How Peter Attia thinks about managing GFR & high blood pressure

Peter Attia MD

8 Feb 202204:36

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

00:00

👨‍⚕️ 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

GFR stands for Glomerular Filtration Rate, which is a measure of how well the kidneys are filtering waste from the blood. In the context of the video, the speaker emphasizes the importance of managing GFR in patients to ensure they can live longer, healthier lives, aiming for a GFR of 107 to ensure the kidneys can function well into old age.

💡Nephrologist

A nephrologist is a medical specialist who has extensive knowledge and training in diagnosing and treating kidney diseases. The speaker mentions not being a nephrologist but being very attentive to managing GFR, indicating a broader interest in kidney health beyond specialization.

💡Aspirational Age

The term 'aspiration' in the context of the video refers to the goal of helping patients live to be 100 years old. This is used to illustrate the speaker's approach to healthcare, which is to aim high in terms of longevity and health outcomes.

💡Epidemiologic Data

Epidemiologic data refers to information gathered from the study of patterns, causes, and effects of health and disease conditions in defined populations. The speaker uses this term to justify the need for higher GFR standards, based on statistical evidence about kidney function and longevity.

💡Time Shifting

Time shifting in this context is a conceptual approach where the speaker suggests treating a 40-year-old patient as if they were 20 years younger to ensure their kidneys can last another 60 years. It's a strategy to extend the life of the kidneys by managing them as if the patient were younger.

💡Hypertension

Hypertension, or high blood pressure, is a medical condition discussed in the video as it relates to kidney health. The speaker questions the standards for treating hypertension, suggesting that lifestyle changes like diet and exercise might be preferable to medication in some cases.

💡Antihypertensive Medication

Antihypertensive medications are drugs used to treat high blood pressure. The speaker expresses skepticism about prescribing these medications for slightly elevated blood pressure, suggesting that lifestyle interventions might be more appropriate initially.

💡Nutritional and Exercise Related Maneuvers

These refer to lifestyle changes such as diet and physical activity that can improve health outcomes. The speaker advocates for these non-pharmacological approaches as a first line of treatment for conditions like hypertension, especially when numbers are not severely high.

💡Blood Pressure Thresholds

Blood pressure thresholds are the numerical values that define what is considered normal, high, or hypertensive. The speaker discusses the implications of these thresholds on treatment decisions, questioning whether current standards are too conservative or aggressive.

💡Conflicts of Interest

Conflicts of interest refer to situations where personal or financial interests might compromise professional judgment. The speaker mentions this at the end of the video, emphasizing transparency and the importance of disclosing potential biases that could affect the advice given.

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.