How Peter Attia thinks about managing GFR & high blood pressure
Summary
TLDRIn this discussion, the speaker emphasizes the importance of setting high standards for kidney function, aiming for a GFR of 107 to ensure kidney health at 100 years old. They debate the current standards for hypertension, suggesting that lifestyle changes like diet and exercise should be prioritized over medication for slightly elevated blood pressure. The conversation also touches on the long-term use of antihypertensives and the need for evidence-based interventions, while reminding listeners that the podcast is for informational purposes and not a substitute for professional medical advice.
Takeaways
- 👨⚕️ The speaker emphasizes the importance of managing Glomerular Filtration Rate (GFR) in patients to extend their healthy lifespan, aiming for them to live to 100.
- 🔍 A GFR of 85 is considered normal, but the speaker argues for a higher standard to ensure kidney health for a longer life expectancy.
- ⏳ The speaker advocates for a 'time shift' approach, treating a 40-year-old patient as if they are 20 to ensure their kidneys last another 60 years.
- 🌟 The aspirational goal is to have a GFR above 40 at the age of 100, which may require revising current standards on hypertension.
- 🤔 There's a preference for blood pressure to be 120/80, but starting medication at 135/85 is questioned due to the long-term commitment.
- 🍽️ Nutritional and exercise interventions are suggested as the first line of action for managing blood pressure, before resorting to medication.
- 🏋️♀️ Diet and exercise are recommended to lower blood pressure, with antihypertensives considered only when dietary means are insufficient.
- ⚠️ The speaker expresses concern over defining hypertension at lower levels without strong evidence to support the use of antihypertensives.
- 📢 The podcast is for informational purposes and should not replace professional medical advice or treatment.
- 💡 The speaker discloses potential conflicts of interest and directs listeners to a website for transparency.
Q & A
Why does the speaker emphasize managing GFR in patients?
-The speaker emphasizes managing GFR because they want their patients to live longer, with the goal of reaching 100 years. They argue that to achieve this, they need to treat patients not according to their current age but as if they were younger, aiming for higher GFR levels to ensure kidney health over a longer period.
What is the speaker’s aspiration for patient care in terms of age?
-The speaker's aspiration is for their patients to live up to 100 years. This involves managing health parameters like GFR more aggressively to ensure long-term organ health and function.
How does the speaker propose treating a 40-year-old patient with a GFR of 85?
-The speaker proposes treating the 40-year-old patient as if they were a 20-year-old to ensure their kidneys survive another 60 years. This means aiming for a GFR of 107, instead of accepting 85 as normal, to ensure the GFR is still above 40 by the age of 100.
Why does the speaker believe we should revise our standards on hypertension?
-The speaker believes we should revise our standards on hypertension because if the goal is to maintain kidney function over the long term, current standards might not be aggressive enough. They suggest focusing more on lifestyle interventions, such as diet and exercise, instead of relying solely on medication.
What is the recommended blood pressure according to the speaker?
-The speaker recommends a blood pressure of 120/80 as ideal. However, they note that if a patient's blood pressure is 135/85, they would not immediately recommend medication but instead focus on dietary and exercise changes.
When does the speaker recommend antihypertensive medication?
-The speaker recommends antihypertensive medication if a patient's blood pressure reaches 140/90 and cannot be lowered through dietary or lifestyle changes. They believe this level of hypertension warrants medical intervention to provide long-term protection.
Why is the speaker cautious about using antihypertensive medication for patients with lower blood pressure levels?
-The speaker is cautious about using antihypertensive medication for patients with blood pressure around 135/85 because they haven't seen evidence that such medications provide long-term benefits for this group. They prefer lifestyle interventions in these cases.
What lifestyle changes does the speaker recommend for managing blood pressure?
-The speaker recommends dietary measures, such as reducing salt intake and choosing healthier foods, as well as regular exercise to manage blood pressure, especially for those with readings around 135/85.
What is the speaker’s main concern with lowering the threshold for diagnosing hypertension?
-The speaker’s main concern with lowering the threshold for diagnosing hypertension is that it might lead to more patients being prescribed antihypertensive medication at lower levels, without strong evidence that this is beneficial in the long term.
What disclaimer is given at the end of the transcript?
-The disclaimer states that the podcast is for general informational purposes only and does not constitute medical advice. It advises listeners to consult healthcare professionals for their conditions and includes a note on conflicts of interest, directing listeners to a website for further details.
Outlines
👨⚕️ Aspirations for Longevity in Kidney Health
The speaker emphasizes the importance of setting high standards for kidney function, specifically GFR (glomerular filtration rate), to promote longevity. They argue for treating a 40-year-old patient as if they are 20 to ensure their kidneys can function well into old age, aiming for a GFR of 107 instead of the typical 85 for a 40-year-old. The speaker questions current standards for hypertension and suggests that lifestyle changes like diet and exercise should be prioritized over medication for slightly elevated blood pressure readings. They also express skepticism about the long-term benefits of antihypertensive medication for patients with blood pressure at 135/85, recommending it only when dietary measures fail to lower blood pressure to a safer level.
Mindmap
Keywords
💡GFR
💡Nephrologist
💡Aspirational Age
💡Epidemiologic Data
💡Time Shifting
💡Hypertension
💡Antihypertensive Medication
💡Nutritional and Exercise Related Maneuvers
💡Blood Pressure Thresholds
💡Conflicts of Interest
Highlights
The speaker emphasizes the importance of managing GFR (glomerular filtration rate) in patients to extend their lifespan and promote optimal health.
Although most would consider a GFR of 85 normal for a 40-year-old, the speaker aspires for patients to live to 100, aiming for higher GFR levels to ensure long-term kidney function.
The concept of 'time-shifting' patients back to a younger state is introduced, where a 40-year-old should be treated like a 20-year-old in terms of kidney care to maintain GFR levels over time.
The speaker suggests aiming for a GFR of 107 for middle-aged patients to ensure their GFR remains above 40 by the time they reach 100 years old.
Standards for managing hypertension are questioned, with the speaker discussing the impact of blood pressure management on long-term kidney and overall health.
The speaker prefers to maintain blood pressure at 120/80 but acknowledges that 135/85 does not necessarily warrant medication.
Instead of immediately resorting to antihypertensive drugs, the speaker recommends nutritional and exercise-related interventions for patients with slightly elevated blood pressure.
At 140/90, if blood pressure cannot be managed through diet and exercise, the speaker advises considering antihypertensive medication.
No strong evidence is presented to support the use of antihypertensives for those with blood pressure at 135/85, highlighting the potential for over-medication.
The speaker emphasizes that dietary measures, such as reducing salt and making healthier food choices, should be the first line of defense in managing slightly elevated blood pressure.
Optimizing health through lifestyle interventions is seen as the best chance for patients to maintain long-term well-being.
The speaker's main concern is the potential for over-prescribing medications for patients who do not necessarily benefit from them at certain blood pressure levels.
The conversation underscores the importance of personalized health care and reassessing current standards for managing conditions like hypertension.
The podcast episode highlights a general call for more conservative approaches to managing borderline health conditions, focusing on lifestyle improvements.
The speaker reinforces the idea that the goal is not just to treat current conditions but to enable patients to maintain optimal health well into older age, ideally living to 100 years.
Transcripts
and the reason i bring this up rick is
is not to be a pain but it's to talk
about how what our standards are really
about right so yeah um i'm not a
nephrologist but boy am i a freak when
it comes to managing gfr in my patients
yeah why good for you but why right
because
i want people to live to 100. that's an
aspiration right most people aren't
going to but we make that the aspiration
so if i'm talking to a 40 year old
patient
and their gfr
is
85
well most people would say that's normal
but
i want that 40 year old not to live to
80
i want her to live to a hundred
which means i can't treat her like a 40
year old i have to treat her like a 20
year old i have to time shift her back
to say
i need her kidneys to survive another 60
years so based on epidemiologic data i
can't treat her as a 40 year old and her
gfr of
87 is not good enough i want her gfr to
be 107
because i need to know that at a hundred
her gfr is still 40.
so
that's why i push back on this idea
because i really want to understand this
if we're in the business of trying to
get people's kidneys
to have a gfr above 40 at the age of 100
do we have to revise our standards on
hypertension it's a wonderful comment
that you make there and um i think that
the
that the answer is uh we would prefer
blood pressure of 120 over 80
but
if it's 135 over 85
to put someone on a medication
that they'll have to take for the next
60 years
i'm not sure that that's the best way to
go i i i think that
doing nutritional and exercise related
maneuvers when you're 135 or 85 should
be the way to go
um and um and it and we can fix it by
diet by reducing
salt and and picking healthier foods and
exercising but when when the trouble
with
with um
when you get to 140 over 90 if you can't
lower
your blood pressure
by uh by dietary means i you really
probably should go on an
antihypertensive because
it will provide protection
over time but when your blood pressure
is like 130 over
135 over 85
i don't i haven't seen any evidence that
anti-hypertensives really provide
long-term benefit to that group um i do
think
that
dietary measures though make sense and i
agree with your
general idea that the idea that you know
optimize health
as best as we can and that's your best
chance to maintain health for the
longest you can and so i like that idea
i think you're you're right on but i
don't know if we should be doing
interventions
the trouble with defining blood pressure
hypertension at a lower level is it
implies that antihypertensive should be
used
at those lower levels and i don't think
that the evidence is strong enough
uh to to warrant that
this podcast is for general
informational purposes only and does not
constitute the practice of medicine
nursing or other professional health
care services including the giving of
medical advice
no doctor-patient relationship is formed
the use of this information and the
materials linked to this podcast is at
the user's own risk the content on this
podcast is not intended to be a
substitute for professional medical
advice diagnosis or treatment
users should not disregard or delay in
obtaining medical advice from any
medical condition they have and they
should seek the assistance of their
healthcare professionals for any such
conditions
finally i take conflicts of interest
very seriously for all of my disclosures
and the companies i invest in or advise
please visit peteratiammd.com
forward slash about where i keep an
up-to-date and active list of such
companies
[Music]
تصفح المزيد من مقاطع الفيديو ذات الصلة
Why is it so important to keep blood pressure in check? | Ethan Weiss & Peter Attia
This is the #1 MOST POWERFUL Kidney Disease Cure and Reduce Creatinine Fast | PureNutrition
HIGH BLOOD PRESSURE को ठीक करने का दुनिया का BEST TREATMENT METHOD | Manas Samarth
Ini 3 Makanan yang Bisa Merusak Ginjalmu
10 Foods to AVOID If You Have High BLOOD PRESSURE!
This Vitamin Stops Proteinuria Fast And Repair KIDNEY Quickly!
5.0 / 5 (0 votes)