110: Why Your Blood Pressure Reading Might Be Totally Wrong!

MK: Alright, welcome back. Well, today I wanna talk about a topic that is, uh, fairly simple, but often incredibly misunderstood. And I'm talking about blood pressure. You know, that's the thing that you measure with, uh, one of those devices here. If you're watching this on a platform that supports video, then you know, this is a blood pressure monitor that I've been using and.

In this episode specifically, I wanna talk about, you know, what is blood pressure and why that one reading that you get once a year when you do your annual physical is likely inherently useless. It's like measuring your blood sugar, your fasting glucose levels once a year at your annual physical. It doesn't really tell.

Anything about your metabolic health, much like a once a year blood pressure reading doesn't tell you anything about your cardiovascular health, and in particular because the blood pressure measured in your arm, the so-called brachial blood pressure is not truly relevant or not a. A good indicator of your cardiovascular health.

What really matters is your central blood pressure at your order. You know that close to the heart, but that doesn't get measured. More importantly, even than just a blood pressure, I would argue is the elasticity. Of your blood vessels, you know, how well do they respond and absorb the pressure of your heart.

And so in this episode, we're gonna talk about all of that. I'm gonna share some of my readings. I'm gonna share a little bit more about this device. This is not a sponsored episode. Uh, I just happened to get my hands on a fairly sophisticated blood pressure monitor that not only measures the blood pressure in my arm like you would, you know, expect from any other blood pressure.

Monitor. It also calculates my central blood pressure, so that's the one that's important at the order. It measures my pulse pressure, my pulse pressure amplification, my augmentation pressure, my augmentation index, and the sub endocardial viability ratio. You don't have to write any of this down. We will talk about it here in this episode, what those terms really mean and how they can give you a much, much better indication of your cardiovascular health, especially if you are maybe someone who you know has slightly elevated blood pressure, or at least that's what you've been told.

So this is not medical advice. None of this episode is. As always, but it hopefully enables you to put in your thinking cap and ask the right questions and do a little bit of your own research to figure out whether or not the blood pressure readings that you've been getting, maybe during that once a year annual physical are meaningful, are helpful, and if there is something maybe that you need to adjust in your lifestyle because ultimately.

Significantly elevated blood pressure is a lifestyle problem, meaning that your diet is shitty, your sleep isn't spot on, you don't exercise enough, you don't move enough, et cetera. There are always lifestyle factors, not genes, not, you know, whatever your parents had that indicate or that influence your blood pressure and whether or not it's a problem.

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Before any more cells decide to retire. So before we go into all of those details, let's just set the stage and talk about what is blood pressure. Well, it's the force of blood pushing against your artery walls, right?

Imagine you have, you know, a garden hose and you turn it on and water rushes through the force that's exerted onto that garden hose. That would be the equivalent of your blood pressure. And it's typically represented in two numbers. The top number is the systolic number. That's the pressure when your heart contracts.

And the bottom number, the diastolic is the pressure when your heart relaxes. And traditionally, as I've said, you know, it's measured using a. Cuff like this and a little device or whatever. Sometimes, you know, instead of having a digital reading, you know, someone actually uses stethoscope and, um, and, and counts to see what your blood pressure is.

But nonetheless, it's typically measured, uh, at your arm, at the paral artery, you know, that's the one that you know, goes through your arm. And one of the most important aspects with blood pressure, much like with most of the other biomarkers or biometrics, is it fluctuates naturally. You know, blood pressure isn't fixed, it ebbs and flows all day long, and it can go up by something as simple as being stressed by, uh, by exercising by.

By really a lot of different things, you know, by hydration levels, by, you know, depending on how you slept, depending on where your sodium intake is. There are so many, and we talk about sodium specifically because no sodium, high sodium diet does not necessarily mean high blood pressure and cardiovascular issues down the line.

We'll talk about this, but there are so many. Factors involved that can make your blood, uh, pressure fluctuate. And if you've ever, if you have your own blood pressure monitor at home and you take your reading, you know, maybe without resting for a couple of minutes, first, it'll likely be higher than if you wait a couple of minutes, calm down, let your heart rate settle, and then measure again.

It'll likely be significantly lower than the first reading. It's very easy to find out. Um, I've noticed that after exercise, once my blood, uh, vessels are dilated, my brachial blood pressure tends to be much lower than it is other times. You know, one thing that's super important is, I've mentioned it initially that getting a reading only once a year and making medical decisions based on that one reading is.

Is a disaster because at once imagine, you know, you, maybe you might be running late, you might be nervous because you are at the doctor. You dunno what to expect. You don't know what, what the doctor is gonna find, you know? So that can make you nervous. And that in itself can already elevate your blood pressure temporarily without you really having a problem.

And so I remember from back in the days when I still had my annual physicals, I no longer do those because they're useless. I check. The importance of every three months, including blood work and all of the things. So I don't go to a doctor once a year. Um, but I do remember back in the days, you know, I would go there, you know, my heart rate would be maybe slightly elevated.

You know, I would just come into the office, you know, I didn't really have a lot of time to rest or anything. And then my blood pressure would be one 30 over 85. You know, that's already hypertension, you know, because anything over 1 20 80, uh, would be considered, you know, high blood pressure. And so. Uh, at that time already, I remember that I said to my doctor, well, you know, let's not jump to conclusions.

Let me take readings, maybe five or six readings throughout the day, over the course of a couple of days. I'm gonna document all of that and then I'll come back to you and we'll discuss it. And lo and behold, my average readings were well within the normal range, uh, within what's considered now normal.

We'll talk about that as well. Because, you know, so if one 20 over 80 is normal, you know, anything higher would be done, you know, either elevated or hyper hypertension, stage one or stage two. So depending on how high you go, you know, it, you, you got categorized into, into different buckets basically, that then very often determine, you know, the course of your.

Uh, follow up treatment. Now, what's interesting however, is speaking of normal ranges, you know, as so often with, you know, lab work ranges and, and many, many other things, those have changed over the years. And funny enough, about 50 or 70 years ago, normal was anything that was below one 40 over 90. You know, so that, that would already be considered, um, stage two hypertension these days and back in the days, you know, doctors usually wouldn't treat unless systolic was over one 60.

So that's the first number, the top number and the, even the concept of, of elevated or pre-hypertension didn't exist at the time. And one could argue, well, you know, that's probably because, you know, now we have more information, there is more data to kind of show that, you know, the higher your blood pressure, the more problematic it can.

Be the more or the higher cardiovascular risk is. But one could also could also argue that there is probably a pharmaceutical component to those ranges because you know those panels who establish those ranges. More often than not, and in the case of blood pressure, that was the case as well. You know, there were panel members that had pharmaceutical ties, and the lower the normal range, the more likely it is that doctors prescribe pharmaceuticals and that means more money for the pharma industry.

I'm not saying that's the only reason or the primary reason. But I would argue that is probably a component that drives lowering the normal ranges so that we can, you know, or not we, but the pharma industry can, can sell more drugs. Now that doesn't mean that high blood pressure cannot be an issue. It absolutely can, but just something to keep in mind.

Not everything is as black and white as it, you know, sometimes might seem one thing that is however very important. And that is not often discussed in the same context or in the same, given the same, uh, attention, I wanna say is the role of arterial stiffness. You know, because blood pressure alone isn't really.

The full story. If you think about it, if you have, you know, like in our house, the water plumbing is all done using either copper or PVC, right? And those are stiff, they don't, they don't expand with higher pressure. If the pressure gets too high, they might burst, right? And the appliances that are attached to it, they might get damaged as well.

If there is just too much pressure while the plumbing is all. Very stiff and, and is not elastic. Now, the same kind of principle applies to your blood vessels. You know, as long as they are elastic, which is their natural stage. You know, when you are born and when you're young, your blood vessels are typically very elastic.

So even if there is a temporary increase in pressure, they would absorb that pressure because of the elasticity. Now, the older you get. Combined with poor lifestyle choices, the stiffer your blood vessels might get, and then you can run into issues because then all the force has to be absorbed by that, by those stiff blood vessels, and they might break at some point or rupture or by the organs that are at the end of those blood vessels.

So think of, you know, like your arteries as shock absorbers. And if there are stiff, then they reflect those waves. Those shockwaves at the end of the day that you get from, you know, the force of the blood pumping through your, your, your blood vessels, they, they get, um, reflected back to the heart and that can raise your central blood pressure and increase your risk of a cardiovascular problem.

And so arterial stiffness is incredibly important, and it often worsens with age, not necessarily because it's, that's just what it is as the older you get. I mean, there is obviously a component to that. Much like my skin is not as elastic anymore as it was when I was a baby, but usually poor diet.

Inflammation and plaque buildup from poor nutrition and other lifestyle choices cause that stiffening to worsen significantly faster. And when that happens, then. You run into a problem, especially if you don't have a combination of potentially elevated blood pressure and stiff blood vessels. That's where the problems start.

Now, one thing here I should obviously mention, because you know, with arterial stiffness and, and blood pressure, all of that, sodium gets very often blamed, you know, we get high blood pressure because we consume too much salt. Well, it's not quite as simple because obviously sodium is incredibly. Important.

You know, it's essential for nerves, for muscles, for fluid balance. Just cutting out all or most sodium is a recipe for disaster and poor health outcome. What's critical, however, and what's not very often covered is the the need for a balanced sodium to potassium ratio. Those two things are like yin and yang.

They need to be in a certain balance so that each of those two. Minerals can do its job properly and doesn't cause any issues because potassium, for example, helps relax vessels. It helps flush out excess sodium, and it also keeps your blood pressure stable. And historically, um, you know, humans have. Had way more potassium in the diet.

You know, from whole foods, from animal organs, et cetera. Maybe from fruits and less sodium from processed foods, because where in nature do you get a whole lot of sodium from? Yes, obviously salt in nature, but unless you know, you discover the salt mine. You would probably not be consuming the amount of sodium that most of us get from highly processed foods.

Right. And those are not even, it's not even the, the, the sodium itself very often, but it's, you know, salt, real salt, natural salt comes with trace minerals, you know, that make the sodium behave significantly differently in the body than if you have a stripped down version, a processed salt at the end of the day that you get with well.

Processed foods. So again, very different. Um, but again, you know, instead of just cutting out salt and reducing your sodium intake, I would argue that if you wanna do something for your cardiovascular health, you know, consume enough high quality salt, consume enough so, uh, potassium, ideally from whole food sources, and limit your intake of overly processed foods that include processed salt and sodium.

Now let's talk a little bit about, you know, more, uh, of those biomarkers that are very much associated to blood pressure and what they mean and how you can measure them. I've mentioned it before. I, I just recently got my hands on this device. Again, not sponsor anything, but it's called Connect and, um, connect Pulse.

That is, and it's a, it looks like a blood pressure monitor. But what it does is it uses a technology, uh, called pulse wave analysis, and that's the gold standard to capture waveforms and to calculate the central blood pressure. So that's the pressure in the order, and that's what your organs feel, if you will, and that is important.

If that is low. Then the brachial blood pressure is significantly less important. It's not irrelevant, obviously, but there is a certain ratio or delta between those two that's important and so. Okay. Besides the central bp, what this guy can measure and calculate is the pulse pressure. And that is the difference between the systolic and the diastolic.

It can measure the pulse pressure amplification, and that is, uh, a metric that, uh, shows how much higher the brachial pressure is compared to central. And that is important because the greater that difference, the, the more elastic your blood vessels are. Or it's an indication of your blood vessel elasticity.

It can also measure the augmentation pressure or ap, and that's the added load from reflected waves in stiff arteries. So if you have very stiff arteries and your blood gets pushed through those, then you get like, you know those, those waves reflected back and you can measure that and that should be relatively low indicating.

Not stiff blood vessels. In other words, if you ever have very elastic blood vessels, then the augmentation pressure should be comparatively low. Then there is the augmentation index, and that's the percentage of reflected pressure. Um, the higher it is, the stiffer your blood vessels not a good thing. And then there's sub endocardial.

Viability ratio, and that's your oxygen supply versus demand for the heart muscle. And again, the higher that is, the healthier your cardiovascular system is. And so all of this is measured, calculated. By this device, and then you get the very neat report. And I just started using this device and, uh, I did a couple of, you know, readings and there were some where my brachial blood pressure, meaning the one in my arm was in the, you know, high one twenties over eighties or so.

There was even one where my diastolic was 90. Um, 1 27 to 94 was one example. Um, but overall, you know, if, again, if it. Look at multiple readings. My brachial blood pressure is pretty much within the, what normal range. Some cases just a little bit over, and that in the beginning I'm like, should I be concerned if my blood pressure is 1 28 over 81 or whatever?

But then I dove a little bit deeper into into the reports and I realized that my central blood pressure is only one 17 systolic, and that is. Low below, uh, on, well within the normal range, I wanna say, and more importantly, than the delta. Between my brachial and my central is fairly high, indicating my blood vessels are very elastic.

And funny enough, many, many years ago already, it just popped into my head. I used a wearable that was called a biosense. It was kind of like a whip strap or an AA ring, but was also a a wrist kind of band. And that device could also measure arterial elasticity. At the time, I didn't really know, you know, what implications that had, but it showed that my, my, the health of my blood vessel was incredibly, uh, good and the very el elastic blood vessels.

And I'm like, okay, cool. Uh, now I kind of understand more about what this means and, and why it's important. Um, going back to the report of that connect, uh, my central pulse pressure is 23. That's even slightly below what's considered normal, and that, again, shows very high elasticity. Of my blood vessels, my pulse pressure amplification is 146%.

Again, indicating that my arteries are very springy. You know, they, they can expand and then bounce back. That's very good. That's exactly what you want to have. Uh, my brachial blood pressure in this particular report that I'm just reading off here now was 1 27 over 94. So the diastolic looks high. But as so often the case, you know, there could be cuff artifacts, there could be other reasons.

Considering all of the other numbers, there is not really anything to worry about. My, my augmentation pressure is three. Normal. My, um, augmentation index is 12%, again, normal. And my sub endocardial vi uh, viability ratio is 165% indicating very good oxygen balance. So the bottom line here really is that there is no issue.

Even though sometimes if I would just go by my annual readings, you know, someone would say, well, you have pre-hypertension because sometimes your, your blood pressure is like high one 20 over, you know, eighties or or something like that. Sometimes even, I've even had individual readings that were like one 40 over over 72 or something and I'm like, well, you know that that is an issue that is if you ask a doctor, you know, that is already something that you probably wanna, wanna, wanna look at.

And goodness is, I did look at it. And again, looking at all of the metrics, especially the ones that really matter. There is no issue and taking several readings potentially throughout the day, um, over a course of a couple of weeks, you know, and then looking at the averages, you can tell if you have chronically elevated blood pressure.

If your central blood pressure is elevated. That's really ultimately what matters. Um, or if there is no problem whatsoever, I mean, considering that what I'm doing, you know, I exercise regularly, I sleep well, I manage stress, I have a proper diet. Um, there is not really anything that. I see that I could be doing potentially wrong.

So there is no reason to believe that my blood pressure there is a problem with my blood pressure. And so my key takeaway is for myself is I'm good. I'm gonna keep an eye on it. Of course, you know, the older I get I might have to tweak certain things. Who knows? Um, I'm always looking at balancing the sodium on potassium intake.

There might be room for improvement. I really like this device. Um, you know, because I can get my, my regular reports and see exactly if there are any changes with my arterial elasticity. Maybe more so important than, you know, changes in my brachial blood pressure. Uh, but for you, you know, if you're listening to this, if you, maybe if you've been diagnosed with, um, you know, pre-hypertension or if your doctor was maybe suggesting, you know, to go on blood pressure medication, you know, maybe take a look at some of those additional biomarkers and say, okay, is there really a problem?

You know, is your central blood pressure high? Is your, are your art arteries already getting stiff? How does your lifestyle look like? You know, how is your sodium and potassium intake, you know, do you regularly exercise? Do you consume an animal based nutrient dense diet? Do you have proper sleep hygiene?

Do you manage your stress well or as much as you can? You know? And, um, if, if the answers to those questions are yes, you're doing all of those things and your blood pressure, your brachial blood pressure might. Be slightly elevated at times during spot readings. There might not really be a problem, but definitely something that you wanna keep an eye on that you wanna dig a little bit deeper.

Blood pressure is obviously important, cardiovascular health is important, but just looking at one number a year and then, you know, potentially going on blood pressure medication. Like a lot of my extended family, they're on blood pressure medication. I'm like, I do not understand why you're doing this, first of all.

You've not exhausted your lifestyle choices or changes to your lifestyle. You know, most of those who are on blood pressure medication don't follow the same lifestyle that we have over here. So there is already room there for improvement. Uh, but beyond that, what is, what is really your, your central blood pressures?

Anyone even looked at that? Try to calculate it. And if the answer is no, then maybe that's something I would do first before you take medication. Um, and with that, uh, we're gonna wrap it up. If you like this episode, send it to someone who might need it, who has been diagnosed with, you know, pre-hypertension or hypertension, and who is considering going on medication.

And, you know, hopefully then coming to the conclusion that there are other things you can do before and should be doing before, you know, trying to fix something, trying to, to treat the symptoms using pharmaceuticals rather than working on the root cause. With that, we're gonna wrap it up. See you next time.