How to measure blood pressure & it's variability throughout the day | Peter Attia & Ethan Weiss

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This clip is from episode # 247 ‒ Preventing cardiovascular disease: the latest in imaging, blood pressure & metabolic health
In this episode, Peter is joined by Ethan Weiss M.D., a preventative cardiologist at UCSF.
In this clip, we discuss:
- The variation of blood pressure throughout the day
- The physiology and pathophysiology of blood pressure
- Research on blood pressure
- Peter’s history with checking blood pressure
- And more
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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[@lilytea3]

0:14: 🩺 Blood pressure varies throughout the day and is influenced by activities such as sitting, sleeping, exercising, and stress. 3:09: ! The optimal way of measuring blood pressure is to have the patient in a quiet room, take multiple measurements with breaks in between, and calculate the average. 6:30: 💉 The speaker discusses his fluctuating blood pressure and questions the accuracy of his readings. 9:50: 🩺 The speaker suggests using a 24-hour blood pressure monitor to get an accurate measurement of average blood pressure over time. 13:03: 💡 There is currently no accurate device available to measure blood pressure, but the speaker believes that it is possible to develop an intravascular device in the future. Recap by Tammy AI

[@rhondaurb]

Thank you!

[@douglasx6915]

You should always throw away the first reading because it’s universally wrong. As soon as that tension is created by the cuff, your body will go into overdrive to compensate for that pressure. And sometimes that reading is spectacularly high. This is really true in the clinic. Doctors take one reading and write it down. THIS IS WRONG. Calm down. You’re not dying. Simply sit there and causally take multiple readings with the cuff remaining on the arm. If you’re at home, take 6, 7, 8 readings. With this, you will get a better idea of what is your true BP. And btw, this may take several days to weeks to truly understand the dynamics of your personal blood pressure. And if you really want to deal with your “essential” hypertension, stop eating sugar. Because elevated insulin has a direct link to elevated hypertension.

[@erastvandoren]

Insulin induces vasorelaxation by stimulating the production of nitric oxide in endothelium. You are wrong about sugar.

[@andyv6127]

It would be interesting if we measured BP when under a standard load (for active people) to see what the variability is with BMI/fitness/height/lean muscle mass etc.

[@davidjudd2283]

The variability means determining the accuracy of BP meters is incredibly difficult to determine. Additionally, I take my BP using the SPRINT methodology pre-exercise then post-exercise. My BP is consistently low post-exercise which seems counter intuitive.

[@donspradley6912]

Is measuring blood pressure the way we currently do on the same level as measuring ones BMI (close to worthless for fit individuals)? Something to think about…

[@abrin5508]

My BP tends to be about 10 below in the Drs office. 115 at home with 5 mins rest using omron and about 105 at docs with approx 5 mins rest. I heard the manual test is more accurate than the digital.

[@timbucker]

I think the best way to measure it is to do it like it's been done for many decades when the statistics were formed from that data. Changing the paradigm now means you can't then compare yourself to the data.

[@andrewthompson9206]

I absolutely have the so-called "white coat syndrome." I don't know exactly why it started because I never used to have an issue. However, when I get my BP checked by someone in a clinical setting my BP skyrockets...at home by myself typically around 116/60ish...

[@Debbie3360]

Sugar & metabolic inflexibility also raises it

[@wellingboroughredburn-yd9yk]

Had to make an appointment for my health insurance at work, the receptionist put me down for half an hour before the time she had told me to be there so when I got there I had 'missed' my appointment. I was rescheduled for half an hour later so I went for a walk around the area, still angry that this receptionist put me down for one time and sent another in the confirmation e mail. When my BP was taken it was high and the nurse put me down as hypertensive. I told her the reading couldn't be accurate (my wife is a nurse and takes mine at home on a regular basis, I have an idea of what my resting blood pressure is) because I was angry about having to spend an extra 45 minutes after 'missing' my appointment. Didn't matter to her.

[@nancyd7441]

Have BP rechecked at the end of your visit too. Usually BP is done too quickly at the start of the appt. Good to compare the readings at the start of the appt. & at the end of it.

[@Unitedstatesian]

The NIRS technology for measuring blood flow to the brain or specific muscles seems like a promising "digital" device. This kind of data might be easier to monitor and be more valuable than BP in many cases.

[@moisesfigueroa8731]

Why not take the BP reading during a stress test and compare it to BP measure at multiple time during the day?

[@user-uq6fk7yr2r]

If blood pressure is variable throughout the day and you get it checked once a year during your annual exam, should you use that as a reference point to actually be diagnosed and medicated to treat the condition?

[@gregwhittier5206]

I wound up on blood pressure meds because of high readings at the doctor and a drug store monitor I used at home that gave a bimodal distribution of readings. I got suspicious and bought the most accurate monitor from a new york times test of monitors and suddenly I didn't have a problem anymore. The data is only as good as the equipment! I take my pressure every day now with the same protocol and find it useful but when I got inconsistent readings when using poor equipment, it just drove me crazy.

[@mlb5525]

What’s the monitor you are using?

[@gregwhittier5206]

Greater Goods Smart Blood Pressure Monitor 0604

[@AG-mo9zs]

Still on medication I wonder?

[@gregwhittier5206]

@@AG-mo9zs haven't been in a long time. never really needed to be (was probably about 130/80 with a working monitor). Now running again, lost weight, and average 118/69.

[@handianus]

Very common. Recommend at home testing even if already prescribed a bp med. They can cause dizziness and hence falling

[@cday0075]

10:27 I think maybe this is an issue of combining people “living in the real world” as mentioned with people who actually have anxiety induced white coat hypertension. For me, my blood pressure at home is generally 117-123/74-76. When I work out, it goes up to just under 140. But in a doctor’s office, I’ll always get readings of 150+. That’s higher than when I’m working out! And I can feel that I’m anxious. So I don’t exactly think that white coat hypertension is just normal from moving around before taking a reading, but that those cases might get lumped together

[@manojlogulic4234]

What about aktiia non invasive BP bracelet? I believe it’s FDA approved to be accurate, does anyone have it, any opinion on that device? Thanks.

[@deirdrecollins3987]

We use mobil- O Graph for ABP M for any patient over 60 to rule out nocturnal hypertension. 15% of hypotension goes undiagnosed r/t normal Bp during the day when it’s typically checked at the GP’s or self measured. ABPM is the gold standard. And yes it’s a drag to have to wear but having mean awake and sleep averages is invaluable.

[@Dr_Oleg_Kulikov]

Buy a blood pressure monitor and measure your BP in reproducible conditions. Like in the morning soon after you are awakened. I am 66. My BP is 102/68. RHR is from 54 to 58. When I was 18, my BP was 110/80 and my RHR was about 42-45 bpm. During recovery time my RHR can be above 60 bpm, and BP - 110/78. Three years ago when I was doing long and intense aerobic exercise (60 - 100 km by bicycle a day) my BP was 90/50 and RHR 46. Pulse pressure (SBP-DBP) correlates with your biological age or actually with your cardiovascular age. It is good to see that my PP now gets closer to the PP when I was young. So, it indicates the rejuvenation of my cardiovascular system. Cheers

[@paulmarshall9189]

Seems like the question is what specifically are you trying to measure? Obviously different people are going to have different degrees of variation in BP. So are we looking at the ability to "breathe it down"? A lower aggregate number throughout the day? A less dynamic response to stressors? These are going to vary with different subjects.

[@alchemy1]

I check my blood pressure every day. Sometimes even 3 to 4 times a day at different times. The measurement can range from 95/68 to 150/95. I have seen it as low as 87/58 ( in the morning after I wake up of course.) At doctor's office I have seen it as high as 165/105. Doctors cause high blood pressure. THAT IS CORRECT.

[@donspradley6912]

Question: could one relive or fix there blood pressure problem by stressing less, breathing more and exercising regularly?

[@bobgug8626]

Exercising and reducing stress, yes. Breathing more, I don't see how. Losing weight is another one (for overweight people).

[@jamesforsythe3566]

I have been athletic my entire adult life, and have had a BP and HR well below normal. After having a heart attack, my cardiologist has insisted on treating me for high blood pressure, despite my having never had high blood pressure. Consequently, I have had very low BPs to the point that it does not feel safe to drive and I'm at risk of passing out (Sys in the 70s). Yet, my cardiologist has minimized and dismissed these side effects. I'm curious if I'm in a unique situation, or if other athletes have had similar issues after a heart attack.

[@wturber]

I'd get a second opinion. Your cardiologist may be doing the exact right thing for you. But it would be nice to confirm that.

[@boatman222345]

The main thing missing in this very interesting discussion is measurement accuracy. A type 1 insulin dependent diabetic for 52 years I was one of the earliest adaptors of home blood glucose monitoring. Over the past 43 years I have taken in excess of 135,000 blood glucose measurements. I originally depended upon Chemstrips which involved very time consuming and highly subjective finger stick, color comparisons. As these were highly unsatisfactory I wound up importing a digital meter system from Great Britian . As American technology caught up I went through a succession of American digital bG meters. For the past several years I have utilized a FreeStyle Libre 2 cgm system. Simply put the accuracy of all of these systems is simply terrible. FDA approval methodology would be funny if not so dangerous and in far too many instances the information obtained via these systems while "better than nothing" is woefully inaccurate. I use a top rated Omiron blood pressure system and I suspect the results I obtain with this device are at times also woefully inaccurate. As in the old saying about inaccurate data, "Garbage in, garbage out!"

[@wturber]

OTOH, I recently bought an Omron cuff for my wife since I was suspicious of the one I bought from Goodwill on the cheap. When I test them against each other they come up almost identical. My wife took the Omron to her doctor and tested it side-by-side with their cuff. Spot on. Take three measurement five mins apart and average the results. That's as good as what they do in the studies.

[@selma5885]

How do you sleep with a 24 hour BP monitor? I would not be able to sleep. So is is an accurate measure?

[@jackfaber7710]

sure not. it's a bull shit.

[@nancyd7441]

I was in a study and had one on for 24 hrs. No issues with sleep.

[@dr.samierasadoonalhassani2669]

Recap,pathology,physiology,3x 5 minutes in between,after resting.120/80-120/70.

[@selma5885]

I've had the same question. My BP is normal in the morning when I wake up but sky high in doctor office 160's, 170's. It's high during the day if I just sit down and take it 150's- but I can meditate for 5-10 Mintues and bring it down to 120's. My problem is I cannot handle BP medicines. They all thus far created side effects I can't tolerate and still don't bring it down in doc office or a home unless I meditate for 5 minutes. It does bring the highs down. Losartan 5 weeks caused extreme fatigue, some ankle swelling, terrible sleep/wake periods during the night. Hydrochlorathiazide made my sodium and Chloride levels go low, and sugar go into prediabetes from 80's. Waking up alot at night to go the bathroom. I was on it for a month. Propanolol gave me scary muscle weakness ( have fibor/neuro symptoms) .Atentolol terrible insomnia. Lisonopril 7 years ago terrible brain fog, fatigue, lower gi pain etc. Now doctor is recommending clonodine. I read that can increase blood cholesterol and blood sugar. And also can cause sun sensitivity. I'm neurologically sensitive to the sun. Seems like so many BP meds raise cholesterol and blood sugar which then raise risk of heart disease?

[@Pops2]

Valsartan?

[@selma5885]

@@Pops2 Nurse Practioner at Cardiologist was of the mindset that if I reacted poorly to one drug with in the same class I'd react poorly to all?

[@Pops2]

@@selma5885 I particularly like how they lowered the bar at my last visit to be below 120 and below 80. It's a struggle, you got this, keep fighting and you'll find a way to lower it. My stay at home daughter has to be the main cause of my high BP 😂.

[@azzbambino]

Can anyone comment on isolated systolic hypertension? My top number seems to always be high and bottom number is always low. Stress maybe?

[@Pops2]

Daughters will do that.😅

[@mylesdent2214]

My blood pressure behaves exactly like Peter's, and like him I always feel that I'm cheating, so as not to accept a bad result. It always comes down to normal for the last two readings, after having relaxed for five minutes between the first and then each of the final two readings. It really bothers me.

[@jackfaber7710]

and what do you want? to your bp is normalize for a seconds after a load? or what? and why it's must go that way?

[@YouLoveMrFriendly]

Practice relaxing every half hour, as if you were taking your BP readings. If you know how it feels when you get your BP down to good levels, then target that feeling throughout the day. Then stick to a twice a day or three times a day routine of checking it with the cuff.

[@VanNguyen-gh9uj]

I am 64 and workout about 6 hours a week, I am rotating strength training and cardio Z2 during the week and VO2 max 4x4 training on Sunday. I had been on this schedule about 2 months however my blood pressure still around 138/78. Should I continue taking my blood pressure medicine

[@AG-mo9zs]

Differently keep measuring it. 138/70 its not very high , but lower the 138 (Systolic) is better

[@Dr_Oleg_Kulikov]

Your BP is too high and it indicates stiffness of the Aorta. It is a result that you do too much resistance exercise. I am 66 and my BP is 100/68 with HRH about 56. A combination of aerobic exercise with HIIT or SIT works better.

[@wturber]

Maybe. You should certainly discuss this with your doctor. But, IMO, you should also inform yourself. Read the SPRINT trial. Do you fit the cohort? If yes, then yeah - you probably should do something to lower your blood pressure. BTW, the cohort is overweight, has either Cardiovascular Disease or a high risk for it (blood lipids, smoking history) and is a little bit older than you on overage. Also, what is your exercise history. If you've been largely sedentary and have only recently started this routine, you'll probably want to give your body some time to adapt. Also make sure you are getting your sleep so you can recover. FWIW, supplementing with GlyNAC appears to have lowered my BP noticeably. Probably 10-15 mmHg on the systolic.

[@Dr_Oleg_Kulikov]

You may find some info on my channel. I am 67. My BP is 105/68 now. RHR is from 48 to 52. When I was 18, my BP was 110/80 and my RHR was about 42-45 bpm. During a recovery day my RHR can be above 60 bpm, and BP - 110/70. Three years ago when I was doing long and intense aerobic exercise (60 - 100 km by a bicycle per day) my BP was 85/50 and RHR 44-46. Pulse pressure (SBP-DBP) correlates with your biological age or actually with your cardiovascular age. It is good to see that my PP now gets closer to the PP when I was young. So, it indicates the rejuvenation of my cardiovascular system. And, IMO, never trust medical professionals and take any medications. Or whatever, your choice.

[@wealth1ness]

Omron has a blood pressure watch.

[@kst157]

My average blood pressure (first reading as well) is typically 98 / 54, is this too low? Am in my 60’s. No faintness or symptoms and I’m an irregular yet very active big wave kitesurfer (it’s weather and waves dependant). Occasional gym (once every three to four weeks). BMI of 20 & 8 % body fat. Friends say it’s dangerously low but is that true? Unsure of what to do?

[@Dedicated_.1]

Yes, it’s too low just look it up, ideal is 120/80

[@kst157]

@@Dedicated_.1 Thavks - some health experts suggest below those figures you mention is better - ideally - but not always how far? Also, age & sex alters the figures. Doctor Gregor, for instance, suggests, even though very difficult to achieve for the public, aiming for towards 100 would be the real ideal level. Also, too low is stated around 90 by many - leaving a large ideal window from 90 - 120 which maybe is open for debate.

[@Lara-dp8gk]

⁠@@kst157you need to discuss with your doctor. The recommendation is 120/80 or lower. But it can go too low and this thus risk for dizziness/fainting. Good nothing has happened to you yet , but you’ll want to find out what the parameters are for your risk. My dad (also a very fit older person) had to be on watch for falling do to low blood pressure. It’s managed now, but he bought a home device to check his regularly as part of that management routine.

[@Pops2]

I'll trade some of my highs for your lows.😅

[@CaptainDave05]

The key to ‘too low’ is if you’re having symptoms. A lot of people who are less healthy than you (like me) would be getting dizzy when we stood up at 98/54. BMI of 20 and 8% body fat tells me you’re in pretty athletic shape. Kite surfing also involves some unique muscular effort that may be helping keep your BP numbers low (lots of isometric exercise holding on - look up isometric exercise and how it lowers blood pressure.). Also look up aboriginal blood pressures in tribesmen who don’t live the western lifestyle and you’ll see similar very low numbers. The 120/80 “ideal” is a very healthy number for people who live the Western lifestyle.

[@hamdiel-sissi7760]

Blood pressure changes during the day as well as during the seasons. During the peak of the summer, you get the lowest readings. Most people have lowest BP during early morning hours; mine is the exact opposite with highest reading during early hrs. Spot measurement during your physician visit is utterly garbage!!

[@richardfish3650]

NIH is captured.

[@Team920_]

Does high blood pressure have symptoms?

[@jackfaber7710]

depends on a concrete human been, mostly no.

[@SeriesOfYouTubes]

Uhh…… headaches, erectile dysfunction, kidney failure… if you have high BP, please see a doctor and start getting it addressed before it’s too late.

[@AG-mo9zs]

Most of the time NO symptoms. that is why they call it " the silent killer"

[@Team920_]

@@AG-mo9zs besides most of the time what are symptoms if any ?

[@AG-mo9zs]

@@Team920_ none

[@elck3]

I think people obsess about the numbers (and variability) too much. It’s more about the trend over time, not day to day measurements. So, calm down.

[@wturber]

Agreed. I've listened to a lot of Peter Attia's videos and his book. It seems clear to me that he leans toward being obsessive. Not how he's concerned that he's "cheating" his BP measurement - when that's exactly the way they do it in the SPRINT trial. So while I think he generally does a very good job at looking at things objectively, when he does err it seems to be toward obsessing on details. I have yet to see/hear him present appropriate evidence to support his inclination to medicate otherwise young healthy people with moderately high blood pressure. Maybe he has that evidence and maybe he's right to do so. But he's not showing the evidence or his reasoning. The evidence he's showing of for older, heavy people with CVD risk. I think it is super important to treat all of these pundits with healthy skepticism. Even the best of them who work hard to be evidence based have biases and blind spots. As do I and as does everybody. BTW, anybody who's endorsing "Athletic Greens" gets a demerit in my book. So far none have provided any evidence of benefit.

[@scottcrosby9827]

The problem with an intravascular pressure sensor is it would require patients to be on antithrombotics for the rest of their lives.

[@scottcrosby9827]

But a lot of the patients who such a device would be indicated for would likely already have a need for antithrombotic therapy, no?

[@pxnchx93]

What about Apple Watches?

[@adamsimmons7646]

Having to Live with one of the worse and deadly sickness can be really frustrating I have had herpes for the last 1 year now and I’m getting really fed up with it.

[@adamsimmons7646]

This is interesting, how did you come about this sorceress that helped you? Perhaps she can help me out with my Herpes that I have been battling for the past years now.

[@adamsimmons7646]

Okay this is comforting, I will have to try her and see as I have tried many things. Thank you very much for this info.

[@fergalcussen]

"It's" means "it is". Tsk.

[@davin8r]

Should be "its" variability, not "it's"

[@golgipogo]

No surprise-he is a man in a hurry, driving a Hummer

[@davin8r]

@@golgipogo where are you getting your info about him driving a Hummer? I know he's not perfect, but he's not a total douche.

[@marthavictoriayogatherapy]

Peter, I am a HUGE fan of you but I have to tell you this!! Please, please, change that chair. You are sitting in a slump position, compromising your breath and the curvature of your cervical. You are undoing everything you and Beth talk about! And keep up your amazing work.

[@youtuberkid2384]

Somebody please summarise? Thanks

[@kevinmccarty6759]

There are AI extensions you can use to get summaries. Available as chrome extensions or standalone. There are also tools available online. Try summarize.tech as an example.

[@MichaelJCroninND]

Lots of words/minutes but no clear useful understanding to monitor mild HTN. Did I miss something?

[@dpm5519]

I’m also a little confused on the proper way to check my BP. Twice a day for 2 weeks I guess ?

[@AntonioRodriguez-gn3lr]

Way too verbose

[@antonchilinski9729]

So go somewhere else.