Why Knowing Your Blood Pressure Is Critical to Longevity | Dr. Peter Attia & Dr. Andrew Huberman
00:00:00.000 | um, since sometimes your recommendations deviate from the,
00:00:05.000 | the standards that one would find online or in the typical doctor's office,
00:00:09.120 | at what point do you get concerned?
00:00:11.000 | Well, I'm, I actually find myself, uh,
00:00:13.640 | quite in line with the most recent available data on blood pressure.
00:00:18.280 | And this has been, um,
00:00:19.920 | obviously there's a topic that's of high concern to any doctor who's taking care
00:00:23.360 | of patients who even pays a fraction of attention to the available literature,
00:00:27.400 | which is that basically with each subsequent blood pressure trial,
00:00:31.840 | the data are becoming clearer and clearer that the more aggressively you manage
00:00:36.320 | blood pressure to be within the one 20 over 80 range, the better.
00:00:41.320 | So, you know,
00:00:42.480 | there's a recent study that even looked at going from what used to be considered
00:00:46.440 | acceptable, which was one 30 to one 35 over 80 to 85.
00:00:49.920 | We used to basically say that's kind of the first level of hypertension.
00:00:54.680 | And we would say, well, you know, do you really need to be better than that?
00:00:58.320 | And the answer turns out to be, yes, you do.
00:01:00.560 | If you want to reduce heart attacks and strokes B,
00:01:03.600 | it's better to be one 20 over 80 than one 35 over 85.
00:01:07.200 | Now this is a whole other rabbit hole that we don't need to go down,
00:01:09.720 | but it's a total obsession of mine,
00:01:11.560 | which is how do you measure a person's blood pressure?
00:01:14.080 | I think this is potentially, I'd have to give it thought,
00:01:18.520 | but honestly I could say top three under diagnosed fixable problems is the
00:01:23.780 | high blood pressure.
00:01:24.660 | It's one of the highest fixable problems in the United States today and probably
00:01:28.300 | globally. In other words,
00:01:29.420 | there are too many people walking around with high blood pressure who don't know
00:01:32.660 | it. And I think part of the problem is it's something that is mostly done in the
00:01:37.660 | doctor's office and the readings that you get in the doctor's office can be often
00:01:41.980 | misleading. You've heard of this phenomenon of white coat hypertension.
00:01:45.260 | So you go to the doctor,
00:01:46.220 | your blood pressure is virtually never measured correctly in the doctor's office.
00:01:51.780 | He's bold. Yeah. If you,
00:01:52.860 | if you look at the rigor with which you need to measure a person's blood
00:01:56.420 | pressure,
00:01:56.780 | the right way to do it is the person has to be sitting like this for five
00:02:01.780 | minutes doing nothing. Okay, folks. So when you go to the doctors now,
00:02:05.780 | you don't let them, don't let them take your blood pressure.
00:02:08.140 | Sitting for five minutes and that doesn't include in the waiting room because if
00:02:11.380 | you walk, because then you get up and walk over. Right. Okay.
00:02:13.700 | So make them stand there. Right. So you, you want to be sitting there like this.
00:02:18.140 | A manual cuff is better than an automated cuff,
00:02:21.060 | but not enough people use manual blood pressure.
00:02:24.460 | So a manual blood pressure means they put a cuff on you and they actually put a
00:02:28.500 | stethoscope on the brachial artery and they're, you know,
00:02:31.260 | using the human ear to listen, which believe it or not,
00:02:34.060 | you would think a machine is better, but it's not.
00:02:36.180 | The machine can be misled by different sounds.
00:02:38.580 | Now I don't want to suggest that automated cuffs are useless. They're not.
00:02:41.740 | But when an automated cuff gives you an answer that is, you know,
00:02:46.740 | potentially suspect, always back it up with a manual.
00:02:49.180 | I'm pretty relentless about checking my blood pressure.
00:02:51.620 | And so I'll do side to side manual versus automated every day.
00:02:57.100 | And there's easily a 10 to 15 point difference between them.
00:03:00.500 | Maybe this is a silly question, but can people check their own blood pressure?
00:03:04.220 | Meaning manually? Yeah. Just could it, could I get it,
00:03:07.500 | get a cuff and a bulb and learn how to do it? Yeah, I think so. I mean,
00:03:11.260 | I can do it, but honestly, I usually have my wife do it. She's a nurse.
00:03:14.860 | But it's not rocket science to check blood pressure. I guarantee you,
00:03:17.780 | there's a great video on YouTube that explains the physiology of it.
00:03:20.740 | And if you're willing to splurge on a good enough stethoscope and cuff,
00:03:24.620 | like the cuff I have is really easy to use. Like it's once you put it on,
00:03:28.260 | you know,
00:03:28.820 | it's in a single thing I'm squeezing the bulb and looking at the pressure gauge
00:03:32.500 | while I've got the, you know, stethoscope on my artery.
00:03:36.260 | I mean,
00:03:36.660 | given the importance of blood pressure and this arteriosclerosis being at the top
00:03:42.140 | of the list of risks for dying.
00:03:45.380 | It seems to me it might be worth the expense. What,
00:03:48.180 | what's a typical range of costs for, for the quality?
00:03:50.980 | I don't, it's not, it's not an ordinate.
00:03:52.780 | Like I feel like my blood pressure cuff is 40 bucks and the stethoscope is a
00:03:57.820 | couple hundred bucks if you're getting a good one. And you know,
00:04:01.660 | good automated cuff. There's, I, I have no affiliation with any of these companies.
00:04:05.620 | I use a, I use two automated cuffs.
00:04:07.500 | One's called Withings and the other one's made by a company called Omron,
00:04:11.060 | O-M-R-O-N. And they're both decent, but again,
00:04:14.660 | they tend to run high and I have yet to find a credible explanation from
00:04:19.700 | cardiologists as to why.
00:04:20.980 | Everybody acknowledges that the manual one when done correctly is the answer,
00:04:25.540 | but I've heard wonky answers about why automated ones are sometimes incorrect.
00:04:31.180 | And again, it's just made me realize we're not checking blood pressure often
00:04:35.940 | enough on people. We're overly relying on blood pressures in the doctor's office,
00:04:39.820 | which are not being done correctly.
00:04:40.740 | So we basically have our patients do this relentlessly.
00:04:44.140 | So how often, let's say someone buys this, cause I think for $240, I mean,
00:04:48.740 | I realize that's prohibitive for some people,
00:04:50.500 | but given the cost of some of the other things that are discussed on this and
00:04:53.900 | many other podcasts,
00:04:54.740 | I would just have people start with an automated cuff to begin with and just
00:04:57.940 | start with there. We generally have people do it for two weeks. You know,
00:05:01.820 | we give our patients a little spreadsheet that automatically calculates
00:05:04.820 | averages and stuff like that. Tells them what to record and where.
00:05:07.220 | And we just say, look, for two weeks, we want to see two recordings a day.
00:05:10.500 | And you know,
00:05:12.340 | do in morning and an afternoon slash PM recording twice a day for two weeks and
00:05:17.340 | let us see those numbers and we'll scrutinize them further.
00:05:23.100 | And if those numbers come in fine, let's revisit in a year.
00:05:26.900 | Will a day ever come when a watch or a wristband can do this really well?
00:05:33.260 | So I hope so. And I'm investigating it.
00:05:36.540 | I I'm actually going to be trying one out in a couple of weeks with a company
00:05:41.780 | that I tried two years ago, two years ago when I tried it, I was not impressed.
00:05:48.140 | So I kind of punted on it. The company,
00:05:51.860 | which I guess I'll not share the name of the company just yet, but they,
00:05:55.340 | they claim that it's significantly better.
00:05:57.660 | So I'm going to put it to the test again and it's basically a continuous
00:06:02.540 | monitor. So it,
00:06:03.660 | it's a wrist device that about every 15 minutes throughout the course of the
00:06:07.860 | day, we'll check your blood pressure. To me,
00:06:11.500 | this would be honestly probably more important. You know,
00:06:14.980 | you know how much emphasis I place on CGM as a great thing to be able to test
00:06:18.620 | glucose monitor, right? I would argue this would be more important when the day
00:06:21.780 | comes that we can continuously assess people's blood pressure.
00:06:24.460 | It would be an integral part of a person's, you know,
00:06:28.460 | health checkup once a year is do two weeks of continuous blood pressure
00:06:32.100 | monitoring right now to do that,
00:06:34.180 | which I've done as well is so cumbersome that it borders on absurd.
00:06:38.340 | You actually have to wear a blood pressure cuff that is attached to a clumsy
00:06:42.660 | device that goes through the whole insufflation exercise every 15 minutes,
00:06:46.900 | including while you're sleeping. You know, it provides some insight,
00:06:50.340 | but it's so disruptive that it's not what we really want. What we,
00:06:53.700 | the dream would be like a patch that you could put, I don't know,
00:06:57.620 | over your chest that can somehow impute changes in blood
00:07:02.500 | flow or something like that and regulate. But we'll see, you know,
00:07:06.980 | between optical sensors and things like that.
00:07:09.100 | I hope that we're getting closer to having something.
00:07:12.460 | [Inaudible].
00:07:13.460 | [Inaudible].