Why is it so important to keep blood pressure in check? | Ethan Weiss & Peter Attia

Summary

The transcript discusses the importance of blood pressure management for overall health, particularly in relation to kidney function. It emphasizes the kidney's sensitivity to high blood pressure and the need to maintain a blood pressure close to 120/80 mmHg throughout life, challenging the notion that higher blood pressure is a normal part of aging. The conversation highlights the significance of clinical trials in shaping current understanding and treatment approaches to hypertension.

Takeaways

• 🧐 The speaker expresses a growing interest in blood pressure and its impact on kidney health, highlighting the kidney's sensitivity to high blood pressure.
• 🌟 The importance of the kidney is emphasized, often overlooked, but it plays a crucial role in regulating blood pressure and is sensitive to changes in it.
• 🕰 The concept of 'bootstrapping' to live longer is introduced, suggesting that maintaining the health standards of a younger age group can contribute to longevity.
• 📉 The use of Systatin C over creatinine to measure glomerular filtration rate (GFR) is mentioned, indicating a shift in medical practice for more accurate kidney function assessment.
• 🚫 The speaker argues against the complacency of considering a GFR of 70 mL/min at age 55 as 'good enough', stressing that it's far from ideal for kidney health.
• 💡 The idea that even slight elevations in blood pressure can negatively affect long-term kidney, heart, and brain health is presented, advocating for normalization of blood pressure.
• 👨‍⚕️ The speaker acknowledges the neglect of the kidney in medical education and practice, sharing personal experiences teaching about hypertension and kidney pathology.
• 🔍 The impact of high blood pressure on the kidney's vasculature is discussed, suggesting the organ's small size and high blood flow make it particularly vulnerable to pressure changes.
• 📈 The speaker reflects on the variability of blood pressure throughout the day and the lack of awareness people have about their own blood pressure fluctuations.
• 🐘 A comparison is made to different animal species, questioning why humans share similar blood pressure levels with much smaller creatures, hinting at evolutionary conservation of the vascular system.
• 🛑 The notion that blood pressure naturally increases with age is challenged, with recent clinical trials suggesting that maintaining a blood pressure close to 120/80 mmHg is beneficial at any age.

Q & A

Why has the speaker become more interested in blood pressure over the past year?

The speaker has become more interested in blood pressure due to its connection with kidney health, which has been a growing concern for them, especially when considering the long-term effects on kidney function and overall health.

What is the speaker's approach to aging and health?

The speaker suggests a 'bootstrapping' approach to aging, where one should aim to maintain the health standards of a younger age group to potentially live an extra few years. This includes maintaining the health of the mind, body, coronary arteries, bone density, and kidneys.

What is the glomerular filtration rate (GFR) and why is it important?

The glomerular filtration rate is a measure of how well the kidneys are functioning, indicating the rate at which the kidneys filter waste from the blood. It is important because it helps in assessing kidney health and is sensitive to high blood pressure.

Why has the use of creatinine been largely abandoned in measuring GFR?

The use of creatinine has been largely abandoned because it has been replaced by cystatin C, which is a more accurate measure for estimating GFR, especially in elderly populations.

How does the speaker view the kidneys in relation to high blood pressure?

The speaker views the kidneys as being exquisitely sensitive to high blood pressure due to their small size and the high volume of cardiac output they receive, making them vulnerable to damage from even slight elevations in blood pressure.

What is the speaker's perspective on the importance of normalizing blood pressure?

The speaker believes that normalizing blood pressure is crucial for long-term health, particularly for the kidneys, heart, and brain, and that even minor elevations in blood pressure can interfere with these organs' health.

What does the speaker suggest about the standard blood pressure reading of 120 over 80 mmHg?

The speaker suggests that while 120 over 80 mmHg is considered normal, it may not be optimal for maintaining long-term kidney, heart, and brain health, and that striving for a lower blood pressure could be beneficial.

How does the speaker's view on treating high blood pressure differ from past practices?

The speaker's view differs from past practices in that they now believe that 120 over 80 mmHg should be the target for all ages, rather than accepting higher blood pressures as a normal part of aging.

What evidence does the speaker refer to that supports the idea that 120 over 80 mmHg is the normal blood pressure?

The speaker refers to recent well-designed clinical trials that have shown that being closer to 120 over 80 mmHg impacts mortality rates and that permitting higher blood pressures can lead to significant health risks.

What are the potential harms associated with treating high blood pressure too aggressively?

The potential harms include side effects from medication, impacts on lifestyle, and serious health issues such as hyperkalemia or an increased risk of death.

How does the speaker connect the aging process with changes in blood pressure?

The speaker connects the aging process with changes in blood pressure by suggesting that while blood pressure does increase with age, it may not be a normal part of aging but rather a consequence of underlying health issues such as decreased kidney function or increased vascular stiffness.