21. Dr. Jay Shah: The Deadly Effects of Hypertension You're Not Aware Of

Do you know the #1 preventable cause of death worldwide? It's high blood pressure—a condition that half of the population doesn't even know they have. Mismanaged and misunderstood, this "silent killer" leads to heart attacks, strokes, kidney failure, and dementia. Yet, most people rely on outdated tools like cuffs that deliver inconsistent readings or aren't used correctly at all. In this episode of Extend, I sit down with Dr. Jay Shah, a cardiologist and blood pressure expert to tackle the barriers holding us back from controlling hypertension effectively. Together, we explore how innovative tools are not just changing how we measure blood pressure, but how we approach prevention, treatment, and even early detection. We also talk about topics like metabolic syndrome, the connection between stress and hypertension, and how small lifestyle changes can yield big results. Dr. Jay Shah is a practicing cardiologist with over 15 years of experience, including tenure at the Mayo Clinic and Mass General. Now the Chief Medical Officer at Aktiia, he is leading the charge in developing wearable health technologies that aim to transform global blood pressure management. We Also Discuss: (00:00) Health Presentation at Harvard Business School (18:14) Understanding Metabolic Syndrome and Its Connection to Blood Pressure (32:52) Lifestyle Factors and Their Impact on Hypertension (40:40) Stress, Sleep, and Their Role in Blood Pressure Management (48:51) Identification and Management of Resistant Hypertension (01:00:15) Strategic Use of Blood Pressure Medications (01:06:16) The Evolution of Continuous Blood Pressure Monitoring Technology (01:12:28) Future Innovations in Blood Pressure Monitoring and Predictive Health Thank You to Our Sponsors: TruNiagen: Whether you are looking to stay sharp, feel more energized or simple age better, go to https://www.truniagen.com/ IFIT: If you are looking to elevate your home gym fitness experience with the best in fitness tech, choose IFIT. Go to https://www.ifit.com/ NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Vitaboom: For supplements you can trust and wellness solutions tailored to your health, visit https://vitaboom.com/https://vitaboom.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn more about Dr. Jay Shah: Website: https://aktiia.com Instagram: https://www.instagram.com/aktiiaglobal/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Today, we're tackling one of the most overlooked threats to your health: high blood pressure, or hypertension, as it's commonly called. Often dismissed as a simple number, it's actually a major root cause of heart attacks and the number-one killer of both men and women in the Western world. It also contributes to many other chronic diseases, including Alzheimer's, strokes, kidney disease, and more. In this episode of Extend, I'll break down how this silent killer develops, the habits that unknowingly drive it, and the powerful steps that you could take to protect yourself. I'm thrilled to be joined by Dr. Jay Shah, a renowned expert in cardiovascular health and preventative care. He's one of the founders of Actia, a revolutionary company that has invented a continuous blood pressure monitor. When I first heard about this device, I tracked down Dr. Jay Shah

• 1:34Dr. Darshan Shah?

  because I wanted to talk to him about the device and how it's going to revolutionize the industry. Together, we're going to be discussing the hidden connection between daily stress, your diet, your sleep, and hypertension. We will reveal the latest innovations in blood pressure management and share actionable tips to safeguard your health from this silent killer for years to come. This episode is packed with insights to help you understand your body and make smarter choices. Let's dive in.

• 2:06Dr. Darshan Shah?

  Dr. Shah, thank you so much for joining today.

• 2:08Speaker 01

  Yeah, thanks very much. Glad to be here.

• 2:11Dr. Darshan Shah?

  Yeah, and so no relation, but Dr. Jay Shah is so crazy. Like, we just met because I kind of stalked you. I got kind of enamored with what you're doing.

• 2:21Speaker 01

  Yeah.

• 2:21Dr. Darshan Shah?

  And I'm like, I have to learn more about this company. I saw there was a Dr. Shah at the helm, so I'm like, I'm gonna reach out and pretend like I'm related to him. So he actually responds to my email.

• 2:32Speaker 01

  That was great. No, it's good to be here.

• 2:34Dr. Darshan Shah?

  Yeah, and it's so great that you're here and we're talking about this on the podcast. I've been tracking what you've been doing for, of course, the last, you know, couple of years.

• 2:42Speaker 01

  Yeah.

• 2:43Dr. Darshan Shah?

  And for the listeners, Dr. Jay Shah is an expert in blood pressure. And your background is in cardiology, is that correct?

• 2:53Speaker 01

  That's right. I'm a cardiologist. I've been practicing for over 15 years. I was at the Mayo Clinic and Mass General before that. And in between, I started and ran my own practice and, you know, medical organization.

• 3:04Dr. Darshan Shah?

  Right, right. I kind of feel like you've been stalking me, though, because you went to the same med school I did 10 years later in University of Missouri-Kansas City, and then you trained at Mayo Clinic where I trained.

• 3:14Speaker 01

  Yeah, that's right. That's right. So follow us in your footsteps there, yeah.

• 3:20Dr. Darshan Shah?

  I love it. But you know what? I really am impressed with what you've done is you took the leap, kind of like I did, to leave medicine to make massive change. And you're doing that by your new company, Actia, where you're the... What's your role at Actia?

• 3:34Speaker 01

  I'm the chief medical officer.

• 3:35Dr. Darshan Shah?

  Chief medical officer, great. So would you kind of describe what you're doing? And then we can set the stage about our conversation today.

• 3:41Speaker 01

  Yeah, absolutely. So Actia is a Swiss company, actually. And it was started in 2018 by two biomedical engineers. And really, their mission was to help the world transition to a better way to look at blood pressure, a better way to measure, monitor, and manage blood pressure. And they've developed, you know, an N of one technology, groundbreaking technology, a continuous blood pressure monitor. And it's really changing the way I think about and look at blood pressure. And those who use it, where we have regulatory approval and where we have access, are also changing the way that patients and physicians interact with blood pressure. And so that's our real mission and vision of the company.

• 4:22Dr. Darshan Shah?

  And I can tell you from personal experience, I had been struggling with uncontrolled high blood pressure for many years. And I was able to fix it through dietary interventions and exercise, et cetera. However, I still required a low dose of blood pressure medication. And for years, my personal physician and me working together could not figure out the right dose.

• 4:43Speaker 01

  Sure.

• 4:44Dr. Darshan Shah?

  And after you sent me a sample of your technology, within six weeks, we figured out that we needed to change my medication, found something that worked, and now I've been a stable 120 over 70 for over a year now.

• 4:56Speaker 01

  Yeah.

• 4:57Dr. Darshan Shah?

  Six weeks of using your device.

• 4:58Speaker 01

  Yeah. Well, it's just because you have the data.

• 5:01Dr. Darshan Shah?

  Right.

• 5:01Speaker 01

  Right? I mean, it's because you get data, whereas before, essentially, and I'm practicing cardiologist, done this for 20 years, essentially, blind.

• 5:10Dr. Darshan Shah?

  Yeah.

• 5:10Speaker 01

  And that's really the paradigm of what has existed in blood pressure and hypertension for the last 50 years. And based on this very episodic technology of a one-size-fits-all, you know, the traditional cuff, which is really, actually, 120-year-old technology that we're still trying to use to manage and monitor the world's most common and impactful disease.

• 5:31Dr. Darshan Shah?

  Yeah. It's amazing, even like the, even the high-tech cuffs are just still a pressure cuff, you know? And it's not, there's not a lot of technology that's been added. Dr. Shaw or Jay, why is it important that people talk about blood pressure and specifically for each individual, know what their blood pressure is?

• 5:48Speaker 01

  It's because it, you know, really, I think, why it's important to really put it front and center in a, in a more meaningful way is because it affects so many other diseases. It is the number one preventable cause of death in the world by far. It causes 11 million deaths per year. It is the primary cause of heart attack, heart failure, stroke, arrhythmias, dementia even, pregnancy-related complications, young, old, man, woman, we all will be affected by hypertension, either ourselves or a loved one, whether you know it or not. And as big of a problem as it is, and as well-known and understood as it is, we're uniquely terrible at managing it.

• 6:27Dr. Darshan Shah?

  Yeah.

• 6:28Speaker 01

  Half of the people in the world, half, don't even know that they have the disease.

• 6:32Dr. Darshan Shah?

  Yeah.

• 6:32Speaker 01

  And only 20% of people have it under control. So it is remarkable at how bad we are at it. And, and it's, you know, one of these things in healthcare and medicine that is just, you know, a huge problem, sitting in plain sight, begging for a better solution.

• 6:49Dr. Darshan Shah?

  Yeah, absolutely right. I mean, it's mind blowing to me, you know, they, we, we call hypertension or high blood pressure, the silent killer.

• 6:56Speaker 01

  Right.

• 6:56Dr. Darshan Shah?

  And it's mind blowing to me how silent it still is in our conversations around health.

• 7:01Speaker 01

  Yeah.

• 7:01Dr. Darshan Shah?

  You know, I, obviously I follow like 500 different wellness celebrities.

• 7:06Speaker 01

  Sure.

• 7:06Dr. Darshan Shah?

  The amount of time people mention blood pressure is like one one hundredth the amount of time they mention other things like insulin.

• 7:14Speaker 01

  Yeah.

• 7:14Dr. Darshan Shah?

  And, you know, heart attacks.

• 7:16Speaker 01

  Right.

• 7:17Dr. Darshan Shah?

  And, you know, all these things are interrelated and important to your point.

• 7:19Speaker 01

  Absolutely.

• 7:20Dr. Darshan Shah?

  And I think there's a big misconception around high blood pressure that I see in my practice, you probably do as well. People think of it as a heart disease, but it's really a vessel disease.

• 7:29Speaker 01

  Yeah.

• 7:30Dr. Darshan Shah?

  Every organ in your body has vessels. And that's why.

• 7:34Speaker 01

  Yeah.

• 7:34Dr. Darshan Shah?

  It leads to damage of every organ, not just your heart.

• 7:38Speaker 01

  Right.

• 7:39Dr. Darshan Shah?

  So can we dive in a little bit about, you know, you mentioned them rapidly, but I'd love to like really dive in about into what high blood pressure means for various organ systems and various disease processes.

• 7:50Speaker 01

  Yeah. I would first say, I would take that even one step further. And to say that even physicians talk about it, not just as heart related.

• 7:57Dr. Darshan Shah?

  Yeah.

• 7:58Speaker 01

  But just as a risk factor, not a disease, which actually reduces the impact or like the sort of urgency of it. But in fact, it is a disease. It's a disease of the vessels. And you said very correctly, it affects every organ in the body. And so just as an example, you know, high blood pressure is the primary cause of stroke. Right. Which is obviously neurologic or, or brain diseases. And the bottom line of a stroke is that some, for some reason, whatever the reason is, brain cells die. And that's, that can happen from tiny vessels being damaged over time with high blood pressure. It can happen from aneurysms, little bulges in the vessels, bleeding also caused by high blood pressure. It can even lead to disorders like cognitive impairment and dementia, which.

• 8:42Speaker 01

  Actually are from a type of vascular dementia, which is due to chronic, long-term damage of the small vessels. All of those things are related primarily to high blood pressure. So that's just one organ. And multiple different diseases all relate to underlying high blood pressure and hypertension.

• 9:00Dr. Darshan Shah?

  Exactly.

• 9:01Speaker 01

  And then you can have the same analogies go for almost every other organ in the body.

• 9:04Dr. Darshan Shah?

  Yeah, let's talk about some of the other big organs that it affects because I think people don't realize that the cause of them having to have repeated doctor's visits, a lot of it is based in high blood pressure. They're not adequately putting focus on that. So let's talk a little bit about kidney disease. Because blood pressure and kidney disease is very interconnected, right?

• 9:23Speaker 01

  Absolutely. So again, any organ that has lots of small vessels is uniquely vulnerable to high blood pressure. And the kidney is a prime example, as the essentially the one of the two filters of our body to clean our blood. And, and over time, high blood pressure damages those small vessels in the kidneys and leads to chronic kidney disease. And the thing is, is that people often put importance on kidney disease, once it gets to a fairly advanced stage. Once you see it in the blood, you know, blood biomarkers, when you get blood and you look at your kidney function, or and someone ends up on dialysis, at which point it's way too late really to do anything about it. Whereas, you know, if we were focused on preventive and proactive sort of strategies,

• 10:07Speaker 01

  we would look at the high blood pressure in people's 30s, 40s and 50s of their life, and try to prevent those outcomes from happening. And of course, physicians in the medical community knows that inherently. But there is an urgency around it, in the same way that there's urgency around treating the end stage of the disease. And that's sort of a cultural phenomenon, as well as lots of other factors there. But, but that's generally why what happens. We focus on the end result of the disease, the heart attack, the stroke, the kidney failure, rather than preventing it.

• 10:38Dr. Darshan Shah?

  Exactly. And, you know, like you mentioned, by the time it is addressed, it's almost always too late. Like the kidney is already damaged, the brain is already damaged, you have Alzheimer's or you had a stroke already. And then, you know, the number one cause of deaths in the Western world is heart. Attacks. And so how does high blood pressure lead to heart attacks?

• 10:55Speaker 01

  Yeah. So multiple areas, again, multiple avenues. The first one is that small vessels, chronic small trauma to the vessels in the heart lead to atherosclerosis progression. And so atherosclerosis, meaning it's the plaque in the arteries of the heart. And then that, of course, eventually, when it gets bad enough, can lead to a heart attack and damage to the heart muscle. And so that's just one example of the traditional sort of typical heart attack.

• 11:22Dr. Darshan Shah?

  Right.

• 11:23Speaker 01

  But there's other types of damage to the heart muscle that occur with chronic high blood pressure. In fact, one of the most common causes of congestive heart failure is due specifically to high blood pressure, causing an abnormal thickness of the heart muscle. And again, that that will cause damage over time, but it's it's different than what people conceive of as the traditional heart attack, still related to high blood pressure.

• 11:45Dr. Darshan Shah?

  Right, exactly. So, you know, I think a lot of people, when we look at cardiac risk, and I'm guilty of this myself as a physician, I'm always thinking, what's the level of plaque buildup in the artery, right? Obviously, it's very important, but there's other types of heart damage that are happening from chronic high blood pressure that cardiologists and doctors in general need to be looking at. And that's kind of what your point is, that those problems can only be maybe assessed with testing like echocardiograms, right? And so when we're looking at the heart, you as a cardiologist and an advanced cardiologist, what is kind of your testing package, I would say, for a complete heart evaluation? If I came to see you as a patient, how would you evaluate my heart?

• 12:24Speaker 01

  Yeah. So I would say it always, it's always focused still to this day on on the the person's history, physical and their symptoms. It's like, what is the reason that that person is coming? What is their issue? Now, that is a very typical approach in medicine, looking at a symptom-based approach to diagnosis, not necessarily a proactive or preventive, but that is how, you know, modern cardiology works. And so generally, it'd be based on that person's symptoms. And then we design a package of testing that would really answer the questions based on that person's sort of likely problems or diagnoses. I think what you're getting at and what a lot of people have started To do is to kind of move that sort of idea of testing into the preventive world.

• 13:09Speaker 01

  And I did a lot of that actually in my practice where people would come and say, look, I want to be preventive. I want to be proactive about my cardiovascular health. My dad had a heart attack at 50 and I want to know, you know, what I can do to try to at least understand my risk personally. And then optimize it. And so some of that's very simple stuff, blood tests, biomarkers, cholesterol values, get your blood pressure, understand that. And then there were certain tests, like for example, a coronary calcium score, which I thought was a very powerful risk prediction tool. A metric of looking at calcium or plaque buildup in the arteries of the heart. Not to say whether that person, there's a blockage here and that's causing a problem. That's really not the point of that test.

• 13:50Speaker 01

  The point of that test is to tell that person, help them understand that their personal risk might be higher than it looks on paper. And that we should maybe be more aggressive with intervention strategies. Or conversely, someone might look really high risk on paper and we might want to start five different medications for that person. When we do a calcium score and actually there's no plaque.

• 14:11Dr. Darshan Shah?

  Right.

• 14:12Speaker 01

  And so maybe their risk level is actually lower. And a lot of that, you know, we don't understand in the genetics of the disease, even as much as genomic testing is come into the modern age. We still are in the very early innings at applying those genetics into personalized medication strategies or intervention strategies. So that was one test as an example. That was really helpful, is really helpful in giving people a personalized understanding of their specific risk.

• 14:39Dr. Darshan Shah?

  Right, exactly. And then if someone wants to be extremely proactive, is there a role to actually start off with a simple echocardiogram? Potentially, you know, there's a clearly test, which is now the AI enhanced visualization of the blood vessels. There's also obviously EKGs, monitors that we can use to test for arrhythmias.

• 14:58Speaker 01

  Yeah.

• 14:59Dr. Darshan Shah?

  Like you said, a lot of this is symptom based testing.

• 15:01Speaker 01

  Yeah.

• 15:02Dr. Darshan Shah?

  And people wait for symptoms, but I do think that there's going to be a shift to proactive preventative. And we've, you know, quite frankly, like in my practice here, we've saved lives by getting this. Calcium score when you know, maybe there weren't zero symptoms, but we still got a calcium score. We saw massive blockage, right?

• 15:18Speaker 01

  Yeah, I think you had to pick and choose. Some of the tests are really uniquely suited for that kind of strategy. Others maybe less so. So for example, like an ECG is very simple, non invasive, but it doesn't, it tells you some things, but it doesn't tell you very much. An echocardiogram actually to this day still isn't really that future looking. Or it doesn't tell you that much about something that isn't there at that moment.

• 15:41Dr. Darshan Shah?

  Exactly.

• 15:42Speaker 01

  But I think those, the tests like a coronary CT angiograms or, or, or CT calcium scores that are really looking at that plaque morphology. Now this is specifically for heart attack and even stroke risk. But still, those are really powerful tools, I think, that we have today, that that's where I would lean into. You know, to do a real sort of full scale, sort of preventive visit. And even then, you know, the stress tests that people do, generally I, I kind of don't really like doing those. I don't do them unless someone's having symptoms because it's a point in time measurement. It doesn't, it's not predictive really at all if someone doesn't have symptoms. So I would really focus less on the traditional type of tests and more on these sort of new novel, you know, future looking tests.

• 16:26Dr. Darshan Shah?

  And that, my question was mostly rhetorical because I feel like a lot of people go to get some of these, you know, executive physicals at places. And they do echoes, they do stress tests, but they don't do a coronary calcium score. And I'm like, that was not a preventative test. That's to diagnose if you're having.

• 16:42Speaker 01

  That's right.

• 16:42Dr. Darshan Shah?

  You know, the end stage of blockages in your blood vessels. There's nothing preventative about that, right? Like if you're getting those, you're in trouble already.

• 16:51Speaker 01

  Right. I think, and or it gives people a false sense of security.

• 16:54Dr. Darshan Shah?

  Right.

• 16:55Speaker 01

  I think that oftentimes happens and I mean, in practice, 20 years in cardiology, I can't count the number of times someone said this. They had a heart attack and I'm seeing them in, in the hospital, let's say. And then they said to me, well, doc, I had a, I had a stress test five months ago. And I said, Okay, I mean, that doesn't really do much for anything like and so they said, well, but doesn't that mean I'm good quote unquote? No, it doesn't. It doesn't mean much at all. So that's it's really to try to understand and put it in perspective.

• 17:23Dr. Darshan Shah?

  Yep.

• 17:24Speaker 01

  And I think medicine is is slowly moving too slowly, probably, but slowly moving in that direction of more preventive and proactive.

• 17:33Dr. Darshan Shah?

  Yeah, thank goodness. So let's go back to high blood pressure. At what age does someone need to worry about their blood pressure? When should people start checking their blood pressure?

• 17:41Speaker 01

  When they're an adult.

• 17:42Dr. Darshan Shah?

  Right.

• 17:42Speaker 01

  Even when you're a child. In fact, there was a study that just came out that one in seven children have borderline or high blood pressure.

• 17:49Dr. Darshan Shah?

  Right.

• 17:50Speaker 01

  So it starts super early and as obesity and lifestyle change and socioeconomic sort of factors are the way they are, it's starting even earlier. And so we, you know, people, as soon as they have a modality and, and, you know, arguably in adolescence to early adulthood should start checking blood pressure on a routine basis. Doesn't happen. Most people don't do it, but that's really when blood pressure starts.

• 18:14Dr. Darshan Shah?

  Yeah, I totally agree with you. I have a 15 year old patient that's a son of another patient of mine. We, you know, looking at him, we could tell he has some evidence of metabolic disease. He has a lot of visceral adiposity, which means, you know, a lot of visceral fat buildup. And so we checked his blood pressure and low and behold, it was like 150 or 80.

• 18:35Speaker 01

  Yeah.

• 18:36Dr. Darshan Shah?

  And we need to get to get that under control rapidly.

• 18:39Speaker 01

  Yeah.

• 18:39Dr. Darshan Shah?

  And this brings up a very good point that I think a lot of, I think doctors even miss now is the relationship between metabolic disease and high blood pressure. Would you comment on, talk about that a little bit for us?

• 18:50Speaker 01

  Yeah, absolutely. So what you just kind of commented is this sort of body type or, or physiology that is called metabolic syndrome sometimes, but it has to do with the central adiposity, which is, you know, increased adiposity around in the stomach area, oftentimes goes with a certain BMI. And there's two things that specifically can be called out with it is one is a tendency for higher blood pressure and two is a tendency for higher glucose measurements and, and prone to eventually getting diabetes. So both things are important. And I think that that's it's it's a it's not just sort of the appearance of the person. It actually relates to the underlying hormonal changes

• 19:30Speaker 01

  of that person that can be changed, too. They are very modifiable. If that person does the right diet and exercise interventions, they are completely modifiable. So it's really an important thing to recognize early. And I think the only other part that I would add into that this metabolic syndrome can also go with sleep disorders like sleep apnea, which has a huge and very strong tie in with blood pressure and hypertension specifically, and is oftentimes under recognized and under diagnosed for long periods of time.

• 20:02Dr. Darshan Shah?

  Yeah, yeah, I think if you're listening to this and you or your loved one that you spend the night with in bed is snoring or gasping for air at night, it's so crucial to get checked for sleep apnea, which is so much easier now, right?

• 20:15Speaker 01

  It's so much easier. You can do a home study. And you're right, it's almost always the partner that recognizes it. The person themselves rarely, right?

• 20:23Dr. Darshan Shah?

  They're gonna deny it, like, I don't snore.

• 20:24Speaker 01

  They're like, I just, but that's just how I sleep. Or I don't know if I snore or not. But usually, it's the spouse that comes in like, please, something is wrong with I have to elbow them because I think they're gonna stop breathing. And that's, you know, I should have a very low threshold for getting checked for sleep apnea.

• 20:40Dr. Darshan Shah?

  Yeah, absolutely. I want to dive in a little bit into the actual mechanism biologically of how high blood pressure develops and what is it bad? Like, what is it actually doing into our blood vessels? And, you know, we mentioned like, the end stage of vessel damage causing Alzheimer's and heart attacks and strokes. But what is it actually doing to the inside of the blood vessel that makes it such a problem?

• 21:03Speaker 01

  Yeah. So the first answer to the question is, why does it happen? For 90, 85, 90% of the people, we don't know. It's a multiple factors from genetics to diet to weight. But there's not necessarily one clear cause. In a 10 to 15% of people, there is a clear and reversible cause, but it's a small minority of the cases. And how does it damage the body's organs? Well, the body's Organs have the tiniest vessels in them, or capillaries, which are the teeny tiniest vessels that are not built to withstand higher pressures. They're built to withstand very low pressures. And our body has a very complex mechanism to decrease the pressure in the arteries and the vessels as it gets closer to the organs.

• 21:48Dr. Darshan Shah?

  Hmm.

• 21:49Speaker 01

  So the organ doesn't see 120 millimeters of mercury. It shouldn't, should never see that high pressure. It should see a very low pressure that allows the blood to go into the organ and the organ to do what it needs to do. So if over time, the pressure in those tiny vessels gets higher and higher, they're just not built to withstand it and they start to destroy. They start to thrombose or clot off. And one at a time, and there's billions of tiny vessels in our organs that'll cause enough lack of blood flow so that the cells of that organ start to die. And that's how high blood pressure causes, generally causes its effects for many of the organs.

• 22:27Dr. Darshan Shah?

  Right. I have this discussion with a lot of my patients around heart disease about, I think there's this like automatic switch that goes off in people's brains that if I have high cholesterol, I will have heart disease.

• 22:38Speaker 01

  Right.

• 22:39Dr. Darshan Shah?

  And I always try to tell them it's really multifactorial.

• 22:42Speaker 01

  Yeah.

• 22:42Dr. Darshan Shah?

  It's actually, it's just as much related to your cholesterol as it is to your metabolic syndrome, as it is to your blood pressure.

• 22:52Speaker 01

  Right.

• 22:52Dr. Darshan Shah?

  All these things work together to cause heart attacks, right?

• 22:55Speaker 01

  Generally, the answer is yes. It is multifactorial and there's genetics involved.

• 23:00Dr. Darshan Shah?

  And yes.

• 23:00Speaker 01

  And the real problem is, we don't know for each individual, how to weight those different factors. So like, if someone who's smoked for 50 years comes in, okay, it's pretty obvious that the smoking is probably the primary driver. But for vast majority of people, how do we know it's their blood pressure is the primary cause? Or their cholesterol? Or is it their genetics? Or is it their diabetes? We don't, we don't really have a clue. We don't have a way to parse it out. Because we don't, generally in our traditional medical systems, we don't do sort of precision testing or precision sort of understanding of that person. But the general truth is it's multifactorial. And it's important, I think, to try to isolate. What's the most impactful to that person?

• 23:42Dr. Darshan Shah?

  Yeah.

• 23:43Speaker 01

  Um, and that's, you know, one of the aspects of that we think about a lot.

• 23:46Dr. Darshan Shah?

  Right. And that's so, and the reason it's important to isolate that is so that you can start checking the boxes and kind of reduce all the risk factors.

• 23:54Speaker 01

  Exactly.

• 23:54Dr. Darshan Shah?

  Hopefully the blood pressure normalizes.

• 23:56Speaker 01

  Blood pressure normalizes, the risk is as low as possible. That that's the goal in the end.

• 24:01Dr. Darshan Shah?

  Right, right. So one of the reasons blood pressure kind of falls into this like black box of uncertainty is no one really has a blood pressure cuff at home. Very few people have a blood pressure cuff at home. You know, I could go to 10 friends' houses. One of them have a blood pressure cuff and they have no idea where it is.

• 24:18Speaker 01

  That's normally the situation. So I have a cuff, it's somewhere in the closet. I don't know where it is.

• 24:23Dr. Darshan Shah?

  It's in the garage somewhere.

• 24:23Speaker 01

  Yeah, like that's a tappy place, you know, it stays there. Yeah.

• 24:27Dr. Darshan Shah?

  The people that have a blood pressure cuff are the ones that their doctor actually said, you have high blood pressure and it's a problem and you need to start checking this. And even those, like even those only 10% of those people buy a blood pressure cuff, right?

• 24:39Speaker 01

  Yeah. Yeah. I mean, so just on that, that point alone. So like blood pressure cuffs are 120 year old technology.

• 24:47Dr. Darshan Shah?

  Right.

• 24:47Speaker 01

  And they take one measurement at a time, which everybody kind of innately understands. They're also cumbersome to put on. They're annoying. Many people don't like how they squeeze your arm, all these factors. So it leads to extremely poor in sort of the commercial world, product market fit. So people just don't use them. Only 17% of people actually consistently use a blood pressure cuff. 17% of people. Half of the people who are diagnosed with hypertension by a physician and are told to check their blood pressure, never check their blood pressure at all. Only 20% of people even check it more than once a week. So it's just a very poorly used solution.

• 25:23Dr. Darshan Shah?

  Exactly. And that's why, you know, your technology, which you have on your wrist right now is going to change the game. I like that color too.

• 25:30Speaker 01

  Yeah, yeah, thanks. We got some new band, wrist color.

• 25:34Dr. Darshan Shah?

  Right. And so I think continuous blood pressure monitoring is going to completely change this equation. And, you know, hopefully this is a technology that almost, I, I would think, you know, if you have any risk of high blood pressure, and even if you don't. It's probably an i- it's a good idea to be measuring your blood pressure. Until someone gets one of your bands in their hands, what is the optimal frequency? Well, once we said, when should someone start? When you're an adult, so 21 and even sooner. People should get checked for it, right? And then what's the optimal frequency for people to kind of check their blood pressure? And I think it's so important to highlight this as well. It doesn't matter, even if you, even if you're going to the gym and you look pretty good and your weight is under control.

• 26:19Dr. Darshan Shah?

  You can still have high blood pressure, right?

• 26:21Speaker 01

  Absolutely.

• 26:21Dr. Darshan Shah?

  Yeah. So what's the optimal frequency?

• 26:23Speaker 01

  Yeah, I mean, I can tell you what the medical associations say, which is at least once a year. If you don't have a diagnosis, at least once a year, you get checked for it. That's, that's the recommendation, but I don't really agree with that. I think the frequency should be much more frequent, you know, at least a couple of times a month over time. And really, and we can get to this in, in, you know, later is like, so how is that going to work? How is it possible to get hundreds of millions, really billions of people in the world, interacting and checking your blood pressure on a routine basis at their home? And do this sort of massive global screening? It's not going to work with cuffs, you know? And so we can get to that because that gets to the sort of the exciting and, you know, sort of thing I wanted to tell you about.

• 27:07Speaker 01

  But that's really the ideal so that you can understand over time. Is your blood pressure changing? Is it staying in there at least in a reasonable zone or the right zone? And even then, those are really still snapshots, but at least it gives you some sense of like, you know, is there a problem here or not?

• 27:24Dr. Darshan Shah?

  Yeah, and I think the other big kind of problem with blood pressure measurements in general is your blood pressure is always changing throughout the day, right? And so when is the actual optimal time to measure your blood pressure? Also, there's a pretty, you know, there's a pretty intense set of actions you need to do before you take your blood pressure, while you're taking your blood pressure. If you're not taking a proper blood pressure measurement, it's pretty much garbage, right?

• 27:49Speaker 01

  Yeah.

• 27:50Dr. Darshan Shah?

  Like crossing your legs, for example.

• 27:52Speaker 01

  Exactly.

• 27:52Dr. Darshan Shah?

  And not having your arm at the right, like even if you raise your arm or put your arm down a little bit, it changes your blood pressure, right?

• 27:58Speaker 01

  They did a study on this about, you know, people were asked to take their blood pressure at home with a standard cuff. And then they looked at like, what was the accuracy of how, not the measurement themselves, but just how that person did the measurement. Seventy-six percent of people did not do the measurement correctly, meaning they put the cuff on in the wrong position. They put it on too tight, too loose. They didn't sit in the right position. They didn't do the seventeen things that you're supposed to do before you take a measurement. So the vast majority of home blood pressure measurements are, are not necessarily accurate. They're often misleading. And this has been shown by several studies, you know, out there. But it's the technology that has been out there in the market. So that's what people sort of know and.

• 28:37Dr. Darshan Shah?

  Yeah, that's kind of all they have available at this point in time. So, you know, for our proactive preventative practice that we practice here in Nex Health, we tell everyone to get a Omron blood pressure cuff. And the reason we do that is because it actually connects to your phone.

• 28:50Speaker 01

  Yep.

• 28:50Dr. Darshan Shah?

  I used to have people write it down. They would always lose the piece of paper, forget. And we have them, we, we encourage them to do it once a month.

• 28:58Speaker 01

  Yeah.

• 28:58Dr. Darshan Shah?

  Even that, like, you know, they don't do it until their visit.

• 29:00Speaker 01

  Right.

• 29:01Dr. Darshan Shah?

  Because they know I'm going to ask them for it.

• 29:02Speaker 01

  Exactly.

• 29:03Dr. Darshan Shah?

  And so, but I think once a month is probably a good frequency for most people. And, you know, a lot of our patients come into our office on a, sometimes even a weekly basis. So we have the benefit of having them here and we train all of our staff in the proper methodology for blood pressure measurement. So we get a lot of blood pressure readings.

• 29:21Speaker 01

  Good.

• 29:22Dr. Darshan Shah?

  And I can't even tell you, like fifty percent of the people that we see have high blood pressure.

• 29:26Speaker 01

  Yeah.

• 29:27Dr. Darshan Shah?

  It's, it's, it's rampant.

• 29:28Speaker 01

  Yeah, yeah.

• 29:29Dr. Darshan Shah?

  And it's almost a hundred percent of the time, it's untreated.

• 29:32Speaker 01

  Yeah. Yes. Yeah. I mean, that's great that they're, they're checking it and doing it. You're being, I mean, you know, you have the clientele, they're, they're being proactive and, and that's great. And I, I think that that's, that speaks volumes. Like, they're the ones who are checking it and you're picking it up.

• 29:46Dr. Darshan Shah?

  Right.

• 29:46Speaker 01

  But think of everybody else, the vast majority of people, it's still there. It's everyone, it's in the, it's in, you know, we all know people, we ourselves will have it. It's there and it's rampant, but that's, that's the issue is that people aren't checking.

• 29:59Dr. Darshan Shah?

  I'm hoping that everyone listens to this is now motivated at least to get their blood pressure checked, whether they do it, you know, at their doctor's office, which I think is a terrible measurement because a person doing their blood pressure stress, do your stress, White Coat Syndrome is real, like it's not a-

• 30:16Speaker 01

  Thirty-five percent of the population has white coat-

• 30:18Dr. Darshan Shah?

  Thirty-five percent.

• 30:19Speaker 01

  Up to thirty-five percent, which means one in three, you know, you'll get a high reading at the office and you go home and it's normal.

• 30:25Dr. Darshan Shah?

  Right.

• 30:26Speaker 01

  But we don't know who those one in three are. They could be hypertensive and they could actually have real hypertension, but you could say, well, maybe this is white coat. So the only way you really know is to check it at home on a routine basis.

• 30:37Dr. Darshan Shah?

  Exactly, and this goes into taking personal responsibility for your health because just because you go to the doctor once a year and they measure your blood pressure, one in three times it's a garbage measurement.

• 30:45Speaker 01

  That's right.

• 30:46Dr. Darshan Shah?

  So you need to take personal responsibility.

• 30:48Speaker 01

  Yeah.

• 30:48Dr. Darshan Shah?

  And this is one of the things that you need to be checking on yourself at home, right? And so your device is going to make it so much easier to do that.

• 30:55Speaker 01

  So much.

• 30:55Dr. Darshan Shah?

  Yeah.

• 30:56Speaker 01

  So in the other thing that, I mean, so this, what we're doing, you know, in Actia, which is in the European markets and launching in Canada here in the next few months, but the idea of a continuous blood pressure monitor and what it opens the door to is a completely different way of how to look at blood pressure.

• 31:14Dr. Darshan Shah?

  Right.

• 31:15Speaker 01

  So I don't think anymore of blood pressure in just millimeters of mercury.

• 31:18Dr. Darshan Shah?

  Hmm.

• 31:19Speaker 01

  I think that's, that's the antiquated way. And I think as the world moves into this, just like it did in diabetes with CGMs, going from episodic spot check measurements to continuous, what we'll see is that millimeters of mercury in one-time readings are really like just the very basic understanding of blood pressure. And what you really want to know is how much time does your body spend in the right or the optimal zone of blood pressure? And that concept is called time in target range. And you can't know that really by doing one-time measurements. The only way you can get to that sort of understanding, which CGMs have done for diabetes, is with a continuous type device, a continuous monitoring device. And we can do that, it's already in our app, it's already there.

• 32:03Speaker 01

  And so that's just one example of like a groundbreaking metric and it's already- Been shown in research papers to be a more powerful metric of blood pressure control and of cardiovascular risk. So those are ideas that are really sort of where where the field is going to go, I think.

• 32:21Dr. Darshan Shah?

  Yeah, no, I mean, I think just as revolutionary as CGMs have been to my practice of medicine and completely turning around metabolic disease.

• 32:31Speaker 01

  Yes.

• 32:31Dr. Darshan Shah?

  I think a continuous blood pressure monitor, especially like, like you're saying, time and target range is so critical. We're going to be able to see a massive reduction in disease in general.

• 32:42Speaker 01

  Yeah.

• 32:42Dr. Darshan Shah?

  All diseases, all chronic disease, Alzheimer's, heart disease, what have you.

• 32:46Speaker 01

  Yeah.

• 32:47Dr. Darshan Shah?

  In general, from these types of measurements. So let's go back to a little bit about the causes of high blood pressure. Just, I just want to make sure we don't ignore this is what are people doing in their day to day life that is causing their blood pressure to be high?

• 33:00Speaker 01

  Yeah. Well, like I said, some of it is genetics.

• 33:03Dr. Darshan Shah?

  Yes.

• 33:03Speaker 01

  So there we, we put that aside, but, but think of just the rest of the things that, that modern life entails. Sitting a lot.

• 33:10Dr. Darshan Shah?

  Right.

• 33:11Speaker 01

  Right? We don't really move that much anymore. Most people don't, you know, our jobs, our lives are, are built around being sedentary. That's a huge factor. Social determinants of health. What food do you have access to? What types of food do you have access to? Is it high dense, high calorie dense food? Or is it, you know, fresh vegetables and fruits? And those are things that people don't necessarily think about. The food chain, the food system itself is really designed to promote chronic diseases in an addictive way. In the same way that high sugar drinks are kind of addictive or high caffeinated drinks are addictive. You know, processed foods are, do have an addictive potential and that's a really significant factor.

• 33:54Speaker 01

  Then there's of course, you know, lack of exercise. We talked about that. High sodium in the diet.

• 33:59Dr. Darshan Shah?

  Which comes from ultra-processed.

• 34:01Speaker 01

  Which comes from ultra-processed foods, or just generally, it's salts in everything. I mean, it's in Cheerios, it's in milk, it's in bread, it's just everywhere. Alcohol has grown in popularity in terms of how much people are drinking, and that, of course, affects it. So these are the types of things that that we have in our daily lives, some of which are not necessarily hard to fix, and you can take those things personally on, some of which are actually deeply rooted in the way we live, and that's why I think we've seen, not just in the Western world and the developed countries, but even in the less developed countries, hypertension and preventable diseases

• 34:40Speaker 01

  are growing at a pace that now they have, they will surpass, even in Africa, communicable diseases like malaria as a cause of death.

• 34:48Dr. Darshan Shah?

  Right, wow, it's incredible. And I think, you know, to highlight the genetics part of it, I'm genetically susceptible to high blood pressure, my whole family has it, it's, you know, being of Indian origin, it's very rampant in our culture, but I do want to highlight that even though you have the genetics for this, this can be controlled, right?

• 35:09Speaker 01

  Okay, for sure.

• 35:09Dr. Darshan Shah?

  And you might need a medication, which are, I mean, now the medications are extremely effective and extremely safe as well, I think, we'll talk about the medications here in a little bit, but I'm a big believer in the Pareto Principle, like, there's 20% of things that you can do that'll give you 80% of the result, and that is, as you mentioned, don't be sedentary, every 45 minutes, get up and move around, eliminate ultra-processed food from your diet, this is gonna automatically change your diet to a much healthier, you know, lower sugar, lower sodium diet, and I don't want to say salt is bad, because, you know, our body needs salt, it's just a massive amount that's shoved into ultra-processed food, that's really, and the chemicals as well that are causing the high blood pressure, and then getting adequate sleep, I think, is also massively important, right?

• 35:52Dr. Darshan Shah?

  And we talked about treating sleep apnea, but I'm also, like, another continuous measurement we have now, I see you're wearing an Oura ring as well.

• 35:59Speaker 01

  Yes, that's right.

• 35:59Dr. Darshan Shah?

  Is getting your sleep right, right?

• 36:01Speaker 01

  Yes, absolutely, there, I mean, there's huge ties into sleep, restfulness, stress, you know, it's all, there's an interplay with all of it. And I think this is where, and you mentioned this with your own experience, like this is where it's hard. There's so many things. Right. It's hard for people to understand the feedback loop for their body, right? So again, going back to the CGM analogy, that's one of the best parts about a CGM is like you can understand how your diet, based on your culture, really affects your glucose. But all these different things we might mention to, to somebody, a patient or whoever with high blood pressure. And they'll say, well, okay, but those are like 10 different life-changing things. Like, what do I start with? How do I know what's going to work?

• 36:42Speaker 01

  And without that data from a sort of a consistent data measurement to give them that feedback loop. So they understand, oh, I did dry January and look at, look at my blood pressure. It really made a difference. Or, oh, I'm, I'm going to just do a challenge just with sodium. I'm going to really try hard at SAT and see if that actually affects my blood pressure. Those are the things that matter, or your experience, like how, we have five different classes of medications. And we give the same doses to everyone when they start. Like, we don't know which dose is going to make a difference for you. We don't know. We just sort of throw it at you one at a time. So closing that feedback loop is super important. And super help only can come from getting that data and showing it to the user or, or the patient themselves

• 37:27Speaker 01

  and really understanding that feedback loop. So that's how, you know, that's as important as understanding the causes and having treatments. Remember, most of this chronic disease management is done by the patient themselves. They are the ones that have to take ownership.

• 37:40Dr. Darshan Shah?

  Absolutely.

• 37:41Speaker 01

  So they're the ones who need the data to make those decisions and to see what works and what doesn't.

• 37:46Dr. Darshan Shah?

  Yeah, I feel, I feel like this is one of those situations where individuals have basically outsourced their health too much to their Western medical doctor. Blood pressure is one of those. And there's no way that's going to fix the problem. And that's why, you know, I, I think sometimes the Western medical system is demonized because there's like a pill for every ill, right? Well, obviously, because you're not willing to take control of this in your own lifestyle. So the doctor's only tool is to give you a blood pressure pill. So you're, to make up for your poor lifestyle choices, right? And so I think that, you know, having the data, taking Responsibility for your own data and having that feedback loop

• 38:22Speaker 01

  Right.

• 38:22Dr. Darshan Shah?

  Empowers people to make positive changes in the right direction.

• 38:25Speaker 01

  Yeah, yeah, absolutely. And we're seeing that already in some of our real world data. Where we can see hypertensive users who consistently use sort of our continuous product have a massive reduction in blood pressure and then it's sustained over time.

• 38:37Dr. Darshan Shah?

  Uh huh.

• 38:38Speaker 01

  It's because they're getting the data so that that allows them to to take control of their own health and that get that autonomy and to do it themselves.

• 38:46Dr. Darshan Shah?

  Yeah, yeah.

• 38:52Dr. Darshan Shah?

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• 39:30Dr. Darshan Shah?

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• 40:10Dr. Darshan Shah?

  Let's touch a little bit on stress because I think this is a really important factor that, you know, is often overlooked. You know, I have a patient, for example, I'm thinking of, he's a CEO of a massive company, has 400 employees. And he has 10 people directly reporting to him. His diet is perfect. The guy goes to the gym every single day. He monitors his sleep, has, gets an hour and a half. Of deep sleep every night. He's got everything dialed in. Okay. And his blood pressure is still pretty high and we're struggling to get it under control and stress is a massive factor.

• 40:38Speaker 01

  Yeah.

• 40:38Dr. Darshan Shah?

  I can't tell this guy quit your job, right? So what are some techniques that you would give, give him to help mitigate the damaging effects of stress on his physiology?

• 40:50Speaker 01

  Yeah, it's a tough one, right? Because unless he's willing to sort of really makes foundational changes in the, in the job, then you're, you're left with trying to work around the realities of being a CEO and, and having all the stressors of that job.

• 41:03Dr. Darshan Shah?

  Right.

• 41:04Speaker 01

  So, but the, but the things that you can do are, you know, that other than getting the good sleep, really making time in the day for exercise, it sounds like he's already doing meditation.

• 41:13Dr. Darshan Shah?

  Yes.

• 41:14Speaker 01

  I think is really helpful. Breathing exercises can be really helpful. And sort of having a, you know, a consistent schedule for that, for those activities within the context of a very busy day and lifestyle, which many people have. And then I think the other part is just to, to take breaks.

• 41:32Dr. Darshan Shah?

  Yeah.

• 41:32Speaker 01

  Not many people do, you know, it's like a busy lifestyle, busy person, busy job, like, where are your vacations? Where are your breaks? Where, where are your long weekends? And that's as important for that person's life as, as anything else. And, and having that world outside of their work. Is it all gonna really make a difference to the blood pressure? I don't know. I can tell you from my own experience with my data, I can see the change when I go on vacation and on the weekends, I can definitely see my blood pressure is better. So it definitely affects some people. It's a challenge though, to really sort of design a program for that person and what are they willing to do?

• 42:10Dr. Darshan Shah?

  Right.

• 42:11Speaker 01

  What are they willing to give up?

• 42:12Dr. Darshan Shah?

  Well, you, you hit on the three biggest things that I recommended to him, actually. I said, look, here's what I want you to do. Three changes. Number one, breath work. Okay? So every day, twice a day, I want you, I gave him a YouTube video of a good breath work exercise to de-stress. Second thing, I had him buy a sauna. And every night now, most nights before he goes to bed, he does a 20 minute sauna session.

• 42:32Speaker 01

  Yeah.

• 42:32Dr. Darshan Shah?

  Not only is sauna incredibly beneficial for a multitude of reasons, just you know, for the science of it, but also just taking that break in there because you can't keep your phone in there. It's like a mental break in there for 20 minutes. And then lastly, I bought him an egg timer because he would just sit at his desk for eight hours and not even get up to eat lunch. So every 45 minutes, he takes a break.

• 42:55Speaker 01

  Got to take a break.

• 42:56Dr. Darshan Shah?

  And that, you know, that cuts off that cortisol release, I think, you know? And it's made a huge difference, actually. I think those are the kind of things that I, that he's, and this is all happening in real time right now, but I really see him just feeling less stressed, but also his blood pressure is coming down. I just can't wait to have your device here in the United States so that we can really dial this in for him, you know? Are there any other kind of techniques before we go into the medications of blood pressure that you've seen work for people? You know, if you touch on exercise, sleep, stress management, dietary changes, anything else you can think of? One of the things that I see is this device that I've tried a couple of times where it's like these massive blood pressure cuffs they put on your, on your extremities.

• 43:41Dr. Darshan Shah?

  And they squeeze and they let go and they squeeze and they let go. Intermittent pulse therapy is called. Have you seen that?

• 43:46Speaker 01

  I've seen it. In cardiology, they've done it for other conditions. You know, in terms of chronic hypertension, I'm not sure that what the data is there. I don't know that necessarily how much it works. I think that, you know, what we talked about in the major things covers most of the lifestyle interventions. And, you know, of course, there's one we didn't mention, which is smoking.

• 44:10Dr. Darshan Shah?

  Smoking and alcohol.

• 44:11Speaker 01

  Not necessarily. Shocker there. But, but I think those are the main ones. You know, I, it's, it's tough though, even, even those, like again, getting back to the way we talk about it and just sort of general recommendations and advice versus being precise in our recommendations and advice. And this is one of the areas where the continuous data would be really, really helpful. And we're already seeing that because salt's a really good example. Sodium is a really example. But we recommend it to everyone. You should reduce your sodium because we're eating too much sodium. And it's going to help your blood pressure. But the truth is for fully half of the people, it doesn't matter. So and it's a really challenging thing to reduce, right? Now, I'm not saying people should go out and eat a lot of salt just because it's okay.

• 44:56Speaker 01

  But the point is, is that if somebody isn't salt sensitive, I'd rather have them focus on something that matters.

• 45:02Dr. Darshan Shah?

  Makes sense.

• 45:03Speaker 01

  Like stress, or like exercise, or like weight loss, or like these other really major things, not just the sodium. But how do we know that? We can't know that because there's no feedback loop if we don't have the sort of more continuous data. And I think the last thing I would just touch base on since now it's sort of a very, you know, a big deal, it's just weight loss.

• 45:22Dr. Darshan Shah?

  Yeah.

• 45:23Speaker 01

  Weight loss itself. Of course, there's weight loss from traditional methods and now weight loss from GLP-1 agonists. And in that scenario, actually, tracking your blood pressure actually can be really, should be really important, especially if you have hypertension and are on medications, if somebody starts a GLP-1 agonist. A GLP-1 agonist are these new weight loss medications like Ozempic.

• 45:44Dr. Darshan Shah?

  Majno.

• 45:45Speaker 01

  Because your blood pressure can drop fairly precipitously while you're losing weight in a rapid fashion. And you need to be able to track that to then understand, do you need to dial back on your blood pressure medications? And so that's just a sort of corollary, but that's a really important thing because otherwise, people stay on the same dose of hypertension medicines. Their weight goes down, the blood pressure goes down. Now, all of a sudden, you're getting really lightheaded or passing out and things like that.

• 46:09Dr. Darshan Shah?

  That's such an important point. Yeah, I think, you know, GLP-1s have really been like an earthquake in medicine, I think.

• 46:17Speaker 01

  Yeah.

• 46:17Dr. Darshan Shah?

  And, you know, I think there's a lot of negativity out there in the GLP-1s. People, you know, cheating and celebrities using it to lose 10 pounds on an award show. But I think all of that noise kind of negates, and also there's this, you know, a lot of resentment to the pharmaceutical companies for making a trillion dollars off of weight loss.

• 46:35Speaker 01

  Money.

• 46:37Dr. Darshan Shah?

  But I think all of that noise does kind of negate some of the like massive benefits it can have for people, right?

• 46:45Speaker 01

  It can.

• 46:46Dr. Darshan Shah?

  And if you have uncontrolled high blood pressure and you're struggling with weight, actually, whether or not you're struggling with weight, I think a GLP-1 might, you might want to consider it if you have any degree of high insulin and metabolic syndrome. Would you agree or what do you think?

• 47:01Speaker 01

  Well, I don't know enough about the, I mean, I'm not, I don't prescribe them very much. So I don't know enough about the other aspects. But what you can say, just based on the clinical trials that have been done is like the, the effects are fairly profound, not just with the weight loss, but especially if that weight loss is sustained across so many other different cardiovascular diseases, heart attacks, other endpoints. And so all of those tie into blood pressure because blood pressure is sort of a foundational horizontal disease that causes so many other disorders. So, I mean, clearly there is some benefit. Of course, there is also some excess use probably for, for lots of reasons. And I'm sure just like everything else, like the pendulum will come back to a sort of a medium where it's appropriately used and, and in the right setting.

• 47:47Speaker 01

  So I think that they have their benefit in the right situation for sure.

• 47:50Dr. Darshan Shah?

  I agree. And also, you know, there's, there's the elimination of sleep apnea potentially as well.

• 47:54Speaker 01

  That's right. Yes, it can be.

• 47:56Dr. Darshan Shah?

  I think, you know, if anyone's considering doing a GLP-1, it's so important to have a really skilled practitioner.

• 48:03Speaker 01

  Yes.

• 48:03Dr. Darshan Shah?

  And you're doing it for the right reasons. You're also putting into place measures, like you said, to monitor your blood pressure and your other medications because you might.

• 48:11Speaker 01

  That's right.

• 48:12Dr. Darshan Shah?

  You, you can get hypotensive, low blood pressure from being on, losing weight and being on these high doses of right blood pressure medication.

• 48:19Speaker 01

  Exactly. Yeah.

• 48:21Dr. Darshan Shah?

  Now, okay, so let's talk about one thing that I, I've seen, I would say two times in the last three or four months, is people that are struggling with their blood pressure medications and just adding one after the other, after the other, increasing dosages with their primary care provider, but they've never been checked for secondary hypertension. So let's touch on that just real quick because I think a lot of people listening to this, that might resonate to them. It'll, it'll at least give them the impetus to ask their doctor about, what about secondary hypertension, right? So talk about secondary hypertension.

• 48:54Speaker 01

  Yeah, that was that 10 to 15% that I talked about. And we're learning it's probably bigger. It used to be talked about as 5% or less of all people who have high blood pressure. Now we've learned at least it's at least 10 to 15% and there's specifically one. Component in there. There's lots of other ones, but there's specifically one component in there called hyperaldosteronism, which is a adrenal hormone that in about 10% of people is just overproduced. And one of its effects is

• 49:22Dr. Darshan Shah?

  10% of people?

• 49:23Speaker 01

  Yeah.

• 49:23Dr. Darshan Shah?

  Wow.

• 49:24Speaker 01

  Of hypertensives that will cause hypertension and it can be checked with fairly simple blood tests. So you can see that pretty simply and the intervention is actually also fairly simple. It's medication driven. It doesn't necessarily mean a surgery or some other thing. And so you can really identify that component of secondary hypertension. So that's a new, fairly new, and just in the last few years phenomenon. And research has shown that we need to be checking for hyperaldosteronism in a more frequent way, a more systematic way than we have had been doing in the past. But that's only one aspect. That's only one

• 49:58Dr. Darshan Shah?

  What's the blood test for hyperaldosteronism?

• 50:00Speaker 01

  It would be a renin aldosterone ratio. There's other ways to do it, but that would be the simplest one, along with just a basic metabolic profile and things like that.

• 50:09Dr. Darshan Shah?

  Yeah.

• 50:10Speaker 01

  And then there's other causes of hypertension that are sometimes pretty obvious. Other times they're not so obvious, but we mentioned sleep apnea. Sleep apnea, in my experience, is a fairly large driver of hypertension. It may not be the primary causative factor, but even if someone has mild hypertension, if you put on top of that significant sleep apnea, people's blood pressure can really go through the roof. And then there's a whole laundry list of other sort of disorders that are much less frequent, that should at least be thought about, especially when you get someone with true resistant hypertension or a young person with really a significant hypertension.

• 50:46Dr. Darshan Shah?

  Right.

• 50:46Speaker 01

  So those would be the sort of aspects to

• 50:49Dr. Darshan Shah?

  Yeah.

• 50:50Speaker 01

  The reasons to check.

• 50:51Dr. Darshan Shah?

  Not to veer off course, but I do want to touch on one quick pearl out there for our listeners is just like you mentioned, 10% of people have a high aldosterone. You can check a renin aldosterone ratio level and then treat it with medication. And it guides your therapy as well. There's this other kind of newer thing. It's been around forever, but a new thing that people are talking about in cardiology, which is the LP little A.

• 51:12Speaker 01

  Yes.

• 51:12Dr. Darshan Shah?

  And so many people have LP little A. Can you talk about that?

• 51:16Speaker 01

  Yeah. So LP little A is a, is a type of molecule of Cholesterol, it's a kind of a cholesterol molecule. And, you know, oftentimes when we've checked traditional cholesterol panels, it doesn't come up on the traditional cholesterol panels. And so people will, will say, well, I have normal cholesterol. You know, you put me on a cholesterol medicine, like, do I really need this? Do I not need it? It depends on the person and what they've had. But one aspect, this is getting back to that idea of screening and being proactive, of looking at people in a more precise way. LP little a is one of those factors that can be tested, a simple blood test. But it can show someone if they're at a significantly higher risk, at least in the cholesterol sort of profile,

• 51:59Speaker 01

  then there maybe they're just their LDL or the bad cholesterol would show. So it, it kind of goes together with the idea of like those calcium scores and those other types of screening. It's one factor to take into account as well. It, you can't really specifically treat it, at least in a large scale way. Some people have tried niacin or other things. But truthfully, we don't know if treating it makes any difference. It's more a, a tool to use as a risk identification tool. And so it can be kind of used to round out that person's profile in a maybe more personalized way.

• 52:31Dr. Darshan Shah?

  Right, right, exactly. So let's talk a little about the blood pressure medications that are out there. You know, there's always like this visceral reaction of patients that get diagnosed with high blood pressure. Like, I don't want to be on blood pressure medication. What do I need to do, you know? And so, and, and I would love, you know, and I fight this battle a lot, actually. Cause you know, like I said, we're finding high blood pressure in 50% of people. They just don't want to hear it sometimes.

• 52:54Speaker 01

  Yeah.

• 52:55Dr. Darshan Shah?

  And my advice to them is, look, you need to get your lifestyle under control. And while you're doing that, we need to get your blood pressure under control. Cause I don't know if you're the type of person that can get your lifestyle to fix this in three months, six months, a year or five years. That's my conversation with people. But I think this is like this, you know, there's this hesitation to be a medication because people are worried about the negative or side effects of medication, which is a valid concern, I think. So how should people think about blood pressure medication in your opinion?

• 53:26Speaker 01

  I think the way you just generally outlined it is, I mean, it's the Recommended way you give people depends on their how high their blood pressure is at first.

• 53:33Dr. Darshan Shah?

  Let's talk about that, the different levels of blood pressure and when you start medication. Could you talk about that?

• 53:37Speaker 01

  So there's two stages in the US sort of system. There's two stages to high blood pressure. There's stage one, which is 130 to 140 on the top number of systolic. And on the bottom number, it's 80 to 90. And then there's stage two, which is over 140 or over 90.

• 53:52Dr. Darshan Shah?

  Yep. And you know what's important about that? Sorry to interrupt you just real quick is there's a significant mortality difference between 130 and 120. Right. And so when people say, I just have a little bit of high blood pressure.

• 54:05Speaker 01

  Yeah.

• 54:05Dr. Darshan Shah?

  There's a significant danger that that's causing you.

• 54:08Speaker 01

  Significant difference is just generally speaking, if you lower your blood pressure by 10 millimeters of mercury, irrespective of where you start, it correlates with a lowering of your cardiovascular risk by 20%.

• 54:18Dr. Darshan Shah?

  Huge.

• 54:19Speaker 01

  So it's a big deal, right? It's a big deal.

• 54:22Dr. Darshan Shah?

  Right.

• 54:22Speaker 01

  The thing is, is that it's just a number. And that's why people don't necessarily have the same. And you don't feel it, right? You don't feel pain or discomfort or anything with it. So it's easy to blow it off or put it aside or to ignore it and those kinds of things. And that's one of the, one of the issues with, with it. So getting back to the medications, generally if someone's over 140 over 90, generally we recommend starting at least one medication right away. If someone's in the lower range of 130s to 140, you could give them a trial of three to six months of lifestyle interventions if there's something to change. That's the first question. I mean, if you have someone who's already doing all the good things, what more can you possibly change in that person?

• 55:04Speaker 01

  It's hard to say, but if someone has some pretty clear and obvious low hanging fruit, you could give them three to six months to try and change. And then I sort of sit at the outset and say, look, you're going to come back in six months or three months. And if we really haven't seen any difference, I'm going to recommend that you start a medication. Now, Is it the easier thing to do as a physician? Well, really, as you said, it's the only tool we have as a physician. I can't go to that person's house and force them to, you know, lose weight or exercise or decrease alcohol or whatever it is. They have to do that. They have to own that themselves. And so generally, just based on human psychology and behavior, most of the time, people aren't able to, you know, do enough lifestyle interventions to really substantially affect their blood pressure because it takes a lot, actually.

• 55:49Speaker 01

  You know, weight loss, it takes almost 10 kilos of weight loss, which is about 20 pounds of weight loss to affect a blood pressure decrease of more than five, four or five millimeters of mercury. It's a, it's a pretty heavy lift. And takes time. No pun intended, but like, yeah, it's a, yeah, it takes time and it takes effort and it's a sustained effort. And again, this goes back to the feedback loop. People, if they don't see the change, if they can't necessarily see it because they're not checking their blood pressure very routinely, they don't see the decrease as if it's one-time measurement. It's hard for them to stick with it. So then you come back and there's medication. Now medications, this is really imprecise. This is really like, I kind of think about, and I've done it 20 years, it's like caveman style, man.

• 56:32Speaker 01

  It's like, yeah, problem, here's our solution. Everyone gets the same solution. Everyone's the same. Caveman medicine, I love it. Yeah, it's just like, higher blood pressure, four medicines, same and same doses. Everyone gets the same sort of treatment and we have no clue about who's going to respond to which medicine, which doses, when should you, when should they take them? All of those things. And everyone's different. And everyone really is different. We just don't have enough knowledge and data generally to understand it. Now, with more data of blood pressure and blood pressure patterns, like the continuous type data, we can really, it gets at understanding of someone's pattern to really be able to, to give a tailored and precise approach to medication. But historically, we have not had that.

• 57:15Speaker 01

  And so everyone gets the same treatment, which gets to another point, which is compliance. Yes. Compliance and we can recommend all the medicines we want. If someone goes home and just puts them on the shelf or doesn't ever pick them up from the pharmacy, what if we, is it not going to accomplish anything? So. They have, the person has to also believe that that medicine is going to help them. And again, they can't feel the benefit.

• 57:37Dr. Darshan Shah?

  Right.

• 57:37Speaker 01

  You can't feel a benefit of 20 years from now of decreasing my risk of a heart attack.

• 57:43Dr. Darshan Shah?

  Right.

• 57:43Speaker 01

  You don't feel that, right? It doesn't have urgency, but taking this pill and me having some side effects is a clear cause and effect. So again, it's about showing them the data that then supports them to continue that intervention. So the compliance adherence is a huge part of it. And if we again, close that feedback loop for them and say, look, you take this medication and now your blood pressure's gone from 145 to 130. And I can tell you that this is really beneficial to you. At least you have numerical data, at least you have impaired data that that person can say, okay, there's value in me continuing this medication and I'm going to keep doing it.

• 58:20Dr. Darshan Shah?

  Yeah, yeah, I think, you know, it speaks volumes to, once again, continuous monitoring. I think, you know, once people see it on their phones, like, oh, that actually worked.

• 58:30Speaker 01

  Yeah, it worked.

• 58:30Dr. Darshan Shah?

  That's great.

• 58:31Speaker 01

  Yeah.

• 58:31Dr. Darshan Shah?

  Then they like, oh, you know, I, I'm now understand why this is helpful for me. And I think, you know, I think also there's a strained relationship between doctor and patients when you get on medication. Because there's always like in the doctor's mind, like, are you really taking the medication correctly? And the patient's like, does this doctor even like monitor this medication?

• 58:52Speaker 01

  Yeah, that's right.

• 58:52Dr. Darshan Shah?

  So there's, there's a lot of that strained relationship, which I think why taking personal responsibility for your blood pressure is going to be a game changer. Because people now have the medication and the monitoring to show themselves there's a change being made.

• 59:05Speaker 01

  That's right. Yeah, that's right.

• 59:12Dr. Darshan Shah?

  This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of wellness, where you can optimize your health span and lifespan using cutting edge technology. I actually founded Next Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide Them with all the tools that I use to get my health in order. The longevity circuit in Nex Health using hyperbaric oxygen, sauna, cryotherapy and LED light is a game changer. In addition, the doctors at Nex Health measure thousands of biomarkers

• 59:55Dr. Darshan Shah?

  and put into place a longevity optimization plan using advanced tools like ozone, plasma exchange and peptides. Go to www.nex.health to check it out.

• 1:00:12Dr. Darshan Shah?

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• 1:00:53Dr. Darshan Shah?

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• 1:01:06Dr. Darshan Shah?

  I had a quick question for you. Could you give us a quick synopsis of the five different classes of blood pressure medications? Maybe a little history behind them and how you think about it? Because I also see very frequently people being put on diuretics that should not be on diuretics, people being, you know, put on calcium channel blockers that shouldn't be on them. So could you kind of give us just a synopsis of that and how you think about it?

• 1:01:26Speaker 01

  Yeah, I mean, generally there's, as you said, there's generally five, mostly four of the biggest categories, which would be like ACE inhibitors, like lisinopril, ramipril, captopril.

• 1:01:36Dr. Darshan Shah?

  Right.

• 1:01:36Speaker 01

  There's ARBs, which would be things like losartan, candar satan, anything that ends in a sartan. Then there's diuretic type classes, which are not that many, honestly, but a few hydrochlorothiazide, chlorthalidone and calcium channel blockers.

• 1:01:50Dr. Darshan Shah?

  And beta blockers.

• 1:01:51Speaker 01

  And beta blockers are there. That's the fifth one. Also aldosterone receptor antagonists like spironolactam can be used as well in certain indications. It is in the sort of pathway of hypertension.

• 1:02:03Dr. Darshan Shah?

  Certain indicate. And so I think the the the moral of that story is you don't want to start off with a beta blocker.

• 1:02:09Speaker 01

  No.

• 1:02:09Dr. Darshan Shah?

  Because I do see a lot of people on beta blockers.

• 1:02:12Speaker 01

  Yeah, it's in no in no national guideline association or expert recommendation is beta blockers a first line, second line, third line, or even fourth line medication.

• 1:02:23Dr. Darshan Shah?

  Exactly.

• 1:02:23Speaker 01

  It gets to fourth or fifth line. So it really isn't a good blood pressure medicine.

• 1:02:27Dr. Darshan Shah?

  It drives me crazy when I see so many people on beta blockers.

• 1:02:30Speaker 01

  There are some instances where where it's sort of being used, for example, for heart failure or coronary artery disease. And and yes, it does affect the blood pressure slightly in some people, some people, others maybe more, but not a good antihypertensive medication.

• 1:02:45Dr. Darshan Shah?

  What's first line therapy?

• 1:02:46Speaker 01

  Generally, it's either an ACE inhibitor or an ARB. And depending on the level of blood pressure combined with a diuretic depends, you know, but those would be the first two medications that would be given. We do recommend, I mean, all expert consensus, if somebody needs antihypertensives, generally a combination pill where ARB plus a diuretic together, because that's been shown to be more potent than either one alone. That's generally the first medication. In certain age and race, then calcium channel blockers can be a first indic- first line medication. But that just depends on the person's age and race.

• 1:03:24Dr. Darshan Shah?

  And you should not be in an ACE inhibitor and an ARB at the same time? Is that true?

• 1:03:28Speaker 01

  Generally, that's correct. Yeah.

• 1:03:30Dr. Darshan Shah?

  And you said there's combo medication. I think this is really important to touch on because that's what finally got me under control.

• 1:03:36Speaker 01

  Yes.

• 1:03:37Dr. Darshan Shah?

  Is a combination of the combo medication.

• 1:03:40Speaker 01

  Right.

• 1:03:40Dr. Darshan Shah?

  Of one of an ACE inhibitor and also there's also ACE inhibitor calcium channel blockers combos, right? That's the one I'm on right now.

• 1:03:46Speaker 01

  There's all kinds of combos now that that they've developed. There's but the point is right that there's usually either an ACE inhibitor or an ARB combined with a diuretic generally is like the first line combination pill. And a combination pill is usually better for Compliance because instead of two bottles, someone just has to take one pill once a day. And it's super simple. Different countries have different, by the way, I've learned very different availability of combination pills. But at any rate, that's generally what we would start with. And it's been shown norm historically, we've just said, start with one medicine, titrate all the way up to the highest dose, then go to the second, titrate all the. But actually, it's been what's been shown is even a low dose of that combination pill can actually be more effective. And that's why.

• 1:04:27Dr. Darshan Shah?

  Yeah.

• 1:04:28Speaker 01

  That combination is has helped.

• 1:04:29Dr. Darshan Shah?

  And the reason I ask you all of these questions is for people out there that are on blood pressure medications should really think about going to a combo pill because you can actually lower your dosage of the blood pressure medication. And this is what worked for me personally. And I've seen it work over and over again for people. Is switching them from a high dose of maybe hydrochlorothiazide to a combo pill.

• 1:04:49Speaker 01

  Right.

• 1:04:49Dr. Darshan Shah?

  They're completely controlled.

• 1:04:51Speaker 01

  Right.

• 1:04:51Dr. Darshan Shah?

  And they're just taking one pill versus two or three separate pills sometimes, right? So this is really an important point.

• 1:04:56Speaker 01

  And and it gets to both just the mechanism of action and the science, but also that that just that human piece of taking just one pill a day. It's easier to remember and it's like easier to just do. And so from just a psychology, I I don't feel like I'm taking five pills or four pills. Like I can just combine it into one. And it's, you know, easier. So.

• 1:05:16Dr. Darshan Shah?

  Man, it took me years to get to this point to figure this out. But if I had, you know, your device a long time ago, like this would have been figured out within the first few months of diagnosis, you know? And so this is another reason. There's so many reasons why this will be a game changer. Number one, early detection of high blood pressure. Number two, assessing lifestyle changes. One at a time and what's working, like a continuous glucose monitor does for foods that cause high glucose versus foods that don't.

• 1:05:42Speaker 01

  Right.

• 1:05:42Dr. Darshan Shah?

  The same with this. And then thirdly, for medication management.

• 1:05:45Speaker 01

  Medications. Yeah, exactly. And where we're really headed with this is now we can look at people's patterns. We don't look at this, like we said, and not just in millimeters of murky, but I can look at Darshan's pattern of blood pressure. And we're getting enough data now that where we're going in the future is now we can start to move into the prediction world where we can say Darshan's type of pattern predicts that his blood pressure is going to respond to medication. And B, but not C and D. So he should really start with those medications and even start tinkering with the doses. That's really where we're going with this in the future. So that's the, that's future state. It's not there right now. But the idea of looking at it in a much more complex, multi-dimensional way is, I think,

• 1:06:29Speaker 01

  so necessary to really understand blood pressure and how we intervene in a more sophisticated way.

• 1:06:35Dr. Darshan Shah?

  The other thing is timing of medication as well, right?

• 1:06:39Speaker 01

  Yes.

• 1:06:40Dr. Darshan Shah?

  So another thing I learned from wearing the Actia was my blood pressure was really high at night. So I changed my medication dosage from taking in the morning to taking before bedtime and it made a big difference as well.

• 1:06:51Speaker 01

  Yeah, exactly. Again, something we don't know. Nobody really knows, you know, and, and so that just having that visualization of the data can be so helpful. And right now we're just, it's just sort of trial and error, but at least you can see the data and you can say, okay, maybe I should switch it to a nighttime. That's never existed before. I never had that kind of visualization for it.

• 1:07:10Dr. Darshan Shah?

  Yeah, I mean, this is, this is incredible. How many years have you been studying the continuous blood pressure monitoring? And I think for, you know, people that are skeptical about it, how accurate is it compared to traditional measurements? Can you talk a little bit about that?

• 1:07:23Speaker 01

  Yeah. So I've been with the company now three years. So I've been deeply involved for three years. The founders of the company have been working on this for 20. Their company was spun out six years ago, but they were doing their foundational research on this. Now it's been 20 plus years. So deeply, deeply, you know, embedded in science and, and research, not just a sort of tech company trying to hack something together and, and put it together. And these were biomedical engineers doing this for a long time at our research institute. And one of the things that we talk about when people ask about sort of validation and accuracy, which of course is reasonable. This is not counting steps or heart rate or oximetry, all of which have wellness categories, which do not require regulatory approval.

• 1:08:06Speaker 01

  Blood pressure across the world, if you want to do it and sell in a country, you have to have regulatory approval by the government.

• 1:08:14Dr. Darshan Shah?

  There's a higher bar set for blood pressure.

• 1:08:16Speaker 01

  Much higher bar set for blood pressure, which is why you haven't seen blood pressure in really. Any consumer device in the in the market, very few, if any. And so that's where we come in. I mean, we have gotten our models and our our technology to the point that in two thousand twenty one, we got our first approvals in the European market. And that's allowed us to go out into the market, get more data and refine. It's all works on foundational machine learning models. And that's that's the sort of underlying underpinning of our technology. And to get into the market, you have to show the regulatory authorities that your technology is as good as traditional methodologies.

• 1:08:58Speaker 01

  So the the science behind it, and we have papers that we published, it's on our website, that show that in the same position, this is as accurate as a blood pressure cuff. And our validation work is actually not done with traditional cuffs, like a regular automated cuffs, because they're too erratic and lots of sources of error. We actually do it to a higher standard where we take two nurses that are blinded from from each other. They're listening with to the carot cuff sounds at the same time, so doing with the stethoscope measurement. And they're blinded to each other and they each report blood pressure values. And then a third observer has to say their their their measurements have to agree with each other within five millimeters of mercury, or you discard the measurement.

• 1:09:36Dr. Darshan Shah?

  Oh, wow.

• 1:09:37Speaker 01

  So our validation work involves tens of thousands of of comparative measurements to then demonstrate that we have the same precision and accuracy as, you know, as a as a standard device. We also have data on arterial lines as well.

• 1:09:52Dr. Darshan Shah?

  Oh, arterial line, meaning like an actual IV basically is put into artery. And then you get the measurement directly, which is what we use in ICU or the ER to measure blood pressure sometimes.

• 1:10:02Speaker 01

  Exactly. So so we have tremendous amounts of validation work. And, you know, that's an on ever going, you know, ongoing process to demonstrate its accuracy and precision.

• 1:10:12Dr. Darshan Shah?

  And I think for for people that haven't seen the device, obviously, you could see it on like Tia's website. But it's not like a tiny blood pressure cuff around your wrist.

• 1:10:18Speaker 01

  No, no, it's not at all.

• 1:10:19Dr. Darshan Shah?

  It's like you're using light.

• 1:10:20Speaker 01

  Yeah, it's just a it's just a bracelet. And and this, what's in here is just two LED lights and optical sensor. So it just sits on your wrist like a bracelet.

• 1:10:29Dr. Darshan Shah?

  Right.

• 1:10:30Speaker 01

  And it collects signals. There's no squeezing. You can't tell when it collects the information, sends it to the cloud. And when you open your app, there's your blood pressure data. And it collects maybe around thirty to thirty five measurements per day on average.

• 1:10:42Dr. Darshan Shah?

  And I think what's important about that is that the data that's collected needs to go to the cloud because your algorithms are intense.

• 1:10:50Speaker 01

  Yeah.

• 1:10:50Dr. Darshan Shah?

  That are looking at this data.

• 1:10:51Speaker 01

  Yes.

• 1:10:51Dr. Darshan Shah?

  So it's not like, you know, it's calculating the blood pressure on the device. There's a pretty, there's a pretty deep algorithm that's been figured out to figure this.

• 1:10:59Speaker 01

  Yes, it's been, I mean, that's what they've developed over all these 20 years of research and development. Plus, our models have just gotten better and better as we've been in the market. We're getting more data to refine those models more and more. And so that's, yeah, that's where it sits in the cloud.

• 1:11:14Dr. Darshan Shah?

  Yeah. Could you give us a quick, like, primer on the physics of this? How does light transmit pressure readings?

• 1:11:20Speaker 01

  Yeah. So it doesn't transmit pressure readings per se, but the light shines into your skin and from the tiny vessels in your skin, you get a reflection back. And that reflection is captured by the optical sensor. And it creates a waveform, actually, much in the same way that a arterial line would have a waveform. Looks different because it's not from an artery, but it has the same type of waveform. And that, those waveforms, we take multiple of them and for each measurement, that's what's analyzed by our, by our models. And so that's how the light, sort of the, that, that process works.

• 1:11:55Dr. Darshan Shah?

  Got it. And how many measurements is it taking, like, in an hour and a day?

• 1:11:59Speaker 01

  So about 35 in a day. And we have lots of filters for quality. So they're not taking every 15 minutes, but it'll try once in a, every 30 minutes or so to take a reading. But if you're moving a lot, if you're walking and your wrist is going like this, the, it will say, you know, there's enough, there's, the algorithm will say, this is too much movement, you're not going to get a good quality signal. So it purposely waits until you're still for about 30 seconds and then it tries to take the measurement.

• 1:12:27Dr. Darshan Shah?

  Got it. Yeah, because I notice on days that, you know, I have a walking desk and, and when I'm on a walking desk, I don't get as many measurements, probably because I'm moving around so much.

• 1:12:35Speaker 01

  Yeah, that's right. But remember, our, our focus isn't about one hour or one day, a couple of days. Our focus is over long periods of time. So if someone just generally, you might have a day where you have less measurements, but if you look at it over a week, we're generally getting 800 to 1,000 measurements. You know, in a month, sorry.

• 1:12:54Dr. Darshan Shah?

  Wow.

• 1:12:55Speaker 01

  In a month. And, and so, you know, people are getting tremendous numbers of measurements that allow us to unlock those other metrics that we were talking about. And there's even more exciting stuff to come in that regard.

• 1:13:07Dr. Darshan Shah?

  Yeah. What are some of the things that you've seen that have surprised you, looking at the data over time with multiple thousand measurements a month? What are, what are kind of some of the things that you guys are seeing?

• 1:13:15Speaker 01

  Yeah, so what we're seeing is some really interesting patterns. And these are things that no one's ever had this data set before. I mean, this never existed, so it's not like we have something to compare it to. It's just totally novel. And, and that's why it's of intense interest across all healthcare organizations for research, for pharmaceutical companies, for, for healthcare organizations to really understand these patterns in a deeper way. And we've embedded it into, you know, 30 or so clinical trials across the world to really start understanding what these patterns mean. But like, for example, one of the things we see is we see, depending on the different dimensions that we're looking at, we can see people are clustered themselves into one of seven or eight different categories.

• 1:13:57Dr. Darshan Shah?

  Really?

• 1:13:57Speaker 01

  And we don't know yet what those mean. But people have these patterns and they, they kind of, they group themselves together in this data set at least. And so now we're trying to do the work to try to figure out, what does that mean?

• 1:14:10Dr. Darshan Shah?

  Yeah.

• 1:14:10Speaker 01

  And understand, how do they react to interventions? How does each cluster react to an intervention differently? How does each cluster, now we're getting genomic data from some of our studies. How do, what are the genomic data inputs? What are the biomarker data inputs? What are the health outcome inputs? And starting to map each one of those clusters to see, try to understand what this actually means in the sort of, in the current context that people would understand.

• 1:14:33Dr. Darshan Shah?

  Can you give us an example of some of these eight different patterns that you're seeing?

• 1:14:36Speaker 01

  Well, it depends on the different dimensions. But let's say, for example, we map things like time on one axis, blood pressure on another axis, and then the day night patterns on a, on a third axis. So we're looking at it in multiple dimensions. And, and so then we can see, okay, there's a pattern necessarily where, where in the morning, there's a, there's a, some people have a larger spike or a larger rise in blood pressure and others have a, have a. Decrease a different type of pattern at night. And these are sort of some of the aspects that we're looking at. As well as there's actual morphology changes that we're seeing in those waveforms. That are that are unique to those waveforms and we can cluster people in any number of ways. So one of the ways we're looking at it is what about just the waveforms?

• 1:15:21Speaker 01

  Not even blood pressure. Just what are these waveforms that we're seeing that do map to blood pressure? But different people have different categories of those waveforms. So we can even look at that level as well.

• 1:15:31Dr. Darshan Shah?

  I mean, do you think that there's a world where looking at these waveforms? We can actually diagnose different types of disease patterns from these waveforms?

• 1:15:38Speaker 01

  Yes, I think where we're going to is that these patterns will be predictive of other related diseases. Because blood pressure is affects so many different diseases, as we've talked about. We can see a pattern and says, just by that pattern, we can say this person probably should be screened for sleep apnea. And this person has a higher risk of kidney disease, but not heart disease. And this person has a higher risk of stroke, but not heart disease. And this one atrial fibrillation, but not stroke. And so on and so on and so on, on down the line. And, and for example, which lifestyle interventions will work? Which medications, at which doses, at which time of the day? That's where I think we'll, we'll go with this.

• 1:16:20Dr. Darshan Shah?

  Wow.

• 1:16:20Speaker 01

  And so that's why I say like, I don't look at it in millimeters of mercury anymore. That's I think going to be the.

• 1:16:27Dr. Darshan Shah?

  Yeah, it's so incredible that like, you know, like this technology around blood pressures is stuck so much in the Stone Age.

• 1:16:34Speaker 01

  Yeah.

• 1:16:34Dr. Darshan Shah?

  And it's just like one data point.

• 1:16:36Speaker 01

  Yes.

• 1:16:36Dr. Darshan Shah?

  And it's so important.

• 1:16:38Speaker 01

  Yeah.

• 1:16:38Dr. Darshan Shah?

  But now pushing this forward to actually looking at the waveforms and what this can do for us.

• 1:16:43Speaker 01

  Right.

• 1:16:44Dr. Darshan Shah?

  It's on a wearable device is going to be a game changer.

• 1:16:47Speaker 01

  Yeah, exactly. And so, so that's, that's how I think about it. And then just sort of the like, one last metric of just understanding how blood pressure affects our body. Remember, there's one time measurements is sort of shooting in the dark. We don't really understand how it affects someone's body. We do know that blood pressure over time affects your different organ systems in, in crucial ways.

• 1:17:09Dr. Darshan Shah?

  Right.

• 1:17:10Speaker 01

  But we don't have great measurements to sort of, to. Demonstrate on a metric. It's just high or low, right? That's how we think about it. So this idea of time and target range is one of them. But even that doesn't go far enough. That's just binary. Are you in optimal range or are you not? It doesn't say how far out of the optimal range you are. And that concept of taking both time outside of optimal range and magnitude is called cumulative blood pressure load. And it's a, it's a, it's a research theory. Never been able to be measured before. Now it can. We can measure it. We can show it. And we're already designing it and starting to think about how to put that in our product experience. So then someone will say, based on your pattern, Darshan, your 10 year risk of blood pressure is, is here, this curve.

• 1:17:55Speaker 01

  And let's do an intervention and then see how it changes your curve. That's personalized. That's precision. That's your risk. It's not just some epidemiologic number.

• 1:18:05Dr. Darshan Shah?

  Exactly. Because, you know, the correlation to that is that, that time under total load of high blood pressure is more important than individual measurements. Because there are times when you do need to have high blood pressure. There's times when you just like you need to have high sugar, some blood sugar sometimes with the CGM. But it's that cumulative amount of time that your vessels are under the strain of high blood pressure is what's really what's impacting our organ and organ health.

• 1:18:31Speaker 01

  And that's exactly what that metric is talking about.

• 1:18:33Dr. Darshan Shah?

  Yes, yes.

• 1:18:34Speaker 01

  So that's right.

• 1:18:34Dr. Darshan Shah?

  So there's a world where almost like it doesn't really matter what the number is. You're looking at your cumulative load instead.

• 1:18:40Speaker 01

  Exactly.

• 1:18:41Dr. Darshan Shah?

  Is there, like, is there this world where that app, our app that's attached to the device will show us this?

• 1:18:47Speaker 01

  Yes.

• 1:18:47Dr. Darshan Shah?

  Yeah.

• 1:18:48Speaker 01

  It's coming next year.

• 1:18:49Dr. Darshan Shah?

  It's coming next year.

• 1:18:50Speaker 01

  My man, we're gonna put it in. So yeah, it's coming.

• 1:18:52Dr. Darshan Shah?

  Darn, I thought I gave you a device and a piece of information that you haven't thought of. Like, we're already there.

• 1:18:59Speaker 01

  No, it's coming. It's coming. All those kind of things are coming. And then we'll have to figure out how to, how to make people engage with it and really understand it and see it in a better way. But that's, that's really how we think about it.

• 1:19:10Dr. Darshan Shah?

  How many people in Europe are wearing your device right now?

• 1:19:12Speaker 01

  About 90,000.

• 1:19:13Dr. Darshan Shah?

  90,000 people are getting continuous blood pressure measurements. Game changing data. I mean, the amount of the never in history has that kind of research been done and 90,000 people.

• 1:19:25Speaker 01

  Yeah, 90,000 and that's we're just scratching the surface. I mean, that's a really small number. I think about all the people with hypertension.

• 1:19:32Dr. Darshan Shah?

  And you have regulatory approval in Canada right now?

• 1:19:34Speaker 01

  We have. We got regulatory approval in Canada as of yesterday and and so we'll be launching in Canada. It'd be later this year or towards early next year.

• 1:19:44Dr. Darshan Shah?

  Got it.

• 1:19:44Speaker 01

  And then, you know, we're targeting the first US launch. I mean, it depends on the FDA, but it'll, you know, late next year or early 2026.

• 1:19:54Dr. Darshan Shah?

  I cannot wait because, you know, as part of our executive fiscal program, we're going to give everyone a continuous blood pressure monitor. I think it's crucial data for everyone to have. So you were mentioning something that you're really excited about. You're like keeping me in suspense. So I want to talk about that.

• 1:20:11Speaker 01

  So what I can say today is that, you know, remember, we talked about this product being driven by our ML models. There's really nothing proprietary in this sensor setup. And so now our models have gotten good enough that we can take a signal from other sensors and still deliver back medically accurate blood pressure and heart rate product. Now, most people think, what about other watches? And we know we can do that already. That's done. But now what we're talking about is is taking the smartphone camera and literally just putting your finger over the smartphone camera like this. No other hardware, no calibration, and this will give you medically and takes three measurements

• 1:20:56Speaker 01

  over 90 seconds and will give you a medically accurate blood pressure and heart rate measurement in 90 seconds.

• 1:21:02Dr. Darshan Shah?

  That's incredible.

• 1:21:03Speaker 01

  Without any and that is, you know, we just gotten, you know, expanded our current portfolio of our CE Mark filings. And so we have the regulatory, you know, sort of process done. So that will launch later this year and early next year. And the product launch will be to come, but just think about now that's a one time measurement.

• 1:21:24Dr. Darshan Shah?

  Yeah.

• 1:21:24Speaker 01

  Okay. But if you think about like, why does that matter? Well, you know, this is great. It gives you continuous data. So people who are interested or hypertension, heart attack, stroke, et cetera, clearly can find value here. There are billions of people in the world, some in places that are not going to be able to afford a device or, or buy anything else, where they just need an easier, simpler, frictionless way to check blood pressure on a routine basis. That, as you said, the, the happy place for the cuffs is the closet. And that's even if they have a cuff. So how do you get to those people? How do you really do global, worldwide blood pressure screening in Sub-Saharan Africa, in India, in all the countries that where people live?

• 1:22:05Speaker 01

  Well, smartphone penetration is 60 to 70% at least in almost all of those countries. Now they can just interact with our app. They don't need to buy anything else. They don't need to go anywhere else and they can get screening and diagnosis just based on that.

• 1:22:19Dr. Darshan Shah?

  That's incredible. I mean, and then if you have high blood pressure, then getting a device.

• 1:22:24Speaker 01

  Then eventually it's a funnel.

• 1:22:25Dr. Darshan Shah?

  Yeah.

• 1:22:26Speaker 01

  For that as well.

• 1:22:27Dr. Darshan Shah?

  Yeah. So actually anyone can download the app.

• 1:22:30Speaker 01

  Yeah.

• 1:22:31Dr. Darshan Shah?

  Get a blood pressure reading that's pretty accurate.

• 1:22:33Speaker 01

  Yeah.

• 1:22:34Dr. Darshan Shah?

  Very accurate.

• 1:22:35Speaker 01

  As accurate as a cuff reading.

• 1:22:37Dr. Darshan Shah?

  Yeah.

• 1:22:38Speaker 01

  Yeah. That's right.

• 1:22:39Dr. Darshan Shah?

  So cuffs will go away. Yeah. That's the end of the blood pressure cuff market right there.

• 1:22:44Speaker 01

  That's our.

• 1:22:45Dr. Darshan Shah?

  I mean, and that really needs to be the goal, right? Because I feel that blood pressure cuffs have been a massive point of friction in diagnosing this very important disease.

• 1:22:55Speaker 01

  Yeah.

• 1:22:55Dr. Darshan Shah?

  They're difficult to use. No one has one.

• 1:22:58Speaker 01

  Yeah.

• 1:22:58Dr. Darshan Shah?

  The measurements are often thrown out because they wasn't done right.

• 1:23:02Speaker 01

  Right.

• 1:23:03Dr. Darshan Shah?

  And so this app actually eliminates the, all of those points of friction.

• 1:23:07Speaker 01

  Those points of friction.

• 1:23:08Dr. Darshan Shah?

  Really?

• 1:23:08Speaker 01

  Yeah.

• 1:23:09Dr. Darshan Shah?

  Wow. I mean, that's just mind blowing that you guys can do that.

• 1:23:12Speaker 01

  Yeah. So that's coming and, uh, you know, a launch in our current markets at first and then, and then we go from there.

• 1:23:19Dr. Darshan Shah?

  Wow. That's, that's, that's going to be game changing. So you said end of next year, we should see the XT in the United States?

• 1:23:25Speaker 01

  That would be our, that's our goal.

• 1:23:26Dr. Darshan Shah?

  Okay.

• 1:23:27Speaker 01

  Yeah. And that's our goal. And we'll see how it goes, but that's. That's the

• 1:23:30Dr. Darshan Shah?

  Yeah, I mean, that's all up to the regulatory bodies, etc.

• 1:23:33Speaker 01

  And we're working already with them and but yeah, that's that's the target.

• 1:23:36Dr. Darshan Shah?

  That's amazing. So for the listeners, the the protocol to follow after listening to this incredibly insightful conversation with you, Dr. Shaw, Jay, is number one, get your blood pressure checked. It doesn't matter what age you are, just go get it done at least once, make sure it's done properly. You know, there's a lot of pharmacies now that have a blood pressure cuff machine there. Just go do it one time. Fifty percent of you out there are going to have high blood pressure. Is that right?

• 1:24:02Speaker 01

  Yeah, in the US, the prevalence is in the high forty percent range. Yeah, so that that's true.

• 1:24:08Dr. Darshan Shah?

  Exactly. And so then, once you have it, don't hesitate to start putting into place these lifestyle interventions. Just another reason to put these lifestyle interventions into place. However, if it's over one forty, over eighty,

• 1:24:21Speaker 01

  One forty or ninety.

• 1:24:22Dr. Darshan Shah?

  Over ninety, talk to your doctor about being put on a medication while you're getting your life cell in order, right? And wait for the XIA band to come out and then really dial it in.

• 1:24:31Speaker 01

  Yeah, that's right. Yeah, we can't wait for it to come out here, but it's going to take some time. But yeah, I think that's the right, that's the right approach. And it's not something you can measure too often, blood pressure is it's not. It's just, you know, make it a habit, basically.

• 1:24:44Dr. Darshan Shah?

  Right, right. Such an incredible conversation, Dr. Shaw. What are you most excited about, other than, I mean, this app is exciting, the the band is exciting being launched. And what else are you excited about personally?

• 1:24:58Dr. Darshan Shah?

  This market?

• 1:24:58Speaker 01

  I think this is, I mean, for me, that's the reason I I left, you know, Mayo Clinic. And it's like, I wanted to to join a company that, you know, could have the potential to to really change the world in some way. And I think this has an impact that is clearly massive. And we all have personal stories. I have my own personal stories about hypertension and blood pressure. And I've done it for 20 years and I've treated the end effects of it primarily, right? Treated the aneurysms, treated the heart attacks, treated the heart failure. You know, and always sort of in my mind, I'm thinking, well, this is great. It's great that we have all the technology and ability to treat those end effects. You know, we should put, I I wanted to put more attention on preventing it. And that's really what what I'm trying to do and.

• 1:25:40Speaker 01

  And why that I really enjoy working with the company and the people within the company are just mission driven. They have this, you know, at their core, in their soul, they're here for, for that, for that vision and mission. And it's been my, you know, life changing for me. So.

• 1:25:55Dr. Darshan Shah?

  Yeah. So you're doing incredible work and we appreciate you and you putting the work in to change lives. I think it's, you know, the benefits go beyond just saving lives. The strain this will take off the medical system, the trillions of dollars we spend every year treating the end stages of these, of this cumulative process is going to be massive as well.

• 1:26:14Speaker 01

  That's right. Yeah.

• 1:26:15Dr. Darshan Shah?

  Massive implications. Thank you so much.

• 1:26:17Speaker 01

  Thank you very much.

• 1:26:18Dr. Darshan Shah?

  Really enjoyed this conversation.

• 1:26:19Speaker 01

  Likewise. Thank you.

• 1:26:24Dr. Darshan Shah?

  That was an incredibly educational conversation with Dr. Jay Shah. I am so excited to share with you my top 10 takeaways. Number one, high blood pressure, AKA hypertension, is a global crisis. It is the leading preventable cause of death globally, causing 11 million deaths annually. Despite its impact, awareness and management are shockingly low, with only 20% of cases under control. Number two, high blood pressure is a silent epidemic. Half of the world's population with high blood pressure doesn't even know they have it. This silent killer remains dangerously under diagnosed and is undertreated. Number three is around the inadequacy of traditional tools. Blood pressure cuffs based on 120 year old technology

• 1:27:08Dr. Darshan Shah?

  are grossly underutilized. Only 17% of hypertensive patients use them consistently, leading to poor management of this condition. Why? Because they're clunky and difficult to use. Number four, high blood pressure impacts multiple diseases. It's not just about heart disease. It significantly increases the risk of strokes, dementia, kidney failure, and pregnancy complications. It's a vessel disease that affects every organ in our body. Number five, time and target range. Continuous blood pressure monitoring has revealed that spending time in the optimal range matters more than individual readings that we typically use. This concept known as time and target range completely changes the way we should think about managing hypertension.

• 1:27:50Dr. Darshan Shah?

  Number six, cumulative blood pressure load. The total duration your blood pressure remains elevated over years has a bigger impact on organ health than occasional spikes of blood pressure. This cumulative load can be measured for the first time with the continuous monitoring device. The Actia monitor is currently available in EU and soon in Canada and hopefully in the US in the next few years. I can't wait to start using it with all of my patients. Number seven, salt sensitivity. While reducing sodium is often recommended for high blood pressure, it only affects about half of those with high blood pressure. This revelation challenges the one size fits all approach to dietary advice of low-salt diets. Number eight, genetics play a role.

• 1:28:33Dr. Darshan Shah?

  Hyperaldosteronism, an often overlooked genetic condition, causes high blood pressure in 10% of cases. A simple blood test can identify this condition, enabling more targeted therapy. Number nine, misuse of beta blockers. Beta blockers, one of the categories of high blood pressure medications, are still commonly prescribed despite being completely unsuitable as a first-line treatment. They are meant for specific conditions like heart failure, not for routine blood pressure management. Instead, a better treatment for high blood pressure is multidrug therapy with more modern medications like ARBs or ACE inhibitors. And number 10, high blood pressure is really a metabolic disease. Controlling insulin and blood glucose levels can lead to a lowering of blood pressure

• 1:29:18Dr. Darshan Shah?

  and should be a primary form of therapy. Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.