good morning thanks for inviting me well in the early morning I’m going to talk
in the early morning I’m going to talk
in the early morning I’m going to talk something a little Behav which is
something a little Behav which is
something a little Behav which is medical and I’m going to talk about
medical and I’m going to talk about
medical and I’m going to talk about something that will disturb you a little
something that will disturb you a little
something that will disturb you a little bit but hopefully to set you thinking
bit but hopefully to set you thinking
bit but hopefully to set you thinking I’ve entitled my talk as three steps
I’ve entitled my talk as three steps
I’ve entitled my talk as three steps ahead and this is one of the most
ahead and this is one of the most
ahead and this is one of the most difficult thing in medicine where you
difficult thing in medicine where you
difficult thing in medicine where you want to be three step ahead way before a
want to be three step ahead way before a
want to be three step ahead way before a stroke happen right way before cancer
stroke happen right way before cancer
stroke happen right way before cancer happened way before anything happened
happened way before anything happened
happened way before anything happened how can we be three step ahead let’s
how can we be three step ahead let’s
how can we be three step ahead let’s just dive in and I’ll show you a very
just dive in and I’ll show you a very
just dive in and I’ll show you a very typical scene you can see this in our
typical scene you can see this in our
typical scene you can see this in our clinic you can see every time your
clinic you can see every time your
clinic you can see every time your parents you go to the clinic and you
parents you go to the clinic and you
parents you go to the clinic and you will notice this thing they are smiling
will notice this thing they are smiling
will notice this thing they are smiling and I call this the fatal smile it’s
and I call this the fatal smile it’s
and I call this the fatal smile it’s called a fatal smile because when you
called a fatal smile because when you
called a fatal smile because when you see the doctor especially when it takes
see the doctor especially when it takes
see the doctor especially when it takes your blood pressure we make an
your blood pressure we make an
your blood pressure we make an assumption because your blood pressure
assumption because your blood pressure
assumption because your blood pressure is now good normal so we assumed it must
is now good normal so we assumed it must
is now good normal so we assumed it must have been good since the last time you
have been good since the last time you
have been good since the last time you came right and then we will have to
came right and then we will have to
came right and then we will have to assume that you will be good until the
assume that you will be good until the
assume that you will be good until the next visit and therefore we smile and
next visit and therefore we smile and
next visit and therefore we smile and because there is good control we won’t
because there is good control we won’t
because there is good control we won’t get a slope we won’t get hired hang we
get a slope we won’t get hired hang we
get a slope we won’t get hired hang we won’t have anything but is it true
look at the number of publication that
look at the number of publication that tells us something not quite right if
tells us something not quite right if
tells us something not quite right if you were to look at this chart it
you were to look at this chart it
you were to look at this chart it actually tells you the number of
actually tells you the number of
actually tells you the number of admission to the hospital for sure and
admission to the hospital for sure and
admission to the hospital for sure and notice is only two thousand so you could
notice is only two thousand so you could
notice is only two thousand so you could just try and extrapolate where is 2017
just try and extrapolate where is 2017
just try and extrapolate where is 2017 this is our figure can you imagine that
this is our figure can you imagine that
this is our figure can you imagine that not only we have strokes increasing at
not only we have strokes increasing at
not only we have strokes increasing at nobody’s business but strokes is
nobody’s business but strokes is
nobody’s business but strokes is happening in the young one of below
happening in the young one of below
happening in the young one of below forty five one in four are below forty
forty five one in four are below forty
forty five one in four are below forty five and they includes a lot of ass
five and they includes a lot of ass
five and they includes a lot of ass isn’t it so when we look at this we know
isn’t it so when we look at this we know
isn’t it so when we look at this we know something is wrong because effective
something is wrong because effective
something is wrong because effective treatment has come in but the trend
treatment has come in but the trend
treatment has come in but the trend hasn’t been arrested why I look at it
hasn’t been arrested why I look at it
hasn’t been arrested why I look at it this way was in the year 2000 I decided
this way was in the year 2000 I decided
this way was in the year 2000 I decided to then launch the company with the
to then launch the company with the
to then launch the company with the invention trying to address this problem
invention trying to address this problem
invention trying to address this problem you see in Singapore if you were to look
you see in Singapore if you were to look
you see in Singapore if you were to look at the cause of death it can be stroke
at the cause of death it can be stroke
at the cause of death it can be stroke can be high tech you one can kick me
can be high tech you one can kick me
can be high tech you one can kick me failure which is a communist
failure which is a communist
failure which is a communist they actually consist of thirty five
they actually consist of thirty five
they actually consist of thirty five percent that means one entry or more
percent that means one entry or more
percent that means one entry or more than one entry person in Singapore who
than one entry person in Singapore who
than one entry person in Singapore who dies died of heart attack stroke or
dies died of heart attack stroke or
dies died of heart attack stroke or kidney failure and this is even bigger
kidney failure and this is even bigger
kidney failure and this is even bigger than cancer and the one that underlines
than cancer and the one that underlines
than cancer and the one that underlines this is the hypertension which is high
this is the hypertension which is high
this is the hypertension which is high blood pressure in our layman’s term it’s
blood pressure in our layman’s term it’s
blood pressure in our layman’s term it’s called high blood pressure hypertension
called high blood pressure hypertension
called high blood pressure hypertension and 25 percent as I said are below forty
and 25 percent as I said are below forty
and 25 percent as I said are below forty five years old so if you were to look at
five years old so if you were to look at
five years old so if you were to look at a mission just now when I show you the
a mission just now when I show you the
a mission just now when I show you the slide it was a mission we this we have
slide it was a mission we this we have
slide it was a mission we this we have not counted people who have stroke and
not counted people who have stroke and
not counted people who have stroke and dying at home people were stroke and
dying at home people were stroke and
dying at home people were stroke and when you see the Chinese physician we
when you see the Chinese physician we
when you see the Chinese physician we will wear a stroke and did nothing at
will wear a stroke and did nothing at
will wear a stroke and did nothing at home we just count the number of
home we just count the number of
home we just count the number of admission then we have one in every 45
admission then we have one in every 45
admission then we have one in every 45 minutes so after this morning we
minutes so after this morning we
minutes so after this morning we probably have three more strokes
probably have three more strokes
probably have three more strokes in Singapore that’s a reality and the
in Singapore that’s a reality and the
in Singapore that’s a reality and the number doubles every fall to five years
number doubles every fall to five years
number doubles every fall to five years every fall value is the number of stroke
every fall value is the number of stroke
every fall value is the number of stroke doubles because our aging population is
doubles because our aging population is
doubles because our aging population is in increasing the number of people
in increasing the number of people
in increasing the number of people getting hyper pressure when you’re young
getting hyper pressure when you’re young
getting hyper pressure when you’re young is increasing heart attack is estimated
is increasing heart attack is estimated
is increasing heart attack is estimated to be 1 in 3 hours now in Singapore the
to be 1 in 3 hours now in Singapore the
to be 1 in 3 hours now in Singapore the figures is going down to 1 in 1 and a
figures is going down to 1 in 1 and a
figures is going down to 1 in 1 and a half hour we have one fresh heart attack
half hour we have one fresh heart attack
half hour we have one fresh heart attack kidney failure every day we have 4 to 5
kidney failure every day we have 4 to 5
kidney failure every day we have 4 to 5 new kidney dialysis patient every day so
new kidney dialysis patient every day so
new kidney dialysis patient every day so how big is the problem
how big is the problem
how big is the problem po is huge because you look at our
po is huge because you look at our
po is huge because you look at our population here in the world
population here in the world
population here in the world 1 billion actually are going to walking
1 billion actually are going to walking
1 billion actually are going to walking around with high blood pressure and you
around with high blood pressure and you
around with high blood pressure and you increase this over the next 20 years so
increase this over the next 20 years so
increase this over the next 20 years so you can imagine 1 in 3 percent in the
you can imagine 1 in 3 percent in the
you can imagine 1 in 3 percent in the world will eventually become
world will eventually become
world will eventually become hypertensive now so are we doing it
hypertensive now so are we doing it
hypertensive now so are we doing it right because we have so much work done
right because we have so much work done
right because we have so much work done with so much medicine and research done
with so much medicine and research done
with so much medicine and research done into her how to treat hypertension but
into her how to treat hypertension but
into her how to treat hypertension but we have not arrested the problem the
we have not arrested the problem the
we have not arrested the problem the hypertension bring so are we doing it
hypertension bring so are we doing it
hypertension bring so are we doing it right I ask myself this every time I sit
right I ask myself this every time I sit
right I ask myself this every time I sit behind my desk in the clinic I look at
behind my desk in the clinic I look at
behind my desk in the clinic I look at the patient and I realize I also did the
the patient and I realize I also did the
the patient and I realize I also did the fatal smile that killed them where is
fatal smile that killed them where is
fatal smile that killed them where is that missing link
that missing link
that missing link I started challenging the norm and that
I started challenging the norm and that
I started challenging the norm and that starts with reflection one of your first
starts with reflection one of your first
starts with reflection one of your first team reflection now I started looking at
team reflection now I started looking at
team reflection now I started looking at high blood pressure or person who is
high blood pressure or person who is
high blood pressure or person who is having a blood pressure how does a bad
having a blood pressure how does a bad
having a blood pressure how does a bad pressure behave throughout the 24 hours
pressure behave throughout the 24 hours
pressure behave throughout the 24 hours if you were to look at a glimpse of a
if you were to look at a glimpse of a
if you were to look at a glimpse of a slit of your window and you will see
slit of your window and you will see
slit of your window and you will see this kind of thing you would guess well
this kind of thing you would guess well
this kind of thing you would guess well most likely it’s a woman beautiful
most likely it’s a woman beautiful
most likely it’s a woman beautiful beautiful woman maybe have some
beautiful woman maybe have some
beautiful woman maybe have some outrageous hair but that’s about all
outrageous hair but that’s about all
outrageous hair but that’s about all that we know but the truth is we have
that we know but the truth is we have
that we know but the truth is we have missed the whole thing this is what it
missed the whole thing this is what it
missed the whole thing this is what it looks like
looks like
looks like or if you were to look at my pressure
or if you were to look at my pressure
or if you were to look at my pressure from this angle and you look at a clinic
from this angle and you look at a clinic
from this angle and you look at a clinic blood pressure when you come to the
blood pressure when you come to the
blood pressure when you come to the clinic we take your blood pressure this
clinic we take your blood pressure this
clinic we take your blood pressure this is the view of the clinic blood pressure
is the view of the clinic blood pressure
is the view of the clinic blood pressure but the truth is it comes from there it
but the truth is it comes from there it
but the truth is it comes from there it doesn’t come from where you think so
doesn’t come from where you think so
doesn’t come from where you think so when we look at the 24-hour blood
when we look at the 24-hour blood
when we look at the 24-hour blood pressure we plot it into a graph and we
pressure we plot it into a graph and we
pressure we plot it into a graph and we look at the way the blood pressure
look at the way the blood pressure
look at the way the blood pressure fluctuates we will see there are normal
fluctuates we will see there are normal
fluctuates we will see there are normal person fluctuates within a certain band
person fluctuates within a certain band
person fluctuates within a certain band and when you sleep at night the
and when you sleep at night the
and when you sleep at night the professor actually drops ten fifteen
professor actually drops ten fifteen
professor actually drops ten fifteen percent and then goes up again when the
percent and then goes up again when the
percent and then goes up again when the Sun comes out up another ten fifteen
Sun comes out up another ten fifteen
Sun comes out up another ten fifteen percent so is the diastolic pressure and
percent so is the diastolic pressure and
percent so is the diastolic pressure and this is the heart rate as you fluctuates
this is the heart rate as you fluctuates
this is the heart rate as you fluctuates in the day above eighty ninety but when
in the day above eighty ninety but when
in the day above eighty ninety but when you sleep you can drop even up to 50 so
you sleep you can drop even up to 50 so
you sleep you can drop even up to 50 so the blood pressure the heart rate has a
the blood pressure the heart rate has a
the blood pressure the heart rate has a rhythm it has a certain rhythm and
rhythm it has a certain rhythm and
rhythm it has a certain rhythm and certain circadian rhythm which is the
certain circadian rhythm which is the
certain circadian rhythm which is the body clock but when we take the blood
body clock but when we take the blood
body clock but when we take the blood pressure pattern across the bottom let’s
pressure pattern across the bottom let’s
pressure pattern across the bottom let’s say for example if I take all of you and
say for example if I take all of you and
say for example if I take all of you and every one of you has a recording of the
every one of you has a recording of the
every one of you has a recording of the blood pressure not everyone will have a
blood pressure not everyone will have a
blood pressure not everyone will have a normal pattern in fact there are many
normal pattern in fact there are many
normal pattern in fact there are many types of pattern and these are some of
types of pattern and these are some of
types of pattern and these are some of them one of these when you see the
them one of these when you see the
them one of these when you see the doctor the pressure goes up let me go
doctor the pressure goes up let me go
doctor the pressure goes up let me go home is actually quite normal we call
home is actually quite normal we call
home is actually quite normal we call this the white coat nowadays there is no
this the white coat nowadays there is no
this the white coat nowadays there is no white coat for doctors
white coat for doctors
white coat for doctors we don’t wear white coat so we court off
we don’t wear white coat so we court off
we don’t wear white coat so we court off fist hypertension which is cleaning
fist hypertension which is cleaning
fist hypertension which is cleaning hypertension we look at people who have
hypertension we look at people who have
hypertension we look at people who have high blood pressure is high in them in
high blood pressure is high in them in
high blood pressure is high in them in the systolic which is high but the
the systolic which is high but the
the systolic which is high but the diastolic is normal where people who are
diastolic is normal where people who are
diastolic is normal where people who are normal here but high here and then we
normal here but high here and then we
normal here but high here and then we have very strange patterns like people
have very strange patterns like people
have very strange patterns like people who only have high blood pressure at
who only have high blood pressure at
who only have high blood pressure at night nobody is going to go to your
night nobody is going to go to your
night nobody is going to go to your house at 3 a.m. and take your blood
house at 3 a.m. and take your blood
house at 3 a.m. and take your blood pressure isn’t it or your parents blood
pressure isn’t it or your parents blood
pressure isn’t it or your parents blood pressure we are missing a whole lot of
pressure we are missing a whole lot of
pressure we are missing a whole lot of these people whose pressures are at
these people whose pressures are at
these people whose pressures are at night and nobody knows until you get a
night and nobody knows until you get a
night and nobody knows until you get a stroke we have people who are pressure
stroke we have people who are pressure
stroke we have people who are pressure hi but they have a nice circadian rhythm
hi but they have a nice circadian rhythm
hi but they have a nice circadian rhythm which is the biological clock just like
which is the biological clock just like
which is the biological clock just like the normal one but there are others who
the normal one but there are others who
the normal one but there are others who are behaving like a straight line which
are behaving like a straight line which
are behaving like a straight line which is actually the nan Dipper we call them
is actually the nan Dipper we call them
is actually the nan Dipper we call them the nan Dipper why are we looking at all
the nan Dipper why are we looking at all
the nan Dipper why are we looking at all these patterns because every pattern
these patterns because every pattern
these patterns because every pattern carries its own risk of heart attack and
carries its own risk of heart attack and
carries its own risk of heart attack and stroke says for example the nan dippers
stroke says for example the nan dippers
stroke says for example the nan dippers are present in a lot of diabetics they
are present in a lot of diabetics they
are present in a lot of diabetics they are 3 to 5 times the risk of stroke if
are 3 to 5 times the risk of stroke if
are 3 to 5 times the risk of stroke if you don’t change them so when we look at
you don’t change them so when we look at
you don’t change them so when we look at those pattern we look at results we
those pattern we look at results we
those pattern we look at results we found that as another pattern there was
found that as another pattern there was
found that as another pattern there was inscribe it’s called a morning search
inscribe it’s called a morning search
inscribe it’s called a morning search there are people who wake up in the
there are people who wake up in the
there are people who wake up in the morning for the next three hours the
morning for the next three hours the
morning for the next three hours the blood pressure is very high then the
blood pressure is very high then the
blood pressure is very high then the rest of the day you are normal and these
rest of the day you are normal and these
rest of the day you are normal and these people actually present with a rupture
people actually present with a rupture
people actually present with a rupture of the vessel and the best example that
of the vessel and the best example that
of the vessel and the best example that I can give you is our late mrs. Lee who
I can give you is our late mrs. Lee who
I can give you is our late mrs. Lee who had morning hypertension where we
had morning hypertension where we
had morning hypertension where we noticed it on a watch so a BPM pattern
noticed it on a watch so a BPM pattern
noticed it on a watch so a BPM pattern is another name for that 24-hour blood
is another name for that 24-hour blood
is another name for that 24-hour blood pressure a BPM stands for ambulatory
pressure a BPM stands for ambulatory
pressure a BPM stands for ambulatory blood pressure pattern so when you have
blood pressure pattern so when you have
blood pressure pattern so when you have a pattern it carries the different risk
a pattern it carries the different risk
a pattern it carries the different risk of your cardiovascular event or what we
of your cardiovascular event or what we
of your cardiovascular event or what we call stroke then if you want to bring
call stroke then if you want to bring
call stroke then if you want to bring the pattern back to normal eventually
the pattern back to normal eventually
the pattern back to normal eventually reduces a stroke or the risk of having
reduces a stroke or the risk of having
reduces a stroke or the risk of having cardiovascular event and this is
cardiovascular event and this is
cardiovascular event and this is actually the evidence-based medicine and
actually the evidence-based medicine and
actually the evidence-based medicine and I will show you that how we can
I will show you that how we can
I will show you that how we can customize treatment so that we can catch
customize treatment so that we can catch
customize treatment so that we can catch them beforehand you see in the
them beforehand you see in the
them beforehand you see in the publication that was done some time ago
publication that was done some time ago
publication that was done some time ago in fact the very big publication for
in fact the very big publication for
in fact the very big publication for Milan 205 they read 5,000 over picture
Milan 205 they read 5,000 over picture
Milan 205 they read 5,000 over picture and they follow them up average of 8
and they follow them up average of 8
and they follow them up average of 8 years but the longest one as I say
years but the longest one as I say
years but the longest one as I say average 8 years but the longest person
average 8 years but the longest person
average 8 years but the longest person is 21 years in this chart and you look
is 21 years in this chart and you look
is 21 years in this chart and you look at the risk of having cardiovascular
at the risk of having cardiovascular
at the risk of having cardiovascular death limbs you actually die from heart
death limbs you actually die from heart
death limbs you actually die from heart attack or stroke and they look at the
attack or stroke and they look at the
attack or stroke and they look at the cleaning blood pressure all of us
cleaning blood pressure all of us
cleaning blood pressure all of us thought this is
thought this is
thought this is the holy truth the gospel truth because
the holy truth the gospel truth because
the holy truth the gospel truth because oh wow the blood pressure goes up as a
oh wow the blood pressure goes up as a
oh wow the blood pressure goes up as a diastolic and systolic goes up well the
diastolic and systolic goes up well the
diastolic and systolic goes up well the reason stroke goes up and and death goes
reason stroke goes up and and death goes
reason stroke goes up and and death goes up but when we need the 24-hour blood
up but when we need the 24-hour blood
up but when we need the 24-hour blood pressure this is the truth it is the
pressure this is the truth it is the
pressure this is the truth it is the night pressure average over tonight that
night pressure average over tonight that
night pressure average over tonight that is very very strong in determining
is very very strong in determining
is very very strong in determining whether you get it or not so if someone
whether you get it or not so if someone
whether you get it or not so if someone wants to know one single bad pressure
wants to know one single bad pressure
wants to know one single bad pressure that is most important to predict the
that is most important to predict the
that is most important to predict the risk is the night pressure but following
risk is the night pressure but following
risk is the night pressure but following that the 24-hour average pressure the
that the 24-hour average pressure the
that the 24-hour average pressure the day pleasure and not the cleaning blood
day pleasure and not the cleaning blood
day pleasure and not the cleaning blood pressure so we have missed the whole
pressure so we have missed the whole
pressure so we have missed the whole thing for a long time if you were to
thing for a long time if you were to
thing for a long time if you were to look at studies done they will show you
look at studies done they will show you
look at studies done they will show you that the reverse dipper the people who
that the reverse dipper the people who
that the reverse dipper the people who are actually very low the reverse sorry
are actually very low the reverse sorry
are actually very low the reverse sorry the people are very high at night they
the people are very high at night they
the people are very high at night they are called the reverse dipper those who
are called the reverse dipper those who
are called the reverse dipper those who are very low and nightly quite the
are very low and nightly quite the
are very low and nightly quite the extreme deeper and we describe this as a
extreme deeper and we describe this as a
extreme deeper and we describe this as a J curve in terms of stroke those who are
J curve in terms of stroke those who are
J curve in terms of stroke those who are very high at night your risk of stroke
very high at night your risk of stroke
very high at night your risk of stroke is so much higher compared to the non de
is so much higher compared to the non de
is so much higher compared to the non de persand deepest and if your blood
persand deepest and if your blood
persand deepest and if your blood pressure dropped too low you actually
pressure dropped too low you actually
pressure dropped too low you actually get a stroke you actually develop a
get a stroke you actually develop a
get a stroke you actually develop a stroke or if you look at the different
stroke or if you look at the different
stroke or if you look at the different patterns depending on what is called
patterns depending on what is called
patterns depending on what is called ischemic stroke ischemic stroke is when
ischemic stroke ischemic stroke is when
ischemic stroke ischemic stroke is when the blood pressure the blood vessel get
the blood pressure the blood vessel get
the blood pressure the blood vessel get blocked by a clot or narrowing then the
blocked by a clot or narrowing then the
blocked by a clot or narrowing then the blood kind of flow to your brain you get
blood kind of flow to your brain you get
blood kind of flow to your brain you get a brain attack just like a heart attack
a brain attack just like a heart attack
a brain attack just like a heart attack if you were to look at extreme dippers
if you were to look at extreme dippers
if you were to look at extreme dippers and you look at the normal ones the
and you look at the normal ones the
and you look at the normal ones the extreme dippers are the ones that are
extreme dippers are the ones that are
extreme dippers are the ones that are very low at night the pressure drops
very low at night the pressure drops
very low at night the pressure drops below at night and they actually develop
below at night and they actually develop
below at night and they actually develop stroke it is blocked but if you are
stroke it is blocked but if you are
stroke it is blocked but if you are looking at people who are purposes very
looking at people who are purposes very
looking at people who are purposes very high at night they get rupture which is
high at night they get rupture which is
high at night they get rupture which is intracranial hemorrhage which means the
intracranial hemorrhage which means the
intracranial hemorrhage which means the blood vessel burst and then they are
blood vessel burst and then they are
blood vessel burst and then they are very strange people who actually come in
very strange people who actually come in
very strange people who actually come in Saudi and say now when does all this
Saudi and say now when does all this
Saudi and say now when does all this happen how can we prevent today’s other
happen how can we prevent today’s other
happen how can we prevent today’s other charting the people who have
charting the people who have
charting the people who have no your what we call the hours of the
no your what we call the hours of the
no your what we call the hours of the day and they found it all between six to
day and they found it all between six to
day and they found it all between six to nine nine nine to twelve is the worst
nine nine nine to twelve is the worst
nine nine nine to twelve is the worst that’s the time when you wake up the
that’s the time when you wake up the
that’s the time when you wake up the first three hours that’s where most
first three hours that’s where most
first three hours that’s where most things happen 60 70 percent happens so
things happen 60 70 percent happens so
things happen 60 70 percent happens so some wise guy came along and say I think
some wise guy came along and say I think
some wise guy came along and say I think we should just not wake up in the
we should just not wake up in the
we should just not wake up in the morning we just wake up in the afternoon
morning we just wake up in the afternoon
morning we just wake up in the afternoon yeah and then schools can start at night
yeah and then schools can start at night
yeah and then schools can start at night which is not bad but it’s not true
which is not bad but it’s not true
which is not bad but it’s not true because someone actually did a
because someone actually did a
because someone actually did a adjustment and show you no matter what
adjustment and show you no matter what
adjustment and show you no matter what time you wake up it doesn’t matter what
time you wake up it doesn’t matter what
time you wake up it doesn’t matter what time you wake up the first three hours
time you wake up the first three hours
time you wake up the first three hours is your dangerous zone and that’s
is your dangerous zone and that’s
is your dangerous zone and that’s something we have not realized so how do
something we have not realized so how do
something we have not realized so how do you measure blood pressure over 24 hours
you measure blood pressure over 24 hours
you measure blood pressure over 24 hours yeah traditionally you have something
yeah traditionally you have something
yeah traditionally you have something like that which looked exactly like a
like that which looked exactly like a
like that which looked exactly like a suicide bomber
suicide bomber
suicide bomber you know you carry a thing like that you
you know you carry a thing like that you
you know you carry a thing like that you have a strap going around with a wire
have a strap going around with a wire
have a strap going around with a wire imagine wearing this in high Marty and
imagine wearing this in high Marty and
imagine wearing this in high Marty and you put a little over on it with the
you put a little over on it with the
you put a little over on it with the wire sticking up in Moscow or in st.
wire sticking up in Moscow or in st.
wire sticking up in Moscow or in st. Peter’s but you’ll be in trouble or you
Peter’s but you’ll be in trouble or you
Peter’s but you’ll be in trouble or you prefer something like that which is very
prefer something like that which is very
prefer something like that which is very challenging we want to replace the whole
challenging we want to replace the whole
challenging we want to replace the whole thing and this is just to show you this
thing and this is just to show you this
thing and this is just to show you this is a typical device that you can have we
is a typical device that you can have we
is a typical device that you can have we cost four to six thousand dollars it’s
cost four to six thousand dollars it’s
cost four to six thousand dollars it’s for ambulatory blood pressure device
for ambulatory blood pressure device
for ambulatory blood pressure device with a pump with the other wires I’m
with a pump with the other wires I’m
with a pump with the other wires I’m going to show you this is a young man
going to show you this is a young man
going to show you this is a young man and after 24 to 48 hours of taking up
and after 24 to 48 hours of taking up
and after 24 to 48 hours of taking up the device you look at his hand imagine
the device you look at his hand imagine
the device you look at his hand imagine if this is your grandmother and the old
if this is your grandmother and the old
if this is your grandmother and the old man you’re going to get bruises you’re
man you’re going to get bruises you’re
man you’re going to get bruises you’re going to get rashes your skin with lava
going to get rashes your skin with lava
going to get rashes your skin with lava and you will never repeat it any more so
and you will never repeat it any more so
and you will never repeat it any more so it is not ideal but it is very important
it is not ideal but it is very important
it is not ideal but it is very important so we need to take away the cuff I need
so we need to take away the cuff I need
so we need to take away the cuff I need to take away that cuff and then don’t
to take away that cuff and then don’t
to take away that cuff and then don’t know how to measure it over 24 hours
know how to measure it over 24 hours
know how to measure it over 24 hours without the patient knowing and we came
without the patient knowing and we came
without the patient knowing and we came up with this thing called a B Pro which
up with this thing called a B Pro which
up with this thing called a B Pro which is first of all a new method of
is first of all a new method of
is first of all a new method of measuring blood pressure we don’t use
measuring blood pressure we don’t use
measuring blood pressure we don’t use the cuff we have to use something else
the cuff we have to use something else
the cuff we have to use something else we
we
we use the arterial waveform which is the
use the arterial waveform which is the
use the arterial waveform which is the pulse see the present method if you
pulse see the present method if you
pulse see the present method if you don’t realize is about 105 is in fact
don’t realize is about 105 is in fact
don’t realize is about 105 is in fact now is about 107 years really
now is about 107 years really
now is about 107 years really that’s how long how old it is the
that’s how long how old it is the
that’s how long how old it is the pressure device that we have been using
pressure device that we have been using
pressure device that we have been using and when we have this kind of new device
and when we have this kind of new device
and when we have this kind of new device that doesn’t use a pump or car when you
that doesn’t use a pump or car when you
that doesn’t use a pump or car when you submit for FDA there’s no precedent
submit for FDA there’s no precedent
submit for FDA there’s no precedent there’s no predicate device at the end I
there’s no predicate device at the end I
there’s no predicate device at the end I don’t know who should I compare my thing
don’t know who should I compare my thing
don’t know who should I compare my thing to where do I find somebody something to
to where do I find somebody something to
to where do I find somebody something to compare with it was a big big challenge
compare with it was a big big challenge
compare with it was a big big challenge we had to invent a device to test our
we had to invent a device to test our
we had to invent a device to test our device that that was how we submit to
device that that was how we submit to
device that that was how we submit to FDA and ever it’s a very virgin feel for
FDA and ever it’s a very virgin feel for
FDA and ever it’s a very virgin feel for validation and we really rock the boat
validation and we really rock the boat
validation and we really rock the boat because the doctors are using it for a
because the doctors are using it for a
because the doctors are using it for a hundred and five years using this and
hundred and five years using this and
hundred and five years using this and here we are saying you don’t need this
here we are saying you don’t need this
here we are saying you don’t need this you take away the car I’ll show you some
you take away the car I’ll show you some
you take away the car I’ll show you some example of people who have put on this
example of people who have put on this
example of people who have put on this is recording by the Watchers and how the
is recording by the Watchers and how the
is recording by the Watchers and how the doctors I won’t go into the detail but
doctors I won’t go into the detail but
doctors I won’t go into the detail but the doctors use the pattern and treat
the doctors use the pattern and treat
the doctors use the pattern and treat and this is before treatment you can see
and this is before treatment you can see
and this is before treatment you can see after treatment we got back the pattern
after treatment we got back the pattern
after treatment we got back the pattern we got back the dip we got back their
we got back the dip we got back their
we got back the dip we got back their normal range another patient this is
normal range another patient this is
normal range another patient this is horrendously high if we don’t do
horrendously high if we don’t do
horrendously high if we don’t do anything about 200 you can be sure you
anything about 200 you can be sure you
anything about 200 you can be sure you guys struggle in the next few days we
guys struggle in the next few days we
guys struggle in the next few days we treated you came down but you could see
treated you came down but you could see
treated you came down but you could see she is a typical non Dipper so if I have
she is a typical non Dipper so if I have
she is a typical non Dipper so if I have corrected this further if I didn’t
corrected this further if I didn’t
corrected this further if I didn’t corrected I have not solved the problem
corrected I have not solved the problem
corrected I have not solved the problem the person still has a problem and we
the person still has a problem and we
the person still has a problem and we don’t realize it unless you do a 24-hour
don’t realize it unless you do a 24-hour
don’t realize it unless you do a 24-hour ambulatory pressure so findings the
ambulatory pressure so findings the
ambulatory pressure so findings the solution is why I call refresh how do we
solution is why I call refresh how do we
solution is why I call refresh how do we find that solution is looking at it from
find that solution is looking at it from
find that solution is looking at it from a different angle and we have come up
a different angle and we have come up
a different angle and we have come up with the first 24-hour device that uses
with the first 24-hour device that uses
with the first 24-hour device that uses the pulse wave which is the arterial
the pulse wave which is the arterial
the pulse wave which is the arterial wave you can see here when you connect
wave you can see here when you connect
wave you can see here when you connect them to our pattern and we record this
them to our pattern and we record this
them to our pattern and we record this and we have broken the world record we
and we have broken the world record we
and we have broken the world record we actually got our FDA approval in six
actually got our FDA approval in six
actually got our FDA approval in six weeks it normally takes two years and
weeks it normally takes two years and
weeks it normally takes two years and because of the amount of allegation and
because of the amount of allegation and
because of the amount of allegation and clinical publication we have the
clinical publication we have the
clinical publication we have the approval in six weeks so if you look at
approval in six weeks so if you look at
approval in six weeks so if you look at a user 1 as I said it looks like that
a user 1 as I said it looks like that
a user 1 as I said it looks like that right
right
right just now we saw that now we are come up
just now we saw that now we are come up
just now we saw that now we are come up with this but we haven’t stopped there
with this but we haven’t stopped there
with this but we haven’t stopped there you see what we have done is – we are
you see what we have done is – we are
you see what we have done is – we are actually looking at a disease from a
actually looking at a disease from a
actually looking at a disease from a different angle when I mentioned we were
different angle when I mentioned we were
different angle when I mentioned we were three step ahead what do I mean by three
three step ahead what do I mean by three
three step ahead what do I mean by three step ahead when we look at people who
step ahead when we look at people who
step ahead when we look at people who are actually having a stroke and then
are actually having a stroke and then
are actually having a stroke and then you need to treat and then you need to
you need to treat and then you need to
you need to treat and then you need to monitor you already are at the end of
monitor you already are at the end of
monitor you already are at the end of this spectrum but before that happen if
this spectrum but before that happen if
this spectrum but before that happen if you can catch them and you intervene
you can catch them and you intervene
you can catch them and you intervene that will be better but before you even
that will be better but before you even
that will be better but before you even catch them at intervene you might say I
catch them at intervene you might say I
catch them at intervene you might say I want to predict prognosticate which is
want to predict prognosticate which is
want to predict prognosticate which is to predict who will get it among a whole
to predict who will get it among a whole
to predict who will get it among a whole lot of you here I know who will be
lot of you here I know who will be
lot of you here I know who will be likely to get it because you are high at
likely to get it because you are high at
likely to get it because you are high at night because you are non Dipper so I
night because you are non Dipper so I
night because you are non Dipper so I can predict then even earlier we went
can predict then even earlier we went
can predict then even earlier we went for screening so that we are diagnostic
for screening so that we are diagnostic
for screening so that we are diagnostic we go up and screen people who doesn’t
we go up and screen people who doesn’t
we go up and screen people who doesn’t have it and then we literally predict
have it and then we literally predict
have it and then we literally predict the outcome so this is very obvious yeah
the outcome so this is very obvious yeah
the outcome so this is very obvious yeah we are looking at here what we are doing
we are looking at here what we are doing
we are looking at here what we are doing is that we are trying to come to this
is that we are trying to come to this
is that we are trying to come to this place which is just way way way before
place which is just way way way before
place which is just way way way before you happen three step ahead so not only
you happen three step ahead so not only
you happen three step ahead so not only we are trees that were here in that
we are trees that were here in that
we are trees that were here in that sense that we have the technology but we
sense that we have the technology but we
sense that we have the technology but we are looking at even as we did the first
are looking at even as we did the first
are looking at even as we did the first generation which is the g1 we already
generation which is the g1 we already
generation which is the g1 we already have gone on to G 2 which is the
have gone on to G 2 which is the
have gone on to G 2 which is the wireless one it’s now in UK Australia
wireless one it’s now in UK Australia
wireless one it’s now in UK Australia China Malaysia and then US this year
China Malaysia and then US this year
China Malaysia and then US this year people are using a wireless cloud-based
people are using a wireless cloud-based
people are using a wireless cloud-based g2 model and what you saw on the
g2 model and what you saw on the
g2 model and what you saw on the computer just now where you see those
computer just now where you see those
computer just now where you see those waveform the whole thing has been strung
waveform the whole thing has been strung
waveform the whole thing has been strung onto the watch and you actually see on
onto the watch and you actually see on
onto the watch and you actually see on wife and this is actually G – while the
wife and this is actually G – while the
wife and this is actually G – while the g2 is out we have very gone ahead to do
g2 is out we have very gone ahead to do
g2 is out we have very gone ahead to do another model which is G treat this is
another model which is G treat this is
another model which is G treat this is how it works in G to the nurse or put it
how it works in G to the nurse or put it
how it works in G to the nurse or put it on a patient and then after that he goes
on a patient and then after that he goes
on a patient and then after that he goes home he sleeps over 24 hours
home he sleeps over 24 hours
home he sleeps over 24 hours either he returns the watch or you
either he returns the watch or you
either he returns the watch or you download it and he goes to the cloud and
download it and he goes to the cloud and
download it and he goes to the cloud and then you get a report and it is not only
then you get a report and it is not only
then you get a report and it is not only a hard copy but some copy anyway
a hard copy but some copy anyway
a hard copy but some copy anyway available and then we are now moving on
available and then we are now moving on
available and then we are now moving on to consumer which is you and I are
to consumer which is you and I are
to consumer which is you and I are parents at home people want to know we
parents at home people want to know we
parents at home people want to know we want to have a watch that you can call
want to have a watch that you can call
want to have a watch that you can call your own that one is actually for
your own that one is actually for
your own that one is actually for doctors to put on a patient this one is
doctors to put on a patient this one is
doctors to put on a patient this one is again Wireless clock base and we hope to
again Wireless clock base and we hope to
again Wireless clock base and we hope to come up and know this year or beginning
come up and know this year or beginning
come up and know this year or beginning of next year and this is release what we
of next year and this is release what we
of next year and this is release what we call sales and service model which means
call sales and service model which means
call sales and service model which means you actually subscribe to a service
you actually subscribe to a service
you actually subscribe to a service now when you harness the power of
now when you harness the power of
now when you harness the power of intellectual property which is here and
intellectual property which is here and
intellectual property which is here and technology I quote renew you actually
technology I quote renew you actually
technology I quote renew you actually change things and look at things a
change things and look at things a
change things and look at things a different way so when we look at
different way so when we look at
different way so when we look at invention which many of you may not be
invention which many of you may not be
invention which many of you may not be into it but some of you might like you
into it but some of you might like you
into it but some of you might like you we always hear people going from ideas
we always hear people going from ideas
we always hear people going from ideas to reality and I use the reality many of
to reality and I use the reality many of
to reality and I use the reality many of us it’s like oh my it’s a dream and you
us it’s like oh my it’s a dream and you
us it’s like oh my it’s a dream and you will come true and you’ll be a straight
will come true and you’ll be a straight
will come true and you’ll be a straight line and we just get away I also thought
line and we just get away I also thought
line and we just get away I also thought that was the way and you I realized it
that was the way and you I realized it
that was the way and you I realized it was a roller coaster before you get into
was a roller coaster before you get into
was a roller coaster before you get into that area first of all you got to get a
that area first of all you got to get a
that area first of all you got to get a proof of concept to prove that it works
proof of concept to prove that it works
proof of concept to prove that it works you have to prove before you make it
you have to prove before you make it
you have to prove before you make it that you worked after you prove the
that you worked after you prove the
that you worked after you prove the concept if you haven’t done anything
concept if you haven’t done anything
concept if you haven’t done anything you’ve got to get funding you become a
you’ve got to get funding you become a
you’ve got to get funding you become a professional beggar you gotta beg for
professional beggar you gotta beg for
professional beggar you gotta beg for money because it costs a lot of money
money because it costs a lot of money
money because it costs a lot of money and then before you taught you good guy
and then before you taught you good guy
and then before you taught you good guy everything down you’re gonna do a
everything down you’re gonna do a
everything down you’re gonna do a prototype which is actually something
prototype which is actually something
prototype which is actually something that work and put on the patient and
that work and put on the patient and
that work and put on the patient and when we thought we have prototype
when we thought we have prototype
when we thought we have prototype finished we got an oh dear I have to go
finished we got an oh dear I have to go
finished we got an oh dear I have to go validation which means I have to prove
validation which means I have to prove
validation which means I have to prove that it works to the regulatory body I
that it works to the regulatory body I
that it works to the regulatory body I have to do what we call clinical trials
have to do what we call clinical trials
have to do what we call clinical trials will to put on page
will to put on page
will to put on page big crowns done by other people party to
big crowns done by other people party to
big crowns done by other people party to publish papers and we thought that has
publish papers and we thought that has
publish papers and we thought that has all been done we sent for regulatory
all been done we sent for regulatory
all been done we sent for regulatory which is the FDA the HS a the c e all
which is the FDA the HS a the c e all
which is the FDA the HS a the c e all this we thought they’ll be the end
this we thought they’ll be the end
this we thought they’ll be the end because this is the final hurdle and
because this is the final hurdle and
because this is the final hurdle and then we came out with a pub after that
then we came out with a pub after that
then we came out with a pub after that everything else is in place the doctor
everything else is in place the doctor
everything else is in place the doctor doesn’t accept it the patient loved it
doesn’t accept it the patient loved it
doesn’t accept it the patient loved it the doctor doesn’t accept it because it
the doctor doesn’t accept it because it
the doctor doesn’t accept it because it rocks the board because I don’t know
rocks the board because I don’t know
rocks the board because I don’t know what is it that’s how the true of the
what is it that’s how the true of the
what is it that’s how the true of the doctor if I have learned a little true
doctor if I have learned a little true
doctor if I have learned a little true my years this is 16 years on this
my years this is 16 years on this
my years this is 16 years on this technology
technology
technology I hope tell you something about doctors
I hope tell you something about doctors
I hope tell you something about doctors yeah quite a funny creature the one
yeah quite a funny creature the one
yeah quite a funny creature the one feature that they have is the more
feature that they have is the more
feature that they have is the more ignorant they are the more arrogant they
ignorant they are the more arrogant they
ignorant they are the more arrogant they are so the more you don’t know the
are so the more you don’t know the
are so the more you don’t know the louder he will speak and they have a
louder he will speak and they have a
louder he will speak and they have a problem accepting so he took us another
problem accepting so he took us another
problem accepting so he took us another quite a few years to get the world to
quite a few years to get the world to
quite a few years to get the world to accept and use and put it on the patient
accept and use and put it on the patient
accept and use and put it on the patient okay so I will leave you with a thought
okay so I will leave you with a thought
okay so I will leave you with a thought that is one of my favorite author
that is one of my favorite author
that is one of my favorite author it’s called the illiterate of the 21st
it’s called the illiterate of the 21st
it’s called the illiterate of the 21st century find out century itself becoming
century find out century itself becoming
century find out century itself becoming more and more blood because literally we
more and more blood because literally we
more and more blood because literally we are going to travel across time very fun
are going to travel across time very fun
are going to travel across time very fun will be those who cannot read alright
will be those who cannot read alright
will be those who cannot read alright but those who cannot learn unlearn and
but those who cannot learn unlearn and
but those who cannot learn unlearn and relearn it’s a bit like reflection
relearn it’s a bit like reflection
relearn it’s a bit like reflection refresh and renew thank you
”
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