Ep. 12: Show Your Heart Some Love: Focus on Hypertension — with Dr. Ellie Campbell, Functional Medicine Physician

Recorded the day before Valentine’s Day, this episode is all about showing your heart some love — by getting serious about blood pressure. Dr. Regina Druz is joined by Dr. Ellie Campbell, a family and functional medicine physician with more than three decades of experience and author of the Amazon #1 best-seller The Blood Pressure Blueprint. They explain why hypertension remains a silent killer, why most blood-pressure readings taken in doctors’ offices are simply wrong, and how to tell white-coat from masked from sustained hypertension. Most importantly, they dig into the hidden root causes — sleep apnea, oral infections, insulin resistance, stress, nutrient deficiencies, and more — and the message that heart attacks are optional and strokes are stoppable if you’re willing to get the tests and do the work.

Watch on YouTube: A video version of this episode is available on the Own Your Heart Health YouTube channel. Subscribe to be notified of new episodes.

Episode Chapters

[00:00] Introduction & Meet Dr. Ellie Campbell
[02:30] The “Trojan Horse” Book & Why Hypertension
[04:30] Dee’s Story: When Best Practice Wasn’t Enough
[09:00] Hypertension, the Silent Killer
[13:00] How Common Is Elevated Blood Pressure?
[18:00] What’s Driving the Epidemic? Toxins, EMF & Cortisol
[24:00] How to Measure Blood Pressure Correctly
[31:00] Reading the Numbers: US vs. European Guidelines
[39:30] White-Coat, Masked & Sustained Hypertension
[44:30] Home Monitoring Done Right
[52:00] Root-Cause Workup: Airway, Labs & Beyond
[58:30] Diet, Alcohol & Quick Wins
[1:01:00] Closing & For Clinicians

Transcript

[00:00] Introduction & Meet Dr. Ellie Campbell

Dr. Regina Druz (00:00): Welcome to Own Your Heart Health. I’m Dr. Regina Druz, your holistic cardiologist. This week we’ll dive into common heart health concerns, uncovering root causes and unpacking scientific discoveries and controversies. The information provided does not constitute medical advice. Please contact your healthcare practitioner before making any changes that may impact your health.

Dr. Regina Druz (00:30): Welcome, everybody. I’m very excited today — we’re recording literally a day before Valentine’s Day, and I’m here with my wonderful guest, Dr. Ellie Campbell, who is all heart: a great mentor, a great friend, and a top-notch primary care and functional medicine doctor focused on cardiometabolic health and longevity. Dr. Ellie, welcome to the show.

Dr. Ellie Campbell (01:00): Thank you so much — it’s my honor to be here. We chose Valentine’s Day to record because cardiovascular disease is the number one killer of men and women in our country, and it doesn’t have to be. We can take it off the list if we’re willing to get the tests and do the work. It’s enlightening for patients to know that they have power — that with the right coaching and guidance, they can make a huge difference in their blood pressure, their cardiometabolic health, and their risk for heart attack and stroke.

Dr. Regina Druz (01:45): A hundred percent. So many of us want a magic bullet, a magic wand — but there really isn’t one. Everything your body is capable of, you can unlock; you just need the right person to help you follow the right steps.

[02:30] The “Trojan Horse” Book & Why Hypertension

Dr. Regina Druz (02:30): You recently released a book on hypertension — The Blood Pressure Blueprint, which I read and genuinely enjoyed. It’s very practical and user-friendly, without a lot of the extra complexity people find in other hypertension books. Given that you’re in the primary-care functional-medicine space, why hypertension? How did you come to this topic?

Dr. Ellie Campbell (03:00): It’s actually a funny story — the book is a Trojan horse. In ancient Greece, a horse was offered as a gift, gladly accepted, not knowing what important things were hidden inside. That’s my book. It’s really about everything every functional medicine doctor talks about — eat clean food, drink clean water, exercise, pray, meditate, spend time in nature, get good sleep, and have a purpose. Those are the fundamentals for everyone. But written that way, it’s a boring book nobody wanted to read.

Dr. Regina Druz (03:45): Right — because people didn’t find the magical solution. You could have said, ‘sprinkle some magnesium, add omega-3s and glutathione, and poof, your hypertension disappears.’ But no, no, and no. It’s about work.

[04:30] Dee’s Story: When Best Practice Wasn’t Enough

Dr. Ellie Campbell (04:30): It’s work — and there’s a story behind the book. I’m a primary-care family medicine doctor; I’ve been doing this almost 35 years. For a while one of my specialties was helping infertile women conceive — mostly through thyroid, adrenal, and progesterone work and detoxifying their lives — and about a hundred babies were born to supposedly infertile couples. One patient, Cheryl, conceived at 42, then said, ‘you’re so good with hormones, my mother needs to see you.’ So now I had three generations in my practice — a real blessing. I began seeing the grandmother, Dee, who had high blood pressure and high cholesterol, which we treated conventionally by the best guidelines, plus bioidentical hormones, and she was vibrant — four-wheeling with the grandkids, keeping the family books.

Dr. Ellie Campbell (06:00): Then one day her daughter found her crumpled on the floor, barely breathing, paralyzed on one side — a massive stroke. By the time she reached the stroke center she wasn’t a candidate for clot-busting drugs; the timing was too long. She went to rehab joking about getting her leg back so she could go line dancing. Then, around day four, she developed hemorrhagic transformation — the damaged vessel bled — and she died. When I got that call, I felt punched in the gut. I had followed the best evidence-based guidelines, treated her the best I knew how, conventionally and integratively, and she had a fatal stroke. Something in my system was missing.

Dr. Ellie Campbell (07:30): So I spent three years going to every conference I could to understand cardiometabolic health and what I might have missed. When I learned the secret, I called her daughter and asked, ‘In the weeks before the stroke, did your mother have a dental problem?’ She said, ‘Yes — a toothache; she was on antibiotics and was supposed to have the tooth extracted the next week, but never made it.’ Mouth bacteria can enter the bloodstream and trigger plaque rupture. That acute dental inflammation was almost certainly the straw that broke the camel’s back. In hindsight I’d also never tested her for sleep apnea or impaired glucose tolerance.

[09:00] Hypertension, the Silent Killer

Dr. Regina Druz (09:00): I have a similar story, more acute. I trained in a hospital serving a large inner-city population, with many young patients who had uncontrolled risk factors, including hypertension. One man in his mid-thirties came for a stress test. By U.S. guidelines he was only stage one — in Europe he might not even be called hypertensive — but he had some inflammatory markers and mild kidney insufficiency, signs his organs were already suffering. As he finished exercising and stepped off the treadmill, his blood pressure skyrocketed into a hypertensive emergency, and he went into acute heart failure right in front of us. We resuscitated him; he survived without neurological deficit. But it could have happened at home, on the street, or picking his kids up from school.

Dr. Regina Druz (11:30): So hypertension to this day remains a silent killer. Do you see it that way — that many people are completely unaware it’s happening to them?

Dr. Ellie Campbell (12:00): Absolutely. If you get a headache, fatigue, or blurry vision from high blood pressure, count yourself lucky — for the vast majority, the only way to know is to have it measured. That symptom of elevated pressure is often the first red light on the dashboard of your metabolic health, usually a marker of oxidative stress, internal ‘rusting,’ or inflammation in the blood vessels.

[13:00] How Common Is Elevated Blood Pressure?

Dr. Regina Druz (13:00): We’re also very good at self-deceit. A patient recently complained that his doctor wouldn’t order ambulatory monitoring because his office reading was high but his home readings were perfect — he assumed it was just a white-coat effect. So, reflecting on your busy practice, how often do you see blood pressure falling into the elevated range by current guidelines?

Dr. Ellie Campbell (13:45): Probably three-quarters of my patients — and remember, these are functional-medicine patients who value their health, spend their own dollars on it, and are highly motivated. Still, about three-quarters have elevated blood pressure. Do they all get medication? No — they all get a blood-pressure plan. That means we start digging: undiagnosed sleep apnea, insulin resistance, dental infection. After Dee, a dental-hygienist friend asked me to co-write a book on oral-systemic health; we pitched it to 85 publishers and nobody wanted it. So I asked Google what people actually search for, and high blood pressure topped health searches ten years running. That’s when I decided to write a Trojan horse — a book about blood pressure.

Dr. Regina Druz (16:00): It’s not surprising. In my practice I see normal blood pressure maybe 10% of the time; about 90% fall into elevated or hypertensive. And the crude U.S. prevalence — 130/80 or higher, or being on medication — is around 50% of adults, rising to 60–70% for people in their mid-fifties to mid-sixties. So statistically, two-thirds of that age group are walking around with elevated pressure.

[18:00] What’s Driving the Epidemic? Toxins, EMF & Cortisol

Dr. Regina Druz (18:00): What do you think is driving this, and how does the U.S. compare with other developed nations?

Dr. Ellie Campbell (18:15): We’re a bit worse than Europe, and our body mass index is worse too. I have two science-based theories. First, we’re more obese than ever because we’re more toxic than ever — pesticides, herbicides, petrochemicals, artificial colors and flavors, flame retardants, microplastics. The body buries these toxins in fat to protect us, and that fat is a metabolic organ that drives oxidative stress, inflammation, and vascular resistance, raising blood pressure. Second, I suspect mitochondrial dysregulation from electromagnetic exposure — we’re bathed in vastly more electromagnetic energy than 20 years ago, which may dysregulate hormonal, metabolic, and immune pathways and leave blood-vessel walls inflamed.

Dr. Regina Druz (19:30): I’d add a third theory: we’re riding a cortisol curve that’s out of control — chronic, repetitive, unresolving stress from work, family, finances, and world events. We’re rarely truly relaxed, so our sympathetic and parasympathetic systems are out of balance and we live in sympathetic overdrive. This is even recognized in resistant hypertension — blood pressure still uncontrolled on three medications including a diuretic — which conventional colleagues sometimes attribute to high cortisol from an adrenal adenoma. But in most of us there’s no adenoma; we’re simply so stressed that we overproduce cortisol, and blood pressure does what it’s designed to do.

Dr. Ellie Campbell (21:30): Even independent of cortisol, it’s a hyper-sympathetic response. I measure many 24-hour cortisols and don’t see an epidemic of high cortisol — but I do see an epidemic of high blood sugar, high blood pressure, and high cholesterol. Think physiology: if a grizzly bear is about to eat me, instantly my pupils dilate, my heart races, and my blood pressure, blood sugar, and cholesterol all rise so I can fight or flee. Beautiful response. The problem is that today there’s no grizzly bear — just endless emails, bills, and commitments, and constant dopamine from our phones — so we never unplug and reboot the parasympathetic nervous system. We stay in fight-or-flight like a broken record.

Dr. Regina Druz (23:00): I see the parallel constantly: some patients finally get good blood-pressure control only after they retire. Sleep deprivation and blue-light exposure are the evil twins traveling right alongside chronic stress.

[24:00] How to Measure Blood Pressure Correctly

Dr. Regina Druz (24:00): Let’s walk through a patient scenario so listeners understand what’s in our heads. Say a 60-year-old man comes to see you for the first time and your staff is about to check his blood pressure. What’s the right way to do it?

Dr. Ellie Campbell (24:30): Let me first describe what most offices do wrong. The medical assistant chats him up on the walk back — ‘how was the commute, how are the kids?’ — sits him on the exam table with his feet dangling, slaps the cuff on, and gets 160/90, rechecks, writes it down. Almost everything there is wrong. The rules: first, let him empty his bladder — a full bladder can raise pressure 10–15 points, and in a 60-year-old an enlarged prostate that prevents full emptying can itself be the cause of hypertension. Treat the prostate and he might be ‘cured.’

Dr. Ellie Campbell (26:30): Next, no chitchat — conversation can add 10–15 points. Use the proper cuff size: most modern adults need an ‘adult long’ cuff, not the standard one. Place it on a bare arm — over a sweater or even a t-shirt can add up to 40 points. And skip the wrist monitors: they’re less accurate and rarely held at heart level. Finally, the patient must be seated with back supported and feet flat on the floor — unsupported feet add 5–10 points, and an unsupported arm adds about 10. I’m short; I’ve probably never had a truly accurate office reading in my life, because no one ever offered me a footstool.

Dr. Regina Druz (29:30): My own routine: I have patients empty their bladder, take them into a dim exam room, and have them lie down for two to five minutes with no phone and no conversation before I measure — they just drove and rushed to get here, so they need that downtime. And here’s a hack to avoid priming anxiety: I take vital signs at the end of the visit, not the beginning, so the patient isn’t fixating on the number from the start.

Dr. Regina Druz (30:30): Hi everyone, it’s Dr. Regina. I know there are contradictory opinions about nutrition for heart health and longevity — the discussion gets heated and confusing. Some push low-fat, low-cholesterol; others are fans of ketogenic diets; and there are many voices urging vegan or vegetarian eating. To cut through the clutter, my team and I created Holistic Heart University: on-demand courses, nutrition and lifestyle resources, and supplement guidance to make healthy choices for your heart easier to understand. I’m especially proud of our open office hours and the Q&A feature where you can put us in the hot seat. Head to the show notes for the link and use promo code OWNER20 for 20% off our annual subscription. I’ll see you in office hours.

[31:00] Reading the Numbers: US vs. European Guidelines

Dr. Regina Druz (31:00): Say you’ve followed all those steps and this gentleman’s reading is 140/90. Is that a concern?

Dr. Ellie Campbell (31:15): By U.S. guidelines, that’s stage two hypertension. Normal is now defined as 119/79 or less; 130/80 or higher is hypertension. In Europe, 140/90 is clearly stage two as well. Could it be a white-coat phenomenon — a stress response the first time we’ve met? Possibly. So we need more data.

Dr. Regina Druz (33:30): I chose 140/90 deliberately, because that’s where the American and European guidelines agree — it’s hypertension. In the U.S., to be normal your top number must be under 120 and your bottom number under 80, so 119/79 passes but 120/80 is already stage one. The European guidelines are slightly less strict in the middle zone, calling 130–139 over 85–89 ‘elevated’ rather than hypertension, and they allow clinical discretion — if you’ve already had a heart attack, you manage more strictly.

Dr. Regina Druz (36:00): The crucial point is context. Hypertension is probably the single most impactful cardiovascular risk factor for heart attack and stroke, so the guidelines always put the number in context of overall risk. Patients get fixated on the number itself, not realizing the same number may be fine for one person and not nearly good enough for another, depending on their 10-year and lifetime cardiovascular risk. It’s a classic case of missing the forest for the trees.

Dr. Ellie Campbell (37:30): I also think we give elderly patients a pass when we shouldn’t. Systemic vascular resistance rises with age, so blood pressure goes up — but so does risk. Just because it’s common doesn’t mean it’s healthy. When I trained, 160/90 in a senior was ‘acceptable’; we feared treating it would cause falls. We now know those seniors suffered heart attacks, strokes, kidney failure, and blindness because we left it untreated. The data show the opposite of what we feared.

[39:30] White-Coat, Masked & Sustained Hypertension

Dr. Regina Druz (39:30): Let’s define white-coat effect. This patient is meeting you for the first time and reads 140/90. What is it, and how do you sort it out?

Dr. Ellie Campbell (39:45): The white-coat effect is a burst of adrenaline — they see the white coat, get fearful, and their pressure jumps, sometimes 5–10 points, sometimes 50. The opposite is masked hypertension: people so good at getting Zen in the office that their reading is perfectly normal there, but once they’re home cooking dinner or wrangling kids it’s off the chart. So we need home data. I would never diagnose diabetes from a single blood sugar, and I’d never build a blood-pressure plan from a single office reading.

[44:30] Home Monitoring Done Right

Dr. Regina Druz (44:30): Both the American and the most recent European guidelines strongly endorse home blood-pressure monitoring on par with 24-hour ambulatory monitoring. I grew up in the era of ambulatory monitors, but they’re noisy, disrupt sleep, and capture only an artificial 24-hour snapshot. How do you contrast the two?

Dr. Ellie Campbell (45:00): An ambulatory monitor is a medical device you wear continuously for 24 hours; it inflates every few minutes, so it’s hard to work or sleep through. Many practices still use them, but I find I get good data at home. A home monitor is one patients buy themselves — and I tell them to skip the wrist cuff, get a validated upper-arm device with the proper cuff size, plant their feet on the floor, empty their bladder, stay quiet, avoid coffee and alcohol, and relax. Blood pressures are a bit like a son-in-law — you want to see them on both their best and their worst behavior.

Dr. Regina Druz (47:00): Let me add specifics for listeners. The CDC publishes a list of validated devices, and common pharmacy brands are usually validated. I believe every adult needs a home monitor; my preferred company is Withings, partly because we can follow the readings on our practice dashboard. I like cuffs that take three readings at a time, because we judge by the average, or mean — not a single number, unless there are clear symptoms. I have patients measure morning and night at roughly the same times for at least two weeks, so I can understand what their vascular system is truly seeing.

Dr. Regina Druz (49:30): So suppose this patient’s office reading was 140/90 but his home average is 130/80. Is it hypertension?

Dr. Ellie Campbell (49:45): Yes — but he’s dropped from stage two to stage one, and the good news is we may find root causes that don’t require lifelong medication. If every home reading were 140/90 or higher, that’s hard to treat without medication; at 130/80, you’ve got a pretty good chance.

Dr. Regina Druz (51:00): And the reverse defines the categories. To call you normal — normotensive — there should be no crossover into a hypertensive threshold in either the clinic or at home. If both are elevated, as here (140/90 in office, 130/80 average at home), that’s sustained hypertension with a white-coat effect. True white-coat hypertension means high in the office but a normal home average — under 130/80 by U.S. guidelines. We’re also close to validating wearables and cuffless tools for blood pressure, but we’re not there yet — don’t trust those numbers, including wrist gadgets and phone fingertip apps, until they’re physician-validated.

[52:00] Root-Cause Workup: Airway, Labs & Beyond

Dr. Regina Druz (52:00): So we’ve established this patient has sustained hypertension with a white-coat effect. As an integrative functional-medicine doctor, what are your top next steps, even before medication?

Dr. Ellie Campbell (52:15): It’s multifactorial, but think ABCs, like CPR: airway first. I need to know their airway is wide open at night and they’re sleeping deeply. So I send a home sleep test to screen for sleep apnea — about 55% of sleep-apnea patients don’t fit the stereotype, and it’s so common, so overlooked, and so treatable. And I have at least six treatments that aren’t a CPAP mask: oral myofunctional therapy, an ENT nasal evaluation, a bite guard, mouth taping, a nasal splint, or a backpack baffle so they can’t sleep on their back. Knowing those options exist makes patients far more willing to be tested.

Dr. Ellie Campbell (53:30): Next, basic blood work for markers of oxidative stress and inflammation, and for nutrient deficiencies — vitamin D, magnesium, and potassium deficiencies can all cause hypertension. Vitamin D is part of why blood pressure drops in warm, sunny climates — the beach effect. And so many patients have been told their pressure is high because they eat too much salt and must cut it out.

Dr. Regina Druz (54:30): And I always say it’s not salt, it’s sugar.

Dr. Ellie Campbell (54:45): It’s sometimes salt, but far less often — and people who are salt-sensitive often aren’t once they’re magnesium- and potassium-replete. Give them enough magnesium and potassium and they can eat the salt they want without it affecting their pressure.

Dr. Regina Druz (55:00): Hi everyone, it’s Dr. Regina. Many of my colleagues and I are seeing patients arrive with self-ordered blood tests. When this trend started, I thought it would help — who doesn’t want more access to their health data? But too often self-ordered labs lead to more confusion and frustration: patients come in with a pile of results and are no better off. That’s why we created HeartWell Toolkits — a curated collection of at-home blood and genetic markers focused on heart and brain health that gives you the data you need to make informed, actionable decisions. You can order them at the shop on holisticheartcenters.com — the link is in the show notes. Use code TESTING10 for 10% off and free shipping.

Dr. Regina Druz (56:00): On my side, every new patient gets vascular scanning, so we look for hypertension-mediated organ damage: thickening of the heart muscle (a sign it’s seeing higher pressures), carotid plaque or an elevated carotid intima-media thickness for age and sex, and atherosclerosis in the abdominal aorta. Combined with blood work — kidney function, inflammatory markers, lipids, glucose, autoimmune disease, occult infection — the key question is whether your office elevation is real or a white-coat effect, and whether your body is already feeling the impact. All of those pieces inform the plan. And to be clear: if you’re in my office at 150s or 160s, you are leaving with a prescription — we’ll sort out the root causes too, but we’ve seen too much to send you out the door untreated.

[58:30] Diet, Alcohol & Quick Wins

Dr. Ellie Campbell (58:30): We’d be remiss not to take a diet, alcohol, and exercise history. If you’re living on Cheetos and Mountain Dew, that’s an easy point to correct.

Dr. Regina Druz (59:00): Yes — and especially alcohol. Patients still cling to old cardiology lore that mild-to-moderate drinking is ‘good for the heart.’ That’s nonsense; later data didn’t bear it out, and the U.S. Surgeon General has now warned that alcohol is a toxin at any dose, implicated in chronic disease and at least six cancers. So please park that idea. For hypertension I often ask patients to do a dry-January-style reset, limit or cut caffeine, start a gentle intermittent-fasting routine, and focus on limiting sugar with some salt substitution — quick, low-cost wins they can start in a couple of hours. Any parting wisdom, Dr. Ellie?

Dr. Ellie Campbell (1:00:30): I just want to say: heart attacks are optional, strokes are stoppable, and dialysis is not your destiny — if you’re willing to get the tests and do the work.

[1:01:00] Closing & For Clinicians

Dr. Regina Druz (1:01:00): I couldn’t agree more — there’s no magic bullet; the magic lives inside you, you just have to unlock it. For listeners who want to go deeper, check out our earlier ‘Rapid Response’ episode on how much weight you need to lose to lower your blood pressure — and if you subscribe on YouTube, you can get our simple blood-pressure weight-loss calculator to estimate how much fat loss it may take to get your pressure under control. Dr. Ellie, thank you so much — it was a pleasure.

Dr. Regina Druz (1:01:45): To the professionals listening: if you’re thinking of launching a cardiometabolic or integrative cardiology program in your practice, we can help. Holistic Heart Centers helps physicians expand into hybrid or concierge services — head to the show notes and click the application link; your intro call is entirely free. Ready to schedule a practice review? Use code DOC10 for 10% off our Practice Power Hour, a 60-minute coaching session. Thank you for tuning in to Own Your Heart Health with Dr. Regina Druz. This podcast is powered by Holistic Heart Centers. If you enjoyed the show, please rate and review us on your favorite platform, and visit holisticheartcenters.com and subscribe to our YouTube channel. See you next week.

Frequently Asked Questions

Why are blood-pressure readings taken in the doctor’s office so often wrong?

Because of how they’re typically taken. Dr. Campbell explains that the common routine — chatting on the way back, seating the patient on an exam table with feet dangling, and cuffing over clothing — inflates the reading at almost every step. A full bladder can add 10–15 points; conversation another 10–15; an unsupported arm about 10; unsupported feet 5–10; and a cuff over a sweater or even a t-shirt up to 40. Using the wrong cuff size (many adults need an ‘adult long’ cuff) and wrist monitors held away from heart level add still more error. A proper reading means an emptied bladder, a few quiet minutes with no chitchat, a correctly sized cuff on a bare arm, and the patient seated with back supported and feet flat on the floor — or, as Dr. Druz does, lying down briefly to relax first. This is educational information, not a substitute for personalized medical advice.

What’s the difference between white-coat, masked, and sustained hypertension?

All three describe how office readings compare with home readings. White-coat hypertension means your blood pressure is high in the office — often from a burst of adrenaline at the sight of a white coat — but your home average is normal (under 130/80 by U.S. guidelines). Masked hypertension is the reverse and arguably more dangerous: normal in the office but high at home during everyday life. Sustained hypertension means it’s elevated in both settings (for example, 140/90 in the office and a 130/80 home average), which is true hypertension, even if a white-coat component nudges the office number higher. This is exactly why home monitoring matters: Dr. Campbell and Dr. Druz emphasize never diagnosing or building a treatment plan from a single office reading. Work with your physician to interpret your numbers.

What are common hidden root causes of high blood pressure?

Beyond diet and weight, this episode highlights several frequently missed contributors. Sleep apnea is common, overlooked, and treatable — and many sufferers don’t fit the stereotype — so a home sleep test is often step one. Oral and dental infections can trigger systemic inflammation and even plaque rupture (the oral-systemic connection). Insulin resistance and high sugar intake, chronic stress and sympathetic ‘fight-or-flight’ overdrive, poor sleep, and nutrient deficiencies (vitamin D, magnesium, potassium) all play roles, as can an enlarged prostate that prevents full bladder emptying in older men. Dr. Druz adds environmental toxins and body-composition changes. The functional-medicine approach is to give every patient a ‘blood-pressure plan,’ investigate these root causes, and reserve or combine medication as needed. Always pursue this workup with a qualified clinician.

What blood-pressure numbers count as high — and do U.S. and European guidelines differ?

Under the U.S. (ACC/AHA 2017) guidelines, normal is under 120/80; 120–129 over under-80 is ‘elevated’; 130/80 begins stage one hypertension; and 140/90 or higher is stage two. The European (ESC 2024) guidelines are slightly less strict in the middle, generally labeling roughly 130–139 over 85–89 as ‘elevated’ rather than hypertension, and they explicitly allow clinical discretion based on overall risk — for instance, stricter targets after a heart attack. Both systems agree that 140/90 is hypertension. The most important theme from this episode is context: the same number can be acceptable for one person and inadequate for another depending on total cardiovascular risk, so numbers should always be interpreted alongside your broader health picture with your physician.

Show Notes & Resources

Guest: Dr. Ellie Campbell, DO

Dr. Ellie Campbell is a family physician double board-certified in Family Medicine and Integrative Medicine, with more than three decades of clinical experience. She runs a solo concierge practice (Campbell Family Medicine) in suburban Atlanta, focused on root-cause resolution, cardiovascular risk reduction, bioidentical hormone therapy, and the oral-systemic health connection. A native Chicagoan, she trained at the University of Illinois, the Kirksville College of Osteopathic Medicine, and the Medical College of Georgia, and is the Amazon #1 best-selling author of The Blood Pressure Blueprint.

Campbell Family Medicine: campbellfamilymedicine.com
The Blood Pressure Blueprint: bpblueprint.com

Resources Mentioned in This Episode

The Blood Pressure Blueprint — Dr. Ellie Campbell’s Amazon #1 best-selling book (bpblueprint.com)
Campbell Family Medicine — Dr. Campbell’s concierge practice in suburban Atlanta (campbellfamilymedicine.com)
ACC/AHA 2017 High Blood Pressure Guideline — U.S. categories (normal <120/80; stage 1 ≥130/80; stage 2 ≥140/90)
ESC 2024 Guidelines on Elevated Blood Pressure and Hypertension (European Society of Cardiology)
CDC validated home blood-pressure device list — how to choose an accurate upper-arm monitor
Home blood-pressure monitoring — Dr. Druz uses Withings; take three readings averaged, morning and evening, for two weeks
Home sleep apnea testing — a common, overlooked, and treatable root cause of hypertension
U.S. Surgeon General advisory — alcohol as a carcinogen and chronic-disease risk at any dose
Earlier ‘Rapid Response’ episode — how much weight loss is needed to lower blood pressure (with a blood-pressure weight-loss calculator on YouTube)
Holistic Heart University — on-demand courses and resources (use code OWNER20 for 20% off annual)
HeartWell Toolkits — at-home heart and brain health lab panels (use code TESTING10 for 10% off and free shipping)
For clinicians: Practice Power Hour coaching with Holistic Heart Centers (use code DOC10 for 10% off)

Holistic Heart Centers

holisticheartcenters.com
HeartWell.ai — AI-powered cardiovascular risk assessment
Address: 55 Bryant Avenue, Suite #6, Roslyn, NY 11576
Phone: 877-511-5166
YouTube: @reginadruzmd
Instagram: @dr.reginadruz
Podcast: Own Your Heart Health — available on Apple Podcasts, Spotify, and all major platforms

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