Dr. Rhonda Patrick: I kind of want to go back to the blood pressure thing as well, because there was an interesting study that was recently published that made a lot of headlines on these isometric types of exercises. Right. The static hold and being better at improving blood pressure. What is the best exercise to improve blood pressure? Right? I mean…

Dr. Benjamin Levine: So, you know, when we take care of patients with hypertension, the first thing the community tells us to do is lifestyle modification. Reduce intake of salt, reduce intake of alcohol, make sure you're getting plenty of sleep, and increase exercise. I will say that traditionally, my approach has been that dynamic exercise is best because that causes relaxation of blood vessels. That's how you get the blood to the exercising muscle. And we'll do one more little science thing, because the body has both a general alerting response as a function of the exercise pressor reflex and a local response. So when I'm exercising hard, the muscles that are contracting are relaxed. Blood vessels everywhere else are contracted. It's really interesting.

So if I'm running, the blood vessels in my arms are contracting as they are in my kidney and my gut. And that's why you sometimes will get catastrophic gut ischemia during extraordinary endurance exercise, because you just don't have enough blood in your circulation to maintain your blood pressure if you've got a lot of skeletal muscle that's requiring blood. It's one thing that the, let's call it the Saltin hypothesis about the cardiovascular limitation to exercise. Because if you add arm exercise while you're doing intense leg exercise, you start to constrict the blood vessels, even in the legs, because you simply cannot sustain your blood pressure with all the blood vessels relaxed, even with a maximal cardiac output.

So the blood vessels have to constrict, but they constrict from this general alerting, increased sympathetic activity. But in the muscles, you get something called functional sympatholysis. What that means is the muscles are releasing metabolites, not just from the muscle, but from the blood vessels and from the red blood cells themselves. ATP and ADP are potent vasodilators. So you get constriction in one place and dilation in another place. And it is the regular contraction, the need, the release of those metabolites, the driving of the cardiac output response that causes relaxation of the blood vessels. And that's what I want in hypertension. I want the blood vessels to be relaxed. Remember we started this by saying blood pressure. I didn't. Maybe I didn't.

We talked about the Fick equation. Blood pressure is also a function of two things. Two things only, cardiac output and vascular resistance. We talked that cardiac output is heart rate and stroke volume. So blood pressure is the triple product of heart rate, stroke volume and vascular resistance, with probably resistance being a very major component. What I typically think is that people need to do sustained endurance activity to dilate those blood vessels, cause that relaxation, and let those blood vessels start to relax as the best way to reduce blood pressure. I don't know what to make about the static training study. It's just one study. It really contradicts a lot of other data in the literature.

I don't think that people say, oh, let me quickly switch to doing planks and wall sits just because this one study showed lower blood pressure. No, for the most part, unfortunately, if you have hypertension and have already done your lifestyle modification, you're probably going to need medication to drop your blood pressure. Hypertension is a cardiovascular disorder, and we've learned that a lot of people are going to develop it. And so I think the lifestyle stuff is the foundation. I don't think it's going to make a huge difference whether you do—it doesn't change my prescription for life. That remains the same.

And I think having a strong component of endurance exercise, but incorporating strength because that's important for life and function as you get older, I think all of that is really important, and it's not going to change my prescription. I do have specific approaches to hypertension in physically active people, but I will remind your audience that many people are salt sensitive, and reducing salt intake in the diet is important. If you have hypertension, maintaining a high potassium intake is also important. And then watch your alcohol, because I think sometimes doctors don't tell you that, but that too much alcohol intake is a very strong contributor to hypertension and making sure you've got good sleep and don't have sleep apnea. So sleep apnea is another thing. If your spouse or partner snores and has hypertension, talk to a sleep doctor. That may be something that's a little easier to manage and can cause dramatic reductions in blood pressure.

Dr. Rhonda Patrick: So along with those, you think it's possible to, with lifestyle intervention, reverse hypertension?

Dr. Benjamin Levine: I think in some cases, in mild hypertension, I think that that's true. If you've got hypertension in a young person under the age of 40, I think you need to look for other causes. I don't think we look hard enough often enough. Probably the single most important is to measure a renin and an aldosterone to look for hyperaldosteronism, overproduction by the adrenal gland of a hormone that raises blood pressure through the kidneys. That ends up being really much easier and more directed to treat. And it's grossly underdiagnosed in our country. So you should have a renin and an aldosterone level measured. There are other rare causes of hypertension. Severe hypertension in young people should get plasma metanephrines to look for unusual tumors of the adrenal gland. But I think that garden-variety essential hypertension, at least at its earlier stages, can well be modified by behavioral modification that we've been talking about.

Dr. Rhonda Patrick: Great. Including someone maybe in their late 60s, if they perhaps do the training, the sleep, looking at the sleep, the alcohol and salt intake—all the things…

Dr. Benjamin Levine: Yes. That can have a huge effect.