contains mile of blood vessels through which the heart must pump blood to sustain the health of the tissues. Weight loss translates to a rapid reduction in the strain placed upon the heart and helps lower blood pressure. 2) Avoiding restaurant and cafeteria food as much as possible reduces the overall intake of sodium chloride (table salt). Anything prepared in quantity is preserved with salt; many easily-identied items such as canned soups, processed deli meats, pickles, chips, Chinese food, pizza, and fast food have enormous concentrations of salt. Salt causes the body to retain uid which translates to a higher pressure within the blood vessels. 3) As sodium is reduced in the diet, potassium intake should be encouraged. These two essential elements work in opposite directions with respect to blood pressure. A diet low in sodium but high in potassium will set the stage for lower blood pressure. This relationship has been noted across many societies and continents when food and water have been analyzed. 4) regular aerobic or dynamic exercise - that is movement of the arms, legs, or both to generate a light sweat over a sustained period (30 to 45 minutes daily) helps with weight loss AND reduces the psychological stress that has become part of the fabric of our daily, hectic lives. This is especially true for people living and working in urban areas.

The importance of treatment

Why do doctors make such a big deal about treating high blood pressure? Sustained high pressures in the blood vessels that serve the brain, heart, and kidneys - the three organs that we cannot do without - can cause progressive and potentially severe damage to the inner lining of these arteries. This sets the stage for thickening, rupture, clot formation, and disruption of blood ow to these organs, which can result in stroke, heart attack, and decline in kidney function or even kidney failure that could possibly require dialysis. When you consider how common and how serious this condition is, it is surprising that so many people refuse to believe they have high blood pressure when rst discovered at the doctors oce. Many factors may contribute to high blood pressure including: family history of high blood pressure, excess body weight, a high salt diet, stress (family, work, nancial), a sedentary lifestyle, and even living in a city. Although it can occur for many years without symptoms, high blood pressure requires careful management by both the physician and the patient over the long term.

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PATIENT PrOFILE

Letting go for your health

Sister Margaret Devine loved her work. Despite the stress and long hours, her job helped people and took her all over the world. However, her job kept her so busy she had little time for her health. I never thought that what I was doing was detrimental to my health because I enjoyed what I was doing. Eight years ago, Sister Margaret found out she had high blood pressure while at a church health fair. Despite knowing the risk, she never thought about slowing down and reevaluating her health needs. My mind was caught up on other things - I was working a lot and wasnt taking any time o. I was really going nonstop. Turning a blind eye to her health, Sister Margarets high blood pressure started to aect her slowly at rst. It wasnt until my second time back in the Philippines, when I was working with poor people in slum areas, that I realized I wasnt able to work as hard as I used to. I needed to slow down and take time for my health. She didnt. A little over a year ago Sister Margaret had a stroke and was hospitalized for four days. It was a wakeup call for me. I didnt want to give up my work, but I had to give most of it up. Accepting her situation, Sister Margaret saw this as an opportunity to nally prioritize her health. The key is letting go, she advises. It can be hard to let go, but your health requires it. Letting go has given her a healthy perspective. You have to let go of those things that prevent you from being healthy. Its important to know when its time to let go, and you dont want to learn that when its too late. Sister Margarets new outlook has changed the way she takes care of herself. Im more careful now I take my blood pressure and I exercise every day, and Im more careful with what I eat. However, she doesnt believe that changing her daily routine to fulll her health needs was burdensome. It gives me peace of mind, and its all part of accepting the situation.
Sister Margaret

Sister Margaret also credits the care she receives at the Lown Center to her success living with high blood pressure. Dr. Blatt and the Lown Center have made a big dierence in my life. The care Ive received and their attention to my health has made me much more aware.

QUESTION & ANSWEr

Assessing the value of care among health providers

Vikas Saini, MD
Nassib Chamoun, Chairman of the Board of the Lown Foundation, led a team that recently published a simple and free tool to compare the performance between dierent hospitals. By measuring clinical outcomes, such as mortality and length-of-stay, the new tool seeks to measure the value of care using publicly available data. An editorial in the journal Anesthesiology, which highlighted their report on its cover, described their technique as an accurate way to compare apples to oranges. Nassib, who will benet most from this model? I think patients will benet the most. Unfortunately right now theres this big debate in health care reform, and a lot of ghting between the constituents involved. A lot has been done for payment reform but little has been done in terms of the quality of care we deliver in this system. Were lacking a value model to guide this process. But the minute you bring reproducible, transparent data to the table, then the conversation between the constituents takes a dierent direction. How is this tool relevant to the Lown Center's work? The position we have taken historically at the Lown Center is that cost and quality are not in conict. We believe you can deliver better quality care by doing more for the patient and less to the patient. The challenge we have is to support our experience with data that other providers can use to make valid comparisons of the strategies we have used for our patients and the outcomes, including both mortality and complications, as well as the quality of life that results. Once you can measure and provide data to support this, people will take a pause and say the Lown model has demonstrated over a period of several decades that cost and quality can go hand and hand if you do right by the patient. What is the broader signicance of this tool for the health care industry? Everybody will be held accountable for the quality and outcomes they deliver. Our health care model is transaction-based, but going forward, everyone is saying we cant aord to be transaction based so were going to start paying for the value that providers deliver. But because its not easy to qualify value, we need a model that answers the question: Did the course of action I prescribe my patient make a dierence? This tool allows everyone to replicate the numbers, look at their data, and compare it to their peers.

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A chair as treatment
Bernard Lown, MD
It has been 60 years since the publication of The chair treatment of acute coronary thrombosis. I co-authored this oddly-titled article with my mentor, Dr. Samuel A. Levine. Few studies have made as large an impact on the treatment of heart attack victims. I recall this seemingly ancient experience because of the lessons it holds for present-day health care. The study involved getting patients into a chair. This may sound bizarre. What is so novel about sitting? However, when I arrived at the Peter Bent Brigham Hospital (now Brigham and Womens Hospital) in 1950, patients experiencing an acute heart attack had traditionally been kept at strict bed rest for four to six weeks. Sitting in a chair was forbidden. They were not allowed to turn from side to side without assistance. During the rst week, patients were fed by a nurse. For the constipated, which included nearly every patient, precariously balancing on a bedpan was agonizing as well as embarrassing. The mortality was awesome. More than one in three patients died. Not surprisingly, many died from blood clots migrating to their lungs. Psychological depression was the rule. Other complications included intractable chest pain, prostatitis, severe constipation, bedsores, frozen shoulders, bone thinning, and collapsed lungs. Medical insistence on rigorous bed rest was based on a sacrosanct therapeutic principle, the need to rest a diseased body part, be it a fractured limb or a tuberculosis-infected lung. Unlike a broken bone, which could be immobilized in a cast, or a lung lobe, which could be collapsed by inating a chest cavity with air, the heart could not be rested so readily. The only approximation to the principle of rest for the diseased heart was to diminish its workload. Thus, bed rest was equated with heart rest. The study involved getting patients into a comfortable chair for increasing durations on succeeding days. By the end of the rst week, they sat up for several hours twice daily. Initially the house sta was vehemently opposed and resisted getting patients out of bed. They even accused me of committing crimes not unlike those of the Nazi experimentations. However, they rapidly became enthusiastic adherents. Patients required fewer narcotics for chest pain and less sedation for anxiety, and they could do without sleeping medications entirely. Nurses commented that the patients demeanor changed from anxious and depressed to more upbeat. The outcome of the study was impressive. During an average of four weeks of hospitalization, only eight of the 81 patients died. This was less than a third of the prevailing mortality among those admitted with an acute heart attack and subjected to bed rest. Although the chair treatment was initially questioned and even derided by the medical profession, rigorous bed rest was soon universally abandoned. Within a few years the period of hospitalization was reduced by half, rehabilitation was hastened, and patients return to work accelerated. In reecting on this experience many years later, I am troubled by the ways in which doctors rationalized a treatment that not only had little or no value, but exacted a draconian punishment to boot. Why subject heart attack victims to rigid bed rest that could only increase their misery and that led to major complications in those who already had a life threatening condition? This was not just a small error; it was a colossal misjudgment, yet another of the numerous examples of medical tradition derailing healthy skepticism and impeding a commonsense approach. A major reason that the detrimental eects of prolonged bed rest were not discovered earlier had to do with the physicians lack of attentiveness to their patients and even a failure to appreciate that churning emotions derange the functioning of every organ in the body, be it heart or intestine. That one can die from an aching heart is widely acknowledged. Even in this age of magical technology and miraculous scientic discoveries, the medical profession is remiss when not being attentive to the heartache that each and every human being experiences.

A hero to many
John Bogle, founder and retired CEO of the Vanguard Group, recently published a collection of essays that reect on our current nancial system. The book, entitled Dont Count On It, devotes four chapters to his heroes and mentors. In one of these chapters he highlights Dr. Lown, whom Mr. Bogle describes as John Bogle The paradigm of the healing physicians, creative, innovative, and world renowned cardiologist. His care carried me through the crucial middle years of my 34-year struggle with heart disease. Mr. Bogle continues, By dint of his powerful character and brilliant mind, Dr. Lown has lengthened and enriched the lives of countless patients...I owe my life to him. Mr. Bogle ends the chapter, Speaking for the world, for his patients, and for myself, Bernard Lown made things better for us all.

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LOWN CArDIOVASCULAr CENTEr

Thank you for your support

The Lown Cardiovascular research Foundation promotes cardiac care that advocates prevention over costly, invasive treatments and restores the relationship between doctor and patient. Your financial support allows us to continue our work and carry our heart health message to local, national, and global audiences. We greatly appreciate any donation you are able to make. You can donate online at our website (lownfoundation.org) or mail your donation to 21 Longwood Avenue, Brookline, MA 02446. Please make checks payable to the Lown Cardiovascular research Foundation. For more information about supporting the Foundation, please contact Andi Brown, Director of Development at arbrown1@partners.org or 617-732-1318 (x3350)

NewsBeat
Benn Grover, Editor of ProCor, participated in the United Health/National Heart, Lung and Blood Institutes Chronic Disease Centers of Excellence semi-annual steering committee meeting in Washington DC on October 7-8, 2010. Dr. Barbara Roberts, Director of the Womens Cardiac Center at the Miriam Hospital and LCrF Board Member, was interviewed by Providence Business News on November 29, 2010 where she discussed the importance of prevention in the ght against heart disease. On December 9, 2010 Dr. Tom Graboys gave a talk at Beth Israel Deaconess Medical Center as part of their quarterly conference series. During his talk he discussed his perspective on the current state of the doctor-patient relationship. At the request of Dr. Andrew Weil, Dr. Graboys contributed a chapter on cardiac arrhythmias to a recently published book titled, Integrative Cardiology. Dr. Weil is an American author and physician, best known for establishing and popularizing the eld of integrative medicine. The Lown Center physicians regularly give lectures to community groups and organizations on heart health topics such as nutrition, exercise, coping with stress, second opinions, and alternatives to surgery. Dr. Vikas Saini spoke at the Goddard House in Brookline on January 24, 2011 and at the Watertown Mall on February 4, 2011. Dr. Brian Bilchik was a guest speaker during the Brookline Adult & Community Education winter semester. He also addressed the Brookline rotary Club on February 10, 2011. In January, the Foundation welcomed graduate consultant, Mychal Voorhees. She is a graduate student in the Health Communication program at Emerson College. Since moving to Boston in August 2009, Mychal has served as a communications intern with the EPA and Health resources in Action. Before moving to Boston to pursue her graduate degree, Mychal worked in the press oce at The Carter Center, a non-prot organization founded by President Carter, in Atlanta. Mychal will research successful communication strategies and create an outreach and marketing campaign for ProCor that targets medical school students and professors in developing countries.

Educational opportunities
Interested in hosting a lecture on a heart health topic by one of our physicians at your worksite or community organization? Please contact Jessica Gottsegen at jgottsegen@partners.org or 617-7321318 (x3805).

receiving the Forum

If you would prefer to receive the Lown Forum by email, send your full name and email address to info@lownfoundation.org.

New patient appointments available

New patient appointments are currently available. If you would like to make an appointment with one of the Lown Group cardiologists, please call 617-732-1318 and select option 1.
Board of Directors
Nassib Chamoun Chairman of the Board Vikas Saini, MD President Bernard Lown, MD Chairman Emeritus Thomas B. Graboys, MD President Emeritus Patricia Aslanis Charles M. Blatt, MD Joseph Brain, SD Janet Johnson Bullard J. Breckenridge Eagle Carole Anne McLeod C. Bruce Metzler Barbara H. roberts, MD ronald Shaich robert F. Weis

CONTACT US
Lown Cardiovascular Research Foundation
21 Longwood Avenue Brookline, MA 02446 USA (617) 732-1318 info@lownfoundation.org www.lownfoundation.org www.lowncenter.org www.procor.org

Lown Cardiovascular Group

Brian Z. Bilchik, MD Charles M. Blatt, MD Wilfred Mamuya, MD, PhD Shmuel ravid, MD, MPH Vikas Saini, MD

Lown Forum Editorial Sta

Andi Brown Jessica Gottsegen Benn Grover Claudia Kenney

Advisory Board
Martha Crowninshield Herbert Engelhardt Edward Finkelstein William E. Ford renee Gelman, MD Barbara Greenberg Milton Lown John r. Monsky Jerey I. Sussman David L. Weltman

2011 Lown Foundation Printed on recycled paper with soybased ink.

Lown Cardiovascular research Foundation 21 Longwood Avenue Brookline, Massachusetts 02446-5239

NON-PROFIT ORG. US POSTAGE

PAID
THE PRINT HOUSE

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Eating healthy
Fred Mamuya, MD, PhD

What are we ordering for take-out tonight?

Most of us believe that we do not have the time to prepare and sit down for an unhurried, home-cooked meal at the end of the day. And so we end up relying on ready-made and take-out meals, as I did during my training years. When perusing the collection of take-out menus or ready-made meals at our local supermarket, we try to make healthy choices salads, roasted chicken, sh, and so on. What could be wrong with those choices? For starters, we usually end up consuming more calories than we think, and there is a direct correlation between calories consumed, weight gain, and high blood pressure. If you have to order out, try splitting an entre and a salad (with dressing on the side) which will help control your calorie intake. Avoid dishes with creams or curries, and skip vegetarian fare loaded with cheese and avocado. Moreover, most of these healthy choices have a signicant amount of sodium, which is associated with elevated blood pressure levels. The daily recommended sodium intake for anyone with elevated blood pressure is 1700 mg. Unfortunately, it is impossible for us to know the exact amount of sodium in any prepared meal. For example, a single taco salad, a seemingly healthy choice, has an average 1800 mg of sodium! I would advise that you skip most soups, since they are usually laden with sodium. For reference, a single cup of

miso soup usually contains about 2500 mg of sodium. request no MSG when ordering Asian fare. Avoid condiments such as mustard, pickles, olives, or feta cheese. Soy or teriyaki sauce-based items should also be avoided for the same reason.

Taking the time to enjoy a home-cooked meal at the end of the day has the additional benet of encouraging healthier eating patterns to our loved ones.
Since prepared meals save time, but come at an unhealthy price, what is one to do? We should start by trying to minimize ordering out or buying prepared meals as much as we can. Increasing our dietary potassium is helpful in lowering blood pressure, and a DASH diet which emphasizes fruits, vegetables, low-fat food, and non-fat dairy products is recommended by most health professional organizations. If you are unable to locate appropriate educational materials, ask your physician during your next visit. Carefully thought-out meals cooked during the weekend can be recycled throughout the week. Meals prepared in a slow cooker can be cooked during the day while everyone is at work or school, and enjoyed together as a family at the end of the day. Taking the time to enjoy a home-cooked meal at the end of the day has the additional benet of teaching and encouraging healthier eating patterns to our loved ones.