X @Nick Szabo

Guidelines & Blood Pressure Targets - The American Heart Association (AHA) and American College of Cardiology (ACC) updated hypertension guidelines in August 2025, shifting blood pressure categories 10 points lower [2] - The new "normal" blood pressure is defined as 110/70 or less, while 120/80 is now considered "elevated" and may qualify for medication [2] - "Stage 1 Hypertension" is now defined as 130/80, potentially leading to more aggressive medication prescriptions [2] - These guidelines are based on the SPRINT study, which showed a 25% relative risk reduction in cardiovascular events using a lower blood pressure target [3] - However, the absolute risk reduction in cardiovascular events was only 2%, and patients with low or average risk had 0% benefit [4] Concerns & Criticisms - Some primary care doctors challenge the assumption that lower blood pressure is always better, suggesting that excessively low blood pressure may increase the risk of stroke and heart attack [5] - Doctors may be incentivized to meet the new hypertension targets, potentially affecting their pay [5] - Blood pressure medications can cause adverse effects such as kidney and electrolyte abnormalities, dizziness, and falls [7] - The new guidelines suggest initial treatment with two drugs, potentially increasing the occurrence of these side effects [7] Alternative Approaches - Optimal blood pressure can be achieved through diet and lifestyle interventions, including a whole foods diet low in sugar, seed oils, and processed foods, and rich in nutrient-dense animal-sourced foods [8] - Prioritizing potassium (minimum 4,700 mg per day) and magnesium (at least 600 mg per day) intake is crucial for the body's Sodium Potassium Pump System [9][10] Financial Implications - The new guidelines may lead to millions of new prescriptions and millions of dollars in revenue for pharmaceutical companies [10]