Transcription
What is an ideal blood pressure? This is a question which is on the lips of millions of people. What should a blood pressure be? Now, our authorities in all their wisdom are getting stricter by the year in terms of blood pressure management. Many of you saw my recent video on this topic and we are going to have an open honest discussion as three doctors who care very deeply about this issue in particular because we deal with it a lot every single day. And for those of you who enjoy our discussions, please check in the links down below for our separate unique channel where we post a lot of exclusive content related to your health and wellbeing. So let's dive straight in then.
What is blood pressure in the first place? You all know I'm sure you have a top number and a bottom number. Dr. Peter, as our cardiologist, you want to chime in with that first basic question?
>> Sure, I'd love to. This is part of the everyday practice of cardiology is managing high blood pressure. High blood pressure is a force of blood as it goes to the arteries. And every time your heart squeezes that's called cy and that's a generating a higher force that causes blood flow to go out through the arteries and the little tiny blood vessels to peruse all the vital organs of your body. And then when your heart relaxes that's called diastilly. And that's when your heart fills up with more blood and it's able to relax. And that's why you have a top number which is higher cuz it's a higher pressure system and that's called cy and diastilly is a lower number and that's a bottom number in that reading.
>> Really well explained. So as you probably know top number is systolic, bottom number is diastolic and the commonly quoted perfect blood pressure apparently for everyone which we're going to discuss is 120 over 80. Dr. Ben, I know you deal with this situation a lot. What do you think about having an arbitrary number like this? And should we indeed all be aiming for the same number? I mean, what do you see?
>> That's a great question. So, we do need some sort of idea of what the basic numbers are that we want to shoot for. But the idea that there is a universal blood pressure that everyone should be trying to obtain, no matter who they are, what their age is, what medications they're on, or what conditions they have, I think is very shortsighted. I can tell you right now that with some of my older patients, you have to be very careful lowering blood blood pressure too much. We often see that sometimes people will come into the primary care doctor's office a little nervous, a little anxious, understandably so. They've just gone through traffic. They come in and their blood pressure is a little bit elevated. And if you're a doctor that immediately puts them on more medications, you're going to get a phone call from their family member that they just fainted because you can overdo it with blood pressure. And what might be great for a 20-year-old doesn't work so well for an 80-year-old.
>> Yep. That's a really good point.
>> That's so true, Ben. And I see that all the time in my practice. I'm in a unique situation where I see a lot of people with really resistant high blood pressure, really difficult to control or people with earlier onset. So really one size does not fit all in here. I think the the best blood pressure is the safer blood pressure, not always the lower. So lower always isn't better in this case. And you're you're right on where you really have to personalize it based on multiple characteristics of a patient's age, body weight, activity. There's just so many factors to to put into play here when you're prescribing medications. And that's one thing that always irks me as a cardiologist. I've seen a patient where they've just been stacked with so many different medications. It's throwing kind of darts at a dart board and maybe one will stick. And that just needs that's not the right way of doing it. That's not the right way of doing medicine. Unfortunately, that's the way blood pressure has become. That's why a lot of people out there may be on lots of medications with side effects or or maybe you you have blood pressure that's not controlled on multiple medications because it's really not personalized for you. That's it. Yeah, it's all about what is right for anybody. And the issue here and why I made my recent video was because authorities particularly in the United States appear to be getting more aggressive by the year. Now we will talk about certain numbers and and when it a number is too high in our opinion but I want to get your your opinion gentlemen on the fact that the American Heart Association and American College of Cardiology consider a blood pressure for 124 systolic. By the way we're talking mainly about the top number here. Bottom number is important as well but usually the two correlate. So we'll stick with the top number. 124 125 is now elevated according to the authorities in the United States. And my big concern especially with people over the age of 65 is that this is going to be used to put more people on medicine. Blood pressure will drop often to the low 100s and then there will be more people dizzy, weak, falling. What do you think about this? And do you share my opinion that it is ridiculous to say that a systolic blood pressure of 125 is elevated?
I agree. That's a blanket statement and you can't tell me that that blanket statement of having that blood pressure covers all different types of people. And so I know that my 85-year-old patient needs a much different blood pressure than my 55year-old patient. And you're putting people a lot of dangerous side effects from just really people over medication. So I think you're getting a lot of people again this algorithmic medicine where you're just following numbers and really not evaluing the patient. And so people are just going to get stacked more and more with more medications and we're going to see just a lot of side effects and adverse effects. So adverse effects are dangerous side effects of medications. Exactly. And there was a time I mean not so long ago where it was thought that a blood pressure up to say 140 or even 150 top number was not an issue. And I don't think the evidence behind making it stricter is that great. I mean we'll talk about the causes of high blood pressure in a moment. How do you feel Dr. Ben? Generally, and again what everybody has to understand is this is a very unique number for any individual. What we're saying here is not direct medical advice because obviously when we give medical advice, we sit down with people and we go over their whole history and sometimes they will tell us that even at a blood pressure of 120 systolic, I feel dizzy and then it's not right. But what what are your thoughts on how aggressive we've become with blood pressure compared to time's gone by?
Well, I think the medical institution as a whole has ignored one basic concept and that's that patients know their bodies and that you've seen this throughout medicine over the years. It's become or it always was very paternal and that it would tell you, hey, I'll tell you exactly what to do. I'm not as concerned how you feel about it. Doctors aren't really listening to what patients are saying. There are many patients that have a slightly elevated blood pressure that you're absolutely right. If you try to lower it more, they get dizzy. They collapse. They syncopize. So, you have to really listen to what your patient's saying. You have to know how they handle their medications, how they handle that blood pressure, what happens to them. Yes, there are effects of having elevated blood pressure over time. There is evidence that high blood pressure is correlated with negative events like heart attack and stroke. But you you can't treat every single patient the exact same way. You do want guidelines. You do want standards. But you have to look at each person individually. I have patients that do have what would be considered elevated blood pressure. But if you try to lower it, they have very adverse effects. So you you really have to be careful with that.
>> I think my main issue is not as much a number, but is a lack of personalization of of blood pressure. And so, you know, just take that systematic approach of why over medication with with too much blood pressure and medications is bad. So, I just like to take a systematic approach. So, we even talk about the head, we're going to get foggess. You're going to have decreased profusion of your brain that can cause dizziness. People have this brain fog. A lot of people probably on certain medications I've talked about beta blockers in the past is a big reason of just just general feeling of fatigue as well. Going down further, people have kidney disease. So underactive or under perfusion of their of their kidneys can can cause worsening of kidney disease. You have increased urination from diuretics which are also used to treat blood pressure that's cause electrolyte abnormality. So there's just a whole laundry list of adverse effects of these medications if they're not really properly managed. And having just this one blood pressure that you're stuck on no matter what the patient is feeling is I think dangerous in my opinion.
>> I completely agree. Yeah. This notion of 120 over 80 for everybody a 20-year-old and an 80-year-old. Now I have seen evidence and in fact back in the day when I used to teach medical students I was a big fan of this particular topic and I always used to present research. The research that I had seen about blood pressure especially in anybody over the age of 75 and 80 was that actually there's a U-shaped curve where if the blood pressure went up too high the top number was say above 180 they would do worse. If it was towards 120 they would do worse and an optimal at least in some studies was around 150. And that is because as Dr. Peter will tell us the arteries around the heart they get heavily calcified and you need that high blood pressure to maintain profusion to your brain. So personally in in in many people that I talk to first of all I don't advise that you go on one blood pressure check at the doctor's office. That's the worst thing you can do. I always advise a blood pressure machine. If this is a problem for you check it for a short amount of time, two weeks at least at least three times a day. morning, afternoon, evening at home. Correlate those numbers. Bring your machine to your doctor's office so you make sure that you're getting the right number with your machine and the doctor's machine. And that will give you a much clearer picture about what is going on. Because the amount of people that I've spoken to now, obviously, it's slightly skewed because I speak to a lot of people and coach a lot of people who are on metabolic health journeys and they're losing fat, reversing insulin resistance, which we'll talk about in a moment. So they're doing other things and their blood pressure when they check it at home is much lower than the doctor's office. It's very very common. And I can't tell you as a hospital doctor the number of times I see people in their 70s and 80s who have been put on blood pressure medications one after the other for decades and they come into hospital and they'll present a story and it's very obvious. This happened to a very dear family member of mine earlier this year. two, three, four blood pressure pills and it was clear that they were very weak at home for a long time and running at this low blood pressure. I believe, as I've said before, they a scandal of of epic proportions. It really is. I actually had a patient who had a very similar story too. She was on multiple blood pressure medications and I remember she came to me and the blood pressure was pretty low. So when we talk about low, the top number was below 100. So that was worth looking at. And I said, "Are you experiencing dizziness?" She'd been dizzy for years. I had just picked her up as a patient. She said years. And when I mentioned, "Hey, this could be from the blood pressure medications." It didn't it didn't occur to her and it hadn't occurred to the people who'd seen her before to ask those questions or maybe consider taking her off. We stopped almost all of her blood pressure medications. She felt amazing. She had more energy. She stopped feeling dizzy and tired. I mean, these this you got to be really careful with this. You can't just look at a number and start throwing pills at.
>> I agree. And a lot of patients coming out of the hospital and this is what I see a lot is timing of medications is so key because lots of people are structured. It's hard to take one pill a day. I don't if you ever guys tried taking an antibiotic multiple times during the day. It's really difficult. People sometimes will take all their blood pressure medications in the morning. So sometimes just taking some medications at night or splitting up your medications, taking some in the morning, some at night, it just gives you smoother control of your blood pressure drastically reduce side effects. If you think about taking three or four blood pressure medications when you wake up in the morning and the next few hours are all going to hit you at once. And so timing of medications is so crucial. In the hospital, it's it's geared cuz it's it's scheduled which easier for the nurses and shifts, but when they come out of the hospital, they're all just put on in the morning. And that's something I immediately change. And that can drastically reduce side effects and also just reduce that danger of hypotension which is that low blood pressure drop. Or the other thing that's really dangerous especially as they get older is orthostatic blood pressure changes. So >> when people stand up they feel dizzy or lightheaded or they feel that kind of sudden almost a little bit of loss of consciousness when they stand up. It's just your body's your blood is pulling in your legs. It hasn't made enough pressure to get up to your brain yet.
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Yeah, absolutely. Yeah, what you alluded to there about the timing of medications. Now, again, this an individual thing. I I often do advise some caution at night when taking a blood pressure pill because some people will then drop their blood pressure at night and then wake up during the night and feel weak and and fall highly individual issue but yet that as Dr. Peter said in the morning, "It's so interesting because as a hospital doctor, you get a bird's eye view of this happening in real time." And for some reason throughout the United States, I believe it's the same in Europe too, doctors will write a parameter of hold the blood pressure medication if the systolic number is less than 100. So think about this. Someone will be in hospital already sick and their systolic blood pressure will be 105 as an example and the nurse will administer two or three blood pressure pills. And that's why if you ask any seasoned nurse, they will say that the time for a rapid response which is a semi-emergent well actually an e situation in the hospital is half an hour to 45 minutes after the med pass. And this happens all the time. And it just it gets to a broader point about our obsession with numbers and what's right for one person may not be right for another. I'll give you an example. And again, nothing we are saying here is direct medical advice. Of course not. We need to know as any doctor needs to know your exact circumstances. But we're making this video to educate you so that you can hopefully have these discussions and listen to your own body. Because some people will say a blood pressure of 119 120 is making me feel dizzy. This is why I get so upset when I see these recommendations from our supposedly intelligent authorities. I wonder what could be motivating them by the way. And I know that these recommendations are going to be used to get people with systolic blood pressures in their 120s on more medicines and particularly in the over 60 to 65 age group. It's it's a disaster waiting to happen. You need to be careful.
>> It's true. And blood pressure is really just a comprehensive treatment, but it's not just medications, right? And so one thing we probably haven't really touched on in this talk, but we do in all our other talks is is lifestyle changes. So you want to make sure that before you're given another blood pressure medication or actually before you even start on a medication, have you really made those changes? Are you are you able to exercise regularly? Watch your diet better. Are there other extraneous or environmental factors that are causing undue stress that are causing your blood pressure to be elevated? I think that's just so important as opposed just to going to right to one medication because you know the the the easiest path to to multiple medications is is starting that first medication, right? And so you definitely need to also take control and there is some personal responsibility I think in controlling blood pressure. I mean it's easy to be put on medication. You're not going to feel well on that pathway. Exactly.
>> So I do think that you know you you not you need to make sure that your lifestyle is really optimized before adding medications. I think that's really important.
>> Oh absolutely. I'm so glad Dr. Peter because you're a good cardiologist, one of the good ones who mentions that because it gets to our next major point. One of the major causes of high blood pressure nowadays. In fact, the vast majority of high blood pressure, especially in anyone under the age of 60, is due to insulin resistance, which is a massive pandemic of epic proportions. I've made other videos on this. I'll include a link down below as well. Feel free to to watch those videos and how you can go about naturally reversing insulin resistance, which can be achieved in weeks by going down the lifestyle route. Um, Dr. Ben, as a a fine primary care doctor, I know you work with a lot of patients on this. Do you see a lot of people go from having a systolic blood pressure say in the 150s, 160s, do you see it come down within weeks when people institute positive changes?
>> Oh, absolutely. But you you have to really do it. So when people are very motivated to make these changes and what you start seeing is they begin to exercise effectively and they change their diet, we work very closely on this. You absolutely see if you see the weight starting to go down, you see the blood pressure start to go down, the labs begin to look better, it's if you can really do it, if you can make those changes, you will see everything start to go in the right direction. I've seen this happen many, many times.
>> Yeah. And insulin resistance directly correlates with body fat percentage. So that is why when people lose weight, they become more insulin sensitive. I want to talk about numbers because I know a lot of you are concerned about individual numbers and that's why we're making this video. Firstly, first thing to do is to know what your blood pressures are at home over an extended period of time so that you can have that discussion with your doctor. So I I will say this generally I when I talk to people I don't start to really worry about blood pressure. Firstly if people are not reporting any symptoms they're not having headaches, chest pains etc. But how do you feel about numbers? I know this is very individual, but when do you start thinking that this is a problem, we need to treat it, you're not getting better or there's other risk factors.
Yeah, I think it's so it's for me it's always symptom based and I have the luxury of of being able to look a step further and and I'll get that into a second but if you as you said before if you're if you have blurred vision or recurrent headaches which is often a sign of just initial signs of high blood pressure some people feel increased stress from high blood pressure. So, we talk about symptomatic hypertension and then there's people who are asymptomatic who kind of walk off the street and go to their doctors for the first time and have their blood pressure checked. It's elevated. The important thing though is that they should make sure that it's checked at the end of the visit checked in both arms. That's very important because if you think about it, you're coming to the doctor's office, you may be running late for the appointment and a little bit anxious being there for the first time. So, your blood pressure may initially be up. So, it's not really fair and it's not healthy to be treated on a on that first blood pressure when you get in. In the cardiology world, there are certain things I I like to tailor people's blood pressure medications with. And people can get and I think that everyone who has a history of long-standing high blood pressure should have an echo cardiogram.
>> An echo cardiogram is an ultrasound of your heart. And it looks at the rooms, the doors, and the pumping function of the heart. And your heart's a muscle, right? So just like any muscle, if it works harder, it can thicken the muscle. All right? So if you have uncontrolled high blood pressure and we see thickening of the muscle, then we know it's really on more on the uncontrolled side. Just like if you lift weights, the heart muscle gets a little strong, a little thicker. And we don't necessarily want to see that. We want to make sure your heart function is normal. The aorta, which is the main hose coming off your heart, while the blood leaves your heart, is important because any pressure, any hose under pressure over time get a little bit bigger. So those would always be red flags for me to more tightly regulate the blood pressure. But if you have some of my more elderly patients or older patients, 150 over 90 I think is probably acceptable in people who are asymptomatic. And I always tell patients, your blood pressure will not always be level, right? If you're in the ICU and people have their blood pressure monitor, it's always going up and down. It's instantaneous reaction to environmental factors. So your blood pressure is never going to be like 130 over 80 all the time. It's going to be go up and down. So the range 150 over 90 for me is probably a good starting point.
Exactly. And I will admit to the fact that my experiences might be slightly skewed because the vast majority of people I work with are doing lifestyle changes and I'm kind of coaching them through that as well, trying to naturally improve blood pressure. We have to be honest, many people don't. And in that case the blood pressure medicine is given. I want to touch upon a couple of other topics as well. One is the importance of the lower number as well. So you mentioned up to 90. I know our current authorities want to be a bit more aggressive than that. I usually find the two correlate. Like I don't like it when the bottom number starts getting into the 90s or close to 100. And what you have to remember as well is that giving a blood pressure medicine like a lot of the chronic disease medicines we use is simply a band-aid over the bigger problem. The bigger problem usually is insulin resistance. How do you feel, Dr. Ben, about the lower number? Do you think the two correlate often? When would you be concerned?
>> Oh, absolutely. I would also bring up another issue. If your bottom number and your top number are very different, you might have another kind of condition happening. So, there are certain kinds of medical conditions that can cause those numbers to be very different. And if your doctor's not paying attention to that and just treating you with a blood pressure medication, they may be doing you a disservice. And Peter, you've probably seen this before. COPD, things like that can cause those numbers to be very different.
>> So you mean a big difference between the two? So the bottom number is there and the top number is very complicated.
>> It's called like a wide pulse pressure is really the the medical term for that.
>> And there are a number of conditions that can do that and your doctor should look into that if you're having that kind of problem. I do think that the bottom number and the top number they're they're both very important. So if if they're both elevated or one significantly elevated, you need to understand why. Now, if your bottom number has always been pretty well controlled, but your top number keeps shooting off every time you come in, that could be stress, that could be anxiety. That's the first number to shoot up as the top number. And often if you allow someone to calm down, wait till the end of the visit, that'll come right down. So it's it's important to know which number you're looking at as well.
>> That's right. And you look statistically at the amount of people who will go say doctor's office and have these readings which are off and then they'll end up on medications and then they'll be piled up over the years. It seems like a complete lack of thought and again gets to a bigger issue of the obsession that the medical establishment has with fixing numbers and having guidelines protocol following being like a robot which is absolutely not what medicine is about. Everybody is an individual. This is an absolutely huge topic and we will certainly continue to talk about it. Let's have closing statements then on our thoughts about the original question. What is an ideal blood pressure? Dr. Ben, would you like to go first?
I deal with this every day. So I want to say blood pressure is also not static and the problem is we are looking at one number and saying you have to be here. What I like to do and what you were both alluding to is that if you're trying to make lifestyle changes and the person's blood pressure is going down, it's going in the right direction. You can look at that, you can work with that person to kind of get it down and do it that way. Instead of focusing on a single number and saying we have to treat to get you there, you have to look at this person's conditions. You have to look at their friend and you have to look at how they feel. And like Peter said, are there changes that are occurring in the body that show that this is a problem?
>> How do you feel, Dr. Ma? Ideal blood pressure. I completely agree with you what you said, Ben. I think the bigger picture is blood pressure controls a balance just like a lot of parts of of life are in and moderation as well. You really have to balance quality of life with side effects. And I've always said this before about a risk benefit balance. And I think that if you can balance the right dose of medications and still have a good quality of life with an with an adequate blood pressure, that's much more important to me than having a blood pressure that's 118 over 60 on the lower side, but yet you can't walk down the road because you're so dizzy, fatigued, or lightheaded. And that's just personalization of blood pressure based on how how you feel.
>> Exactly. It is. It's very individual. My my own thoughts as well like I have been saying the whole time is that this is something which is highly personal. You know your own body and if you think that your doctor is being overly aggressive or you have a loved one who quite clearly is exhibiting symptoms of low blood pressure then it's important to take that a step further. I am not a fan by any stretch of the imagination that anybody can have an ideal blood pressure and it has to be 120 over 80. As I've said, people, especially those that I'm fortunate to work with, are making positive lifestyle changes and they'd be told they have high blood pressure. It's very important to make sure that you actually have high blood pressure. Don't just go on what's in the doctor's office. So, monitor it at home, see what it's doing during the day so that you can follow up with your doctor and have that discussion. And let's take a hypothetical scenario. Supposing everybody's doing everything right and the blood pressure is remaining elevated. I would start to get worried if the blood pressure was creeping up towards 150. The number that you alluded to, bottom number being 90, I think there is evidence that that is high. Now, over the age of 65, it's probably a little bit different, but the medical establishment needs to get its act together. As I stated in the last video, the number one cause by far of high blood pressure nowadays with the metabolic health crisis, increasing obesity, is insulin resistance. And I cannot believe for the life of me that when the American College of Cardiology and American Heart Association just put out their guidelines on lifestyle, they mentioned exercise. They mentioned salt, vegetables, grains. Not one bit of advice on the number one thing that people can do to reduce insulin resistance, which is cut back on the enormous amounts of carbs, sugars, and processed foods. That was nowhere in their advice to cut back on sugars. And you look at the sheer amount of calories that Americans are consuming right now and British people in many other countries and it's overwhelming the body causing insulin resistance. Again, check in the links down below. I will include links to my videos on insulin resistance. But people who want to go on this journey of reversing insulin resistance will nearly always have an improved blood pressure after only a few weeks. So those are our thoughts. As always, speak with your doctor who knows you, knows your history. Go on your gut instinct as well and how you feel. But please be sure, especially if you're over the age of 65, that you're not being overtreated for blood pressure. The doctors are being too aggressive, and your blood pressure is dropping, and it's making you feel weak, dizzy, and you can easily be checking up on your blood pressure at home. Thank you everybody for watching. We appreciate you doing so. We will revisit this topic again in the future. Stay well, stay informed. We are rooting for you to succeed as naturally as possible. We want your best possible health and success. Do check in the links down below for our health and well-being store. Ohighwwellness.com if you're in the USA, North America, ohighwwellness.co if you're in the UK, Europe. Also all of those other links I mentioned. Keep going everyone and we will speak again in the next.