EVERYTHING You NEED to Know About High Blood Pressure

Hello everybody, this is Dr. John Osborne, the Chief Scientific and Medical Officer of Cleer Cardio. I am really excited to show you today one slide that will tell you everything that you need to know, for the most part, about the disease that half of US adults have. Many of them have no idea they have it. Many of them may know they have it, but aren't under treatment. Some know they have it, some are being treated for it, but it's not controlled. And as it turns out, a very small number of people with this condition that affects half of US adults know about it, are in treatment, and this condition is controlled. And this problem is high blood pressure. In fact, what's striking to me A statistic that really just sticks with me all the time, that high blood pressure, because it is shared by so many people in the United States, in fact, from the age of 40 onwards, the lifetime risk of developing high blood pressure in the US is 90%. But if you look at all adults, 18 and up, just adults, all ages, all comers, half of US adults have it. But by the time we're 40 or above, our lifetime risk developing high blood pressure is 90% in the US. So it is astonishingly common. It is asymptomatic. That's why they call high blood pressure the silent killer, because your blood pressure could be normal, it could be modestly elevated, really elevated, or really, really elevated, and odds are you'll feel fine. I will say there are a lot of people who say, well, you know, I get flushed, I get a headache, or I feel my blood pressure. I'm going to say, you know, the best way to understand and check and monitor your blood pressure is you got to take it. So a couple things I'm going to mention before we go into the slide about how important blood pressure is, what's good, what's bad, what's ugly, where the harm begins, is how we should check blood pressure. As it turns out, home blood pressure monitoring is even more accurate than what we call seated cuff blood pressure in the clinic. And that's because of a lot of reasons. Mostly, at home, you get a lot more numbers. So the more numbers we have, the better we can see what the trend is, what the average is. Whereas when you're in the clinic, we might check it once, maybe sometimes in some clinics they check it twice. Sometimes, rarely, 3 times. So because you're checking it multiple times at home, different times of the day, we'll always get a better understanding of the real mean, the average, what the trend is at home than just the average blood pressures in the office. Of course, you know, and you've probably heard of something called white coat hypertension, right? You go to the doctor's office and your blood pressure goes up just because you're freaked out and you're anxious. I get it. By the way, there also is the opposite of white coat hypertension. It's called masked hypertension. So masked hypertension means that you're at the office, you're chill, you're having a good time with the staff, the doc, whomever, and your blood pressure looks great. But out in the real world, it's high, and that does exist. So that's why checking it at home is so Very important. In addition, another very important point is use an upper arm cuff blood pressure monitor. The wrist monitors, I'm going to say, and I say this all the time, the wrist monitors are random number generators. You might as well flip a coin to understand what your blood pressure is. So you have to use the right equipment. The upper arm blood pressure monitors are great. So my favorite blood pressure monitor right now, and of course they always evolve and change, Is one called the Omron, O-M-R-O-N, Omron. They make lots and lots of blood pressure cuffs and monitors, but don't buy their wrist monitor, okay? Wrist monitors are junk. Not useful, not helpful. They make a blood pressure cuff called the Omron Evolv, E-V-O-L-V, available on Amazon, and it's like $70. Really slick, fairly compact, also hooks up to your phone via Bluetooth. It'll send all the blood pressure data right to your Bluetooth phone, create a nice log of that. It's a really slick app as well. So that's a great blood pressure monitor, but frankly, any of the digital monitors that are out there that are upper arm cuff blood pressure monitors are great. The key thing is use it a lot. In general, I'm going to tell you, check your blood pressure in the morning. If you're just going to check it once daily, check it in the morning because— You're going to be the lowest. The blood pressure in the morning is generally the highest blood pressure of the day, and I want to see the worst blood pressure of the day. So when you're checking it, if you're just going to check it once, check it in the morning. Now, you can check it multiple times throughout the day. I just, I don't want to burden anybody with checking it and getting all wrapped up in their blood pressure too much, but you can check it multiple times. But if you want to confirm that your highest blood pressures are in the morning, Check in the morning and maybe a few other times during the day, at least to start, to see if that's your pattern. Most people, highest blood pressure is in the morning when you wake up. But sometimes, that's not always the case, but you can confirm that with your own blood pressure cuff and your own blood pressure numbers. So why in the morning? Well, because at night, our body is preparing us for the stress of waking up. We make cortisol, lots of adrenal hormones. We make epinephrine, norepinephrine. Adrenaline, all these stress hormones, they begin to pour out of our body, our hypothalamus, our brain, in the early hours of the morning. So our blood pressure starts going up in the early hours of the morning in preparation for the stress of waking up. So that's why in the morning our blood pressure is generally the highest that it's going to be over the next 24 hours. Again, not all the time, but you can check your blood blood pressure a few times during the day and see if your highest is in the morning or not. Most people, that'll be the case. Now let's jump into a classic study. I'm going to go back to 23 years ago. This is 2002, published in one of the world's best medical journals called The Lancet. This was a group of hypertensionologists, a group of investigators from Uh, the remarkable statistical and medical research group at Oxford University. And what they wanted to do was very simple. What they wanted to do was to isolate high blood pressure as a sole variable, understand what high blood pressure meant with respect to cardiovascular death. So that's something that's pretty important. So I'll tell you how they did that, and then I'm going to walk you through This slide right here. So what they did back then is, this is big data, 23 years ago, they took 1.2 million people, 61 trials, lumped all those individuals and all those trials together. They then divided those group— those individuals across 4 different blood pressure groups, as shown here, starting at 115/75. Then lastly, and I'll tell you how they did it scientifically, but I'll tell you really what it means in a moment, Then lastly, what they did is statistically adjust for all the other risk factors for cardiovascular events, for strokes and heart attacks. So age, sex, blood pressure, cholesterol, diabetes, weight, et cetera. So by adjusting for all those other risk factors for heart disease, they could isolate the impact of blood pressure alone on cardiovascular events. Cardiovascular death. This is death due to either a fatal stroke or a fatal heart attack, something that we want to completely avoid. I'm sure you do, and I most certainly do as well. So the way I like to explain it, and I'll avoid from now on all the scientific ways that they did to answer this question, what is the impact upon blood pressure as a sole variable on cardiovascular death? The way I— like to explain these slides is imagine I had 2 twins, one twin with a blood pressure here, one twin with a blood pressure here, and they're identical in every way— cholesterol, age, of course, blood cholesterol, blood sugar, height, weight, etc. But the only difference between these 2 twins is their blood pressure. So what they found is that starting from here, 115 over 75, which is normal blood pressure. By the way, I'll get to these horizontal bars in a moment, what they mean. For the most part, for right now, we're just going to focus on the vertical rectangles. So what they found was that starting at 115 over 75, which is normal, every time we go up 20 points higher on the top, shown here, that's the systolic blood pressure, or 10 points higher on the bottom, That's the diastolic blood pressure. Either one, 20 points higher on the top, 10 points higher on the bottom, the risk of a fatal stroke or a heart attack solely based on the difference in blood pressure has now doubled. If we go up another 20 or 10, doubles again. Another 20 or 10, doubles again. So to put this, say this same thing in a slightly different way, If there were 2 twins, one twin here with normal blood pressure, the other twin in this 4th column here with a blood pressure of 175 on the top or 95, whichever one of these numbers is higher, this twin, all other variables equal, is at 8 times the greater risk of a fatal stroke or heart attack than this twin at this blood pressure. So really striking, and I can't tell you When I show this to my patients, I walk them through the study, what this means, pretty consistently, whenever I walk people through this, they go, oh, wow. And in fact, that's why we're doing this video today, so that I can share this with oodles of people, because this is so incredibly important. I mentioned before an amazing statistic. I'm gonna share that with you now, and I think this begins to make some sense in light of what we just walked through. If tomorrow, because high blood pressure is so common, so prevalent in the US, half of US adults have it, from the age of 40, 90% of us will get it. If tomorrow we're able to eliminate high blood pressure, okay, via whatever mechanism, a miracle, medications, diet, exercise, whatever, but we're able to eliminate high blood pressure and tomorrow everybody's blood pressure was normal, simply by doing that, And nothing else, forget cholesterol, smoking, diet, exercise, treating diabetes, any of those things that we do in my space to make people live longer, better, happier, keep you happy and above ground, I like to say, if we eliminated high blood pressure tomorrow, we would extend the lifespan of everyone in the US by 3.2 years. Now, you might go, 3 years, that's pretty cool. But that's 3 years. It's not 10 years, 20 years. Okay, let me put this in a frame of reference. If tomorrow all women got mammograms as appropriate, as they should, to detect breast cancer early and then treat them, if we did that perfectly, all women getting mammograms in the US to detect early breast cancer and then treat them, that would extend the average lifespan Of all of us, sharing that benefit across men and women by 1 month. Eliminating high blood pressure, averaging that benefit across everyone, reducing the risk of heart failure, kidney damage, dialysis, blindness, strokes, and plaque development, eliminating high blood pressure would add on another 3.2 years for everybody equally. Mammograms for women, add on 1 month. Now, it's important that we do all of these things, and of course, from the guy that always says, I'm the guy below the neck and above the diaphragm, the cardiologist, I want to make sure that my patients have optimal blood pressure, and we also want all of our women to have their mammograms as well. But I think it really illustrates the impact of high blood pressure on the common good, the common health, the public health of us in the US, and frankly worldwide as well. So I hope you got some great data from this. I'm gonna follow up with one more point about this slide. So what I also did is I overlaid these horizontal bars are the 2017, the most common blood pressure guidelines from the American Heart Association and the American College of Cardiology. They were last published in 2017. We should have some new ones coming up early in the near future, but these are the last blood pressure guidelines from the American Heart Association, American College of Cardiology. And basically what I want to point out is literally for decades, the definition of high blood pressure by guidelines did not start until 140/90. So anything below that was not high blood pressure. The big news 15 years after this study was published in 2002, in 2017, the big news was we lowered the threshold for where high blood pressure started, which is completely appropriate if you look at this chart, to 130/80. There's still a lot of confusion about high blood pressure. What is that definition? What is high blood pressure? Where that starts? So let me be startlingly clear, very, very clear. Let me be transparent. If it is consistently above 130 on the top or 80 on the bottom, that is high blood pressure. Obviously, Stage A, Plan A is always going to be non-pharmacologic tools, diet, exercise, watching your salt intake, lots of other things that we can talk about as far as the non-pharmacologic treatments as well. There's also a fantastic diet called the DASH diet that was designed specifically To help lower blood pressure, doing the DASH diet, which you can look Google, there's lots of great resources that are free on the internet, doing the DASH diet lowered blood pressure by about the same as my giving you a pill. So I always like to say the first pill, the first tool that I'm going to use to treat blood pressure is always going to be the DASH diet. So there's a lot of non-pharmacologic things we can do to lower blood pressure, watching salt, losing weight, lots of things. We can talk about that, customize a specific personalized program for you to help with blood pressure, either to prevent it or to treat it. But lots of non-pharmacologic things that we can do to treat blood pressure. Now, there are 15 classes, 150 different drugs out there to treat high blood pressure if we need to, if the non-pharmacologic approaches do not work. So no one should suffer the consequences of high blood pressure in the 21st century, In the US. Remember too, the definition of high blood pressure is now the top number greater than 130 or the bottom number greater than 80. That is the definition of high blood pressure and makes complete sense. You can see before these guidelines came out that 130 over 85 was still called okay. We didn't call that hypertension, whereas 2017 we recognized that— 130 over 85. It needs to at least be below 130/80. What is controlled high blood pressure? That means consistently below 130/80. However, the best data over the last few years shows that 120/80 is really the optimal ideal number. We've seen that in patients with diabetes, we've seen it without— in patients without diabetes. We've done multiple trials of patients randomized to achieve a blood pressure less than 140, Or blood pressure less than 120. Those trials are very, very consistent, showing the cardiovascular benefit and even all-cause mortality benefit of having a blood pressure of less than 120 on the top versus a blood pressure of less than 140. So I hope— I hate to say you've enjoyed this material. I hope you've learned a lot. As you know, I am absolutely dedicated to radical overeducation in the world of cardiovascular disease, in the world of Keeping you healthy and happy and above ground. I hope this was helpful and useful. As I tell all my patients, again, when I share this with them, they're really pretty flabbergasted. There's a lot of myths out there about blood pressure, what's good, what's bad, what's ugly. You just heard from the horse's mouth what is good, what's bad, what's ugly, and why high blood pressure is bad for you, why we need to identify it, how to best measure it, And we'll work with you at Clear Cardio to make sure that your blood pressure is optimal, because nobody should be suffering the slings and arrows of outrageous hypertension in the 21st century. So again, this is Dr. John Osborne, the Chief Medical and Scientific Officer of Clear Cardio, wishing that you keep it on the low down. That is, you keep that blood pressure optimal. Have a wonderful day. Thank you.