New Hypertension GuidelinesMarch 2018
By William Faloon
As I was finishing this article, two people I personally know suffered strokes that were most likely caused by their high blood pressure. One of them is paralyzed on one side and will likely be confined to a nursing home for their remaining years. Both knew they had hypertension, but like so many individuals today, they dealt with this deadly disorder as if it were a trivial matter. No medical authority discounts the dangers posed by hypertension. Yet a stupendous number of aging people are failing to maintain their blood pressure in optimal ranges.
In the United States, 1 out of every 3 adults has high blood pressure.1
Only 45% have it controlled. To make matters worse, this 45% statistic is based on higher-than-optimal blood pressure ranges, meaning most adults today endure chronic hypertensive damage to their tissues.2
Conventional doctors diagnose hypertension when a patient’s readings exceed 140/90. The scientific literature, however, indicates that the ideal range should be around 115/75.3 When blood pressure exceeds 115/75, there is an increased risk of heart attack and stroke, which are the leading causes of disability and death in modern societies.4
The market for antihypertensive drugs is huge. Virtually every pharmaceutical company at one time or another has aggressively promoted their patented product to physicians. Once a doctor gets into the routine of prescribing an antihypertensive drug, they often continue prescribing the same drug even when newer and better ones are approved.
Insurance companies are increasingly refusing to pay for newer and better drugs because generics cost less.
For those with blood pressure readings significantly over 115/75, I have some great news. In 2014, the FDA approved a generic version of an antihypertensive drug that lowers blood pressure more consistently than other classes of medications and has ancillary longevity benefits.
The side benefits of this drug include improved insulin sensitivity, enhanced mitochondrial activity, and better endothelial function.5-12 Preclinical research indicates that it may also help control body weight.6,13,14
This article reviews conventional protocols that are failing to maintain optimal blood pressure levels throughout the day. The reader will then be enlightened to what we believe is the best drug for most people with elevated blood pressure that cannot be controlled with lifestyle changes.
Medicine often progresses at a dreadfully slow pace.
The first direct measurement of arterial pressure occurred in 1733 in a horse.15 It took almost 100 years before a primitive device was developed to measure blood pressure noninvasively in humans.
Around 1900, some physicians started testing their patients’ blood pressure. Skeptics criticized that reliance on a mechanical device would “weaken clinical acuity.”16
The impetus for widespread blood pressure testing did not emanate in the medical community. It was life insurance companies who spearheaded it because early mortality was so clearly evident in those with higher blood pressure readings. Credit the Northwestern Mutual Life Insurance Company for stating in 1911 that blood pressure testing devices are “indispensable in life-insurance examinations.”17
Conventional doctors were not persuaded by insurance company actuaries. In 1931, an article published in the British Medical Journal stated that, “The greatest danger to a man with high blood pressure lies in its discovery because then some fool is certain to try and reduce it .”15
This misguided thought process persisted for decades, despite a growing body of published studies linking hypertension with sharply higher rates of stroke, heart disease, and kidney failure.15,18-27
I relate this brief history to demonstrate how far behind medical authorities have been in recognizing this leading killer. The problem is that most conventional doctors still are not optimally diagnosing and treating hypertension.
Overworked Doctors And Under-Motivated Patients
I am more sympathetic to practicing physicians than ever before. The volume of published medical studies has exponentially increased, record numbers of different antihypertensive drugs are available, and doctors face humongous patient loads.
So a typical person today will be diagnosed as having hypertension when readings exceed 140/90. They will usually be prescribed a drug that the physician has long used. Another appointment will be made to see if the drug is working. This is all wrong!
For example, a 2002 meta-analysis of 61 prospective studies showed that blood pressure readings over 115/75 increase mortality from stroke and heart attack.4 This means a huge number of people today are being told their blood pressure is “normal,” when it may be dangerously high, i.e. over 115/75.
No one should think “normal” connotes safety. There’s nothing “normal” when an aging person suffers a stroke, heart attack, or kidney failure. You don’t want to be “normal” when it comes to the diseases of aging…you must seek “optimization.”
Secondly, most drugs don’t keep blood pressure low over a 24-hour time period.28 One might wrongly assume that lowering blood pressure most of the day is sufficient. The reality is that damage to blood vessels occurs whenever blood pressure is elevated.
By relying solely on doctor’s visits to measure blood pressure, patients taking their antihypertensive drug in the morning may show perfect readings at the doctor’s office that day, but their blood pressure could spike dangerously high in the evening and throughout the night. Anyone with a hint of hypertension should have an at-home monitoring device to ensure that whatever drug they are prescribed is working 24 hours a day and that their blood pressure readings do not significantly exceed 115/75.
I am often surprised when someone is prescribed an old-line antihypertensive drug (like a calcium channel blocker or beta blocker) when more effective medications with fewer side effects were long ago approved.
The good news is that a motivated patient today can work with their physician to achieve optimal blood pressure readings 24 hours a day, every day.
Low-Cost Antihypertensive Drug With Side Benefits
In 1995,30 the first drug in the class of angiotensin II receptor blockers was approved.31,32 Two trade names for this class of drug are Cozaar® (losartan) and Hyzaar® (losartan plus a diuretic). This class of drug had many advantages over previously used drugs for hypertension, yet it never gained the widespread acceptance it deserved. One reason was an overwhelming amount of medical journal advertising for older-line antihypertensive drugs, and the aversion doctors have to “changing” their prescribing habits.
In 2002,33 the drug Benicar® was approved, and an advantage was that it required only once-a-day dosing.34 Losartan often failed to control blood pressure all day, but this information was not widely known. I recommended to members that they check their blood pressure 12 to 15 hours after taking losartan and many reported back that they needed to take it twice daily (and thanked me for possibly saving their lives).
Benicar® has recently and uncommonly been associated in some sensitive patients with chronic diarrhea, weight loss, and other digestive problems caused by shrinkage of the villi in their small intestine.35 It is the only blood pressure drug in this class linked to this condition. Fortunately, there is a superior antihypertensive drug called telmisartan, in the same drug class as Benicar®. A number of studies suggest that telmisartan provides multiple disease-preventing effects.
Telmisartan (trade name Micardis®) was first approved in 1998.36 In 2009, following the results of the ONTARGET trial, it was the first drug in its class that the FDA allowed a claim that it “reduces the risk of heart attack, stroke, or death from cardiovascular disease in patients at high cardiovascular risk who are unable to take ACE inhibitors.”37
What should pleasantly surprise members taking antihypertensive drugs now is that telmisartan has displayed longevity benefits above and beyond its ability to control blood pressure 24 hours a day—and it recently became available in generic form, making it more eligible for health insurance coverage.38,39
Insurance coverage is important for most people because even generic telmisartan can cost about $145 per month.
Longevity Benefits Of Telmisartan
Typical prescription drugs have unpleasant or lethal side effects that cause health-conscious people to want to avoid them wherever possible. There are exceptions, such as the antidiabetic drug metformin, which for most people provides far more benefits than risks.
A little known side benefit to the class of antihypertensive drugs known as angiotensin II receptor blockers is that they enhance insulin sensitivity, increase utilization of fat as energy, and improve mitochondrial function.5,7,13,38,39,100 Of all the drugs in this class, telmisartan stands out as superior for potential longevity enhancement.101-103
As humans age, mitochondrial dysfunction becomes a deadly factor in the development of obesity, insulin resistance, endothelial breakdown, and type II diabetes.104-109 Telmisartan helps correct these underlying mechanisms of aging and death (as do many of the nutrients Life Extension® members already take).
Telmisartan activates a regulator of cellular energy called PPAR-gamma coactivator 1 alpha (PGC-1a), which stimulates the burning of excess calories.110,111 This can be a crucial factor in weight management.
Studies indicate that telmisartan directly stimulates PPAR-gamma (peroxisome proliferator-activated receptor gamma), a key inducer of beneficial metabolic effects.112-114 PPAR-gamma activating properties have also been reported for other angiotensin II receptor blocker drugs, but telmisartan is at least 10 times more powerful.112
Telmisartan has been shown in preclinical models to reduce weight gain, increase total energy expenditure, and increase expression of key mitochondrial enzymes in skeletal muscle better than a more popular drug in this class (Diovan®).7,13,39,115-117
Atherosclerosis remains a leading killer of Americans.118 Telmisartan functions by multiple mechanisms to protect against arterial occlusion,119-121 including increasing beneficial endothelial nitric oxide.39,122,123
Lastly, telmisartan appears to promote biochemical, biological, and metabolic effects that some researchers have suggested could boost athletic performance.112
How To Take Telmisartan
Those with elevated blood pressure (levels exceeding 115/75 based on our findings) can be prescribed telmisartan in one-a-day doses of 20 mg, 40 mg, or 80 mg.
Even in generic form, the cost is currently around $145 for a 30-day supply of any dose. Drug companies for years have charged the same price for “any dose” of their drugs, which reveals that the active ingredient costs virtually nothing.
As more generic competitors emerge, prices may come down, but as we’ve exposed in past issues of this magazine, many generic prices remain stubbornly high.
Consumers of higher-priced branded antihypertensive drugs may save considerable dollars by switching to telmisartan, and derive potentially lifesaving side benefits. Some insurers virtually give away generic drugs, but charge patients a fortune for name brand versions.
Our Mission Is To Keep Our Members Alive!
We offer a number of dietary supplements that have been shown to lower blood pressure. If these supplements fail to keep blood readings consistently around 115/75, and other lifestyle modifications like weight loss are unsuccessful, we suggest that you ask your doctor to consider prescribing telmisartan.
We have no financial interest in telmisartan or other prescription drugs we have recommended for their ancillary disease-preventing benefits (such as metformin). Our interests lie purely in keeping our members alive and healthy for as long as possible.
If one needs to take an antihypertensive drug, it makes sense to take one that provides the best longevity side benefits, which telmisartan appears to do.
I am grateful to report that the cost of quality at-home blood pressure monitors keeps dropping. A new model has features that enable precise data about one’s blood pressure fluctuations to be stored and calculated over an extended time. You can read about this new at-home monitor on the next page.
For more detailed information, view our High Blood Pressure protocol.
For longer life,
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- Patti ME, Butte AJ, Crunkhorn S, et al. Coordinated reduction of genes of oxidative metabolism in humans with insulin resistance and diabetes: potential role of PGC1 and NRF1. Proc Natl Acad Sci USA. 2003 100:8466-71.
- Bach D, Pich S, Soriano FX, et al. Mitofusin-2 determines mitochondrial network architecture and mitochondrial metabolism. A novel regulatory mechanism altered in obesity. J Biol Chem. 2003 May 9; 278(19):17190-7.
- Coletta DK, Mandarino LJ. Mitochondrial dysfunction and insulin resistance from the outside in: extracellular matrix, the cytoskeleton, and mitochondria. Am J Physiol Endocrinol Metab. 2011 Nov;301(5):E749-55.
- Conley KE, Marcinek DJ, Villarin J. Mitochondrial dysfunction and age. Curr Opin Clin Nutr Metab Care. 2007 Nov;10(6):688-92.
- Lesnefsky EJ, Moghaddas S, Tandler B, Kerner J, Hoppel CL. Mitochondrial dysfunction in cardiac disease: ischemia—reperfusion, aging, and heart failure. J Mol Cell Cardiol. 2001 Jun;33(6):1065-89.
- Hernandez-Mijares A, Rocha M, Rovira-Llopis S, et al. Human leukocyte/endothelial cell interactions and mitochondrial dysfunction in type 2 diabetic patients and their association with silent myocardial ischemia. Diabetes Care. 2013 Jun;36(6):1695-702.
- Terashima M, Kaneda H, Nasu K, et al. Protective effect of telmisartan against endothelial dysfunction after coronary drug-eluting stent implantation in hypertensive patients. JACC Cardiovasc Interv. 2012 Feb;5(2):182-90.
- Amano Y, Yamaguchi T, Ohno K, et al. Structural basis for telmisartan-mediated partial activation of PPAR gamma. Hypertens Res. 2012 Jul;35(7):715-9.
- Benson SC, Pershadsingh HA, Ho CI, et al. Identification of telmisartan as a unique angiotensin II receptor antagonist with selective PPARgamma-modulating activity. Hypertension. 2004 May;43(5):993-1002.
- Schupp M, Janke J, Clasen R, Unger T, Kintscher U. Angiotensin type 1 receptor blockers induce peroxisome proliferator-activated receptor-gamma activity. Circulation. 2004 May 4;109(17):2054-7.
- Berger JP, Petro AE, Macnaul KL, et al. Distinct properties and advantages of a novel peroxisome proliferator-activated protein [gamma] selective modulator. Mol Endocrinol. 2003 Apr;17(4):662-76.
- Feng X1, Luo Z, Ma L, et al. Angiotensin II receptor blocker telmisartan enhances running endurance of skeletal muscle through activation of the PPAR-δ/AMPK pathway. J Cell Mol Med. 2011 Jul;15(7):1572-81.
- Sanchis-Gomar F1, Lippi G. Telmisartan as metabolic modulator: a new perspective in sports doping? J Strength Cond Res. 2012 Mar;26(3):608-10.
- Sugimoto K, Qi NR, Kazdová L, Pravenec M, Ogihara T, Kurtz TW. Telmisartan but not valsartan increases caloric expenditure and protects against weight gain and hepatic steatosis. Hypertension. 2006 May;47(5):1003-9.
- Verma DR, Brinton EA. Management of hypercholesterolemia for prevention of atherosclerotic cardiovascular disease: focus on the potential role of recombinant antiPCSK9 monoclonal antibodies. Rev Cardiovasc Med. 2014;15(2):86-101; quiz 101.
- Goyal SN, Bharti S, Bhatia J, Nag TC, Ray R, Arya DS. Telmisartan, a dual ARB/partial PPAR-γ agonist, protects myocardium from ischaemic reperfusion injury in experimental diabetes. Diabetes Obes Metab. 2011 Jun;13(6):533-41.
- Iwai M, Inaba S, Tomono Y, et al. Attenuation of focal brain ischemia by telmisartan, an angiotensin II type 1 receptor blocker, in atherosclerotic apolipoprotein E-deficient mice. Hypertens Res. 2008 Jan;31(1):161-8.
- Iwanami J, Mogi M, Tsukuda K, et al. Low dose of telmisartan prevents ischemic brain damage with peroxisome proliferator-activated receptor-gamma activation in diabetic mice. J Hypertens. 2010 Aug;28(8):1730-7.
- Yuen CY, Wong WT, Tian XY, et al. Telmisartan inhibits vasoconstriction via PPARγ-dependent expression and activation of endothelial nitric oxide synthase. Cardiovasc Res. 2011 Apr 1;90(1):122-9.
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Best Drug To Treat HypertensionMarch 2015
By William Faloon
Life Extension® has waged a long battle over what defines optimal blood pressure.
Back in the early 1980s, doctors delayed treatment until systolic blood pressure exceeded 150 mmHg.
We argued against allowing patients to have blood pressure this high. Our readers were urged to target their blood pressure below 120/80 mmHg.
Against us was a medical establishment that viewed systolic blood pressure of 140-150 mmHg as “normal.” They viewed it as “normal” because most elderly people were in these high ranges.
Our rebuttal was that it is also “normal” for older people to succumb to heart attack, stroke and kidney failure related to higher-than-optimal blood pressure.
On November 13, 2017, at the American Heart Association’s annual conference, revised hypertension guidelines were issued. The new guideline specifies that normal systolic pressure is under 120 mmHg.
We applaud this turnabout, but regret it took over 30 years for this common-sense approach to be recognized. The cost in shortened lifetimes caused by the establishment’s delay in recognizing optimal blood pressure is enormous.
This editorial clarifies these new hypertension guidelines and suggests how to better lower your blood pressure.
As you can see by the chart at the bottom of this page, the majority of Americans aged 65 and older have high blood pressure that is medically defined as hypertension.
With the new hypertension guidelines from the American Heart Association and the American College of Cardiology, an even greater number of Americans are now clinically hypertensive. This will enable more people to take assertive actions to achieve lower blood pressure and reduce their risks of losing their eyesight, suffering kidney failure, and developing coronary-cerebral artery occlusion.
It’s important to note that the study the American Heart Association and the American College of Cardiology most relied on to revise blood pressure guidelines downward involved people at risk for cardiovascular disease.1 Some argue these findings may not apply to individuals at low risk.
I continue to urge that healthy individuals of all ages strive for low-normal blood pressure readings. I say this based on a volume of observational studies, including data showing that people who have mid-life hypertension are at higher risk of vascular events even when they lower their blood pressure in later life.2-5
Arterial damage is most severe when blood pressure peaks. You don’t get credit for the hours when blood pressure is in low normal ranges. This is why at-home monitoring of blood pressure at different times of the day is so important.
The charts you see on these pages are from the many Power Point presentations I have given suggesting most people target their blood pressure around Life Extension’s optimal range of 115/75 mmHg.
Another purpose of this editorial is to provide guidance to help ensure that elderly readers do not lower their blood pressure too quickly, as this can create adverse consequences.
Early Data Showed Benefits of Lower Blood Pressure
In year 2013, a published analysis of 18 prior studies showed that people whose systolic blood pressure was in the range of 120-139 mmHg were at a 50% increased risk of coronary heart disease and 71% increased risk of stroke.7
The studies analyzed in this 2013 report are among those that Life Extension used long ago to recommend that optimal systolic blood pressure for most individuals is around 115 mmHg.
Mainstream medicine during this pre-2017 era did not classify people with systolic readings of 120-139 mmHg as hypertensive. The tragic results, based on observational studies, are many preventable heart attacks, strokes, and other degenerative conditions that can occur when systolic pressure exceeds 119 mmHg.8-10
The systolic number is most important as this reflects the pressure applied to the arterial system with each heartbeat. Higher arterial pressure causes greater damage to the endothelium, renal tubules, and delicate structures in the eye.
The Study That Woke Up the Medical Establishment!
The studies compiled for publication in 2013 were not enough for establishment cardiology to pay attention. They wanted to see hard data from a carefully controlled clinical trial.
The sought-after trial was initiated in 2010 with a large group of people. The purpose was to assess whether targeting a reduction of systolic blood pressure below 120 mmHg was superior to the then-current standard of reducing it to below 140 mmHg.
The doctors focused on the systolic (top) number because it is a better predictor of heart attack and stroke.
The name of this study is Systolic Blood Pressure Intervention Trial, also known as SPRINT.11 It was published in the New England Journal of Medicine in 2015 and garnered huge media coverage.
The SPRINT study was supposed to last five years, but was stopped after 3.26 years because it was abundantly clear that the group whose blood pressure was reduced to a target systolic range under 120 mmHg were dying 27% less frequently.
What impressed the study’s researchers the most was a striking 43% lower relative risk of cardiovascular death in those whose blood pressure was aggressively reduced.11
The SPRINT study also found that heart failure rates plummeted by 38% in patients whose target blood pressure aimed below 120 mmHg. Heart failure occurs when the heart cannot pump enough blood and oxygen to support other organs in one’s body. It is a leading cause of hospitalizations and costs this nation an estimated $32 billion each year.12
Heart disease remains the number-one cause of death in the United States, killing about 610,000 Americans each year.13
The dramatic (43%) drop in cardiovascular deaths shown in the SPRINT study motivated mainstream cardiologists to question their long-standing practice of largely ignoring their patient’s blood pressure until readings exceeded 139/89 mmHg.
Based on widespread media coverage and physician concurrence, it appears the medical establishment has finally woken up to what readers of this publication were told to do in the 1980s.
Safety Concerns When Blood Pressure is Lowered too Much
Older individuals face a dilemma when it comes to rapid blood-pressure reduction.
Decades of systolic blood pressure above 115 mmHg, along with risk factors in the blood such as C-reactive protein, homocysteine and triglycerides can damage the delicate endothelium that lines the inner arterial wall.
As a result of prior arterial injury, some older people need to maintain higher-than-optimal blood pressure to ensure their kidneys are sufficiently removing waste products, and that their brain is receiving sufficient oxygen flow.
In the SPRINT study that convinced the American Heart Association and the American College of Cardiology to adopt lower systolic guidelines (below 120 mmHg), there was an increase in the risk of kidney problems.
Practical Steps to Blood-Pressure Control
I continue to be shocked by antiquated recommendations made by organizations like the American Heart Association.
In revising their definition of optimal systolic pressure to below 120 mmHg, the American Heart Association suggests people have their blood pressure tested once every two years at their doctor’s office.18
This suggestion makes no sense considering that low-cost at-home monitors are widely available and are proven to enable superior 24-hour blood-pressure control.
There is extensive individual variability in patient responses to blood-pressure lowering therapies. Some people need twice-a-day drug dosing, or only need to take their medications in situations when their blood pressure elevates (such as when drinking caffeine or under stressful events or during particular times of the day/night).
I have vociferously argued for decades that systolic blood pressure should be below 120 mmHg. I am equally confident that most readers of this magazine can better control their blood pressure using an at-home monitor. This enables precise control of drug dosing and offers the ability to measure the effects of lifestyle changes like losing weight, healthier diets and getting more physical activity.
Blood Tests Measure Kidney Function
For those who now seek to aggressively drop their systolic reading to below 120 mmHg, we urge this be done slowly, using an at-home monitor to carefully control the rate of blood-pressure reduction.
As blood-pressure readings drop, check your blood markers of kidney function using low-cost blood tests that measure creatinine, blood urea nitrogen (BUN), glomerular filtration rate and lots more. Blood test panels that include these measures of renal function cost very little.
If blood-test results indicate a kidney problem, cut back on your blood pressure reduction program, consult your physician and retest within two weeks.
The most accurate measure of renal health is the cystatin-c blood test. This costs more than standard CBC/Chemistry blood tests, but for those at risk for renal complications, we have long advocated its use.
These blood tests can be ordered 24 hours/day by calling 1-800-208-3444 or logging on to LifeExtension.com/labtesting
Protecting the Brain against Reduced Oxygen Flow
Aggressive blood pressure reduction can create problems for certain elderly, frail people.
Older patients with significant pre-existing vascular disease and other medical problems often require higher blood pressure to perfuse critical organs like the brain.
These patients require a higher perfusion pressure to allow blood to reach critical organs and tissues throughout the body.19
We described the phenomenon in previous issues of Life Extension Magazine®,20 whereby some older patients do not tolerate aggressive blood pressure reduction to a predefined value (such as under 120 mmHg).
These individuals require careful monitoring using blood tests as well as assessments of cognitive function.
These tests are necessary to facilitate appropriate dosing of antihypertensive medications to a blood pressure that can be tolerated by these patients.
When lowering one’s blood pressure, one should be cognizant of dizzy spells, memory lapses, and perceived loss of motor coordination (frailty).
Ideally, one would have clinical measures performed using a standardized frailty index score, but this is not available from most physicians.
Nutrients most readers of this magazine take, along with healthy diets containing plant-based polyphenols, can protect and help restore cerebral circulation.21-23
Those embarking on an aggressive blood-pressure reduction program may also consider a periwinkle-derived alkaloid called vinpocetine that has been used for decades in Europe by those with chronic cerebral hypoperfusion.24-26
Blood-Flow-Restoring Effects of Vinpocetine
Cerebral ischemia (loss of blood flow) can lead to irreversible brain damage. It is therefore important to rescue hypoperfused areas of the brain whenever possible.
A review was conducted on the effects of vinpocetine on chronic cerebrovascular patients.25 Studies included cerebral perfusion imaging and clinical assessments of cognitive function after single dose and long-term vinpocetine use.
The results from these clinical trials showed that vinpocetine increased cerebral perfusion,26 elevated brain-cell consumption of glucose-oxygen,26,27and improved other measures of neurological function.28
This analysis showed that vinpocetine improves blood flow to hypoperfused areas of the brain and enhanced quality-of-life scores.25
Those seeking to avoid depriving their brain of blood flow when lowering their blood pressure may consider supplementing with 20-30 mg daily of low-cost vinpocetine.
Nutrients Versus Drugs
There are a wide variety of nutrients that produce modest blood pressure-lowering effects.
If your systolic pressure is around 125 mmHg and you seek to bring it down to the 115 mmHg range, you might be able to accomplish this by losing a little weight, improving your diet, exercising more, and supplementing with quercetin and melatonin.
For many people, however, they will need the appropriate prescription medication to achieve optimal blood-pressure goals. The long history of use with these drugs and their low cost causes us to recommend certain drugs that not only safely lower blood pressure, but confer other benefits such as improving endothelial function.
In the March 2015 issue of Life Extension Magazine, we published a report on a generic drug called telmisartan that we felt was the best antihypertensive drug for most individuals to consider.29
With the availability of low-cost at-home blood-pressure monitors, there is no longer a need to speculate as to what approach one should take.
If lifestyle changes and/or nutrients enable one to achieve optimal readings (115/75 mmHg), then prescription drugs are obviously not needed for blood-pressure control.
If systolic pressure remains persistently above 119 mmHg, then 40 mg a day of telmisartan (and/or other medications your physician prescribes) should be attempted. Telmisartan doses can be increased to 80 mg/day if needed.
Unlike many drugs the FDA approves that are side-effect prone and don’t work particularly well, certain antihypertensive medications have lifesaving properties that cannot be overlooked if one’s blood-pressure readings remain higher than optimal.
The Turning Tide of Medical Opinion
Fascinating reviews about the history of hypertension can easily by obtained via Google searches.
As recently as 1949, an esteemed physician published that systolic blood pressure over 200 mmHg need not be treated.30
In the 1980s, many doctors accepted systolic readings of 160 mmHg as normal and did not treat it.31
The revised 2017 guidelines that normal systolic pressure is under 120 mmHg will spare many humans from disability and death.
An abundance of published findings confirms that keeping one’s blood pressure on the low end of the reference range confers significant protection against a host of degenerative conditions.
The easiest way to accomplish this is with an at-home blood-pressure monitor. This enables you to assess your blood pressure at several different times of the day to ensure there are no significant elevations above 119 mmHg.
The box on this page is a description of a recent study showing vastly superior results when people check their blood pressure at home, rather than waiting for their next doctor’s visit.
For longer life,
William Faloon, Co-Founder
Life Extension Buyers Club
- . Available at: http://www.ajmc.com/conferences/aha-2017/80-new-guidelines-say. Accessed December 13, 2017.
- . Gottesman RF, Albert MS, Alonso A, et al. Associations Between Midlife Vascular Risk Factors and 25-Year Incident Dementia in the Atherosclerosis Risk in Communities (ARIC) Cohort. JAMA Neurol. 2017;74(10):1246-54.
- . Gilsanz P, Mayeda ER, Glymour MM, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017;89(18):1886-93.
- . Kennelly SP, Lawlor BA, Kenny RA. Blood pressure and dementia - a comprehensive review. Ther Adv Neurol Disord. 2009;2(4):241-60.
- . Allen N, Berry JD, Ning H, et al. Impact of blood pressure and blood pressure change during middle age on the remaining lifetime risk for cardiovascular disease: the cardiovascular lifetime risk pooling project. Circulation. 2012;125(1):37-44.
- . Available at: https://www.cdc.gov/nchs/fastats/older-american-health.htm. Accessed December 15, 2017.
- . Huang Y, Wang S, Cai X, et al. Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Med. 2013;11:177.
- . Kshirsagar AV, Carpenter M, Bang H, et al. Blood pressure usually considered normal is associated with an elevated risk of cardiovascular disease. Am J Med. 2006;119(2):133-41.
- . Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206-52.
- . Taylor BC, Wilt TJ, Welch HG. Impact of diastolic and systolic blood pressure on mortality: implications for the definition of “normal”. J Gen Intern Med. 2011;26(7):685-90.
- . Sprint Research Group, Wright JT, Jr., Williamson JD, et al. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med. 2015;373(22):2103-16.
- . Huynh-Hohnbaum AL, Marshall L, Villa VM, et al. Self-Management of Heart Disease in Older Adults. Home Health Care Serv Q. 2015;34(3-4):159-72.
- . Available at: http://www.cdc.gov/heartdisease/facts.htm. Accessed August 22, 2016.
- . Myers MG, Cloutier L, Gelfer M, et al. Blood Pressure Measurement in the Post-SPRINT Era. A Canadian Perspective. 2016;68(1):e1-e3.
- . Niiranen TJ, Kantola IM, Vesalainen R, et al. A comparison of home measurement and ambulatory monitoring of blood pressure in the adjustment of antihypertensive treatment. Am J Hypertens. 2006;19(5):468-74.
- . Fagard RH, Van Den Broeke C, De Cort P. Prognostic significance of blood pressure measured in the office, at home and during ambulatory monitoring in older patients in general practice. J Hum Hypertens. 2005;19(10):801-7.
- . Agarwal R, Andersen MJ. Blood pressure recordings within and outside the clinic and cardiovascular events in chronic kidney disease. Am J Nephrol. 2006;26(5):503-10.
- . Available at: http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/How-High-Blood-Pressure-is-Diagnosed_UCM_301873_Article.jsp. Accessed December 18, 2017.
- . Stocchetti N, Chieregato A, De Marchi M, et al. High cerebral perfusion pressure improves low values of local brain tissue O2 tension (PtiO2) in focal lesions. Acta Neurochir Suppl. 1998;71:162-5.
- . Available at: http://www.lifeextension.com/Magazine/2016/11/Why-24-Hour-Blood-Pressure-Control-Matters/Page-01. Accessed December 18, 2017.
- . Vauzour D. Dietary polyphenols as modulators of brain functions: biological actions and molecular mechanisms underpinning their beneficial effects. Oxid Med Cell Longev. 2012;2012:914273.
- . Kennedy DO. Polyphenols and the human brain: plant “secondary metabolite” ecologic roles and endogenous signaling functions drive benefits. Adv Nutr. 2014;5(5):515-33.
- . Bowtell JL, Aboo-Bakkar Z, Conway ME, et al. Enhanced task-related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation. Appl Physiol Nutr Metab. 2017;42(7):773-9.
- . Horvath S. [The use of vinpocetine in chronic disorders caused by cerebral hypoperfusion]. Orv Hetil. 2001;142(8): 383-9.
- . Bagoly E, Feher G, Szapary L. [The role of vinpocetine in the treatment of cerebrovascular diseases based in human studies]. Orv Hetil. 2007;148(29):1353-8.
- . Bonoczk P, Panczel G, Nagy Z. Vinpocetine increases cerebral blood flow and oxygenation in stroke patients: a near infrared spectroscopy and transcranial Doppler study. Eur J Ultrasound. 2002;15(1-2):85-91.
- . Szilagyi G, Nagy Z, Balkay L, et al. Effects of vinpocetine on the redistribution of cerebral blood flow and glucose metabolism in chronic ischemic stroke patients: a PET study. J Neurol Sci. 2005;229-230:275-84.
- . Balestreri R, Fontana L, Astengo F. A double-blind placebo controlled evaluation of the safety and efficacy of vinpocetine in the treatment of patients with chronic vascular senile cerebral dysfunction. J Am Geriatr Soc. 1987;35(5):425-30.
- . Available at: http://www.lifeextension.com/Magazine/2015/3/Best-Drug-To-Treat-Hypertension/Page-01. Accessed December 18, 2017.
- . Moser M. Historical perspectives on the management of hypertension. J Clin Hypertens (Greenwich). 2006;8(8 Suppl 2):15-20; quiz 39.
- . The 1980 report of the joint national committee on detection, evaluation, and treatment of high blood pressure. Archives of Internal Medicine. 1980;140(10):1280-5.
- . Krakoff LR. Blood Pressure Out of the Office: Its Time Has Finally Come. Am J Hypertens. 2016;29(3):289-95.
- . Fuchs SC, Ferreira-da-Silva AL, Moreira LB, et al. Efficacy of isolated home blood pressure monitoring for blood pressure control: randomized controlled trial with ambulatory blood pressure monitoring - MONITOR study. J Hypertens. 2012;30(1):75-80.
- . Breaux-Shropshire TL, Judd E, Vucovich LA, et al. Does home blood pressure monitoring improve patient outcomes? A systematic review comparing home and ambulatory blood pressure monitoring on blood pressure control and patient outcomes. Integr Blood Press Control. 2015;8:43-9.
- . Agena F, Prado Edos S, Souza PS, et al. Home blood pressure (BP) monitoring in kidney transplant recipients is more adequate to monitor BP than office BP. Nephrol Dial Transplant. 2011;26(11):3745-9.
- . Imai Y, Obara T, Asamaya K, et al. The reason why home blood pressure measurements are preferred over clinic or ambulatory blood pressure in Japan. Hypertens Res. 2013;36(8):661-72.
- . Fuchs SC, Mello RG, Fuchs FC. Home blood pressure monitoring is better predictor of cardiovascular disease and target organ damage than office blood pressure: a systematic review and meta-analysis. Curr Cardiol Rep. 2013;15(11):413.