Navigating Paralyzing Fear and Uncertainty: Women's Heart Health

The Institute for the Advancement of Women’s Health is not a political organization, nor is this newsletter article a political statement. Instead, it is this organization’s effort to address one of the many pressing women’s health issues of our time – in real time. The experiences associated with this turbulent federal government transition include massive job losses among the federal workforce, the sudden and unexplained disappearance of co-workers, widespread unemployment and the scramble to find new equitable and meaningful employment, loss of benefits, family disruptions, and growing U.S. domestic economic and foreign policy uncertainty. These are the kinds of stressors that can exacerbate pre-existing health conditions and create new health challenges (Centers for Disease Control and Prevention, 2020).

Stressed Federal Worker

The pressures of these unprecedented times are taking a significant toll on heart health, with stress and anxiety emerging as critical factors. For members of the federal government workforce, chaos is being served up every day and having an immediate impact on the mental and physical well-being of women and men across the nation. Let’s explore the profound impact that trauma and stress can have on a heart health and share a few effective strategies for coping and emerging out of shock and paralyzing fear into a better space.

 Heart Health and Stress

The connection between stress and heart health is well-documented. Chronic stress and anxiety can lead to increased blood pressure, inflammation, and other cardiovascular issues, putting women at a higher risk of heart disease. As women grow older and approach menopause, hormonal changes add another layer of complexity, exacerbating stress and anxiety and increasing vulnerability to cardiovascular issues, including arrythmias (irregular heartbeats). The decline in estrogen levels, naturally associated with aging, disrupts the protective mechanisms for heart health, that would ordinarily regulate cholesterol and reduce inflammation.

When a woman experiences repeated fear, shock, chronic stress and worry, her body's fight-or-flight response is constantly activated. This means that hormones like cortisol and adrenaline are released repeatedly. Over time, elevated levels of cortisol can lead to increased blood pressure, which puts extra strain on the heart and blood vessels. Adrenaline can cause the heart to beat faster and harder, further increasing the risk of hypertension.

Additionally, chronic stress can trigger inflammation in the body, which is a known risk factor for heart disease. Inflammation can lead to the development of atherosclerosis, a condition where plaque builds up in the arteries, narrowing them and restricting blood flow to the heart. This can result in chest pain (angina), heart attacks, or strokes.

Irregular heart rhythm

Another significant connection between stress and heart health is the impact on lifestyle choices. Women under chronic stress like, dealing with the cascading issues associated with prolonged job insecurity or personal trauma, like loss of health insurance, balancing household expenses -making rent/mortgage and car payments, student loan debt, school fees and activities for children, may turn to unhealthy coping mechanisms such as unconscious, emotional eating, smoking (including cannabis and vaping), excessive alcohol consumption, and suddenly more sedentary living. These behaviors can contribute to the worsening of risk factors for heart disease like overweight/obesity, high cholesterol, and uncontrolled Type 2 diabetes.

The mental health aspect of stress cannot be overlooked. Anxiety and depression, which can accompany this kind of aggressive change made by a new administration, are also closely linked to heart disease. Women with anxiety and depression are more likely to experience heart palpitations, chest pain, and other symptoms that mimic heart conditions. These mental health issues can make it difficult for women to adhere to medical advice or maintain a healthy lifestyle, further increasing their risk of cardiovascular problems.

Overall, the intricate relationship between chronic stress, trauma, and heart health underscores the importance of addressing mental and emotional well-being as part of a comprehensive approach to cardiovascular health. By managing stress through healthy coping strategies, such as mindfulness, regular exercise, and seeking professional support, women can significantly reduce their risk of heart disease and improve their overall quality of life.

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Let’s Recap:

1.      Stress and Cardiovascular Risk: Chronic stress and anxiety can lead to increased blood pressure, inflammation, and other cardiovascular issues, putting women at higher risk of heart disease, especially as they approach menopause and experience hormonal changes.

2.      Fight-or-Flight Response: Repeated fear, shock, and chronic stress activate the body's fight-or-flight response, leading to the release of cortisol and adrenaline. Elevated cortisol levels can increase blood pressure, while adrenaline can cause the heart to beat faster, raising the risk of hypertension.

3.      Hormonal Impact: The decline in estrogen levels during menopause exacerbates stress and anxiety, increasing vulnerability to cardiovascular issues, including arrhythmias (irregular heartbeats). Estrogen's protective mechanisms, such as regulating cholesterol and reducing inflammation, are disrupted.

A Human Heart

4.      Inflammation and Heart Disease: Chronic stress triggers inflammation, a known risk factor for heart disease. Inflammation can cause atherosclerosis, where plaques build up in arteries, leading to chest pain (angina), heart attacks, or strokes.

5.      Unhealthy Coping Mechanisms: Women under chronic stress may resort to unhealthy behaviors like emotional eating, smoking, or excessive alcohol consumption, contributing to weight gain, high cholesterol levels, and diabetes, all of which are risk factors for heart disease. Additionally, anxiety and depression related to stress can mimic heart conditions and make it difficult to maintain a healthy lifestyle.

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Online Therapy from the Comfort of Home

Suggested Coping Strategies

Adopting healthy coping strategies, such as mindfulness, regular exercise, and seeking professional support can mitigate the impact of stress and hormonal changes on heart health and overall well-being. Effective coping strategies are essential for managing stress and anxiety. Combine any or all these approaches. Some evidence-based approaches include:

1. Seek Counseling: There is nothing to be ashamed about seeking counseling from a licensed professional therapist. It's important for women experiencing anxiety, depression, and overwhelm to seek counseling, as professional support can provide effective coping strategies and improve mental health. Embracing counseling can help you reclaim your centeredness and actually provide you with the coping and conquering tools needed to navigate challenges with confidence. There are many on-line counseling services available. You can begin your search with services like GrowTherapy, BetterHelp, TalkSpace. IAWH is not making a recommendation. You will need to check insurance coverage for each service.

   
   

2. Medication Adherence: Just a fancy way of saying, take your prescribed medication on schedule and as prescribed. This goes for the management of your high blood pressure, Type 2 diabetes, high cholesterol, overweight/obesity and other chronic physical and mental health conditions.

   
   

3. Smart Wear: Smart watches, Smart rings, Apps, Pedometers are much more affordable now. Make use these tools to help keep track of your health (steps, heart rate, calories burned, sleep quality, blood oxygen level and more).

   
   

   

   Meditation and Centering

4. Mindfulness and Meditation: Engage in practices that promote relaxation and mental clarity. This can reduce stress and improve heart health (Harvard Health Publishing, 2019). Go online or find local studios, gyms, or the YMCA and look for group or private sessions for guided meditation, yoga, sound bathing, reiki, and outdoor forest bathing.

   
   

5. Physical Activity: A gym membership is not required for you to achieve physical activity goals. Regular exercise, such as walking or yoga, can lower blood pressure and reduce anxiety (Mayo Clinic, 2021).

   
   

6. Healthy Eating: We all know that a balanced diet rich in fruits, vegetables, and whole grains supports overall health and can mitigate the effects of stress (American Heart Association, 2021). To avoid bouts of emotional eating, maybe refrain from stocking your shelves and fridge with the salty, crunchy, sweet goodies so that there is less temptation to give in to.

   
   

7. Social Support: In times like these community is everything. Finding and keeping social support, community, and faith connections are absolutely essential. Building strong social connections - just having someone to talk with and share experiences and stories with can provide much needed emotional support and can buffer against the negative effects of stress (Cohen, S., & Wills, T. A., 1985).

References:

1. American Heart Association. (2021). Stress and Heart Health. Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/stress-and-heart-health

2. Centers for Disease Control and Prevention. (2020). Health Disparities. Retrieved from https://www.cdc.gov/healthyyouth/disparities/index.htm

3. National Institute of Mental Health. (2022). Women and Mental Health. Retrieved from https://www.nimh.nih.gov/health/topics/women-and-mental-health

4. Harvard Health Publishing. (2019). The Relaxation Response. Retrieved from https://www.health.harvard.edu/mind-and-mood/the-relaxation-response

5. Mayo Clinic. (2021). Exercise: A drug-free approach to anxiety. Retrieved from https://www.mayoclinic.org/diseases-conditions/anxiety/in-depth/anxiety/art-20045497

6. Cohen, S., & Wills, T. A. (1985). Stress, Social Support, and the Buffering Hypothesis. Psychological Bulletin, 98(2), 310-357.

7. American Psychological Association. (2014). The Road to Resilience. Retrieved from https://www.apa.org/topics/resilience

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Cheryl Thompson, MSPH

Co-Executive Director

All Heart, Health, and Hope - Catching Up with Carlotta

Welcome to the next in a series of IAWH HerStories, featuring participants of the 2022 Self-Measured Blood Pressure (SMBP) hypertension control program. These stories are heart-warming and informative and are shared to inspire you as you travel along your health improvement journey. This HerStory profiles the health journey of Carlotta Hughes- Culp, a mental health professional, counselor, a cancer survivor, and a women's health inspiration.

Q: Tell us about yourself. For example, where were you born, what you do for a living, your hobbies/interests/activities, how long have you lived where you live now? If you are not native to where you currently live, what brought you there?

A: I was born in a small town in Tennessee about 50 miles outside of Nashville. I attended public schools and eventually graduated from the University of Tennessee, Martin with a degree in social work. Upon graduating from college I lived and worked in Nashville before returning to school for a Master’s Degree in Social Work. The next few years would take me to Louisville, KY, Albuquerque, NM and Atlanta before marriage and a return to Nashville for the next ten years. I currently live in Reynoldsburg, OH, a suburb of Columbus.

My husband’s work brought us to Ohio; however, with the flexibility of having social work experience and past employment with the American Red Cross, I was soon able to find employment with the Greater Columbus ARC where I would be for the next seven years.

Upon my daughter graduating from high school and starting college, I decided to pursue another Master’s degree from the University of Dayton, this time in Counseling.

My career has been a journey lending me the opportunity to increase my experience and skills in mental health counseling, tobacco cessation, grief counseling and facilitating health and wellness programs. I am a behavioral health provider and a licensed professional counselor.

When I am not working, I am actively involved in community outreach programs, my church health ministry and an advocate for breast cancer awareness. My leisure time is spent sewing, crafting, reading, home gardening (houseplants), and yoga.

Before COVID, I was involved in an intense exercise program for cancer survivors and a collaborative lifestyle intervention program for knee osteoarthritis. I worked out 4 to 5 days per week in addition to learning the importance of healthy eating.

Q: When were you first diagnosed with hypertension? Many people immediately vow to make changes in their lives and to their lifestyles to avoid taking medication. Some people are shocked and had no idea that they had high blood pressure. What was your reaction?

A: I don’t recall exactly when I was diagnosed with hypertension, but it was soon following a diagnosis of fibromyalgia. I recall that each time that I visited the health care provider that I had at the time, my blood pressure would read as elevated. I attributed it to the relationship that I had with that provider that was by no means the best. Her bedside manner was not pleasant and I couldn’t wait to get out of her office. It wasn’t very long after that I changed providers. I was in my early 40’s and had a great deal of stress in my life at the time.

I actually thought that I would not succumb to hypertension, because of early changes I made in my life to try and avoid the disease. I always avoided extra salt, but perhaps what I didn’t do was change my lifestyle and some forbidden foods that are high in sodium content. Before I knew it, I was on medication and although my blood pressure was always normal at my doctor visits, there was never a discussion of removing me from the medication. I was devastated by the diagnosis, but in the next 10 years I would be diagnosed with breast cancer. At this point, survival was the focal point of my life. My mother died of breast cancer one year after my graduation from college. I wanted to live to see my daughter graduate college, get married and make me a grandmother.

Q: Were you surprised by your diagnosis of hypertension? Do you have a family history of hypertension or other chronic conditions? Do you know anyone else diagnosed with hypertension?

A: I was initially surprised by my diagnosis thinking that being conscious of my diet would make a difference. My maternal grandmother and later my father both had hypertension and my mother changed the way that we ate at home. With my picky eating habits, it was easy to continue some of the practices. Unfortunately, regular exercise wasn’t one of them. Years afterwards, my only sibling, a sister, would also have a diagnosis of hypertension about 10 years prior to my diagnosis.

Q: What steps did you initially take (with or without your health provider) to get your hypertension under control? Were these methods at all successful? Often health providers provide basic information on health conditions. Where did and do you look for information to learn more and stay current on hypertension control?

A: I don’t think initially I thought about changing the course of reversing my hypertension and getting off medication, especially when I would go for medical visits and was told it was normal. I was then focused on my breast cancer diagnosis and the fibromyalgia.

I don’t feel that health care providers really give the information that people need to manage their blood pressure or other diagnosis for that matter. I have read and learned lots of information on my own. In fact, I was trained to facilitate a self-management program for chronic conditions, diabetes and pain that have educated me on much more than I learned from my primary care. Because I am interested in women’s health, I try to stay informed through reading and support programs.

Before I knew it, I was on medication and although my blood pressure was always normal at my doctor visits, there was never a discussion of removing me from the medication.

Q: How has your lifestyle changed since ? (What was your diet before diagnosis vs. after? Has your physical activity changed? How has your awareness and knowledge about your health changed?)

A: After the birth of my daughter, I didn’t lose the so-called baby weight gain. I was shocked the first time I saw “obesity” as a diagnosis on my medical record. I’ve tried diets, evidenced-based diet programs and even exercise to try and lose weight, but I am usually easily bored and lose the motivation to continue.

Before COVID, I was involved in an intense exercise program for cancer survivors and a collaborative lifestyle intervention program for knee osteoarthritis. I worked out 4 to 5 days per week in addition to learning the importance of healthy eating. These programs unfortunately ended during COVID and I am only gradually returning to the gym. What I miss most is the support from other participants. I am not as motivated to do things alone.

Q: How did you learn about IAWH’s SMBP Program? What made you interested in participating? What have you gained from this program?

A: I have been a follower of IAWH programs for at least two years. I am a member of the NANBPWC, Inc., which I believe is an affiliate partner with IAWH. I was actually on a zoom meeting when the SMBP Program was introduced. I had hoped that NANBPWC, Inc. would apply to be one of the affiliates and that it would trickle down to the local clubs. As a member of the Health Committee of my local club, I was hoping that we would be able to qualify as a program affiliate.

I have gained enormously from the program. Measuring my blood pressure daily has been insightful and has increased my awareness of the disease. While I am not in the DC area where the other members are, I still feel a connection to the other ladies in my group and look forward to their input. I regret that I can’t participate in the physical activities that they do in a group and that is the missing piece.

My maternal grandmother and later my father both had hypertension and my mother changed the way that we ate at home.

Q: How and why did you decide to do this program?

A: I decided to do the program because first I was aware of the contents and benefits of participating. I was afraid at first since I wasn’t in the DC area that I might not be allowed to participate. I am so thankful that the consideration was made to include me.

Q: Do you have an accountability partner or partners for your SMBP hypertension control efforts and/or other things about your health? If yes, do you give each other reminders? How? Give some specific examples.

A: I feel that from my group, Carolyn Woods has been one of the most supportive. She has reached out to me by email, phone and sharing information with the group. I would like to build on developing partners for accountability. While I have friends and acquaintances in Columbus who have the same diagnosis, it has been difficult getting together. While we have discussions on the phone, I need a partner to encourage and motivate me to exercise.

Q: What have you gained from participating in this SMBP program? (What knowledge has been validated? What is something new that you learned or gained?

A: I have gained a lot of knowledge from the professional presenters as well as the informal discussion in the small group meetings. All of the presenters for “lunch and learn” have been great. I was especially impressed with the presentation by Dr.Yola and her recommendations for taking control of blood pressure by adding some supplements. She also confirmed what I knew about looking for reliable resources when researching information on media sites.

I was also very pleased when, unfortunately for the group, the breath and meditation activity was done virtually. It gave me a chance to participate. Yoga and then meditation are right up my alley. I have also learned lots about plant-based eating. It has helped me to make some significant changes in my diet.

Q: How are you approaching and understanding the management of our blood pressure differently now that you've been in the IAWH program?

A: When the program is over, I know that I will continue to monitor my blood pressure more often, no doubt still daily. I will continue to focus on increasing exercise and making lifestyle changes permanently instead of temporarily.

Q: Where would you like to be healthwise in five years?

A: In 5 years, I hope to reach and maintain a healthy weight. I also hope that I will be able to decrease the medication that I am taking. As my age and other chronic conditions will allow, I would like to remain physically active every day.

Q: What advice would you give to others who may be considering, just beginning, restarting, or continuing on a health improvement or a hypertension control journey?

A: I think it is important to research and study as much as possible about healthy living practices, including diet, nutrition, exercise, lifestyle and managing stress. Not only are these things important in avoiding hypertension, but also in controlling hypertension. Find an accountability partner. This is not always the person you are living with, so reach out to friends or get involved in a program. There are many programs and studies out there if you seriously look for them.

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Executive Directors Writer/Editor

Janine E. Payne, MPH Melissa Kluczynski, MS

Cheryl J. Thompson, M.S.P.H.

Finding Her Balance - Physical, Mental, and Spiritual Health

Meet Tanya, a very motivated woman who decided to join the IAWH Self-Measured Blood Pressure (SMBP) Hypertension Control Program after hearing about the program on her favorite radio show. She grew up in West Philadelphia, but has spent most of her adult life in the Washington, D.C. area, where she feels at home. Tanya has adopted a healthy cooking regime which has not only led to many physical benefits, but also provides her with much comfort and relaxation. Tanya loves walking in the park and has even found a walking buddy through the IAWH program. She wants to spread the message, “Love others enough by loving yourself.” Continue reading to learn more about Tanya and her health journey.

Q: Tell us about yourself. For example, where were you born, what you do for a living, your hobbies/interests/activities, how long have you lived where you live now? If you are not native to where you currently live, what brought you there?

A: I am a 62y/o hypertensive African American woman. I currently live in the Adams Morgan subdivision of Northwest Washington, DC. I have lived in Adams Morgan for six of my forty years in the Washington, DC metropolitan area. I am an educator and personal assistant.

I was born and raised in West Philadelphia and attended Philadelphia schools. I also attended Temple University through my sophomore year and then attended Virginia Union University for 3 years. I then moved to DC to attend Howard University's School of Engineering. This geographic area has always presented opportunities for growth, as well as, a wide range of diverse cultural spaces. In DC I felt a sense of belonging and familiarity among the brownstones, the history and tree-lined streets of this city. I enjoy long scenic walks in and around Rock Creek Park. My favorite past-times include listening to jazz, attending plays and concerts and gardening. Recently, I discovered that creating healthy meals is relaxing. I get a rewarding feeling, while cutting, slicing and preparing wholesome healthy and tasty meals.

I never took the prescription to be filled at the pharmacy. Diet changes did not happen. Sodium intake remained detrimentally the same. Nothing changed, if nothing changed!

Q: When were you first diagnosed with hypertension? Many people immediately vow to make changes in their lives and to their lifestyles to avoid taking medication. Some people are shocked and had no idea that they had high blood pressure. What was your reaction?

A: For most of my life I had been free from any physical illnesses. Aside from a childhood hernia and a recurrence in my twenties, I have been healthy and strong until I reached my early fifties. During a rare emergency room visit, for a serious depressive episode, vital signs indicated a blood pressure reading of 204/102. The attending emergency room physician ordered an EKG and decided that I would need to stay in the ER until my blood pressure lowered to a non-critical level.

Fourteen hours later I was admitted for acute depression and chronic hypertension. Upon release, I was given a prescription for 10mg once daily of Amlodipine Besylate. I now had a diagnosis of Hypertension Stage 2. The severity of my condition was never explained to me. There was never a conversation with the medical personnel about necessary changes to diet or adoption of healthier habits. So I left the hospital with a prescription in hand and went back to life as I knew it.

I never took the prescription to be filled at the pharmacy. Diet changes did not happen. Sodium intake remained detrimentally the same. Nothing changed, if nothing changed! Hypertension remained, silently effecting my organs. My 20/20 vision was no more. My annual physical exams revealed higher and higher blood pressure readings each year. The two primary care physicians that I had over the course of a ten-year period did take an interest. They tried to emphasize the impact that uncontrolled, untreated hypertension would have. On a recent visit to the dentist to have a small cavity filled, the procedure was denied when the dentist, upon taking my vitals, got a blood pressure reading of 201/90. The dentist ordered me to go to the hospital immediately. Admittedly, I had not complied with physician's prescribed medications. Low self-esteem, lack of discipline and complete lack of knowledge about the disease caused me to minimize my condition. The dentist’s warning was the very first time that I actually realized the urgency and severity of my hypertensive condition.

Immediately, after leaving the dentist I returned to my apartment and took my medication. Then I logged into my MyMedstar patient portal and left an urgent message for my primary care physician. My doctor urged me to schedule an appointment immediately. Within a week, the office visit took place. My physician did a medication review and recommended adding another medication to the regimen. This time, a conscious decision was made to adhere to all medical advice and prescribed medications. Shortly thereafter, I made a firm and critical decision to effectively and positively change my unhealthy habits.

Q: Were you surprised by your diagnosis of hypertension? Do you have a family history of hypertension or other chronic conditions? Do you know anyone else diagnosed with hypertension?

A: Yes, I was surprised by my diagnosis.

Q: What steps did you initially take (with or without your health provider) to get your hypertension under control? Were these methods at all successful? Often health providers provide basic information on health conditions. Where did and do you look for information to learn more and stay current on hypertension control?

A: Being at home all day during the COVID-19 pandemic, gave me the opportunity to plan my meals and grocery-shopping lists to be compatible with the well-balanced nutritional goals that I desired to accomplish. Drastically reducing or eliminating certain things like sodium, processed foods, and sugary snacks was a major change. Long walks around the neighborhood and nearby parks helped me focus on my resolve to get better and stay better, while, at the same time getting fit. I routinely took my medication. Drinking plenty of water was also something of importance to my lifestyle correction. I also read many research - based articles on diet and exercise.

Q: How has your lifestyle changed since? (What was your diet before diagnosis vs. after? Has your physical activity changed? How has your awareness and knowledge about your health changed?)

A: A typical day’s food choices include, low fat organic Greek yogurt topped walnuts, almonds, fresh or frozen berries. I sprinkle chia or flax seeds on almost everything. Scrambled eggs are also a choice. Sardines, salmon, beans over long grain rice, Tuna fish open - faced sandwiches or boiled eggs, baked chicken, salads, string beans, cabbage, fresh vegetables of all sorts seasoned with herbs, garlic, onions and cooked with low sodium vegetable broth. Keeping track of my sodium intake is imperative. I have discovered that mindful meal planning and creative food preparation is exciting and delicious. The aroma of fresh wholesome foods is therapeutic. Passionate preparation of meals brings me joy and satisfaction.

Being at home all day during the COVID-19 pandemic, gave me the opportunity to plan my meals and grocery-shopping lists to be compatible with the well-balanced nutritional goals that I desired to accomplish.

Q: How did you learn about IAWH’s SMBP Program? What made you interested in participating? What have you gained from this program?

A: One day, while listening to my favorite radio station, 89.3FM (WPFW Jazz and Justice) the talk segment of the hour featured one of the Co-Directors of the Institute For The Advancement Of Women's Health, She spoke about a program that would include 20 female hypertensive participants. I immediately believed that my participation would be a perfect opportunity to gain support and knowledge. I also hoped that a platform for accountability and networking would be available to me. I immediately completed the on-line application and was accepted into IAWH's Self-Monitoring Blood Pressure (SMBP) program. It was a very happy moment when I received notification of my acceptance into the group.

I made an honest commitment to wholeheartedly participate in the activities, virtual Small Groups and Lunch and Learn sessions with highly qualified medical, nutritional, fitness and other health professional and experts in their respective fields. The other women in the program have been highly supportive. They share with transparency their personal experiences, struggles and successes. I have made new acquaintances and friends whom I share the common goal for achieving quality lifestyles by improving our health standards.

Once a week, I and another Washington, DC participant meet up at a popular trail in Rock Creek Park and enjoy an hour long fresh air and scenic hike. It's rewarding and exhilarating! Even better, IAWH provides each participant with a Bluetooth OMRON Blood Pressure monitoring device. I take my blood pressure twice daily and it has become a part of a new routine that provided the accountability which I definitely wanted and needed.

I gratefully welcomed the feeling of being cared about. Happily, I can report that the biggest and best benefit and accomplishment from being one of the program participants has resulted in a major reduction of my average blood pressure readings. At the time of this writing, six-months after joining the SMBP program, my weekly average BP is 121sys/71dia. This is a 30-point lower difference in my systolic pressure. I joyfully report that I feel so much better. I received excellent information and tips from my co-participants. The women are friendly and willing to share.

Taking good care of yourself and your body, mind and soul is the best way to show love to others.

Q: How and why did you decide to do this program?

A: I wanted a support system that would bolster accountability.

Q: What have you gained from participating in this SMBP program? (What knowledge has been validated? What is something new that you learned or gained?

A: I have been able to share my weekly readings with my primary care provider. This was a valuable tool for my medication management. My primary care provider (PCP) was able to note any fluctuations or patterns that required attention or possible medication changes. I also used tools like my online Patient Portal to communicate with my physician. Also, valuable to me are the articles and essays shared through the IAWH's interactive online forum.

I have benefited from shared recipes and affirmations. The IAWH's SMBP program has been a priceless addition to my life and lifestyle. Although I recognize that progress is only sustainable with dedication and commitment, I realize that whole body health is physical, mental and spiritual maintenance. I have recently sought and acquired mental health services for therapy and emotional balance. I fellowship and worship with my spiritual family at my church. My health insurance qualified me for a free annual membership at The Anthony Bowen YMCA. My advice to others who have health challenges is to embrace the programs and services that are available. Seek out resources. "Love others enough by loving yourself”. Taking good care of yourself and your body, mind and soul is the best way to show love to others. I decided that it was selfish to possibly burden others by being too unhealthy to take care of myself. Therefore, it made better sense to avoid the pitfalls of poor health and rise up for better health and well-being each day that I am BLESSED with another day. Keeping this focus has allowed me a healthier outlook, lower blood pressure and potential to live a longer joyful life.

Q: How are you approaching and understanding the management of our blood pressure differently now that you've been in the IAWH program?

A: After losing thirty pounds, I still strive and commit to leave the obese category. I know that weight management is very much a part of controlling or reversing hypertension. My goal is to lose thirty more pounds over the remainder of 2022. I view my weight loss as a major success and realize that more progress will follow.

Q: Where would you like to be healthwise in five years?

A: In five years, I will be free and in normal BP range on a regular basis. I will be at a normal weight for my height. My body mass index (BMI) will have improved greatly.

Q: What advice would you give to others who may be considering, just beginning, restarting, or continuing on a health improvement or a hypertension control journey?

A: If you need added support and accountability for your condition, the Institute for the Advancement of Women's Health Self-Monitoring Blood Pressure program is second to none. If they accept me again I will join the next group. It has been a super-fun, super- rewarding and supportive learning experience. From the professional and kind approach of the IAWH team, to the group of women that shared this experience with me for six months, it has been amazing. The other women in my group have enhanced my life in immeasurable ways.

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Executive Directors Writer/Editor

Janine E. Payne, MPH Melissa Kluczynski, MS

Cheryl J. Thompson, M.S.P.H.