June 1, 2023

Watch the full episode of this “Ask Me Anything” episode #15 of The Peter Attia Drive here:

Last case because i know we’re going to run out of time here in a second it’s a real interesting case that kind of goes back to the metabolic one that we talked about earlier so this is there’s a guy in his mid 40s who’s quite healthy but he does have elevated blood pressure and he’d been diagnosed long before we had seen him with essential hypertension which is

Just another word for hypertension of an unknown etiology nobody could figure out why his blood pressure was elevated but it was clearly elevated so when he would log his blood pressure twice daily it was ranging from 140 over 90 to 160 over 90. so when he came to us he was taking lysinopril which is an ace inhibitor and that was bringing him down into the 120s oh

To 130s over the 80s to 90s which is still higher than i would like for a 46 year old especially if he’s interested in longevity and in the case of this patient he actually had a positive calcium score so there was even more reason to be aggressive with respect to his blood pressure management just based on the lipids but again it’s important to reiterate this is

A guy that on paper looked really really good and if you looked at him in person he looks great he’s very muscular and lean he runs and exercises six days a week he’s doing all the right stuff eats all the right stuff but his uric acid was 6.1 and it was quite stubborn never went down no matter what we did dietarily tweaking protein levels reducing fructose didn’t

Matter could not get his uric acid below six it was always between six and seven and again just to make a plug for the rick johnson podcast if people haven’t heard it rick makes an exceptional case as to why you want that number lower and again internally we have been targeting five so we finally put him on uloric and i gotta be honest with you i don’t remember if

We put him on allopurinol first and he had a reaction to it or what the reason was but nevertheless we put him on ulrich and that fixed uric acid he was now in the mid-fours and he had to come off his blood pressure medication and his blood pressure normalized so we took the uric acid from six point call it one down to say 4.1 and he no longer needed the ace

Inhibitor and without any other change this is not a guy who gained weight lost weight made any other meaningful change even in his exercise but his blood pressure now is sort of 120 over 80. and that’s i think to set expectations a pretty unusual response to just lowering uric acid but it’s also a great teaching point that says don’t go after blood pressure until

You’ve fixed uric acid get that uric acid below five and then start playing with the blood pressure medication if you need it but i mean the broader point is try to fix the insulin resistance and metabolic syndrome first which in this case he didn’t have but he did have the elevated uric acid before you go after the knee-jerk and easy reaction which is here’s a

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Transcribed from video
Peter Attia Patient Case Study: Elevated Uric Acid and High Blood Pressure By Peter Attia MD