High blood pressure affects more than a billion people worldwide and remains one of the leading drivers of heart, kidney and brain disease. In this episode, I sit down with Dr Raymond Townsend, Professor of Medicine and Director of the Hypertension Programme at the University of Pennsylvania, to uncover what truly causes blood pressure to rise, how it damages the body, and what steps can help reverse or prevent it. With more than four decades of clinical and research experience, Dr Townsend shares insights into the mechanisms of hypertension, the importance of early detection, and why empathy, consistency and accurate measurement matter as much as medication or diet. Together we explore how blood pressure control can protect vital organs, extend healthspan and reduce risk long before symptoms appear.
Interesting comments on Taurine and BP:
Taurine is the most underrated supplement when it comes to blood pressure, abundantly found in heart muscle tissue, modulates calcium handling, reduces sympathetic tone, and enhances nitric oxide.
It’s fully charged. I just used it tonight. The measurements were 123/69. It only goes into the high 90s when I take Telmisartan 20 mg. 123 is a little high, but it’s better than too low and passing out. I guess I’ll have to wait for my arteries to clog up more before taking Telmisartan.
Success! By switching to tadalifil from Telmisartan, I am able to get my SBP into the 100-110 range. This is optimal for me because if my SBP dips below 100, I start to feel dizzy, nauseous, fatigued and uncomfortable. 100-110 is my sweet spot where I feel normal and yet my SBP is low enough to feel that I am healthy.
Telmisartan took my SBP and DBP too low 90-100 for SBP and below 55 for DBP which is probably not healthy for me. It’s a great drug for anyone who needs more aggressive BP lowering though.
The channel aims to optimize biomarkers across various organ systems, such as the kidney, liver, immune system, and metabolic health.
A significant aspect of this focus is the regular tracking of blood pressure, which raises the question of its importance in health outcomes.
Research indicates that reducing blood pressure can lead to a 15% lower risk of dementia and decreased cardiovascular-related events, including heart attacks and strokes.
Understanding Blood Pressure Changes with Age
Systolic blood pressure tends to increase with aging, while diastolic blood pressure increases until midlife and then declines.
The data presented spans from September 2022 to early May 2025, encompassing 336 measurements of systolic and diastolic blood pressure.
Data Collection Methodology
Blood pressure measurements were standardized to a specific time frame, taken between 11:30 AM and 1:00 PM, to minimize variability.
The speaker took blood pressure readings five to six times within that time window, averaging the results for accuracy.
Measurements were conducted four to five hours after consuming food or water, ensuring consistency in testing conditions.
Systolic and Diastolic Blood Pressure Trends
The average systolic blood pressure recorded was 122 mmHg in 2022, decreasing to 119 mmHg in 2023, 118 mmHg in 2024, and remaining at around 118 mmHg in early 2025.
For diastolic blood pressure, averages were approximately 73 mmHg in 2022, 69 mmHg in 2023, and returning to about 70 mmHg in early 2025.
The speaker highlights their ability to maintain blood pressure levels lower than the expected values for their chronological age of 52 years.
Factors Influencing Blood Pressure
The speaker suggests that a lower body weight may be a contributing factor to their ability to resist age-related increases in blood pressure.
A correlation analysis shows a significant positive relationship between body weight and both systolic and diastolic blood pressure.
When the speaker’s body weight was around 138 to 140 pounds, their blood pressure readings were at their most youthful levels.
Future Plans and Diet Tracking
The speaker plans to monitor dietary correlations with blood pressure and make adjustments if necessary to maintain youthful blood pressure levels.
They emphasize the importance of tracking food intake, macro and micronutrient consumption, and their impact on blood pressure.
I was reviewing the transcript of this recent Optispan / Kaeberlein interview with Brad Stanfield and saw this statement:
In a moment of personal revelation, Dr. Stanfield shared that he personally uses an SGLT2 inhibitor. He takes it not for diabetes, but as an “off-guideline” treatment for his high blood pressure, a decision made as an informed patient in consultation with his kidney doctor.
and I was a little surprised as I had not noticed this before. So - I looked into it more. Here is the summary of the research and clinical evidence on SGLT2 inhibitors lowering blood pressure:
CGPT5 Response:
Short version: yes—SGLT2 inhibitors lower blood pressure, but the effect is modest (roughly −3 to −5 mmHg systolic and −1 to −2 mmHg diastolic on average), seen on both clinic and 24-hour ambulatory monitoring, across diabetes, CKD, and heart-failure populations.
What the best evidence shows
Meta-analyses (ABPM + office BP): Class effect of ~−3.5/−1.7 mmHg on 24-h BP; consistent office SBP reductions as well.
Ambulatory BP RCTs: Empagliflozin lowered 24-h SBP/DBP in randomized trials and ABPM cohorts (daytime and especially nighttime dips). Typical magnitude ≈ −5/−2 mmHg at 1 month.
Resistant hypertension: In patients with apparent treatment-resistant HTN on background meds, dapagliflozinproduced additional BP lowering vs placebo (modest but significant).
CKD: DAPA-CKD analyses show modest SBP/DBP reductions with dapagliflozin; effects seen with and without diabetes.
Heart failure (HFrEF/HFpEF): Trials (DAPA-HF, EMPEROR) report small average SBP decreases (~1–3 mmHg) while outcome benefits occur across baseline BP strata.
Who drops the most: Higher starting BP and nighttime BP tend to show larger falls; ABPM often shows a slightly bigger effect than office readings.
Reduced arterial stiffness / improved vascular compliance (pulse-wave-velocity and related measures improve).
Weight loss contributes (analyses attribute a meaningful fraction—on the order of ~40%—of BP fall to weight change).
Possible sympathetic dampening (trial comparing empagliflozin with HCT looked at muscle sympathetic nerve activity).
Practical takeaways
Magnitude: Expect ~3–5 mmHg SBP lowering on average; larger in those with higher baseline BP and at night on ABPM.
Populations: Effects occur in T2D, CKD (with/without diabetes), HFrEF/HFpEF, and resistant HTN—though the BP effect is smaller than classic antihypertensives.
Safety/monitoring: Watch for volume depletion/orthostasis, especially in elderly or with loop diuretics; adjust other diuretics if symptomatic. (Monitored in the cited RCTs/meta-analyses.)
He (Dr. Brad Stanfield) actually made a whole video about this, which I posted here - and it’s a pretty involved thing with polypharmacy, where he had to counteract some effects with other drugs:
@RapAdmin a while back you posted about a new blood pressure product that also did something like pulse wave velocity? A bit more than that even. I can’t find it under blood pressure, or anything else actually. What was that thing? I need a new BP cuff anyway.
