Blood pressure-how to measure, manage, and treat high blood pressure [AMA 48 sneak peek]
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- Опубликовано: 8 июн 2024
- Watch the full episode and view show notes here: bit.ly/43SH4rw
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In this “Ask Me Anything” (AMA) episode, Peter delves into the critical subject of blood pressure, which is one of the three primary causes of atherosclerosis, along with high apoB and smoking. He begins by unraveling the nature of high blood pressure, its prevalence, and why it often goes undiagnosed. Peter describes in detail the proper way to accurately measure blood pressure and what determines a diagnosis. Next, Peter discusses the actionable steps one can take in response to high blood pressure, shedding light on the extent to which factors like weight loss, exercise, and nutrition can make an impact. He also explores the pharmacological options available and offers valuable insights on how to approach them.
In this sneak peek, we discuss:
00:00 - Intro
02:45 - Blood pressure and other risk factors for cardiovascular disease
06:05 - Defining blood pressure and the purpose and meaning of a blood pressure measurement
10:57 - The implications of high blood pressure and the importance of maintaining an optimal level [10:30];
In the full episode, we also discuss:
-The importance of accurate measurements of blood pressure and how Peter approaches the care of patients at the very top range of “normal”;
-The prevalence of high blood pressure-a hidden epidemic?;
-The consequences of high blood pressure on cardiovascular health, brain health, kidneys, and more;
-Low blood pressure: symptoms and consequences;
-How to properly measure blood pressure;
-Daily variance in blood pressure and the transient changes in blood pressure during exercise;
-Primary hypertension vs. secondary hypertension: what to look for;
-Lifestyle factors impacting blood pressure: weight loss, exercise, and sodium;
-Impact of insulin resistance and type 2 diabetes on blood pressure;
-How sleep impacts blood pressure;
-Pharmacologic options for managing blood pressure; and
More.
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 60 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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In this sneak peek, we discuss:
00:00 - Intro
02:45 - Blood pressure and other risk factors for cardiovascular disease
06:05 - Defining blood pressure and the purpose and meaning of a blood pressure measurement
10:57 - The implications of high blood pressure and the importance of maintaining an optimal level [10:30];
Hi Peter, I was wondering if your new book Outlive will come out translated to Spanish any time soon. I would like to gift it to my parents who are in their late 60s and hopefully improve their overall life. Cheers
If heart were a pump
1. Is the size of the heart big enough to circulate roughly 5L of blood per minute round the body?
2. Position of the heart at the top of the circulation seems to be highly inefficient requiring a larger capacity. It should have been ideally in the feet where the blood flow is reversed (sump?).
3. Ideally the inlet should have very low velocity compared to leaving the heart but I understand the velocity of blood entering and leaving the heart is almost same.
4. Further I understand that the aorta that arches down is pulled towards the portion that goes up from the heart instead of being pushed away. If the pressure is really higher, it should move away. As an example, observe a coiled garden hose and when you suddenly open the valve, the loose end jumps away from the coiled hose.
5. As I understand, the blood vessels are lined with negatively charged exclusion zone with structured water which makes the blood and other solids positively charged and the attraction between the negatively charged structured water lining and positively charged blood which establishes movement of blood and the direction is set forth by the beating of heart. Ex. The sap reaching greater heights than limited by hydrostatic limitation in large trees. Please also refer to the 4th stage of water by Gerald Pollock.
the best
I'm already on 2 different tablets and my pressure is still 140/100. I'm going to try upping my fitness levels see if that makes a difference.
I’ve had many doctors who were all quite smart and informed me that my hypertention needed to be addressed pharmacolically. I half listened. Somehow, after hearing you share your story about your dad and how you knew you were going to deal with ur issue head on almost in a competitive spirit, I have been 100% compliant for over 3 months. So thanks! 10mg a day, staying quiet for 5 minutes, im now 120/74 with a pulse of 60. A far cry from 148/98. These podcasts work. Keep up the good work!
What are you taking? Please. Just curious. 65yo female 5' 106#. Thank you. Distrust of Docs. Thanks!
Which episode does he talk about his dads experience of you don’t mind sharing?
My bp was a little high due to stress. My weight trainer showed me how I DON'T have high bp. Before, during, after and one hour after weight training, I took my bp. Each of the first 3 times the bp went down. The reading one hour after the work out, my bp was perfect. Breath deeply, weight train, eliminate sugar! Oh, and I drink coffee.
Thank you for sharing this.
My blood pressure is always higher the first time I take it. When I repeat the test it is lower as I relax more.
I have always tensed up and become stressed when I test for anything even as a child.
yep.. same exact thing for me
Same here. For me cardio is the quickest and most effective fix for blood pressure. As soon as I neglect cardio my blood pressure creeps back up.
You are not alone, same here I am, my cardiologist told last time that i dont have high bp bit its because of stress
Hidden gem channel with good timestamps!❤❤❤
Doctors offices are too casual when taking blood pressure so accuracy suffers.
You need to be sitting rested/relaxed for 5 minutes before taking blood pressure.
You should not have just had coffee or caffeine in the past hour.
You need to not talk or move while it is being taken.
You should not have to go to the restroom. Holding your urine to relieve yourself will raise your blood pressure.
Your blood pressure changes thru out the day and is impacted by stress levels.
It is best to take your blood pressure at home at the same time every day under controlled circumstances and track the results.
Too many people have white coat hypertension just from going to the doctors office.
Those with hypertension should be encouraged to address this with life style changes along with medication if that does not work.
Doctors offices should tell people that lowering their weight thru diet and exercise may have the same result or better than medications.
Nutrition and exercise education should be the first option in treatment.
👍
I couldn't agree with You more!
Im not even sure they know the proper way to take it. Those digital bop cuffs never give me an accurate reading. I take mine at home with the old fashion Bo cuff and stethoscope.
I have had mine taken after drinking coffee and it is normal.
@@MeHere650
The digital cuffs are way off, most of the time.
Problem is, no one is taught to do it with a stethoscope and proper cuff these days.
True just common sense but common sense not common anymore thanks for sharing
Lifestyle changes and proper eating.
(Grapefruit everyday for me. No alcohol. Some light exercise. Deep breathing relaxation. Zero meds now.)
God bless you doc for healing my high blood pressure completely, after 5 years of suffering from High blood pressure thank you sir i appreciate your good work♥️.
I really appreciate this, but I didn't find the information on how to reduce blood pressure. Any help would be appreciated.
okay okay, I'm getting my membership today! 🙏💗
Becoming a member today. Currently average 170/135 - taking 3 different prescriptions - hoping I learn something specific & definitive to help with this
170 sys. 135 dys, question say what thats dangeroius!
How are you now?
Dr. Attia, can you please do a video about Cordyceps Militaris and the effects it has on the Adrenol gland? I take Cordyceps every day and especially before the gym and I want to know for me and others if we are putting too much load on our adrenaline system.
I read your book, and it was amazing, thank you very much.
From IRAQ.
European, UK, and WHO guideline is 140/90 before medication. This needs to be discussed, especially for those over 60. Having such a hard time finding a blood medication that i can tolerate that doesn't make me feel exhausted, insomnia, muscle weakness, low NA and Low chloride, etc etc
yup. It's a money thing in the US. We pour the most money into healthcare but have horrid outcomes. I feel for you at finding something you can tolerate. Are your home readings high as well? I hope you find something that brings you relief.
york cardiology . please have a look at some of his videos on blood pressure and medication
Cant wait to listen tothis thenk you
Zone 2 cardio does wonders for my blood pressure.
New subscriber! Great info! I'm so glad you were on Thomas DeLauer ( sp?!😮) ❤
I sure do appreciate all of your work
How did they determine high risk for CVD in the trial?
You talk I listen.
Dr. Attia - Thanks for the years (decades) of translating studies and communicating those data/results to us. My son, 17 years old, has been diagnosed with hypertension. We've done weeks of measuring BP (sized properly, automated). We will start taking it after resting for 5 minutes. QUESTION: My son's BP is like 140/72 or 145/80 or 160/80. His diastolic is always good. Thoughts? Thanks again!!
Respect the grind but a teaser isn’t useful to me if it doesn’t say include at least *some* useful information. This felt like a long preamble.
Spot on!
I believe I have listened to all your podcasts! And I even have a few of your books. Please continue in educating us for better lifestyles! Question: I’m an avid triathlon, ultra runner, Ironman, etc. I’m 54 yrs old male. I noticed my blood pressure has increased. I’m taking olmesartan at 40mpk. Does all the sports nutrition such as electrolytes, power bars, jels, sports drinks, others supplements contribute to my elevated blood pressure? How do I fuel my myself as I continue my sports and care for my health?
Thank you very much!
Rohan
Should we stop daily consumption of caffeine if our BP is above 120/80?
My blood pressure raises when I stand. I get bad headaches. I’m on 10mg of lisinopril but it doesn’t help.
Does aggressive treatment using meds cause other health issues?
Damn I really wanted to hear his answer to that last question!
Yes ! Very disappointed 😢
Does this work with secondary hypertension ?JOE
Are the AMA’s in people’s opinion worth the membership price. On the fence since I have so many
I think so. I'd recommend splitting a membership with some one, if possible.
The European Society of Cardiology in their Hypertension Guidelines ((ESC-ESH Guidelines 2018) have NOT adopted the treatment thresholds of below 130 systolic /below 85 diastolic.The SPRINT results was criticized and it was found that there is no compelling reason to change the target conventional systolic blood pressure of
What about proper BP combined with alcohol and smoking?
What if I have made all the suggested lifestyle mods but my BP is still 130/70. Should I really be asking for a med to get it under 120?
No Ylie bottom number is great don’t panic all good
Definitely not
I found the fastest way to lower blood pressure 30 points is to give up coffee and alcohol.
Alcohol yes but coffee no. Unless your testing it when you took some espresso or frappe then in that moment it could raise bp
Low carb or zero carb plus zero sugar diet have miraculous effect on lowering BP, said by some sharp doctors. Alcohol has carb effect by the way. Salt & coffee can be taken moderately.
Giving up coffee is a non starter.
@@BigDees19 Coffee raises bp. But practically this is only dangerous if you are already at risk of or already have hypertension
@@jagslabAbsolutely. It raises mine for around 3 hours after one cup. That’s not healthy.
What about standing blood pressure?
I am a bit confused Doctor Attia, 120/79 blood pressure is the standard, does your Blood pressure stay the same when you are say doing your workout? thanks for answering
I believe your blood pressure would be elevated during your workouts.
Blood pressure is a variable thing, it changes all the time. From laying to standing, or from exercise, stress, etc.
The measure where these standards apply is when resting and sitting taken with your arm at heart level.
Please discuss when quoting trials if they included women.
Not a member (yet) but curious if anyone could explain how he checks pressure like he mentions that he will later in the podcast. Thx
Seated. Feet planted on floor. Arm at heart level. 5 ro 10 min rest before reading. Proper size cuff. Instructions are included with all the devices themselves.
You gotta speak louder or turn up the volume 😊
I've listened to Ken Berry and he says there are 2 thought schools in USA when it comes to blood pressure. One is AHA which supports 120/80 stance and other is family doctors who think 140/90 is normal after certain years.
Just want to point out that there is a difference between what is normal and what is optimal. 140/90 could be normal, and
I assume Attia is talking about optimal as the basis for all his guidance.
@@thomassponholtz1538 By normal i meant optimal.
@@thomassponholtz1538 For an example, i have 2 friends, both are regularly training, athletic(one is more than the other, and one of them is an MD) and both of them have 140/90, they aren't obese, no high blood sugar etc.
140/80 was the standard for YEARS. Take a guess why and who changed it.
@@BlackMan614 Who? Legit question.
I definitely need this. I was 149/103 first thing in the morning.😢
@@MajesticArtimus thank you. Yes I actually increased my daily Lisinopril to 40mg, lots of water to drink and a hot bath have helped.
I’ve found that early morning readings are higher. I think it is the natural cortisol your body produces then to get you going. You might try throughout the day.
I had higher BP for most of my life. Even when I was 20 and doing sports as a "professional" swimmer - 9 trainings a week, 1.5 hours in the pool each one. And even at that point I had an elevated blood pressure 145/85, I was super lean and super fit. Then I get a meds that I took for 2 years. Now I am off the meds (beta-blockers), trying different approaches last 2 years. I live really healthy, exercise 3 times a week, occasional fasting, water only, lot of vegetables, nuts, lean meat, doing like 9.000 steps a day in average. No smoking, almost no alcohol (1-2 bears a week or less), lot of sleep, now I am trying meditation, also cold showers. For me worst enemy is stress, my head is still running - so meditation and cold showers seems to be a good to calm your mind down. Also I found out that too sugary stuff - like a piece of cake on party is RAISING my BP to the highs as 150/80. Now I am in the state that sometimes I have like 120/70, usually around 130/80 and sometimes 140/80. I trying as hard as I can manage this but I barely can get it under 130/80, especially the SYSTOLIC part. I also quit coffee this week. I am supplementing omega-3, vitamin D+K2, Magnesium, Potassium, Garlic and drinking herb tea to lowering blood pressure. I am still thinking if go to meds or not, when I am doing nothing I think my pressure is OK but when I am doing some weight lifting in the gym, that is the question if that HBP can't be just too much and at one point of time, in future I will get a heart attack or stroke. SO I am still trying to fight it. The worst part is that you never know if that HBP is ok for you or not. Someone can be used to that and can live long and happy life and someone can be killed by the same pressure even at young age.
How old are you? Blood pressure generally increases with age as your blood vessels/heart gradually stiffen and irreversibly occlude with plaque. If you’ve consumed fatty foods for a large majority of your life and your >30 years of age, an elevated blood pressure is not nearly surprising. Peter said in another video, reducing apoB has to begin in your 20s to be effective against long term ASCVD
Get on the cinnamon if you aren't going with meds. The only food clinically proven to work.
Don’t be so obsessed with your BP. The views expressed here are not consensus views As a supper fit young man your slow heart rate has an effect on systolic BP. With slow heart rate a lot of blood is injected into the arterial system suddenly as opposed to a person with a pulse of 75. Heart rate is not taken into account when measuring systolic but of course it matters
@@alfredopampanga9356wow never knew this. I’m in the exact same boat as the comment about. 25, eaten well all my life, addicted athlete, resting heart rate of low 50s high 40s. The more I research this the more I’m realizing everyone is different. Obviously shoot for the best BP possible but I truly believe some people are in their “normal” range at spots like 130/80 - 140/80
I’m in the exact same boat as a OP and comment above. Literally. I started a low dose of telmisartan. It’s always been my top number as well. Lingers in the 130-140 region most days.
Beetroot juice concentrate, citraline and potassium has brought my blood pressure down a good bit. Still not in the green but a lot closer. I have always exercised regularly. Weights and at least one hour walking daily. I think I may be a candidate for meds although I want to see if I can lower it naturally before getting entangled with a doctor.
just curious, are you a larger than average body weight?
@@djwgmail I have some excess body fat to lose but I wouldn't be considered obese or look like a fat person.
@@sunset5461 was more curious about your size in general, I think height and overall body mass can have an effect
@@djwgmail
Interesting you ask this because I’m a relatively fit 240lb, 6’2 guy, who played contact sports. I have high blood pressure technically but I also am really healthy and I was wondering if they have controlled these blood pressure finding for height and muscle mass? So have been asking myself a similar question to you.
If you are fit and bigger you probably are to big for your frame and have a too high or above average BMI or it's mostly genetic and could run in your family
Average blood pressure determination using a strict method of resting calmly prior to obtaining a reading is still subject to a broad range of day to day averages for someone whose day to day average is in the high stage 1 to low stage 2 range. Exercising mostly by 90 minutes a day brisk walking and an hour of meditation early every morning have some bp lowering effect but the absolutely most effective lifestyle strategy
Well, this is long overdue.
What are your thoughts on white coat syndrome? Home/ambulatory BPs consistently 90-110/ 60-70 any health care clinic to include PT 150-160/80/90. Thank you
Same here ;) I mean, I am literally panicked (but try to disguise this) so a high reading should not be surprising here as I am opposite of relaxed.
@@Rhythmandosyche I can feel the tension but the irony is that this is a relatively new phenomenon for me (x past 15 yrs) especially since I worked in the health care field for 40 yrs.
I have been reading 110-103 over like 68 down to 63 the lower diastolic readings kind of scare me lol
What about any supplements? Are there any proven supplements that lower BP?
You lumped all salt together. Is there a difference in regular table salt which is processed and removes minerals and Celtic salt/Himalayan salt that have minerals left in tact and effects to BP.
some people have found using flaxseed oil can help.
My understanding is that it is the sodium in the salt which raises blood pressure, not the other things or lack of other things in the salt. Sodium attracts water, which can increase the fluid volume (more blood in the same arteries) which can give you higher blood pressure. Not a doctor.
My blood prrssure has been read between 110-103 over 67-63, my diastolic getting to low?
Do you get lightheaded when you stand up? That's a potential sign of low bp.
Has anyone tried Nitric oxide supplements?
Treating?
Where was the protocol ?
I appreciate dr obulor on RUclips for helping me suppress my high blood pressure with his medication.
According to new guidlines. the BP should be determined for dif age groups. Ex 140/90 for 65 and 159/90 over 65.
These numbers make more sense than having 120/8] for all. Your thoughts!
@LaNo1955 that's not what the new guidelines say. What they show is that people in different age groups will find themselves having different average blood pressure, and as you point out, the older, the higher the average blood pressure. But, these are not what the BP target should be for each age group, which remains at 120/80 for ALL age groups.
The consequence is the older we become, the harder, on average, it will be to be remain within the 120/80 target.
Does advanced age makes a difference in your blood pressure?
120/80 is achiveable if you are a small 21yo. But this goal is not appraopriate for most people. Children have a much lower BP, and large people need a higher BP for good health. Gender and Age are also very important, as the arteries grow old more pressure is needed for health. The problem is applying this as a standard for all. As a 64 yo still with some extra lbs, I get dizzy on a 120/80. So I have set my target at 130/85 and I achieve that with 5mg of ramipril (which I have had to bring down) and fasting with low carb.
What is [Ape oh B]?
I came across this video after searching as I'm concerned about my BP. I'm a LOT more concerned now. I've been getting readings of up to 160/95.
Talk to your dr- do you get to sweat a lot during the day, do you hydrate? My partner died at 54. Its not a silent disease, we ignore the symptoms.
It def is a silent killer. I was diagnosed in my mid 40s. Cycling all the time. 4 or 5 hour rides. 0 symptoms. Happened to try a machine at the pharmacy. Had 160/120. Felt great.
@@joerenner8334how have you dealt with it?
@@nicohalverson4352 Meds. And I still cycle all the time. Have my own monitor which is crucial as you need to read BP while relaxed at home.
@@joerenner8334 interesting that you're another fellow long distance cyclist. i ride about 6k-7k miles a year, and have for decades..just turned 40. blood pressure 120/80, but somewhat surprised its not lower. i wonder if cycling too much, especially in middle age is somehow detrimental?
Is the video available anywhere?
For me, lifestyle changes weren't enough. I take an ACE receptor blocker called Telmasartin. For me, it's better than a beta blocker since beta blockers tend to reduce exercise tolerance, and I need to exercise.
ARB
How much mg of telmasartin do you take 🤔🤔
@jatinlama2721, I take 40 mg of telmasartin per day.
😊
Sugar and fasting. Get the majority of sugar out of your diet, other than natural and even then minimise. Fasting, hit a 16/8 fasting regime. Drink water and get exercise - job done!
So fasting does not raise blood pressure??
In the weeds again please give the action steps
Well, I like listening to this doctor but wow way over my head. I never quite caught even looking through the transcripts on anything about managing the blood pressure.
I really want to appreciate Dr Obulor on RUclips for helping me cure high blood pressure you are so wonderful Doctor🫡….
I don’t know where the SPRINT study got their patients. Such low blood pressures are quite rare in middle aged people
Why is Peter getting strangely excited when he talks about "aggressive treatment" with medication? Same was for ApoB and he proudly said that he's taking a few cholesterol lowering medications like it's candy. Now with the cited research we want to "aggressively treat" people with BP of 121/81? The lower, the better they say.
Idk man, I was paying attention to the things he said till he started shilling new pharma drugs.
@@incisor78 he does it in almost all of his interviews. I don't think there's nothing to learn from him but it's getting fishy with all the drug pushing.
There's alot of reasearch indicating that statins are not effective and shouldn't be used. Listen to the Joe Rogan podcast with Dr Aseem Malhotra. I medicate for high blood pressure but in my experience these medication won't make you feel better (heart palpations, hard heart beats, tired etc etc). But maybe make you live longer? If I was below border line high blood pressure (like 135/85) I wouldn't touch any medication. However, I would do anything in my power to lower the blood pressure without medication.
Good observation! I’m convinced that Dr. Attia has a dark side where he drawn to all things extreme. As a kid he had an emotional distant workaholic father and the young attia hates celebrating his birthday. He has been to rehab a couple of times to fix his anger management issues. And the list goes on and on…
At one time recommended blood pressure, systolic was your age plus 100.
Does this mean that the elderly were more prone to high blood pressure in the past, or is the issue of high blood pressure more a modern issue - some studies suggest the later.
Even though it is important to be consistent in the technique of measuring and calculating blood pressure - this does not occur. The arm is left to dangle on the lap while the nurse chats away.
Blood pressure is calculated by taking an average - even though the systolic blood pressure might vary by over 50 points during the day.
Variation of blood pressure is supposed to be more problematic - but the nurses do not seem to have received that advice.
The main treatment is taking channel blockers or ACE inhibitors - as though your issue is a bodies deficiency in both these medications - so does nothing if your blood pressure is all over the place - or might occasionally drive it too low making you more prone to fainting and breaking a bone.
What the heck !you never talked about how to treat high blood pressure!!!
A recent editorial in the New England Journal of Medicine postulated that folic acid and other B vitamins may promote atherosclerosis by increasing cell proliferation in atherosclerotic plaques, enhancing methylation of DNA (leading to gene activation) and augmenting levels of asymmetric dimethylarginine (16). Asymmetric dimethylarginine is an endogenous inhibitor of nitric oxide synthase, and has been implicated in the pathogenesis of endothelial dysfunction and accelerated vascular disease. Thus, it is biologically plausible that folate and vitamins B6 and B12 could have negative effects on the endothelium that offset their potential benefit from homocysteine lowering.
good luck going to a doctors office and sitting still for 5 mins before getting a blood pressure reading. this should be a minimum to get an accurate reading.
Oh, there are more guidelines than that.
Stop drinking alcohol and exercise daily. Hot yoga, bike, walks, jogs, and some strength training
Why didn’t he talk about the role of insulin resistance in primary hypertension and the mechanism of insulin resistance (retaining water, lower nitric oxide at endothelial cells) causing high blood pressure?
I think this episode is almost useless.
Check out Dr Ben Bikman and many other low carbs docs instead.
Logic tells us you can’t use a faulted test protocol, which probably every doctor uses and compare that to the sprint study testing protocol
Spring study protocol was sit for five minutes. Take the first reading rest another five minutes. Take the second reading rest another five minutes to take the third reading and get the average.
The testing protocol in probably every doctors offices walk into the examination room sit down the assistant or the nurse takes your blood pressure within 5 to 14 seconds of you sitting down and now you’re going to use that number compared to the sprint study testing protocol on the average of three this is why so many people are on unneeded blood pressure medication
In addition to this, where I find fault with the sprint study is, they took people who already had cardiovascular problems
The study doesn’t tell us that of a normal healthy person has a 128/82 they should be on medication
I have searched and am unable to find who funded the sprint blood pressure study ?
Why did they take out type 2 diabetes. Now these results don’t apply to me ffs
This is an add.
No practical tools on this one
GHTUU
Is it me or does this guy make everything sound so complicated, we are not doctors
Every time I see Dr. Attia’s videos come up, I vaguely recall that there’s some reason I don’t ever click on them. Now I remember: because they’re all bait and switch rambling intros, with the actual info behind a paywall! If the guy is butthurt about “giving away” information, he’s on the wrong platforms. That’s not how RUclips and podcasting work. Now I’m going to block this channel so I don’t have to deal with this annoyance again, and I’ll move on to one of the millions of content creators who understands how this stuff works.
OK I am not a doctor, but I have done my research and I am really sick and tired of the words smoking is bad for you being taken out of context. Smoking is a general term. If you’re going to say smoking is bad for you be specific. Are you talking about cigarettes? Are you talking about cigars? Are you talking about pipe smoking? There is documented evidence that cigars and pipe smoke do not damage the body as badly as cigarettes. In fact, there may be some benefit to the more natural tobacco.
I appreciate dr obulor on RUclips for helping me suppress my high blood pressure with his medication.