- Dr. Grossman, is there a clinical case that you could think of, that could illustrate some of the topics that we discussed today on hypertension treatment in the setting of metabolic syndrome and obesity? The best example that I can give is - this was 20 or 30 years ago - when the patient who was 60 years old then, came to me - he was diabetic, he had severe hypertension, systolic blood pressure of 200, all side effects of hypertension - target organ damage, left ventricle hypertrophy, mild renal failure. I gave him four drugs to lower the blood pressure. And he died only recently when he was 90 years old, without even myocardial infarction or stroke. He died of cancer. Of course, you can say that anti-hypertensive medications exposed him to cancer - but without the medications he would not have lived even 5 years. I mean, he would have died at the age of 65 or 70, and he survived to the age of 90 and he was alert and active, and unfortunately, died of cancer. You have to die of something. So he died of cancer. That gives you an example of how important it is to control the blood pressure. You can not rely in hypertension treatment decisions on a certain case, you have to rely on big data and see what is the advantage, the benefit of lowering arterial blood pressure. And I believe that if the patient is compliant, in about 90 to 95% of the patients I can control the blood pressure, even though maybe not to 130 over 80, but to 140 over 90 in most patients. I think that's a very important story, because it underscores how and why it's important to really weigh the real risks as opposed to perceived risks. If something does not cause pain or any other symptom in the body that something is wrong, it doesn't mean that it does not carry significant risks, like hypertension. And you cannot go back - once you have a stroke, that's it, you are handicapped, you are paralyzed, you cannot go back and say, "Oops, I want to live again and take the anti-hypertensive medication". It's too late! And you see so many patients who didn't treat high blood pressure. Just recently, between Rosh Hashanah and Yom Kippur, several months ago, I had a good friend of mine, he was a cantor, a well known person, he had hypertension and diabetes. He didn't take the medications, and he told everyone that I was controlling his blood pressure, and I didn't treat him at all. And then he went to an eye doctor, ophthalmologist, who said, "Oops, you have changes in the blood vessels in the eye and you have to be careful and control your blood pressure", and he said, "OK, it will be OK". And then he traveled to the United States and he died of subarachnoid brain hemorrhage. This was definitely a consequence of hypertension that was not treated. So don't challenge your life! You have to take medications and you have to lower the blood pressure. Life has enough external risks - accidents, whatever it is. If you can control something and prevent diseases, do it. - Yes! Dr. Grossman, is there anything else you'd like to talk about? Are there any questions that I should have asked and didn't ask? I think you've covered the topic of hypertension well enough for everyone. And if someone has more questions they can contact me, and I would be happy to help and give answers. Dr. Grossman, thank you very much for this conversation! I very much appreciate it, and looking forward to continue reading your research and sharing your data with patients around the world. - Thank you! My pleasure!
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