"You may not feel ill, yet it silently wreaks havoc on your body." This statement perfectly encapsulates the insidious nature of high blood pressure. To unveil the risks of this condition, and how it can be measured, managed, and treated, we dive into an insightful conversation from episode 48 of Dr. Peter Attia’s AMA (Ask Me Anything) series on the Drive podcast.
"High blood pressure, along with high APO B and smoking, is one of the three leading causes of atherosclerosis," Peter explains, "What's perhaps most insidious is that many of you listening to this don't actually realize you have high blood pressure."
Understanding Blood Pressure
Blood pressure is a concept that is both simple and complex. It is, as Dr. Attia explains, the pressure exerted by circulating blood on the walls of blood vessels. It’s a dynamic quantity that fluctuates with the rhythm of our heartbeats, involving two phases of the cardiac contraction - systole (heart contracts) and diastole (heart relaxes).
The two-part reading of blood pressure, systolic pressure over diastolic pressure, represents these phases. When you see a blood pressure reading like 120/80, 120 refers to systolic pressure, the pressure in the arteries when the heart contracts. The 80 refers to diastolic pressure, the pressure in the arteries during relaxation between heartbeats. When either or both of these readings are consistently high, a person is said to have hypertension or high blood pressure.
While the mechanics of blood pressure are relatively simple, its effects on the body are complex and profound. Hypertension is widespread, affecting millions worldwide, and its stealth nature means it often goes undetected. It's been called a "silent killer" because many people with high blood pressure feel perfectly fine, but internally, the condition could be causing severe damage to their heart and blood vessels.
Peter emphasizes that getting an accurate blood pressure reading is of utmost importance, as the measurements taken in a doctor's office might not provide an accurate representation of your typical blood pressure levels.
"You get a cuff and you figure out how to do this at home," he recommends. "It's really the way in which you go about doing this and the repeatability of the measurements and the time you take to do it that determines whether or not you can make the diagnosis of high blood pressure."
Peter goes on to discuss the various factors that can influence blood pressure, such as weight loss, exercise, and nutrition. However, when lifestyle changes fail to produce the desired results, he delves into the pharmacologic choices available.
Peter's comprehensive discussion on blood pressure also encompasses its profound effects on cardiovascular disease and dementia. He highlights how high blood pressure contributes significantly to the risk of these diseases and how managing blood pressure effectively can reduce this risk.
The conversation goes beyond just understanding blood pressure, moving into a detailed explanation of systolic and diastolic pressures, and their significance. He also clarifies some of the key terms and guidelines associated with hypertension.
Measuring Blood Pressure
Given the hidden danger of hypertension, accurate and regular measurement of blood pressure becomes crucial. However, Dr. Attia raises a critical concern about the common practice of measuring blood pressure in doctors' offices. Such readings, he notes, are often flawed due to the brief snapshot they provide and the potential for white coat syndrome, where a patient's blood pressure may be elevated simply because they are anxious in a medical setting.
Therefore, Dr. Attia emphasizes the importance of individuals measuring their blood pressure at home. Using automated or manual cuffs, individuals can take multiple measurements at different times, providing a more accurate and comprehensive picture of their blood pressure. The most critical aspects include the process of measurement, the repeatability of measurements, and the time of measurement.
"Hypertension is then divided into two stages. Stage 1 hypertension involves systolic pressure ranging from 130-139 or diastolic pressure from 80-89. Stage 2 hypertension is identified when systolic pressure is 140 or higher, or diastolic pressure is 90 or higher". Peter explains.
Interpreting Blood Pressure Readings
Understanding blood pressure readings is another crucial piece of the hypertension puzzle. Dr. Attia breaks down the classification of blood pressure into normal, elevated, and two stages of hypertension, as outlined by the American Heart Association. Normal blood pressure is considered a systolic reading below 120 and a diastolic reading below 80. Elevated blood pressure is identified when systolic readings consistently range from 120-129, and diastolic pressure is less than 80.
Hypertension is then divided into two stages. Stage 1 hypertension involves systolic pressure ranging from 130-139 or diastolic pressure from 80-89. Stage 2 hypertension is identified when systolic pressure is 140 or higher, or diastolic pressure is 90 or higher.
The Risks of Untreated Hypertension
The importance of managing hypertension is accentuated when Dr. Attia elaborates on the potential health risks posed by uncontrolled high blood pressure.
He explains, "When left untreated, high blood pressure can lead to serious complications, such as heart disease, stroke, kidney disease, and even cognitive decline."
Dr. Attia underlines, “It's crucial to understand that high blood pressure is a risk factor for atherosclerosis, the buildup of plaque in your arteries. This can lead to heart attacks and strokes. It's a slow process, but the end result can be devastating."
Managing and Treating High Blood Pressure
When it comes to dealing with a diagnosis of hypertension, Dr. Attia offers comprehensive advice, emphasizing lifestyle modifications as the first line of defense.
"Lifestyle changes like weight loss, regular exercise, dietary changes, stress management, and reducing alcohol consumption can all help lower blood pressure," he says.
However, he also acknowledges that lifestyle changes may not be enough, prompting the need for medical intervention. He stresses, "Even with the best efforts at lifestyle changes, some people will still need medication to manage their blood pressure. That's why it's important to have a close relationship with your healthcare provider."
Medications for Hypertension
Dr. Attia further explores the role of medication in hypertension management, underscoring that the treatment approach should be individualized. He says, "There's no one-size-fits-all approach to treating high blood pressure with medications. It depends on your overall health, the severity of your hypertension, and how your body responds to different medications."
"There are multiple classes of blood pressure drugs, including diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and more. Each class works differently and has different side effects."
- High blood pressure is one of the leading causes of atherosclerosis.
- Blood pressure measurements taken at home are more accurate than those taken in a doctor's office.
- High blood pressure can be classified into normal, elevated, and two stages of hypertension.
- Lifestyle changes and pharmaceutical interventions can help manage high blood pressure.
- High blood pressure is a major risk factor for cardiovascular disease and dementia.