Blood pressure is one of the most critical indicators of our cardiovascular health. But for anyone trying to understand their own readings, the landscape of what's quote-unquote normal can be incredibly confusing. The American College of Cardiology gives you one set of numbers. The European Society of Cardiology gives you another, and then other global health organizations have their own distinct guidelines. It can really lead to the valid question of. Which standard should we actually follow? In this podcast, we're going to clear that all up, break down the different recommendations, and give you the authoritative guide on what your numbers really mean. Welcome back, team, to the Building a Lif Athletes Podcast. Thanks so much for stopping by. I really appreciate it. If we haven't had the chance to meet yet, my name is Jordan Rein I a dual board certified physician in family and sports medicine. And the goal of this podcast can be healthy and active for life through action Em's form education. So, today we're talking all about blood pressure management. So, let 's get into it. So, before we talk about the guidelines, we need to get on the same page about what those two numbers actually mean. So, at its core, blood pressure is just a measurement of force your blood exerts against the inner walls of your arteries as your heart pumps. So, as your heart's pumping, How much pressure is being exerted on those blood vessels, right? So, the top number is your systolic blood pressure, and this represents the maximum pressure in your arteries, which happens at the exact moment your heart contracts to pump the blood out. So, essentially, When you pump the blood out to the rest of the body, that is going be a higher pressure. That's your systolic blood pressure. You can think of it as kind of a peak force of your blood vessels that have to withstand. With every heartbeat. So, with every heartbeat, as it's squeezing out the blood, you're going to have some sort of force on those blood vessels. And then the bottom number is called the diastolic blood pressure. And this is the pressure essentially on those same arteries when your heart relaxes between beats to refill with blood. So it tells us the constant resting pressure that's always present in the system. So syst is more when we're pushing out. Diastolic is where we're rel. And both these numbers are clinically significant, though, right? So, for a long time, people used to say it's just one number versus the other, just diastolic. You know, at the end of the day, we now know that they are both very important. Systolic and diastolic can be there. And it Elevated reading of either of them is, you can use that to have and diagnose high blood pressure. So, both of them are very, very important. And so. Now that we know what these numbers mean, but it's really important we have to talk about getting an accurate reading because that's a whole other ballgame and very important. So your blood pressure is incredibly dynamic, meaning A lot of little things can temporarily throw off measurements. For example, if you have a reading taken while you're simply talking, it can elevate your blood pressure by as much as 10 points potentially. And this is why there's a highly specific protocol that we're trying to use to minimize these errors and prevent a mis, right? So, first is patient preparation and positioning, right? For at least 30 minutes before you're getting this blood pressure, you should avoid caffeine, exercise, and tobacco. I would say, even further than that, you know, if you do an intense workout just 30 minutes before, like, I don't think that's enough time, but have to think about that. On top of that, you need to rest calmly in a chair, not a couch. So you're sitting upright. And for at least five minutes, you're sitting there with your feet flat, back supported, legs uncrossed. That's ideal, ideal. And then, next, your arm and the blood pressure cuff. It's also very important. Your arm should be bare, so you're not over-clothes or over-sweat or anything like that. And your arm should be supported on a flat surface, like a table, so that the cuff is at the level of your heart. An arm hanging too low will give a falsely high reading, and vice versa, too high could be conversely low. The cup also has to be the right size. A cup that's too small on your arm is a classic cause of falsely elevated blood pressure reading. So there's lots of stuff. And finally, we really shouldn't trust a single reading. The official guidelines recommend having at least two separate measurements spaced one to two minutes apart and then averaging those results. But let's be real, this entire meticulous process almost never happens in a busy doctor's office visit, right? Uh, there's lots and lot of issues. Usually, you're running late, you get taken back right away, you get blood pressure, it almost never happens. And so, just wanted to mention this is like how when they check in studies, this is how they do it. But that never ever -I't think it's ever happened once in the history of going to the doctor. So there's lots of limitations, right? So we have to understand that. And clinical practice, because of that, has also kind of shifted towards using more out of office blood pressure management methods and monitoring methods. To confirm and manage it. So, all the time, like, I mean, this happens all the time. Patients will come in, it's elevated, and I'm like, okay, cool, that's great. Let's have you take it at home. So, you can do these things. Follow the steps and do that. That's becoming much, much, much more common. And making the diagnosis of hypertension in the clinic is something I rarely do. It's usually based on home values as well now. So we are kind of shifting, but just wanted to mention that as well. And so since we know that those one-off readings have limitations, clinical guidelines are suggesting and advocating for out-of-office monitoring, like I just mentioned before. There's two main ways we do this. The first is ambulatory blood pressure monitoring or ABPM, which is considered like the gold standard. So, this involves wearing a device usually gets sent to you or you pick it up somewhere. It's like Not yours to keep, but it monitors it. And it wears a portal device that automatically measures inner cores your blood pressure every 15 to 30 minutes over a full 24-hour period, giving you data while you're awake and you're sleeping. So, that nighttime data is actually really important. Because your blood pressure should normally dip while you sleep, and a failure to do so could be linked to a high risk of cardiovascular events. So, this blood pressure monitoring can be annoying. That's the big thing. You're just every 15 minutes, you feel the pressure putting in there, and that can be problematic for sleep. It's a gold standard, but it's less utilized just because it can be kind of annoying. A more practical and recommended alternative is home blood pressure monitoring. This is simply where you measure your own blood pressure at home using a validated device. That's a very big thing. You can go into a website like validatebp. org, it gives you a list of devices that are validated, meaning: hey, if you just pick up a random $10 one from your local pharmacy that may not be ideal. It could give you false readings. So, a validated one is important. And the American Heart Association specifically recommends an automatic upper arm cuff as the wrists and finger models are known to be less reliable. Using these out-of-office methods is actually crucial for diagnosing important conditions, right? So, the first is that white coat hypertension, right? Everyone says, I have the white coat hyper, I have high blood pressure, just when I'm at the doctors. And so, it's high in the medical setting, but normal at home. If that's the case, that's great. We just saved it from being diagnosed. And then, second, though, and the more dangerous condition that it helped identify is mast hypertension, which is the opposite, where your office readings are normal, but your blood pressure is consistently high at home. And so, people with mast hypertension. Have a cardiovascular risk that is higher, and it's similar to those with sustained hypertension. So, we want to make sure we're not missing them with these kinds of monitoring. So, that's the big thing for me if my patient's anywhere borderline close. I'll say, hey, let's go get some readings at home. Message me back. Let me know what they are so we can make the diagnosis. And so now I want to dive into the landscape, right? So, this is the landscape of hypertension and the hypertension diagnosis in the U. S It went. A big shift in 2017 happened. So, the American College of Cardiology and the American Heart Association released new guidelines that fundamentally redefined what high blood pressure was. The most significant change was lowering the threshold for stage one hypertension. So, for years, the standard was 140 over 90, right? So, this is a big one. The new guidelines lower this diagnostic line to 130 over 80. And this was a deliberate move based on a really big study in review of the evidence, including the Sprint trial, which people have talked about, which showed that treating to more aggressive targets reduced heart attacks, strokes, and deaths. So, from all the data, they said, hey, let's move it from 1 down to 130 and from 90 to 80 for the die stock. And so, this update also eliminated the old category of pre-hypertension and introduced a new five-category system. It's important to know, though, that. If your systolic and diastolic press fall into two different categories, you're always assigned to the higher, more severe category. So if you're normal on systolic, but high and diastolic, you're still in that whatever category the higher one is. And so here are the five categories. Normal is less than 120 over 80. So they're saying, hey, ideal pristine blood pressure, less than 120 over 80. Elevated is 120 to 129 systolic, and less than 80 diastolic. So You can't be over the thresholds of either of them to be just in the elevated, but elevated is 120 to 129 and less than 80. Stage one hypertension is either syst of 130 to 139. Or diast of 80 to 8. And stage 2 hyper is 140 over 90 or higher. So essentially, if your style's over 1 or diast over 90, that's it. And they do also mention a hyper crisis. It's a reading of greater than 180 over 120, which requires additional ev usually. So, you know, it 's not necessarily the case all the time. That's a whole different podcast and discussion. But if you're getting over 120 over 80, Probably should reach out and talk with someone. But those are the new, you know, kind of relatively new-ish ones that happened in the U. saying, hey, we kind divided up in these five things. This is. Interesting though, but this is a fundamental and often misunderstood part of the New American Guidelines. Just because you get a reading of 135 over 85, you know, or 140 over 90 or whatever it is, you're diagnosed. It doesn't automatically mean you get a prescription for medication, right? So people are saying, Hey, I'm up there, I'm elevated, what do I do? No, for anyone, it's in that stage one category, right? So not quite as high. The guidelines integrate a formal cardiovascular risk assessment into the treatment plan, right? So we use a tool called the ACC pooled cohort equation. It can calculate a patient's 10-year risk of having a heart attack or stroke, and this creates a much more personalized and nuanced approach to care. So essentially, what you're doing is: hey. You have an elevated reading that would classify as hypertension. Then you use this ris tool. And then, once you have that, the recommendation is then split based on the risk score. So if you have stage one hypertension and Have a history of heart disease or calculate a 10-year risk factor of 10% or greater, you're considered higher risk. And they say, hey, probably should be getting, you know, lifestyle and a medication to lower that. However, if you have stage one hyper, but your 10-year risk is less than 10%, you're considered more low risk, right? Not necessarily like no risk, but lower risk. And the recommendation is to focus primarily on lifestyle changes. mean diet, exercise, things like that, without medication. And this allows for aggressive treatment in those who will benefit the most while avoiding potential costs and side effects in lower risk individuals. And so once again, I've seen a lot of people say, oh, they lower these just so everyone can be on a medication. That's not the case. That's not what the guidelines say. Does it come down to more people being on medication? Yeah, it typically does. And that's one of the negatives we can talk about this, but. I just want to mention that as well. It's not necessarily just pushing pills. On top of that, they do mention: hey, not everybody has to do that. You can personalize this for every person's individual risk. And now that we've covered the aggressive American guidelines, let's talk about the European perspective, which is guided by the European Society of Hypertension and the European Society of Cardiology. And this approach has remained more conservative. So the most striking difference is the primary diagnostic threshold, right? So the European guidelines continue to define hypertension based on Blood pressure management in readings of 140 over 90. So, the same person with a blood pressure of 135 over 85 who's diagnosed with stage one hypertension in the U. S. would not be diagnosed with hypertension in Europe, which is kind of interesting. But like their American counterparts, they strongly agree on the importance of out-of-offense monitoring, meaning, hey, you need to look, and their thresholds are nearly identical. They diagnose hypertension if home readings are consistently 135 over 85 or greater, and that's at home, right? Or if the 24-hour ambulatory average is 130 over 80 or greater. And that's because when you're sleeping, when it's measuring, you should be lower. And if you're not, and that's where it comes down to, we think, hey, you're probably high. And so they say, once again, most people are going to have to do it out office. That's very helpful. But where they diff significantly again is the treatment targets, right? Which are heavily stratified by age, potentially. So, for younger patients, if they're younger than 65, the goal is still less than 130 over 80. They say that's where we should be. But for those age 65 to 79, Targets relaxed a little bit to 1 over 80. And for patients 80 or older, the syst target could be even more conservative at 1 to 1 potentially. And this reflects their greater concern for the tolerability and side effects of aggressive treatment in older adults, saying, hey, Once you start getting up there and you're in age, these medications may lead to unintended consequences or side effects that are more dangerous to them than actually having their blood pressure be a little higher. And that's a pretty valid point. I think most people talk about that. And they do talk about that in the other guidelines as well: saying, hey, like if you can't tolerate medication, don't keep taking it, we got to adjust it. But the European guidelines kind of seem to have that built in a little bit more. And so we have two major evidence-based guidelines from highly respected organizations. Then, what gives us these different read and recommendations and why? Well, it really comes down to two different philosophies or points of view. The American approach takes a more proactive public health stance, right? So by lowering the diagnostic bar to 130 over 80, the goal is to identify at-risk people much earlier and to intervene sooner, right? To prevent potential heart attacks and strokes. This strategy intentionally has a wider net, which results in millions more people being diagnosed with hypertension. This is where people say, you know, these are co-op by a big pharma and it's suggesting to be on more medications. You know, I don know what to tell you. Maybe that's the truth, but I think there's decent data that the lower you are, the less incidence you have. And so it's just kind of that risk balance thing. Whereas the European approach is more conservative. I've said that before. It aims to avoid potential over-medicalization and over-medication and focus resources on those with more established high blood pressure, reserving the hyper label for the traditional 140 over 90. So they place A greater emphasis on age as well, relaxing treatment targets as people get older with concerns about side effects. But it's important to note that while both systems use risk assessment, They use it differently, right? U. S guidelines use a risk score to determine whether to start a medication in stage one, while European guidelines use the risk score more to decide how urgently to treat someone who's already been diagnosed with 140 over 90. And despite these differences, they both agree that the most On really, the most critical points that lifestyle is the foundation of treatment, and out of office monitoring is essential for an accurate diagnosis. And so, the way I kind of think about this is: Americans say, Hey, like, clearly, we have an issue with this: heart attacks, strokes, all those things. We want to go ahead and get it and get ahead of it. And yes, that's how America works is like cutting-edge stuff, right? A lot of cutting-edge stuff comes from America. Say, hey, we want to be on the front, we want to do this. Whereas Europe says, hey, actually. We think that's not necessarily the data is not as strong as we want it to be. And we really value on making sure we get it right and understanding those are people who are at risk, and then also stratifying them based on age a little more. And so they're kind of taking a more conservative approach. I don't necessarily think that one is right versus the other. And just because you're here in America doesn't mean you can't have the approach or vice versa. And so it's really kind of understanding. And we'll see time and time again, it really comes down to being individualized, right? Your treatment plan should be individualized. Studies are great, but studies look at what? Thousands of people, which is just a huge population of people. And you're not a huge population of people, you're an individual person. So you might say, hey, I'm not comfortable with this. I have a history of cardiovasc disease in my family. My grandpa had a stroke, whatever. I want to be more aggressive. Or you might say, hey, you know what? Actually, like, I don't want to be on a medication. I really don't. And I'm okay with my blood pressure floating around in the 1. I'm okay with that. And the trade-off is fine. And that's fine. That's great. Guidelines are guidelines, right? They guide you. They aren't like rules, right? You don't go thrown in jail because you're not on medication if you're at a certain threshold. And so I just wanted to mention that and at least bring that up. And so, but to also round out this global picture, there are other bodies that have recommendations. We have the World Health Organization and the International Society of Hypertension. Sweet, that's a sweet group name. I love that. They also do have some recommendations. And for the most part, though, they align with the more conservative European approach using that 140 over 90. To make an office diagnosis. So, after looking at all these expert opinions, we can finally answer one core question. And the most important point is this. There is universal and pretty much unambiguous agreement across every single major guideline that an optimal or normal blood pressure is less than 120 over 80, right? So we say that's good. If you're under that, that's wonderful. That's a benchmark for ideal cardiovascular health. The public confusion and entire debate arises from the definition of normal. Not necessarily from that, but from the definition of hypertension, right? So normal, yep, 120 over 80, we feel good on that. What is hypertension? Ah, should shrug emoji, right? We 're not necessarily sure. The specific threshold where it's diagnosed. And where it's elevated kind of depends on the guidelines. The U. S. is aggressive, saying 1 over 80. And I should mention this is not the entire U. this is the ACCHA, JNC, which is a whole other guideline. Pro, they're still at 1 over 9. And so this is just some of America. It's not everything. But whereas pretty much all the big bodies in Europe say 1 over 90. So I do want to say that. You know, other people in America they still follow 1 every night, and that's okay too. But I 'm just saying this is where we're starting to see if you're following the literature, like where this is coming from. A, pretty darn Powerful, and this is where the recommendations are. But this does reveal the true unifying principle of modern blood pressure management: personalization based on total cardiovascular risk. Is coming, right? The era of one size fits all target is over. The clinical decision of how aggressively you want to treat a patient's blood pressure is now a sophisticated judgment call that weighs the benefits of lowering it against the potential risks for that individual, right, based on their age. Their health profile, their previous risk factors, all those things. So, lots of things, as I mentioned, are going to be the future of personalized care. And the guidelines we've discussed so far for the general adult population, like we've talked about, hey, just the general adults, this is what it is, but things get even more nuanced when we look at special groups. For example, older adults, especially those over 65 or frail, managing blood pressure is a delicate balance, right? So the U. S. guidelines recommend, once again, that less than one-third over 80. But Europeans say, hey, aim for less than 1 over 90. And some of them, if you're over 80, can be even higher in cyst 1 or 50. And this really this caution is driven by the risk of side effects, right? So that the big thing. As a physician. You see this in the hospital. Patients who are aggressively controlled in their blood pressure can lead to something called orthostatic hypotension, where you have a drop in pressure upon standing that can cause dizziness and lead to falls, and that can be even more catastrophic than just having high blood pressure. And so. We really have to think about that. And on top of that, we have children, right? So the system is completely different. Just want to mention that if you're a child or you're talking about your child here, it doesn't apply to them. They're constantly growing. A single number doesn't work for them. So instead, They use it based on a percentile-based system that compares a child's reading to others of the same age, sex, and height. So that's a whole different thing. And readings below the 90th percentile are normal. But if you're less than 13, that's not there. But 13 is when the system transitions and the guideline from the American Academy of Pediatrics switch from percentiles to the same number, which once again If you're a 13-year-old, there should be less than 120 over 80. And so you do have to balance this, right? So I, all the time in the hospital, take care of patients in the hospital, and there, I saw someone a couple weeks back, a couple months back. In their 80s, and blood pressure was, they're on like five different medications, right? And they're getting dizzy, they had side effects, they had low sod, hypon. So we pulled back some of their medications, and that's a constant thing we're balancing is how aggressive we want to be. And so it's not a one-size-fits-all, never will be, but age is also a big consideration. And then the other special population I want to talk about are patients with diabetes or chronic kidney disease. For these individuals, controlling blood pressure is absolutely critical because hypertension dramatically accelerates the progression of both kidney and heart disease. However, the precise target for high-risk groups is an area of Disagreement, we'll say, as most things are in blood pressure management from the different organizations, right? So, this is actively debated, and yeah, it's what it is. So, for example, though, the influential K Daig or K Dig, which is a big nephrology group. Their guideline for kidney disease recommends the most aggressive target, syst less than 120, where, in contrast, the European Society of Cardiology recommends a more conservative range of 130 to 139. That's a potential 20-point difference in recommendations between two major expert groups. And it's super frustrating, right? And you're kind of in the middle. You have the American Heart Association, which is 130 over 80. And so it can be maddening at times, absolutely. But I just want you to understand either as a clinician or as a patient where this is coming from. A factor that often helps clinicians decide on a more aggressive target is the presence of albonuria. So, this is essentially excessive protein in the urine and a clear marker of kidney damage, right? So, if you have that, you have a high level of that. Usually, this means you want to lead to a more aggressive type thing, so that can be helpful. But ultimately, this disagreement among experts just reinforces our central theme that optimal target is a clinical judgment based on complex risk-ben calculation for each individualized patient. And so, why do we care so intensely about all these numbers, right? So, you're like, Jordan, this is scaring me. I hate this. What's going on? Well, it's because the consequences of high blood pressure are very serious, right? So, hyper is famously known. As the silent killer, and for a good reason. It typically causes no symptoms while it progressively damages vital organs over many, many years, right? So let's start with your heart and arteries. The constant excessive pressure damages the inner lining of your arteries, promoting the build of fatty plaques, which is atheroscler. So, this process narrows your arteries and can lead to coronary artery disease, heart attacks, all that fun stuff. And it forces your heart to work even harder, too, leading to the muscle to thicken of your heart, which can then weaken it, leading to heart failure. So that's just heart, lots of bad issues. Your brain is also highly vulnerable, right? Hypertension is a primary cause of stroke, which occurs when a vessel of the brain is either blocked or ruptures and then causes to bleed. Over time, this reduced flow can also lead to things like vascular dementia. Impairing memory, thinking, and reasoning, lots of things. And the damage truly is systemic, right? Your kidneys, in the high-pressure situation, it destroys the delicate network of blood vessels. We're sponsoring for filtering waste, making it a leading cause of kidney failure. And similarly, you can damage the small blood vessels in the retina of your eye, a condition called hyper retinopathy, which can lead to blurred vision and even complete vision loss. We care about this because we know this is like it. Silent killer is very, very real. Like, if your blood pressure is not checked in, it really puts you at risk later in life. What does checked in mean? Well, that's up for debate and how much risk you want to have, but this is why we care, right? It's not just like, oh, it doesn't do anything. No, this is like very real hard outcomes that are very bad, and that's why we care. And so, while most of our focus is rightly on high blood pressure and the other end of the spectrum, it also carries a risk, right? So, low blood pressure, blood pressure that is too low or hypotension is generally defined as a reading below 90 over 60. But it's really primarily considered a medical issue only when it produces symptoms, right? So, when your pressure is too low, it doesn't adequately perfuse your brain and organs. So, you don get oxygen and nutrients necessarily to where they need to be. And that's why we care. That's the big reason. So it can lead to symptoms like dizziness, lightheadedness, fainting, blurry vision, or fatigue. And this is the big thing. And for older ad in particular. The most common danger associated with this is suffering a serious injury, like a fracture or concussion or fall or hitting their head. Those are the big things we worry about. And so Hypotension, very, very real, can happen, but we kind of have to think about it. But in some acute and severe cases, a sudden drastic drop in blood pressure can lead to shock. So shock is a life-threatening condition. Where your organs aren't getting enough oxygen due to insufficient blood flow, and that's an emergency. You're usually, you know, have to get fluids, or you're an ICU requiring other medications. I'm not saying that happens because you're on a medication. Usually it's not like suddenly, but that's what the worry is. If your blood pressure is too low, that's why we really care. Usually it happens when you're really sick or you in affection or something like that, or your heart's not working. It's not like, hey, I take a little bit more blood pressure medication. Usually, that's like, hey, I'm gonna be light, dizziness. You scale back on the med, you're totally fine. But there is risk on both ends. Hypotension, we really worry about in our elderly so it doesn't lead to falls and other injuries. And so, I would say, at the end of the day, I'm not too worried about this in most of my patients. If I had a patient in low 100s, You know, over 60s, but they feel fine, then I'm fine with that. But if they're, hey, I feel lightheaded or dizziness, then yeah, we're going to talk about that. And so it does kind of Produce an interesting concept, though, right? The risk at both ends illustrates this concept of a J-shaped curve. So while the danger from hypertension is immense, the risk of adverse events from being too low. Is also prevalent. So we kind of have this J shape where, hey, you have some risk at the way low and then risk at the high, and there's kind of this sweet spot. And so the goal of therapy isn't simply to drive the pressure as low as possible, but to maintain it within a safe and optimal range or a sweet spot. One might say. That's kind of the idea. So it minimizes risk from both sides. And now, though, we do want to talk about treatment, right? So we have to talk about what this looks like, a proactive approach. For blood pressure management is very important. For every single person with a blood pressure reading above the normal category, we will have lifestyle recommendations. That's the biggest thing. Hey, like remembering, like, just take a medication. That may be part of the plan if you're really, really high, but we're always going to start with lifestyle medications, and they're the first step. And really, we shouldn't underestimate these changes. I've had previous podcasts all about. Exercises medicine, what it can do for you. But there are lots of things you can do to lower blood pressure more than just taking a medication. So, the most effective interventions are weight management. Losing weight can be very effective, where losing even 10 pounds can make a big difference. And adopting a more healthy eating pattern, something like the DASH diet, which they talk about in a Mediterranean diet potentially, could lower systolic blood pressure by 11 to 14 points. So the DASH diet specifically. They've seen studies can lower systolic blood pressure by 11 to 14, which can be enough to take you out of hyper to non-hyper, which is pretty cool. And the big part of that diet is sodium reduction, limiting salt or sodium to 1 milligrams per day, and that can also potentially lower it. And that's a big thing. But it also means you're gonna have to read your food labels, eat fewer processed foods, and overall, just a healthy pattern shift can be helpful. I'm not saying the Dash diet, you have to eat that. That's been shown to be helpful, but also Mediterranean has low carbs have as well. Really, what it is is taking away modern processed foods. Removing a lot of that salt and eating fewer processed foods, and that's probably going be beneficial for you, and weight loss can be as well. And on top of that, of course, we have physical activity, super important. Building lifelong athletes. I'm all about that. Trying to hit our physical activity guidelines: 150 minutes per week or 75 of vigorous. That's important there. But if you hit those 150 minutes, you can lower the blood pressure by an average of four to nine points, which hey, you add that in with diet and lifestyle, it might be where we need to be. Also, they talk about limiting alcohol consumption that can play into it. But all these things, there's lots of things you can do to help minimize your risk and decrease your blood pressure that are outside of medication. So, that's the first line that I'll always tell people. That's what we're going to do. That's what we need to do. Even if we start a medication, it's very, very important. But talking about lifestyle medications or medications while lifestyle is important. Sometimes they're not sufficient, right? So you do everything right, you're trying to eat well, you're exercising, but you still can't get that blood pressure and goal. Well, that's where medications come in and may be necessary, right? So for most patients, though. There's four main classes of these meds we think about that are first-line therapy. Typically, these are thy diuretics, or some people say water pills. ACE inhibitors, angiot receptor blockers or ARBs, and then calcium channel blockers. All of them work through different mechanisms to safely and effectively lower blood pressure. And yeah, there's There's lots of medications you could start there, but a significant evolution in treatment strategy, particularly in the U. is also mentioning that a lot of times, if you're high enough, meaning stage two hypertension, they recommend starting a lower dose or a comb pill of two different medications. So, a lot of times it's one pill, two different medications can be very, very helpful. And this approach is more effective at lowering blood pressure. We found that if you start two, it seems to have a syner effect. And crucially, using two medications at lower doses can lead to fewer side effects than using one medication at a higher dose. So, this is kind of strategic, right? Combined with the improved patient adherence from a single pill, this can make a smarter, more effective modern approach to treatment. We're also kind of thinking about that for cholesterol as well. If you need to starting lower of two different ones, at the end of the day, if you're very high, a lot of times one medication won't do it. And just going higher and higher just increases your risk of potential side effects. And so starting Lower with two medications, one better side effects, and then hopefully, two, you're hitting two different targets, right? So, these medications target different things in your body to have their effect. So, you're hitting two pathways instead of just one, which may be beneficial. And so Medications, we can talk, that's a whole different talk about ACEs versus ARBs and with patients with diabetes and all these things. There's lots of unique things. That's not what this talk is all about necessarily, but those are the most common things you see in terms of the categories of medications. And Ultimately, the takeaway here is that I just want you to think about blood pressure. I want you to have heard this and understand that it's very, very important. It's one of the things that I talk about all the time. One of the big rocks that I think we really need to focus on. And so, if you haven't ever checked your blood pressure, it'd probably be a good idea. This is one that's a universal screening, right? People recommend once you, you know, pretty much every year have a blood pressure screening. This is a good thing. This is one of the very few screenings that's probably like uniformly worth it, definitely worth it to get it. So, if you don't know your blood pressure, it's time to know what your blood pressure is. And so we can manage that if need be. That's going to be it for today. Thank you so much for stopping by. I appreciate it. If you did enjoy the podcast, it would mean the world to me if you either share this with a friend, left a five-star rating on your podcast platform of choice, or subscribed on YouTube. But that's it for today. Now get off your phone, get outside, have a good rest of your day, and we'll see you next time.
