When it comes to Sodium supplementation I think it is always important to make sure that there is sufficient Potassium. Hence if you are taking NaCl also take at least 1/3 of the quantitiy of KCl. I don’t know of the limitations. It may be better to have similar quantities of NaCl and KCl, but I don’t know.
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I wasn’t aware that there was a cancer association with sartans. Just saw this today. Anyone else heard of this?
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It talks about exposure to daily high dose for up to 3 years. What is high dose? If I’m not mistaken, Lasartan was recalled sometime in the past due to contamination. I started taking telmisartan, 20mg/day.
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In general, a “high dose” of telmisartan is considered to be a dose that exceeds the maximum recommended dose of 80 mg per day.
Telmisartan is available in several different doses. The most common doses of telmisartan are:
- 20 mg tablets
- 40 mg tablets
- 80 mg tablets
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I have been monitoring my blood pressure recently and it fluctuates so much based on time of day, activity level, perceived stress level, etc. I was listening to an episode of The Drive recently and Attia was talking about the challenges of monitoring blood pressure. I noted that he gets patients to check it 5x per day for 2 weeks. Makes me think about the best BP measuring protocol.
The bottom line is that in one day, I can see readings as high as 127/87 (lunch time) and as low as 107/74 (bed time). That’s a big swing. The truth is that in only happy with one of these numbers.
Curious to understand how other people approach monitoring BP and which results they choose to follow.
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Finally a good, simple continuous blood pressure monitoring bracelet?
Approved in UK and EU:
FDA approval expected to follow.
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I think that measuring twice daily for a week or two and calculating average and MAP would be sufficient (reavaluating maybe every 6 months or so). If any of single measurements would be in hypertension territory (systolic over 135 and diastolic over 85) one would need to look more into it. But remember measuring BP you need to be seated down for few minutes before and not doing it soon after exercise or when stressed. If stressed is your way of being then you have a problem. 
FWIW
As of 04/07/2023
Aktiia Cost $268 / £199.99 / AU$366
Since October, 2022
I use/have been using the E500 watch. I calibrate the watch software to an independent OMRON BPM Model BP760N, BP reading is + or - 3%. Measuring 24/7 every 5 minutes.
I spent a total of less than $100.00 usd for the watch new and the BPM which was used.
And I do have a mercury sphygmomanometer and several {more than three] other BP measurement devices.
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Interesting. I thought others had accuracy issues with the E500, but that was perhaps more is CGM estimates?
Do you know if there are any clinical data on the E500s BP accuracy?
What I like with Aktiia is that it has a lot of clinical validation and approval by regulatory agencies and also that Eric Topol is very credible in this space and it got as close of an enforcement that you ever see him give something.
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Hi there, Personally, not going for sufficient, but for optimal 
As with for instance glucose, averages of just select point in time measurements do not contain as much information as patterns, including variability and peaks.
See eg the conversation between Peter Attia and Ethan Weiss, a leading preventative cardiologist at UCSF linked below
Especially this part:
Blood pressure variability, how to best measure it, and data suggesting the enormous impact of keeping blood pressure down [1:21:00]
Peter also explicitly discusses why it would be valuable to have continuous blood pressure measurement.
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Would you accept that Peter Attia might have a personality trait (would not go that far to characterize it as PD) and things he says must be taken trough this optics? If you measure your blood pressure twice daily for two weeks you notice if you have any problems and if you have any problems with BP, than this is something that needs more looking into and this is where continuous monitoring makes sense, but wearing it all the time what good would that cause? BP like every parameter fluctuates and small deviations are not a concern. If exercise is beneficial for example and we know it acts as blood pressure lowering strategy it will cause you BP to go up during and up to several hours after exercising one could argue that fluctuations are not only normal but desired that occasional stress makes us stronger in the long run. Something that is repeatedly concerning and showing a trend must be looked more into…
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I think it’s best to get the highest measurement of the day (any testing after 15 minutes of sitting and not straight after drinking or eating) at or below the 120/80.
My highest of the day appears to be first thing in the morning so I rarely test at any other time (and when I do it is always lower).
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I am also very hopeful to see this device approved for the US. I’ve signed up to be notified when its available.
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I use an Omron (which I tested against the E500 and posted about) I have records since 2016 morning and evening in bed for something over 99% of potential readings.
The highest BP will be during or right after vigorous sex, but I don’t think those extreme measurements are considered indicative of high blood pressure. Nevertheless folks (particularly men) over 65 do tend to get mini-strokes disproportionately during sexual activity, though I suspect arterial stiffness plays a role. Measuring arterial stiffness or taking Cialis as a prophylactic against extreme blood pressure spikes may be a good precaution for anyone over 65.
As for time of day, it depends : My doctor had me on Losartan taken once a day at bedtime (the normal recommendation, since most deaths due to high BP occur during your sleep since you won’t be able to call 911!). Since Losartan has a half-life of 10 hours, my highest blood pressure was right before dinner when the drug had mostly worn off. I now split my dose and take half after breakfast and half after dinner.
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There was a large study that found that reducing salt in your diet is typically an excercise in futility since the body’s craving for salt/sodium is so strong that you end up eating more salt than you realize. According to the study those on a low sodium diet ended up ingesting just as much sodium as controls. The only exceptions were people whose starting sodium blood levels were actually high. Trying to control blood pressure by lowering salt intake, when sodium levels (as measured by blood tests) are within normal range, is an exercise in futility.
In addition those with higher sodium levels (within normal range) in the blood actually have lower total mortality rates than those with lower (within normal range) sodium levels : While lower sodium levels reduces Cardio mortality rates it raises mortality rates from slip-and-fall accidents, caused by impaired responsiveness of the central nervous system.
Raising potassium levels may be more useful, particularly since they are often low to start with.
Since the salt craving of the body is really a craving for sodium, and blood pressure rise only happens if you raise both sodium and chloride levels, I wonder if you can trick the body by ingesting baking soda along with your low salt diet : this should help reduce blood pressure (since chloride levels will drop) but still provide enough sodium for the central nervous system. One problem is that blood tests may not reveal any effect from ingesting baking soda since blood levels of bicarbonate is under tight control (since it affects alkalinity of blood), and any sodium + potassium in the blood must be balanced by chloride + bicarbonate levels. However tissue levels of chloride vs bicarbonate levels may shift towards higher bicarbonate levels, which might help with blood pressure. There is also a belief that raising alkalinity of tissues (other than blood) is protective against cancer.
Sorry not trying to upset anyone. I was sharing info on the device because it felt like interesting technological piece of progress that could help the many data driven, experimenters here.
I was trying to just share a relatively low cost way that those of us here who are interested could learn more about ourselves - at the deeper level that many of us here are interested in.
Fyi worth Dr. Eric Topol was the main source, not Dr Attia - he is a member of the National Academy of Medicine, and is one of the top 10 most-cited researchers in medicine!!! For decades an international leader in (1) cardiology, (2) precision medicine, and (3) digital health). Did you feel that any of his perspectives on the power of accurate wristband BP sensors was off? If so what specifically? I thought basically each point about the types of value that he made was spot on.
Re Peter Attia, I’d take his more aggressive approach to the value of data vs more conversional medicine anytime.
For instance I’ve always had amazing Hb1Ac and fasting glucose measurements from blood tests and when asked my doctors if anything I could do to improve further they have just been, no those are great numbers. But the amount of learnings from now and then wearing a continuous glucose monitor have been truly amazing to me (the way certain foods nevertheless can spike me, but others don’t, how different type of post meal activity blunts the spikes to different degrees, and a whole range of minor things I can do to minimize my variability and spikes (which might be a big part of why Cana, Acarbose and Metformin each has been seen as synergistic with rapa for rodent life extension)).
The amount of quick feedback loops and micro experiments I (and others here) would be able to get and do if relatively low cost wearables can give accurate BP is quite powerful.
And given that cardiovascular disease is the biggest killer, seems like an area that might be worth optimizing.
Also having a benchmark sense for how ones blood pressure is during the night can be very valuable in order to be able to pick up night blood pressure changed in the future that traditional ways of measuring blood pressure would never pick up. And for me building a time series like that over the coming years will be valuable and something to also correlate towards my other sleep metrics.
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Cool, yes, exciting stuff!
I totally agree that technology advancing is amazing stuff (and can’t wait when my AppleWatch will be able to measure also my BP and glucose levels 
) but I was just referring than in normal healthy individuals you can get away with occasional/intermittent/sporadic measurements as fluctuations are normal and might produce unnecessary anxiety… e.g. if I am stressed for a week/month and my BP goes higher does not mean that I have high BP and that I necessarily need to be aggressive with medications or lifestyle changes, but if I see an upward trend in a year/two then I would think, can I do something about it. I am just saying to spot a trend you don’t need to be that obsessive. I even listened to Peter Attia The Drive #247 you shared and it is full of useful information. I was just saying that something actions of people like Peter Attia are motivated by personal anxiety, which PA clearly states in latest podcasts often… he is talking about fear of ASCVD and dying young, about anger and drive against it… so if you shave off that layer and understand his personal fears it is easier to understand what is rational metrics and what is irrational (but still useful in some cases).
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A cardiologist’s view of the latest BP trials
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