AMA #48: Blood pressure—how to measure, manage, and treat high blood pressure

**Peter Attia** (0:11)
Hey, everyone, welcome to a sneak peek, Ask Me Anything, or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to Ask Me Anything episode 48 I'm once again joined by Nick Stenson. In today's episode, we will focus on one topic, and that topic is blood pressure. If you listen to this podcast, you have heard me talk quite a bit about cardiovascular disease. And usually when I'm doing so, I'm doing so in the context of talking about prevention, vis-a-vis ApoB and lipoprotein manipulation.
But you've probably also heard me talk about blood pressure because high blood pressure along with high ApoB and smoking is one of the three leading causes of atherosclerosis.
What's perhaps most insidious is that many of you listening to this don't actually realize you have high blood pressure.
And we therefore kind of begin the discussion by talking about what high blood pressure is, how common it is and how you go about measuring it. It turns out that the measurement you get in the doctor's office is probably not that accurate for multiple reasons, which I go into in this episode. So what's most important for anybody who really wants to get under the hood of their own blood pressure is that you get a cuff and you figure out how to do this at home. Now, this can be done with an automated cuff or a manual cuff, and we'll talk about both of those, but it's really the way in which you go about doing this and the repeatability of the measurements and the time you take to do it that determines whether or not you can make the diagnosis of high blood pressure. We then focus on what to do about it. And this is where I think the most important part of the discussion takes place. How much does weight loss, how much does exercise, how much does nutrition, how much do any of these things tweak blood pressure? And if they still fail to do so, what are the pharmacologic choices you have and how should you be thinking about them? This is an extremely important topic, not only for cardiovascular disease, but also for dementia. And when you think about the prevalence of those two conditions, I think you'll understand why knowing your blood pressure is simply a non-negotiable. And if your blood pressure is elevated, it has to be addressed.
One last thing to note is that this is an audio-only AMA. There's no video for it. However, the show notes will include any figures and studies that I've discussed here, and then some. So without further delay, I hope you enjoy AMA number 48

**Nick Stenson** (2:49)
Peter, welcome to another AMA. How you doing?

**Peter Attia** (2:51)
Very well, thank you.

**Nick Stenson** (2:52)
Awesome. You know, before we get started on this one, some of the people who listened to one or two AMAs go, and we were going over your decks of results.
We were talking and telling the story about Reese's Pieces and how you had never heard of them. And we did a call out to say, hey, if anyone else has never heard of them, please reach out. And you will be pleased to know we probably had about 30 to 40 people who were in the same boat as you and had no idea what Reese's Pieces are. So you are not the only one.

**Peter Attia** (3:22)
Not the only one on this planet.

**Nick Stenson** (3:24)
Not the only one. I mean, again, 30 to 40 compared to our listenership is not a good percentage. So you're definitely in the minority. But yeah, shout out to everyone who reached out and the person who was the first to reach out. We have something special going in the mail for them. And ironically, they reached out to us before we even sent the email saying the podcast was live. So to say they are an active listener would be an understatement. So shout out to that person. They know who they are.
Today's AMA is going to be on one subject, but one important subject, which is blood pressure, and all things blood pressure.
And people who have listened to the podcasts will have heard us talk about blood pressure before. Most recently, the episode we released with you and Ethan Weiss, Ethan coming back for the second time, you both spoke a lot about blood pressure. And as you said in that one, if you look at cardiovascular disease, three main risk factors for cardiovascular disease are gonna be smoking, which we don't necessarily talk a lot about because as you've said before, we're kind of under the impression, if you listen to this podcast and you still smoke, you probably should know you shouldn't. So that's nothing really we need to say there. The second is APO-B, which clearly is a topic that we cover a lot and has been covered. And then the third is blood pressure. And we kind of realized we hadn't done as much of a deep dive on blood pressure, and we get a lot of questions. So we compiled all those.