In this presentation Dr. John Osborne expands on his earlier "Hypertension 101" video with a detailed analysis of high blood pressure (hypertension). He introduces a seminal 2002 Lancet study from Oxford that attempted to isolate blood pressure as the sole variable influencing fatal cardiovascular events. Osborne explains the physiological differences between systolic and diastolic pressures, noting that after the early 50s arteries stiffen, causing systolic pressure to rise while diastolic pressure plateaus or falls. He reiterates that hypertension is defined uniformly as ≥130 mm Hg systolic or ≥80 mm Hg diastolic, regardless of age or sex, and that controlled hypertension is <130/80. Using the Oxford data, he shows that risk of fatal stroke or heart attack rises exponentially with higher blood pressure and older age, with logarithmic risk curves translating into 2‑ to 256‑fold greater risk across age‑blood‑pressure strata. He highlights that the lifetime risk of developing hypertension in the U.S. after age 40 is about 90%. Osborne emphasizes lifestyle interventions (DASH diet, exercise, weight loss, salt reduction) and medication as means to keep blood pressure low, describing hypertension as a silent, equal‑opportunity killer that also threatens vision, kidneys, and overall mortality. The talk concludes with a call to monitor and treat blood pressure proactively.
Chapters
Hey everybody. So I don't know if you caught my prior talk on high blood pressure. I'm going to encourage you to seek that out. It'll be on our YouTube channel as well, talking about the role of high blood pressure, what's good, what's bad, what's ugly, what is high blood pressure, what those numbers are, how to best monitor it. That's all in that other video. So I'm going to encourage you to start with that. So we're going to call that video High Blood Pressure or Hypertension, 101. Now we're going to do a deep dive. I'm going to call this Hypertension 202.
So here we are, sit down, fasten your seatbelts, and let's get rolling.
So in the prior video, I talked about a really, really important study, a seminal trial that was published in The Lancet back in 2002. Again, this is a group out of Oxford. They have some of the best medical researchers in the world there. And what they wanted to do is to understand if I can isolate just high blood pressure as a sole variable. Now, here's the thing. High blood pressure doesn't exist as a sole variable. It comes in people of different ages, sex, different levels of cholesterol, diabetes, weight, et cetera. So they did a variety of statistical manipulations to try to isolate high blood pressure as a sole variable. So if you're interested in that, and you should be, and you haven't seen the first video on high blood pressure, please go back and check that one out now. Okay, you come back, you've watched the first video, now let's do Hypertension 202. So what they also wanted to do is to look at what is the relationship of high blood pressure, and when we talk about high blood pressure, you're probably aware there's 2 numbers. There's the top number, the systolic blood pressure, And the bottom number, the diastolic blood pressure. Now, again, since this is High Blood Pressure 202, I'm going to get a little deeper into this. Both of these numbers are very, very important. However, as we get older, as we get more mature, I like to say, because none of us get older, we get more mature. From roughly the early 50s, our vessels tend to get a little stiffer. Okay. This is also the time that You know, we start having to use peepers and we get presbyopia. That is, you know, that issue where you have to move things out a little bit because your vision, your near vision gets blurry. So lots of things occur around that time. That's usually about 45 or 50. But another thing occurs in our blood vessels. So in our early 50s, our blood vessels start getting a little stiffer. What that means is that the top number, the systolic blood pressure, the top number starts climbing.
And as we get older, it tends to climb more and more.
So as we get more mature, again, roughly from our early 50s, it's not uncommon for the top number to keep climbing, alas, but the bottom number, the diastolic number, actually plateaus as we get older, or may actually go down. That is because as the vessels get less stretchy, which happens when we get older, more mature, that tends to amplify the top number, but it tends to lower the bottom number. Now, in young people with hypertension, we'll say 30s, 40s or so, not uncommon, the top number is not that bad, we'll say, 135, 140, not uncommon, but the bottom number is the real giveaway. It can be 95 or 100, which is really quite elevated. So optimal blood pressure should be below 120 on the top, below 80 on the bottom. And to remind everybody, the definition of high blood pressure, regardless of age, there is no adjustment for age. You'll hear that myth that with was put to bed years and years and years ago. There is no adjustment for age. There is no adjustment for sex.
It is—
high blood pressure is an equal opportunity killer. 130 on the top or 80 on the bottom is high blood pressure, controlled via non-pharmacologic approaches— diet, exercise, weight loss, watching your salt, DASH diet, etc. Please see the first video. Or, and/or medications. It should be below 130/80. That is the definition of controlled hypertension. If you have that, which alas, from the age of 40, if you heard my other video, I'll repeat it again because it's so important. From the age of 40, the lifetime risk of developing high blood pressure in the US is 90%. I like to think of it going to a casino. The only question is how many zeros you're going to write them. Because those casinos, don't make their money off of food, drink, entertainment. They make their money off of your gambling, which is why I don't gamble, because I'm too tight with my money. But that's another issue. So getting back to this study, the people from Oxford back in 2002 wanted to isolate high blood pressure as the sole variable. They did that via some statistical procedures that I won't get into, but they also wanted to look at if we break people down in different ages, what is the impact of high blood pressure as we get older? So they broke this down by age and by both systolic blood pressure and diastolic blood pressure. So I'm going to walk you through the systolic blood pressure, and then I'll walk you through the effects of diastolic blood pressure. Systolic, top number, diastolic, bottom number. So this is really fascinating for me as a physician, but also I'm going to tell you, this is pretty scary, okay?
So on the left here, they're looking at the increased risk of fatal events. This is a fatal heart attack or a fatal stroke, best both avoided, based on blood pressure. As you can see, as blood pressure goes up, That risk of a fatal stroke or heart attack increases. Now, also note, here we have individuals in the 40 to 59 year range, 50 to 59, 60 to 69, 70 to 79, and 80 to 89.
Now, not terribly surprising, as blood pressure goes up, the risk of a fatal stroke or heart attack also goes up, and this is isolating high blood pressure as the sole variable. This is independent of age, sex, cholesterol, diabetes, smoking, all of those things. all those other variables.
So you can see a very powerful relationship between blood pressure, the top number, systolic blood pressure, and the risk of fatal strokes and heart attacks. But also too, as we get older, that risk is further amplified.
Now here's the scary part. If you were looking at this very closely, you may have noticed something.
This y-axis here, On the x-axis, we have blood pressure.
That's linear.
That's the x-axis: 120, 140, 160, 180.
However, this y-axis—the risk of a fatal stroke or heart attack—is actually logarithmic.
It is exponential. So we go from one times risk, two times risk, four times, eight times, six times, sixteen times, thirty-two times greater risk of fatal strokes or heart attacks, sixty-four times.
Greater risk of strokes and heart attacks.
128. And 256 times greater risk of strokes or heart attacks. So there's a dramatic interplay between both blood pressure and age as well. So to show in our younger individuals, even the 40 to 59-year-old, in your young individuals, here we'll say a blood pressure of 115 at that age Is our reference. That is the reference number, and all these other ages and blood pressures are set at that reference. So if we look at this young population, 40 to 59, I wish I were still there, but that young population, which is why I call it young, note as blood pressure goes up, we go from 1 times risk, this is the comparator, up to about 8 times greater risk.
If you're in that 40 to 59-year young range.
If you're a little bit older, 50 to 59, here we're already starting at about 3.5-fold greater risk just because of age, and we go all the way up to about a 16-fold greater risk at the higher blood pressures in the patients who are 50 to 59. A little older, we're already starting at 8 times the risk of a fatal stroke. So, stroke or heart attack, and we go all the way up to about a 32 times greater risk of stroke and heart attack at higher systolic blood pressures. 70 to 79, we're already starting at about 20, 25-fold greater risk because of maturity, of birthdays, but we're going to take that all the way up to about 64 times greater risk of a fatal stroke or heart attack versus that 40 to 59-year individual with optimal blood pressure of 115. And then lastly, of course, if we're older, that much older, much more mature, 80 to 89, we're already starting out at 64 times the greater risk of strokes or heart attacks at that age, even with optimal blood pressure. But if we take it all the way up to pretty terrible blood pressure, a systolic of 180, you can see we're pushing 128 times Greater risk of a fatal stroke or heart attack.
So you can understand why I am a blood pressure hawk. Very important. It is the silent killer. Very important. We measure it, we monitor it, and if it's high, we treat it because it is a major killer, a major cause of both death as well as strokes, heart attacks, blindness, also kidney failure as well. None of those things we want.
That's why I'm a blood pressure hawk. Now, we walked through systolic blood pressure.
This will be pretty simple now.
We're also going to look at diastolic blood pressure, the lower number. Again, the same relationship. Here we have the younger individuals, 40 to 59, 50 to 59, 60 to 69, 70 to 79, 80 to 89.
Again, the same sort of relationship with diastolic blood pressure as well.
Optimal, 80 or below. High, anything above that. And as you can see, as we get older and both with higher diastolic blood pressures, it really dramatically increases the risk of fatal strokes and heart attacks.
So with that, I hope you now know a lot more about one of the most common cardiovascular diseases out there, which is high blood pressure.
Hopefully understanding this will make this a little more understanding of me when you—
when I talk about high blood pressure, how important it is, even though you may not feel it, you may not have symptoms. Again, it is the silent killer, but very important that we understand it, we measure it, we monitor it, and then if needed, we treat it as well. So looking out for all of you, keep your blood pressure on the down low. This is Dr. John Osborne, Chief Medical and Scientific Officer of Clear Cardio. Have a wonderful day.
