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New Hypertension Guidelines

March 2018

By William Faloon

William Faloon
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.

Best Drug To Treat Hypertension  

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

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.

Is Lower Always Better In Terms Of Blood Pressure?
Is Lower Always Better In Terms Of Blood Pressure?

The concept that “lower is always better” can be a recipe for disaster in terms of blood pressure reduction, in particular for elderly, frail patients.

Often told is the story of the young intern fresh from medical school graduation starting ward duties. The intern aggressively treats his older patients to achieve rapid blood pressure reduction, yet is dismayed when their kidney function and cognitive abilities deteriorate rapidly.

Wiser, experienced physicians know that older patients with significant pre-existing vascular disease and other medical problems often require higher blood pressure than optimal levels to perfuse critical organs like the kidneys and brain. These patients require a higher perfusion pressure to allow blood to reach critical organs and tissues throughout the body.29

Some patients simply do not tolerate aggressive blood pressure reduction to a predefined value, and careful monitoring of kidney function with simple, cost-effective blood tests for BUN (blood urea nitrogen), creatinine, and electrolytes like potassium and sodium, as well as assessment of cognitive function, allows for appropriate titration of antihypertensive medication to a tolerated blood pressure best for these types of patients.

For those with systemic circulatory problems, blood pressure readings over 115/75 may be needed despite the increased damage this may inflict over the longer term. This adds to the critical importance of protecting one’s inner arterial lining (endothelium) throughout life.

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.

Who Should Keep Blood Pressure Levels Higher?
Who Should Keep Blood Pressure Levels Higher?

Elevated blood pressure at young ages inflicts damage to capillaries40 and small arteries41 that may result in stroke (ischemic and hemorrhagic), coronary artery disease, renal failure, and dementia later in life.42-53

In the March 2014 issue of this publication, we featured an article on a small artery disease (leukoaraiosis) in which tiny areas of the brain become oxygen deprived.54 The pathological result of this cerebral blood flow deficit is sharply higher risks of dementia,55 stroke, and cognitive impairment.56-68

Hypertension is a leading risk factor for leukoaraiosis,56,57,69 as is elevated homocysteine,70-74 endothelial dysfunction,75-77 inflammation,78 abnormal platelet aggregation,79 and other common vascular toxins.80-87

The problem with some elderly individuals who have had chronic high blood pressure is that they need to maintain a higher-than-optimal blood pressure to literally squeeze oxygenated blood through damaged capillaries in their brain and other organs. Until their endothelial damage can be reversed, these individuals need to maintain higher-than-optimal blood pressure readings to adequately perfuse certain organs.

This is regrettable since the short-term fix for diminished capillary blood flow, i.e. higher blood pressure levels, causes even more capillary and small artery damage. Validated ways to markedly reverse endothelial dysfunction are urgently needed.

Pomegranate is one of the better documented nutrients one can take today to help restore endothelial function.88-92

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

A Lung Cancer Controversy For Telmisartan… Or A Statistical Fluke?
A Lung Cancer Controversy For Telmisartan… Or A Statistical Fluke?

A highly controversial 2010 meta-analysis suggested that patients taking angiotensin-receptor blockers (ARBs) for hypertension, including telmisartan, experienced an increased risk for lung cancer, but no link to breast or prostate cancer.93

This finding is quite strange, and inconsistent with other research, since telmisartan has been shown to exert antitumor effects in human lung cancer (adeonocarcinoma) cells.94

In 2010, the manufacturer of telmisartan (Boehringer Ingelheim) conducted a rigorous assessment involving 50,000 patients treated with telmisartan, which including data from the ONTARGET, PROFESS, and TRANSCEND studies. The results showed no increased risk of cancer in the telmisartan treatment groups. “In preclinical trials, clinical trials, and day-to-day patient exposure with telmisartan, we have not seen any significant finding related to malignancies,” said Senior Vice President of Medicine, Dr. Klaus Dugi at Boehringer Ingelheim, in a company statement.95

Subsequent peer-reviewed publications have failed to show a cancer increase in patients using telmisartan.

For example, a subsequent 2011 analysis using data from 31 trials and 156,000 patients compared patients randomized to an ARB or “non-ARB treatment.” Overall incidence of cancer events in the ARB group were 1.82 per 100 patient-years, compared with 1.84 per 100 patient-years in the non-ARB group. This meta-analysis found no evidence of an increased risk of cancer-related death, breast cancer, lung cancer, or prostate cancer in patients receiving ARBs, and no difference between the two groups was found regardless of statistical method or comparator group (placebo or another drug).96

As another example, in 2013, published research from the US Department of Veterans Affairs of over 1,000,000 veterans did not show any evidence of risk for either lung cancer or prostate cancer.97,98 In fact, using a double-robust statistical regression, the researchers found a 26% reduced risk of lung cancer with ARB use. These researchers indicated: “In this large nationwide cohort of US Veterans, we found no evidence to support any concern of increased risk of lung cancer among new users of ARBs compared with non-users. Our findings were consistent with a protective effect of ARBs.”

At the present time, the weight of the evidence does not suggest ARBs, or telmisartan in particular, increase lung cancer risk.99

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,

For Longer Life

William Faloon

References

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  85. Seo SK, Jung I, Lee SM, et al. Relationship between leukoaraiosis and menopause in healthy middle-aged women. Fertil Steril. 2013 Aug;100(2):500-4.
  86. Szolnoki Z. Pathomechanism of leukoaraiosis: a molecular bridge between the genetic, biochemical, and clinical processes (a mitochondrial hypothesis). Neuromolecular Med. 2007 9(1):21-33.
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  88. De Nigris F, Williams-Ignarro S, Botti C, Sica V, Ignarro LJ, Napoli C. Pomegranate juice reduces oxidized low-density lipoprotein downregulation of endothelial nitric oxide synthase in human coronary endothelial cells. Nitric Oxide. 2006 Nov;15(3):259-63.
  89. Aviram M, Rosenblat M, Gaitini D, et al. Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation. Clin Nutr. 2004 Jun;23(3):423-33.
  90. Sumner MD, Elliott-Eller M, Weidner G, et al. Effects of pomegranate juice consumption on myocardial perfusion in patients with coronary heart disease. Am J Cardiol. 2005 Sep 15;96(6):810-4.
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  98. Rao GA, Mann JR, Bottai M, et al. Angiotensin receptor blockers and risk of prostate cancer among United States veterans. J Clin Pharmacol. 2013 Jul;53(7):773-8.
  99. ARB Trialists Collaboration. Effects of telmisartan, irbesartan, valsartan, candesartan, and losartan on cancers in 15 trials enrolling 138,769 individuals. J Hypertens. 2011 Apr;29(4):623-35.
  100. Shiuchi T, Iwai M, Li HS, et al. Angiotensin II type-1 receptor blocker valsartan enhances insulin sensitivity in skeletal muscles of diabetic mice. Hypertension. 2004 May;43(5):1003-10.
  101. Lacourcière Y, Krzesinski JM, White WB, Davidai G, Schumacher H. Sustained antihypertensive activity of telmisartan compared with valsartan. Blood Press Monit. 2004 Aug;9(4):203-10.
  102. Littlejohn T, Mroczek W, Marbury T, VanderMaelen CP, Dubiel RF. A prospective, randomized, open-label trial comparing telmisartan 80 mg with valsartan 80 mg in patients with mild to moderate hypertension using ambulatory blood pressure monitoring. Can J Cardiol. 2000 Sep;16(9):1123-32.
  103. Lacourcière Y, Lenis J, Orchard R, et al. A comparison of the efficacies and duration of action of the angiotensin II receptor blockers telmisartan and amlodipine. Blood Press Monit. 1998 Oct;3(5):295-302.
  104. 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.
  105. 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.
  106. 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.
  107. Conley KE, Marcinek DJ, Villarin J. Mitochondrial dysfunction and age. Curr Opin Clin Nutr Metab Care. 2007 Nov;10(6):688-92.
  108. 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.
  109. 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.
  110. 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.
  111. 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.
  112. 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.
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  115. 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.
  116. 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.
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Best Drug To Treat Hypertension

March 2015

By William Faloon

William Faloon
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.

Severity of the Epidemic
Severity of the Epidemic

Persons defined as hypertensive by CDC:6

Men 65-74 years 63.4%
  75 years and over 72.3%
Women 65-74 years 64.3%
  75 years and over 79.9%

These data published by the Centers for Disease Control and Prevention in 2016 reflect the percent of hypertensive Americans based on antiquated reference ranges that diagnosed hypertension when blood pressure reached 140/90 mmHg.

The new guidelines stating optimal systolic pressure is under 120 mmHg will cause the percent of Americans classified as hypertensive to skyrocket, which should enable a marked reduction of vascular disease risk.

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.

Deadly Impact of Systolic Blood Pressure 120-139 mmHg7
Impact of Systolic Blood Pressure

A year 2013 analysis of 18 studies showed correlation in those with systolic blood pressure between 120-139 mmHg and an associated:

  • 50% increased risk of coronary heart disease
  • 71% increased risk of stroke

Decades of published data reveal that low-normal blood pressure slashes heart attack and stroke risk. This 2013 analysis shows the lethal impact of systolic blood pressure ranges of 120-139 mmHg, a level previously termed “prehypertension.”

On November 13, 2017, the American Heart Association and the American College of Cardiology abolished the term “prehypertension.” Anyone with systolic pressure above 119 mmHg is classified as having “elevated” blood pressure.

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.

Risk Reduction of Intensive Treatment
Risk Reduction of Intensive Treatment

Risk Reduction of Intensive Treatment (Below 120 mmHg)
Compared to Standard Treatment (Below 140 mmHg)

This chart shows reductions in death and disease when systolic blood pressure target is below 120 mmHg compared to below 140 mmHg.

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Practical Steps to Blood-Pressure Control

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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.

Benefits of Lower Blood Pressure Confirmed in 201511

Compared to people with a target systolic blood pressure below 140 mmHg, subjects with target blood pressure below 120 mmHg had:

  • 38% lower risk of heart failure
  • 43% lower risk of cardiovascular death
  • 27% lower overall mortality

The SPRINT study published in 2015 confirmed that targeting systolic blood pressure below 120 mmHg results in substantial reductions in heart disease and lower overall death rates.

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

An Important Overlooked Fact

An underappreciated problem that has been ignored by SPRINT study advocates has been the manner in which blood pressure was measured in SPRINT.

Specifically, the study used an automated measurement device, the Omron 907XL.

“In SPRINT, study staffs were trained to program an Omron 907XL, to wait five minutes and then record three readings at one-minute intervals. After the device was activated, research staff left the examining room, with the patient then being alone during the five-minute rest period while the three readings were recorded automatically.”14

This protocol is very different from the method used in the vast majority of physician’s offices where a single measure of blood pressure is taken with medical staff present in the room.

Automated blood-pressure measurements generally deliver readings significantly LOWER than readings in a physician’s office.

This suggests that the SPRINT systolic values obtained were on average 7 to 10 mmHg lower than blood pressure measured in routine clinical practice.

Taken as a whole, this also suggests that systolic blood pressure as measured in recent randomized trials, including SPRINT, is up to 10 systolic points LOWER than that measured with traditional office measurement methodology.

The consequence is that targeting systolic blood pressure below 120 mmHg without using similar measurement automated methods (as in SPRINT) may increase the risk of adverse events. This might occur by overshooting the SPRINT trial-based systolic blood-pressure targets and potentially leading to hypotensive complications.

Stated another way, a systolic blood pressure of 120 mmHg in conventional practice would be roughly the equivalent of a systolic blood pressure of 110 mmHgin SPRINT. Conversely, a blood pressure of 130 mmHg systolic in conventional practice is roughly the equivalent systolic blood pressure of 120 mmHg in SPRINT.

This suggests that blood-pressure readings over 120 mmHg using conventional testing are not as dangerous as what the SPRINT findings showed.

These data suggest that more precise blood pressure monitoring may enable aging individuals to benefit from superior hypertension control.15-17 We believe many people can better achieve this using an at-home blood pressure monitor.

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

View Our Updated Hypertension Protocol Online

An enormous volume of data has been published in recent years that relate to what groups of aging people most benefit from with blood-pressure reductions, along with better ways of achieving optimal control.

We’ve analyzed and compiled this data, which you can view at no charge by logging on to LifeExtension.com/hypertension-protocol

An example of what you’ll read relates to what diabetics should do when their blood pressure is too high. Current evidence suggests that there may be adverse effects when diabetics are overly aggressive in reducing only moderately elevated blood pressure.

My personal rebuttal to these studies is that diabetics should do more to reverse their glucose/insulin imbalances, along with other known vascular risks.

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.

Importance of At-Home Blood-Pressure Monitoring

Monitoring blood pressure outside of the doctor’s office is emerging as a standard of care for high blood pressure, as it helps to more accurately diagnose and track treatment efficacy.32

Everyone who has been diagnosed with high blood pressure should have an at-home monitor in order to ensure that any intervention they are undertaking is working to help keep their blood-pressure readings around 115/75 mmHg throughout the day.

The importance of regular at-home blood-pressure monitoring cannot be overstated.

In fact, monitoring your blood pressure at home may help you better control it, possibly obviating the need to increase medication dosage.

In a randomized controlled trial, 136 participants with uncontrolled high blood pressure were assigned to at-home blood-pressure monitoring or usual care; their medication regimen was not modified.33

Those who regularly monitored their blood pressure at home saw significant reductions in systolic and diastolic blood pressure compared with those who did not self-monitor.

At the end of the two-month trial, 32.4% of the self-monitoring (at-home) group had blood pressure of less than 130/80 mmHg, while only half as many participants—16.2%—who did not self-monitor saw their blood pressure fall below this level.33

Several other studies have found similar benefits associated with at-home blood-pressure monitoring.34-37

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

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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,

For Longer Life

William Faloon, Co-Founder

Life Extension Buyers Club

References

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  3. . Gilsanz P, Mayeda ER, Glymour MM, et al. Female sex, early-onset hypertension, and risk of dementia. Neurology. 2017;89(18):1886-93.
  4. . Kennelly SP, Lawlor BA, Kenny RA. Blood pressure and dementia - a comprehensive review. Ther Adv Neurol Disord. 2009;2(4):241-60.
  5. . 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.
  6. . Available at: https://www.cdc.gov/nchs/fastats/older-american-health.htm. Accessed December 15, 2017.
  7. . Huang Y, Wang S, Cai X, et al. Prehypertension and incidence of cardiovascular disease: a meta-analysis. BMC Med. 2013;11:177.
  8. . 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.
  9. . 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.
  10. . 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.
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  12. . 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.
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