The Peter Attia Drive
AMA #48: Blood pressure—how to measure, manage, and treat high blood pressure
Mon Jun 12 2023Description
This episode provides a comprehensive overview of blood pressure, its measurement, and its impact on cardiovascular health. It emphasizes the importance of lifestyle changes in managing blood pressure and discusses the findings of the Sprint Trial, which demonstrated the benefits of aggressive blood pressure control. The episode also highlights the different categories of blood pressure and their significance.
Insights
Measuring Blood Pressure
Measuring blood pressure at home is more accurate than in a doctor's office.
Lifestyle Changes
Weight loss, exercise, and nutrition can help lower blood pressure.
Pharmacologic Choices
If lifestyle changes fail, there are pharmacologic choices available.
Importance of Knowing Blood Pressure
Knowing your blood pressure is crucial for preventing cardiovascular disease and dementia.
Understanding Blood Pressure
The heart pumps blood through the arteries during systole, which is when the ventricles contract. The left ventricle is responsible for pumping blood to the rest of the body against systemic resistance. Blood pressure measurements typically refer to the blood pressure in the circulatory system of the periphery, not in the lungs. During systole, blood leaves the heart through the aortic valve and moves quickly to the rest of the body. There is a pressure in the artery experienced by blood pushing against its walls during systole. After systole, during diastole, the heart relaxes and fills with blood through the atria. The heart receives its own blood supply during diastole while other organs receive theirs during systole. Even though arterial pressure is lower during diastole, there is still some pressure within artery walls. Blood pressure readings consist of two numbers: one for systolic pressure (during contraction) and one for diastolic pressure (during relaxation). High blood pressure is defined as having a systolic reading at or above 130 or a diastolic reading at or above 80.
Blood Pressure Categories
Normal blood pressure is less than 120 and less than 80. Elevated blood pressure is 120 to 129 over less than 80. Stage one hypertension is 130 to 139 or 80 to 89. Stage two hypertension is greater than 140 or greater than.
The Sprint Trial
The Sprint Trial was a study published in 2015 that examined the benefits of aggressive blood pressure control. The trial included just under 10,000 people with systolic blood pressure of at least 130 who were at advanced cardiovascular risk but did not have type 2 diabetes. Participants were randomized into two groups: intensive treatment (systolic blood pressure less than 120) and standard treatment (blood pressure less than140). After one year, the average systolic blood pressure in the intensive group was significantly lower at121.4 mmHg compared to136.2 mmHg in the standard group. The primary outcome of reduction in cardiovascular mortality showed a significant relative reduction of about25% and an absolute risk difference of approximately0.54% over one year. All-cause mortality was also reduced by27% with a1.2% absolute risk reduction. Aggressive blood pressure management to a systolic pressure less than120 compared to standard care (130-140) demonstrated clear efficacy.
Importance of Blood Pressure Control
High blood pressure left untreated for most of a person's life can have long-term consequences. The short duration of the trial still gives confidence that high blood pressure should be taken seriously. Compounding is powerful in relation to smoking, apo B, and blood pressure. Hypertension and smoking disrupt the endothelium, while Apo B causes pathologic events. Lower is better when it comes to blood pressure. Even if someone has normal blood pressure but is creeping towards elevated levels, it may be cause for concern.
Chapters
Introduction
00:11 - 06:56
- This episode focuses on blood pressure and its importance in cardiovascular disease prevention.
- Measuring blood pressure at home is more accurate than in a doctor's office.
- Weight loss, exercise, and nutrition can help lower blood pressure.
- If lifestyle changes fail, there are pharmacologic choices available.
- Knowing your blood pressure is crucial for preventing cardiovascular disease and dementia.
- The AMA episode includes figures and studies discussed in the podcast.
Understanding Blood Pressure
06:32 - 13:30
- The heart pumps blood through the arteries during systole, which is when the ventricles contract.
- The left ventricle is responsible for pumping blood to the rest of the body against systemic resistance.
- Blood pressure measurements typically refer to the blood pressure in the circulatory system of the periphery, not in the lungs.
- During systole, blood leaves the heart through the aortic valve and moves quickly to the rest of the body.
- There is a pressure in the artery experienced by blood pushing against its walls during systole.
- After systole, during diastole, the heart relaxes and fills with blood through the atria.
- The heart receives its own blood supply during diastole while other organs receive theirs during systole.
- Even though arterial pressure is lower during diastole, there is still some pressure within artery walls.
- Blood pressure readings consist of two numbers: one for systolic pressure (during contraction) and one for diastolic pressure (during relaxation).
- High blood pressure is defined as having a systolic reading at or above 130 or a diastolic reading at or above 80.
Blood Pressure Categories
13:08 - 20:32
- Normal blood pressure is less than 120 and less than 80.
- Elevated blood pressure is 120 to 129 over less than 80.
- Stage one hypertension is 130 to 139 or 80 to 89.
- Stage two hypertension is greater than 140 or greater than.
The Sprint Trial
20:09 - 25:35
- The Sprint Trial was a study published in 2015 that examined the benefits of aggressive blood pressure control.
- The trial included just under 10,000 people with systolic blood pressure of at least 130 who were at advanced cardiovascular risk but did not have type 2 diabetes.
- Participants were randomized into two groups: intensive treatment (systolic blood pressure less than 120) and standard treatment (blood pressure less than140).
- After one year, the average systolic blood pressure in the intensive group was significantly lower at121.4 mmHg compared to136.2 mmHg in the standard group.
- The primary outcome of reduction in cardiovascular mortality showed a significant relative reduction of about25% and an absolute risk difference of approximately0.54% over one year.
- All-cause mortality was also reduced by27% with a1.2% absolute risk reduction.
- Aggressive blood pressure management to a systolic pressure less than120 compared to standard care (130-140) demonstrated clear efficacy.