Take the Pressure Down—Why Hypertension Can Be Bad for Your Brain Health

00:00:03: Welcome to the Brain Health Mission Podcast, exploring how science policy and everyday choices shape the health of your brain.

00:00:10: And what you can do.

00:00:24: In today's episode we are looking into brain health and chronically elevated blood pressure, a condition also called hypertension.

00:00:44: Joining me from Switzerland is Professor Thomas Lucia.

00:00:49: Before we delve in to the topic of todays podcast How Hypertension can affect your Brain Health Could you just say few words to yourself Thomas?

00:01:00: Yes my name is Thomas Lucio.

00:01:02: I'm a cardiologist working mainly in england at the royal bronton and herfield hospitals and the king's college.

00:01:10: And part time also in zurek, i have a broad interest uh in cardiovascular medicine at large currently also president of european society of cardiology just one of the largest educational societies.

00:01:26: and of course hypertension or high blood pressure is an important topic.

00:01:30: it has been important topic of my research as well.

00:01:36: Thank you Thomas, very happy to have you here because hypertension is one of the risk factors for developing dementia and also other brain diseases.

00:01:48: but first of all let's start with a concept hypertension or chronically elevated blood pressure.

00:01:55: what does that actually mean?

00:01:57: how do define it?

00:01:59: What is an elevated blood?

00:02:02: Yes, of course there is a continuum between blood pressure and the risk of myocardial infarction stroke and vascular dementia.

00:02:12: So that means that you know it stepwise increases.

00:02:16: There's no strict limit where You say?

00:02:19: It's normal.

00:02:21: but of course The higher he gets to the higher is the risk.

00:02:25: But in you know brings me back to what as a normal blood pressure.

00:02:29: And when we look at natural tribes living in the Amazon, or the Kuna Indians and Panama.

00:02:37: Or in New Guinea they all have blood pressures in a range of one hundred to one-hundred ten maximum over seventy two eighty.

00:02:47: so it's rather low blood pressure importantly doesn't increase with age.

00:02:52: In our population is typical that after fifty or sixty blood pressure steadily increases and so does the stroke risk for other cardiovascular events.

00:03:05: This is a brain health podcast Thomas, obviously as you already mentioned there's link between hypertension And as I said previously, the Lancet Commission actually stated hypertension is one of the fourteen risk factors for dementia.

00:03:23: In The St John and another article found that the population attribute to risk of hypertension for dementia was fifteen point eight percent.

00:03:33: so that means if you had hypertension You have a potential additional risk of fifteen-eight percent To develop dementia.

00:03:44: So,

00:03:45: optimal

00:03:45: detection and treatment particularly in midlife was suggested to substantially reduce the global burden of dementia.

00:03:55: Could you elaborate a little more on how hypertension could affect your brain?

00:04:00: And what should we think about high blood pressure as a heart and brain health issue.

00:04:05: You know, neurologists tend to think about the brain... ...and we don't necessarily think very much about the blood pressure.

00:04:12: but maybe we also the listeners should think little more about that?

00:04:18: Yeah first of all it matters when blood pressure develops.

00:04:23: so there are large data sets from large populations showing if you have high blood pressure between fifty forty-fifty The risk of dementia is the highest.

00:04:34: If you get high blood pressure, when you're seventy... ...the risk of Dementia's much lower.

00:04:40: So it not only matters how higher blood pressure is but how long.

00:04:46: at this elevated blood pressure We would say above hundred twenty over eighty How long your brain is exposed to.

00:04:54: And of course exposure to blood pressure particularly a higher values of blood pressure provides a basket changes.

00:05:04: There is remodeling of the brain vessels that unfavorably affects the perfusion of brain tissue and there's also an increased risk of bleeding, particularly at very high levels of blood pressure.

00:05:18: so it was important to detect blood pressure early on.

00:05:21: everybody should know his blood pressure already when he has twenty and thirty and forty.

00:05:29: any increases, needs or management of different kinds.

00:05:35: Could you say that what is perhaps not pathological?

00:05:41: That means a sickly level for one person could be too high for another person if that person has had lower pressure in his or her twenties for instance.

00:05:53: Well we cannot say there are differences susceptibility to high blood pressure among individuals.

00:06:02: The data I haven't shown that, but what we know is that females get more events at any level of blood pressure compared to males.

00:06:11: Females are more susceptible to the untoward effects on high blood pressures

00:06:20: What would be a little hypertension and very much hypertension in your view?

00:06:28: In principle, the best blood pressure is that allows you to speak when standing upright.

00:06:36: That's in range of a hundred and ten systolic.

00:06:42: But it matters first at what age we are... ...and what we call normal blood pressure or therapeutic targets.

00:06:53: So imagine if you have had blood pressure of one hundred fifty over ninety for a couple years, then there is also already changes in your vasculature.

00:07:04: And it has been shown that the fuel lower blood pressure too low and these people That they may be actually on tour defects.

00:07:11: so-called curve means that The optimal blood pressures than rather in the range from twenty to one hundred thirty or eighty And so currently the guidelines of Americans are a bit stricter than that ones on the Europeans, but in general under twenty over eighty is optimal.

00:07:36: Under thirty is also fine and even Europe with the guidelines even allow for under forty or less who have more then sixty-five years old age because then of course the exposure to high blood pressure is less in duration and therefore has a bit of a less-of an effect.

00:07:59: But particularly if you're between fourteen and fifty, You should have hundred twenty over eighty ideally And If not it should at least take some lifestyle changes that too accommodate better blood pressure.

00:08:12: Mm-hmm Chris what are saying?

00:08:14: Is there time matters here.

00:08:16: The Time That You Have an untreated, elevated blood pressure is crucial in how your brain is affected.

00:08:26: Absolutely!

00:08:27: This also applies for lipids and diabetes...

00:08:30: That's true that long you live with them.

00:08:32: so early detection wouldn't say this a keyword here?

00:08:36: Absolutely the lifetime risk is important.

00:08:40: if your life time rest is ten years it less of an issue than if its thirty or forty years.

00:08:47: So anybody that has high blood pressure early on, because of family genetic background one has to take it very seriously.

00:09:00: Thomas when we have experts out in our podcast We also use the opportunity To bust a couple health myths That are wandering around And there is particularly about hypertension Because many people think If they feel okay then their blood pressure must be okay too.

00:09:22: But even so, the blood pressure has been described as a silent killer!

00:09:31: Is it true that if you don't feel anything in particular and do not feel more tired or exhausted than your blood pressure is ok?

00:09:40: Or does this mean it's subtle?

00:09:45: It's quite clear that normally blood pressure doesn't... induce any symptoms, except if it's very high.

00:09:52: You know for instance Roosevelt Franklin D. Roosevelt had a blood pressure of two hundred.

00:10:00: three hundred over one ninety were couple days before he had a fatal brain hemorrhage.

00:10:08: in this case that has been described In the literature And at that time people felt that the blood pressure is not a risk factor.

00:10:19: So they understood, you know comes out of blue sky but it wasn't.

00:10:24: and this very high levels... Of course people have high-take commonly or more frequently But in the blood pressures we see today between hundred twenty and two hundred usually people don't feel anything at all.

00:10:40: That's interesting.

00:10:41: so What you're saying is that, in most cases... You won't feel your blood pressure being elevated.

00:10:50: In a chronic state?

00:10:52: But are there symptoms that should alarm you if suddenly developed and could point towards an elevated blood pressure?

00:11:05: Of course!

00:11:05: If it's very severe blood pressure of two hundred twenty to one hundred fifty as we saw it in the old days, much less common than it can actually induce brain edema.

00:11:19: Then of course there is severe neurological symptoms but that's very rare today.

00:11:27: Thomas could you conclude people shouldn't take for granted their blood pressure is okay even if they feel good or not feeling any... altered at all, that the best thing to do is on a regular basis get your blood pressure measured?

00:11:46: Yes indeed.

00:11:47: I mean we did a survey in Switzerland with three thousand five hundred individuals and most of them knew their blood pressure which was huge progress compared when it wasn't fellow in hypertension.

00:12:00: Today blood pressure is the risk factor people know about.

00:12:05: they usually also know their own blood pressure unlike blood sugar.

00:12:11: But what a normal block pressure is, that of course it's different because the norm values have changed massively.

00:12:19: you know when I was a fellow they said hundred plus age.

00:12:22: then we say one hundred sixty or

00:12:25: ninety five

00:12:27: and now we say hundred twenty over eighty.

00:12:30: so its clear this shows history for high ball pressure that there is no distinct limit of good or bad.

00:12:42: It's a continuum, so the lower your block pressure to better unless you have dizziness because it's too old but usually that's hardly the case.

00:12:52: So I think that has to be considered.

00:12:56: and second aspect is increases with age common not in natural tribes.

00:13:03: I have no noise.

00:13:06: Have only natural sounds, they have good food and so on And then not overweight.

00:13:12: They usually don't have this increase in blood pressure with age But the western population's blood pressure increases after fifty to sixty years of age.

00:13:23: In very elderly The majority has high blood pressure.

00:13:28: Why is it so?

00:13:29: You said something about environmental influences, but why do we get more elevated blood pressure as we age?

00:13:40: Yeah that's a very good question and currently the thinking is following.

00:13:45: first of all most people increase their body weight with age.

00:13:49: And bodyweight has close relation to blood pressure because they don't hunt for food.

00:13:55: it can just walk around the corner.

00:14:00: can this that they don't run.

00:14:02: They don't exercise, exercise lowers blood pressure because it declines the sympathetic nervous systems activity and so that is very good.

00:14:13: And then also food matters.

00:14:15: people that eat a lot of vegetables but containing potassium and oil sodium Is also important.

00:14:23: So to make you take care if your blood pressure exercise Don't take salt, don't never take salt.

00:14:33: in addition when you eat and then cook also avoid food that is salty.

00:14:41: Then try to eat fruits and vegetables with high potassium levels than your blood.

00:14:47: Potassium is good for blood pressure And of course make sure the body weight is optimal with a BMI below twenty five.

00:14:57: Listeners, you already heard some very good tips from Thomas not only for hypertension to avoid that but also brain health in general.

00:15:05: We are later on going to ask Thomas what he is doing for his brain health?

00:15:09: But before that could you just... Very briefly Thomas tell us how does hypertension develop?

00:15:18: What's actually happening when the blood pressure is elevating?

00:15:24: Yes, that's a very important question.

00:15:27: There are several mechanisms.

00:15:29: It is either increased blood volume or it has increased the resistance in the resistance arteries.

00:15:36: These are arteries much smaller than the ones we see on angiograms and CT scans.

00:15:44: these are usually blood pressures in range of two hundred micron in diameter.

00:15:50: They're remodeling occurring with subtle increases in blood pressure and that drives of course this age-dependent increase in blood pressures.

00:16:00: And there is, of course a genetic component.

00:16:03: we have investigated children or parents who had high blood pressure.

00:16:09: exposed them to psychological stress which was until arithmetics higher in those with a genetic background of hypertension.

00:16:21: That means they do cope less well, with the stress of any kind and whenever their body is stressed psychologically or physically They have higher peaks block pressure and sympathetic drive.

00:16:34: therefore sudden changes in blood pressure more lead to remodelling of microcirculation increases resistance that the heart is exposed to and therefore increases blood pressure.

00:16:49: Isn't it quite interesting how all these things fit together?

00:16:52: because we already know, you have negative stress?

00:16:57: That means having a lot of cortisol in your blood Problems or experiencing huge challenges in your work, private life and so on is not good for you because it does something to the immune system.

00:17:14: And now you are saying that also doesn't do anything very well with your blood vessels.

00:17:20: It's interesting how all these pieces fit together.

00:17:23: You can just move one of them.

00:17:25: You have think about whole person.

00:17:30: Of course genetic background is important.

00:17:34: You have no hypertension background at all in the family, your likelihood that you develop high blood pressure is much lower.

00:17:43: So there's a genetic background on top of that and we know those people react differently to any form of stress for their body which of course is in large parts genetic nature.

00:17:58: But can we then also deduce that if you know your parents have a history of elevated blood pressure, or hypertension?

00:18:07: Then probably should be even more careful in trying to exercise and keep weight.

00:18:15: And not smoke for instance than if you haven't had those genetic inheritance.

00:18:22: Absolutely, absolutely.

00:18:23: And of course body weight is very important.

00:18:26: I mean smoking.

00:18:27: it's very important too but does not really affect blood pressure But by itself It has bad risk for infarction and stroke Of course

00:18:37: Because you in me we know You can't choose your parents luckily enough!

00:18:42: And also cannot choose your genetic mapping.

00:18:48: You influence with what you're born with.

00:18:55: Exactly!

00:18:56: This has been shown that people with high genetic risk for myocardial infarction, if they live a very good lifestyle... ...they massively reduce their risks.

00:19:10: So it is modifiable.

00:19:12: but some are lucky and can do whatever they want.

00:19:20: The nature is not just in this sense, yes.

00:19:23: That's true.

00:19:23: but then again I think we shouldn't blame the parents.

00:19:27: if we can do something on our own as well?

00:19:30: Absolutely yeah.

00:19:32: Thomas!

00:19:32: I promise to listen because you already came with very good and sound health advice that has been proven for ages.

00:19:42: people should be more healthy avoid salt and so on.

00:19:48: I'm also interested in knowing what do you have, like three things that you prioritize on your daily life to keep healthy and maintain normal blood pressure.

00:20:04: And of course this podcast is about taking care of the brain.

00:20:09: Yes my brain is a priority for me because i am a scientist.

00:20:15: without it can't do science nor be a good doctor.

00:20:20: So, first of all I try not to get too much excited about things.

00:20:28: And the older you get... ...the more likely will be able do this by frontal control over the midbrain.

00:20:36: Secondly i of course tried to avoid any elevator.. ..I always take stairs either in my apartment that is on the fifth floor without dancing.

00:20:50: That's number two.

00:20:51: Number three, I also walk to the hospital and of course... ...I ride a bike regularly at least twice or three times a week.. ..I do one hour bike riding up-and down hills.

00:21:07: Then i can see how well I am fit And then offcourse.

00:21:14: I think sleep is important.

00:21:19: You need eight, seven or eight hours sleep.

00:21:23: That's also important to have a balanced regulatory system of the circulation.

00:21:31: I think these are very sound advice.

00:21:33: and but i hope you wear head protection when your biking.

00:21:41: Of course

00:21:43: You were almost obliged to say that.

00:21:46: Because sometimes I see very sporty colleagues who are riding on their bikes without any head protection and then,

00:21:58: oh!

00:21:59: It is still a dangerous sport in a way.

00:22:04: but so training of balance also important when you have a safe ride.

00:22:09: And you know what I also would like to mention?

00:22:11: To eat a lot of fruits, salads and vegetables whenever... ...you have dinner or lunch is all advisable.

00:22:21: I think so too!

00:22:22: And i'd also liked that by having yourself as your control set to say That when are doing exercise You can compare it last week Or see the next week that you're progressing The hill is less exhausting to get up on and so.

00:22:40: And I think that's very wise too, because sometimes you know a bad condition sort of sneaks onto us.

00:22:49: but by doing this so regularly having the same route i do sometimes this myself.

00:22:54: then you can compare it.

00:22:56: just when i get a cold or flu i definitely feel like this was very hard today and then i say okay?

00:23:01: Then next week its flying away while im jogging

00:23:08: when you didn't do it for a week or two, so one loses fitness very quickly.

00:23:16: Yes that's true!

00:23:18: So to have yourself as your own control and not lose the fitness feeling is important but there... As I said You were good at focusing on some advice from listeners.

00:23:32: sometimes three things can be too much Which would be the one thing if people just went away from this podcast?

00:23:44: What should it be, that they take with them and try to alter or do in their daily life.

00:23:54: The easiest is to walk whenever possible.

00:23:58: To walk quite fiercely quickly... ...and never take the elevator!

00:24:06: And these are already things that, because it occurs continuously every day.

00:24:13: Every hour possibly and then of course also sitting in standing is good.

00:24:18: That has shown.

00:24:19: if you work can stand working Stat dictating or stand discussing and then sifting again.

00:24:29: I think sifting is something which isn't very good.

00:24:33: So we should avoid as much as possible.

00:24:36: I think that's good.

00:24:37: So do not fall into temptation and take the elevator, try to avoid it as much as possible And then...I think there will be a challenge That most people could Do something about.

00:24:54: It is for free!

00:24:56: It's for free, thats true.

00:24:58: To avoid escalators Also its a wise thing to do and healthy Of course, because it's so tempting.

00:25:08: I mean you come into somewhere and it's like oh It's on the fourth floor And then you find yourself in the lift or in the escalator.

00:25:16: Yes So to be conscious about that i think That is important.

00:25:23: But again Thomas we talk About what people can do for themselves but We must also say there Is a responsibility of politicians

00:25:35: of

00:25:35: the authorities to make our societies more healthy, to make them more brain friendly and also we can say in this podcast more blood pressure-friendly.

00:25:50: Are there some things that you would like to be different?

00:25:54: In your country or Europe?

00:25:57: how could people be encouraged to make these good choices that we are describing in this podcast.

00:26:05: Yeah, We created with the European Union The Safe Hearts Plan That presented on December ten last year by Oliver Warhally, the EU Commissioner of Health and it has ten flagship initiatives And important ones our knowledge about good-and-bad food.

00:26:27: Secondly, to avoid high-calorie drinks and processed food.

00:26:35: And also make sure that you maintain your weight.

00:26:39: Avoid the cardiovascular problems associated with increased body weights such as diabetes, liver dysfunction... ...and renal dysfunction.

00:26:52: eventually then heart failure Stroke and my card of infarction impregnate your desk.

00:26:59: So this is important the part of these safe hearts plan that hopefully their union will provide funding for, but we are still fighting

00:27:11: And I also think it's important that society nudges you to do the good choices.

00:27:20: I mean, if lemonade and soft drinks are much cheaper than water for instance or you can get much more chocolate then you could get apples.

00:27:33: this is something because price matters also availability.

00:27:39: yes European Union actually considering a tax on seafood.

00:27:46: They rightly argue that things on the healthy and visiting hospitals, getting procedures should be paid by factors that induce them.

00:28:01: That's a plan but it is politically not terribly easy to implement because he agrees with this.

00:28:09: But in principle there must be taxes for unhealthy food!

00:28:14: I definitely agree, and it's important also to say that we must not put all responsibility on the individual but also see that society is directed towards this goal.

00:28:29: That we live as healthy.

00:28:34: I remember when i was the mother of two small boys, in Norway.

00:28:38: it's like... When you go to supermarkets near by the cashier that is where chocolate is kept.

00:28:44: So when your standing there queuing up for your goods then of course the boy would see the chocolate and they will start saying ''I want chocolate''.

00:28:52: Then he'd have say nooo!

00:28:54: It´s Monday.

00:28:55: so we had all this stress And some countries actually made an agreement with supermarket.

00:29:03: they should move the sweets and snacks away from that area.

00:29:09: And I think these are psychological small steps, which actually matter a little.

00:29:15: Yes!

00:29:16: That's called notching so you can notch people into healthy behaviour... ...and it is in classical example to have fruits or vegetables when you wait for it to shear.

00:29:29: It takes more of an effort to find the unhealthy food.

00:29:33: Absolutely, there's also attempts in some countries... ...to label unhealthy foods and all these things do help but they usually have minor effects.

00:29:46: one has to be realistic.

00:29:48: so I think taxes are probably more effective because if you feel it in your wallet You're more likely to follow the advice.

00:29:59: Yes,

00:30:00: that's true!

00:30:00: That is very true.

00:30:02: Thomas thank you for being our guest.

00:30:05: The topic of this podcast was how chronically elevated blood pressure could affect your brain health and also what you can do about it And give us super tips and advise and explain the connection between brain health & blood pressure which we are enlightened.

00:30:23: Also to me something you would like to say before we wrap up this podcast episode?

00:30:32: Well, I think it is just important to consider what you can modify.

00:30:40: Because the genetics cannot be modified but the environment that works on your genetic background by unhealthy food.

00:30:48: whenever you can walk or take the stairs.

00:30:52: try Eat in a healthy manner by also starting with low calories like salads and vegetables, and water because it fills your stomach.

00:31:07: And you have better satiety.

00:31:11: A quicker satiety!

00:31:12: You eat less and you've got better body weight.

00:31:15: so these are things that are easy to do.

00:31:22: That was very well said, Thomas.

00:31:25: Super!

00:31:25: Thank you so much and not only for your last remarks but also being guests on this podcast.

00:31:32: we are approaching the end.

00:31:34: perhaps some of the listeners took these podcasts out with them while walking.

00:31:39: that would be a success already.

00:31:41: otherwise it could or perhaps standing instead of sitting.

00:31:56: So join us again, both you who follow us on a regular basis and also those who are new!

00:32:04: And if you enjoyed this episode, follow us in your preferred podcast platforms Do share it with your network... ...and stay tuned for more exciting conversations on the theme brain health.

00:32:16: There is more to come

00:32:22: where science meets action for a healthier brain.

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00:32:32: For more tools tips and expert insights head to www.BrainHealthMission.org.

00:32:40: Until next time take care of your brain.

00:32:42: it is the only one you've got.