Alex X-Health.show: 0:00

What happens when you are up there, like, at 3000-4000 metres?

Dr. Josep Solà: 0:03

That's scary. You do not want to know it (laughter).

Alex X-Health.show: 0:05

Hi, I am Alex and welcome to the X-Health.show where I talk to visionaries behind the latest innovations in healthcare. For the eXtra health of the future. We are in Neuchâtel, Switzerland, in a sweet sandstone townhouse where doctors offices were turned into a startup headquarters. My guest today is Dr. Josep Solà, biomedical engineer, scientist and co-founder and CTO at Aktiia. He is one of these people that managed to align their life and work priorities quite early in their career. I guess this fueled him to work for 16 years in optical blood pressure monitoring research, and continuous in a start up. His Aktiia sells now technology that allows patients to control their hypertension effectively. A bracelet that monitors blood pressure 24/7. You will hear about hypertension, why hypertensive patients do not follow doctor's advice, continuous blood pressure monitoring, prototypes, trial and error, and even blood pressure monitoring history that involved... horses. You just surpassed 10 million blood pressure data points in your database. What does it mean?

Dr. Josep Solà: 1:32

It is 100 million, indeed, so it is 10x. What it means, it means that we have a device being used by people. And we have a device being loved by people.

Alex X-Health.show: 1:44

It was 85 million just a couple of months ago or a month ago.

Dr. Josep Solà: 1:48

Yeah, about a month ago.

Alex X-Health.show: 1:50

So why did it grow so fast?

Dr. Josep Solà: 1:54

We started a startup, putting this device on the market about one and a half years ago. And people started buying it. Those that need it continued using it and more people came in. So every day now while speaking with you, every day there are just more people coming in, and people still using it. So the amount of readings that come into our servers just continue to exponentially increase, they just go up and up. Which means that the device just gets better for everyone.

Alex X-Health.show: 2:25

What are the data points?

Dr. Josep Solà: 2:26

A data point is a measurement that is being performed on the wrist of a user. We have these patients and users buying the device, wearing this bracelet on the wrist. And they just get their continuous measurement of blood pressure coming over the day or the night. And they just come to the app every day. Normally, in the morning or the evening, they just come to the app and they want to see how their blood pressure is behaving. And then they take actions based on that. So data point for us is a one single measurement done on a real patient somewhere out there on their blood pressure.

Alex X-Health.show: 3:03

We have one such patient just here. You are wearing the Aktiia bracelet on yourself and guys, for you, it is like a black watch strap, basically...

Dr. Josep Solà: 3:16

Oh, do not call it a watch.

Alex X-Health.show: 3:18

No? What would you call it?

Dr. Josep Solà: 3:20

So mine is black, but we have several colours. It is a bracelet. We do not want to compete against watches. We are in Switzerland, OK, the space is crowded enough, so our goal is not to compete with those watches. Our goal is to have a device that is also on the wrist, can be on the same side as a watch or the other side. It is a bracelet worn by people that is just simply there. So those people acquire it, they start wearing it and they forget about it. And whenever they need to take any action on their blood pressure, change medication, go to the physician to change medication, start doing yoga, changing diet, changing physical exercise, they will simply go to the app and see what happened last day, one week, one month.

Alex X-Health.show: 4:09

Right. So you have your watch on one wrist and your bracelet, several of them, on the other wrist.

Dr. Josep Solà: 4:16

We tend to have several bracelets, here, people working in Aktiia, trying to improve them.

Alex X-Health.show: 4:20

OK, so can we check on your data points, like what data can we actually see from this bracelet?

Dr. Josep Solà: 4:29

Absolutely. So people... they do not see what I am showing you but mainly what it is... I just opened the app and I am showing you the app of my today readings. OK, so mainly what you would see is that since midnight, I was supposed to go sleeping. So when you go sleeping, normally, if you are a healthy individual, your blood pressure should just go down. That is when your heart will start relaxing. So normally when you go to sleep, the blood pressure should go down, should stay down until you wake up. So If you look at my my graphs now, well, you will see that at midnight, my blood pressure was was still very high, or pretty high, it did not go down until 2am. That's when I went to sleep.

Alex X-Health.show: 5:11

So you worked?

Dr. Josep Solà: 5:12

Correct. And you will see that at 6am it goes up again. So mainly what it is saying is that today, I had about two hours of what is called night dipping, we had two hours while my heart could relax, blood pressure went down, the arteries could relax to get ready for the next day. And this, I mean, I am a healthy individual, but for those that are changing or adapting their lifestyle, or changing the medications, going to the physician, this kind of information can help them to decide when, for instance, take the drugs. So if you know that you went to bed at 10pm, but your blood pressure did not go down until 1am, probably the time where the medication was taken to lower the blood pressure was not the right one. So now, physicians, based on these data data, they can start adapting which medication and when this medication needs to be provided to the patients.

Alex X-Health.show: 6:11

So let's go back a bit to the report that you are holding in your hand, what is that? What is the data or what is the information?

Dr. Josep Solà: 6:20

OK, so let's go to the basics. So we all have a heart and this heart's goal is to keep pressure in the blood of the arteries. And that is important because this will make your brain have enough oxygen. And this will keep you alive. Now, we as humans, we tend to be badly designed. And as we get older, our blood pressure will go higher and higher, and higher. And this at some point will be damaging for the arteries of the brain, of the heart, of the kidneys - everywhere. So some people they are better designed, and their blood pressure will stay stay stable until very elderly. But it happens to be that more than half of the adults, when they go above 40 years old, their blood pressure will go too high. There are two numbers of blood pressure. They are called the systolic blood pressure and the diastolic blood pressure. So when you go to the physician, they will put a cuff around your arm that will measure those numbers. And they will tell you two numbers 130 over 90.

Alex X-Health.show: 7:19

All right, so that is the systolic and ...

Dr. Josep Solà: 7:21

Systolic is 140 and then it is diastolic. Now, there are some guidelines, which depend on each country, on where these numbers should be. But in general it is the lower, the better. So it should not go above 140, for instance. So what we are doing is that we are continuously measuring those numbers. In your life, as I said before, when you go to bed, these numbers should go down. When you wake up, they should go up. Now, during the day, as you get stressed as you do physical exercise, they will go up and down. Now, how up and down they go and how much of the time they are above that threshold of risk, that's an important thing. So what we do as a startup is that we deploy devices and services to the users via the app to help them manage their hypertension. So we help them to manage getting those numbers low.

Alex X-Health.show: 8:19

And the curve that is in the report, is it this high blood pressure or low, or both of them? In one point or other two curves?

Dr. Josep Solà: 8:28

What I am showing to you now is two curves are being shown. So we're measuring the systolic and the diastolic

Alex X-Health.show: 8:33

OK

Dr. Josep Solà: 8:34

And we can do this day over day, night over night - for everyone.

Alex X-Health.show: 8:40

Let's go back to this 100 million blood pressure data points. What can you see there?

Dr. Josep Solà: 8:47

That is a fantastic question. So just to give you an idea, until one year ago, the largest data set that existed on blood pressure in the real life was about 1000 data points.

Alex X-Health.show: 9:02

In the world?

Dr. Josep Solà: 9:03

In the world. There was one data set that was done two years ago that went up to... less than 10 million data points. Now we are really exceeding the 100 million data points. What do we see there? – to your point. We see patterns, we see different behaviours based on different kinds of people. With this, we see different behaviour in different countries. So now we know that in countries like Germany, the pattern of dipping of blood pressure when people go to sleep is not the same, overall, than in Switzerland

Alex X-Health.show: 9:41

What are the differences?

Dr. Josep Solà: 9:43

Probably sociological, probably based on habits, based on how much and how you eat, at what time you eat. But there are clearly patterns that are still starting to pop up on how differently the blood pressure of different populations behave.

Alex X-Health.show: 10:01

So is it for example, in Switzerland the blood pressure at night is higher or lower in comparison with Germany?

Dr. Josep Solà: 10:08

We are going to publish this soon, I do not want to just... bring a scoop here. What I can say... just to give one example, I have tested this myself a lot and people here, in the company, they tested it. What we do in Switzerland, we eat cheese fondue. So it is very clear, we call it the cheese fondue effect. You wear the Aktiia bracelet, you go out with friends to have a cheese fondue and you will see that that night your blood pressure will not go down. Because of the very hard digestion of the cheese. During that night the blood pressure will just stay high. Which does not matter. It is not too bad. But if your diet habits contain too much fat by instance, you will be forcing your body to be at high blood pressure night over night over several months, years. And that is the thing that will create cardiovascular risk at the end. So two questions, we see a lot of different patterns based on age, based on gender, based on body mass index, so how much fat your body has, based on physical activity, based on... And those kind of things were not available until now. And now we can start providing hints and advices to those people how to make their cardiovascular risk go lower.

Alex X-Health.show: 11:26

So let's say that you wear the bracelet, your data goes to Aktiia cloud, I can imagine. What happens there?

Dr. Josep Solà: 11:36

So first of all, the data will go into a secured data cloud, where it will be stored. The data will be processed to provide you, you particularly as a person, a feedback on your blood pressure. So now you can act on it yourself. And the data will be also stored in a different server in a completely anonymized way. So that we can use it to create these kind of population analysis. So on your side, the first one that will take a benefit of this data is yourself. Now, I mean, you know that in the market, there are already these heartrate monitors on the wrist, take any smartwatch, you can measure your heart rate, which is fantastic. But anyone could measure heart rate alone, you just put your fingers on your neck, or you put your fingers on your wrist, and you can feel my heart going too weak or too slow. For blood pressure, there is nothing like that. So you and we are all living with our own blood pressure day over day, but we have no way to feel if it is too high or too low. Now, can you imagine if we start giving you every time you want it a feedback on if it is too high or too low. So now you can see, OK, it is too high. But probably I was not doing any exercise for the last one week, and I was eating every night a cheese fondue. This can explain it. But if we do not give you the data, you do not know what you need to change.

Alex X-Health.show: 12:58

Right. So I had this episode like a couple of months ago, like I felt there is something with my blood pressure, and what I did, I was checking my blood pressure with this electronic cuff monitor. So basically, you need to take it out and put it on yourself. I mean, I can imagine like if someone has continuously issues with hypertension, this can be problematic. And each time you need to sit down, you need to put it in the right place, right...

Dr. Josep Solà: 13:26

And it will only measure when you do that measurement. But your blood pressure is not only that moment, your blood pressure is something that changes continuously. So the only way to get a real idea of whether it is too high or too low, is to have these kinds of what we call 24/7 measurements. We do not need to measure continuously, we do not need to measure it every second, we just need to have enough measurements during the day and during the night to give you a feedback, saying, look, something seems to be going wrong, now it is time to go see your physician and change medication, or start having a more healthy diet, or do more exercise. And you can start playing with each of those and you will see which of those interventions will really lower your blood pressure.

Alex X-Health.show: 14:12

Who is it for? Because I can imagine, I mean, it is for everyone, right? We can say for everyone who wants to know about their body, right? If someone is curious about, you know, the quantified self. But I can imagine you deviced it for some people in mind.

Dr. Josep Solà: 14:30

All the quantified self people, they were the first one buying the device, which is cool, it is fine. But those are not the people that need it more. So who is it for? It is for everyone who is on the way to become hypertensive or who is already hypertensive. Hypertensive mean someone who has been diagnosed with too high blood pressure. Just to give you an idea, 50% of the adults above 50 something years old, they go into the hypertensive space. So they will be living with that, it is fine, and they will be 60, and they will still be hypertensive, if they do not do anything, which is fine. When they will go to the 60+ or 70, that is where strokes will start, heart attacks will start. So the sooner these people start managing and empowering themselves to change, to lower the blood pressure, the less the risk of that stroke happening at the 70s will be. So it is for everyone who has gone above the 40s, 50s, and wants to start managing the blood pressure.

Alex X-Health.show: 15:44

Well, data says the number of people with hypertension is growing and growing continuously, right. How many people are there now in the world...

Dr. Josep Solà: 15:54

It's over 1 billion people who are hypertensive. And what is scary is not the number of people hypertensive, it is the number of people that are hypertensive but are not under control. And this one is increasing even more. So we are all getting older, so the population is just getting older, our lifestyle, it is, in most countries, not improving in terms of cardiovascular health, so the amount of people that are going not under control in high blood pressure is just increasing. Which will have a dramatic impact in 15 years from now. So if we do not start now taking advantage of the fact that we can control blood pressure and do it, the consequence will be 15 years from now, where the amount of strokes and heart attacks will just exponentially increase.

Alex X-Health.show: 16:46

And what do you mean by "not under control"? They do not go to a doctor to check on their hypertension or...

Dr. Josep Solà: 16:55

It can be two things. First is that most patients which are hypertensive, they are not aware they are. So that is the point, people which do not know they are hypertensive, so they do not do anything. The second one, which is even more scary, is, people that are aware but they do not really care. And that is why hypertension is called the silent killer. So it is a disease that is on ourselves, but we do not feel it. So they have been once diagnosed hypertensive by a physician but since in the daily life it does not change anything in their behaviour, they do not want to change that behaviour. So they do not care. So they do not take any action and 15 years after that the will have the first cardiovascular event. So hypertension – there are two components of it. One of it is genetics, some people... we are more ready to be hypertensive like myself, I know from my family. So there is a family history of hypertension, hypertension means that the likelihood that you will be hypertensive is higher. But the second component is lifestyle. Dozens of things that we can do to go back to a healthy life. Very easy, healthy life, that will prevent hypertension. And these are the preventive parts. So we can easily start as humans being over 40, 50 to do those things which are very easy. So if so, if no one is telling us, look, you should be doing them because you are really going to the red side of things, you are becoming hypertensive, if you are not being told that, there is no reason why you would do that thing.

Alex X-Health.show: 18:41

You know that I was actually on the island where there are no strokes, and no coronary heart diseases. That is in the Pacific Islands, on Trobriand Islands. And actually, that is the place where some medical doctors did some research, and that is the lifestyle that feeds into this, these healthy habits. So these are people who eat a lot of tubers, like potatoes, sweet potatoes, yum, cassava, then, during the day fruit, sometimes fish – not too much. And yeah, in the evening again tubers. And physical work, loads of physical work. I mean, people are really muscle and bones basically.

Dr. Josep Solà: 19:37

And it works. But that being said, this will not work for everyone. And for sure there are some people on that community that are also hypertensive because they have this genetic bias to be habitant.

Alex X-Health.show: 19:50

But this is what I am saying, the doctors who did the research, they did not find them, OK. Quote unquote"stroke and ischaemic heart disease appear to be absent in this population".

Dr. Josep Solà: 20:04

So we should all move there! (laughter)

Alex X-Health.show: 20:08

Yeah!

Dr. Josep Solà: 20:09

There are so many factors that play a role in hypertension that we cannot control of all of them. That island does an amazing one, I did not know that case. But us here in Switzerland, there is a mixture of things, which is genetic, and which is behavioural. So let's start looking at them. And let's start finding for each particular person out there, which is the thing that he or she can do to start getting under control. And there are a lot of things, we just need to inform people. Look, you started doing this thing and that intervention really worked for you. So let's keep doing that.

Alex X-Health.show: 20:45

Yeah, so exactly, was it that meeting during the day? Or was it the fondue in the evening? Right?

Dr. Josep Solà: 20:50

Yeah, that's it. I mean, if you go to the physician and he is telling you, look, you start to become hypertensive, you should do... He will give you a list of 12

things to be done: 21:00

stop smoking, stop alcohol, stop eating too much fat, do exercise, do yoga, blah, blah, blah. A lot of things. You will never do that. And you will not know which of those, if it works, was the one that work. So we just see with data, control of blood pressure is getting worse because people are not empowered by themselves how to manage that thing.

Alex X-Health.show: 21:28

Are you speaking about your research, right? How do people actually control or not control...

Dr. Josep Solà: 21:33

Correct. It is part of our research, it is part of also international research on the same topic. The lack of control today, of blood pressure, is mainly due to the lack of awareness, and the lack of engagement. So patients that are being diagnosed, they are being said, do this, those things and take all those pills, and then they are left alone for one year at home. How the hell these guys they will do all the things? They will need to change their life! They will not do it.

Alex X-Health.show: 22:02

Why they would not?

Dr. Josep Solà: 22:04

Because they do not feel it. They just do not feel it. I mean, when you go into the diabetes, it is different. If you do not treat your glucose with insulin right now, you will faint. So there is a reward for to you to do the right thing now.

Alex X-Health.show: 22:19

And an immediate one.

Dr. Josep Solà: 22:20

Correct. For hypertension, the final damage is as worth as it is, because in 10 years from now, you might be dying, but today, there is no reward for you to do it. Apart from that in one year from now, your physician may be blaming you because you did not take the tablets that you need to take take. So that is really the hypothesis behind Aktiia. We want to provide day to day feedback to every hypertensive patient to keep them engaged and empowered in whatever they do to maintain their blood pressure at low levels.

Alex X-Health.show: 22:58

Is it for patients only, or can I share it with physicians?

Dr. Josep Solà: 23:02

It is for both. So the target number one is the patient, he is the one living with his or her body, he is the one that needs to take care of the body. And he is the one that needs to be rewarded by something good that is on his or her body. But then, for those that became really patients, which are really hypertensive, at some point, if the change of lifestyle did not work, they will need to go to the physician and get under drugs. So that is the interface where the physician needs to step in, and needs to get the data presented in a way that he or she can start treating the patient. So to your point, it is for both. But the first interface and where 80% of the things will happen, it is the patient.

Alex X-Health.show: 23:47

You were mentioning he or she - do you see in your data, the users are mostly men or women? How is that divided?

Dr. Josep Solà: 23:56

Today what we see as a trend is that there are more males than females getting the device.

Alex X-Health.show: 24:02

How does it translate to the cardiovascular diseases?

Dr. Josep Solà: 24:06

A lot. So males... we tend to be... I am trying to be politically correct, we tend to be genetically worse designed. So males we tend to go into hypertensive status earlier than female. So a higher awareness of hypertension among males than females. And that is why there are more men buying our device than women today.

Alex X-Health.show: 24:39

[MID-ROLL BREAK] This episode is brought to you by the X-Health.show and me so if you like this podcast, be generous hit follow, leave a review. That'll help me invite more such amazing guests for you. Thank you. How did you get into optical blood pressure in the first place?

Dr. Josep Solà: 25:02

That is a long story.

Alex X-Health.show: 25:04

It started a long time ago, right?

Dr. Josep Solà: 25:06

In my case, I started working on this almost 20 years ago. So I am coming from a family of hypertension history. So most of my family has been and is still today under drugs. So I was really exposed to that problem. I know where it is. And I know, the how anxious they were one week before going to the physician, because they knew they did not take the drugs as they had to. So the blood pressure was still too high and they will be blamed for that. So since a child I have been exposed to that.

Alex X-Health.show: 25:41

And then there was also this white coat hypertension, at the doctor's office, right?

Dr. Josep Solà: 25:47

Yeah. Even at home. I could see my mom getting just nervous thinking about, she was going to take the device from that cupboard, put it on the table, she was already stressed and panicking just because of the fact that she had to measure her blood pressure. So I have been living with that, which happens in most families, since a child. Then I moved into engineering, I moved into telecommunications, signal processing. And at some point, I decided, what could I do to take those techniques that are well known in signal processing, so treatment of data, for antennas, and for radio communications, for my family. So that is where I moved into a Swiss Centre of Research, which is called CSEM, in Neuchâtel, where they were starting these kinds of... using optical sensors for new things. That was far before any smartwatch existed, really far before, that was in 2004. But that group at CSEM were starting to explore what those sensors, if ever, could be used to manage cardiovascular things.

Alex X-Health.show: 26:56

So they already were thinking about cardiovascular diseases?

Dr. Josep Solà: 26:59

Yes, that was a highly pioneering work done here in Neuchâtel in the 2000s.

Alex X-Health.show: 27:04

So you basically found them, or someone, like a professor told you about them, because you were searching for...

Dr. Josep Solà: 27:11

I was literally looking for research groups that were working in cardiovascular new things, close to the Alps. Because I wanted to get close to the Alps. So I found Neuchâtel. And these guys had a lot of publications somewhere about early use of optical sensor for cardiovascular things. So I just conducted them. I got my position here. So I came here in 2004 and that is how I started working on this.

Alex X-Health.show: 27:37

And I read that the first research was about fingertip and the chest.

Dr. Josep Solà: 27:42

Yeah, look, by then, again, there was no smartwatch available. So now it is kind of obvious, let's go to the wrist. But then we had no clue. So literally, what we did is we filled ourseves first with sensors everywhere. Just think any part of your body, so we tried to attach optical sensors there. And we try to get first data sets on which of those parts could even have any relevant information

Alex X-Health.show: 28:11

Could we go one step back, how does the technology work? The optical technology. What is it called? How does it work?

Dr. Josep Solà: 28:21

OK, the name is a pretty difficult one. So it is called PPG, which stands for photoplethysmography. You do not need to repeat that.

Alex X-Health.show: 28:29

Thank you.

Dr. Josep Solà: 28:30

So mainly what we do is the same thing you get in any smartwatch today. What we do is that we have a very small light source, it is called an LED, that is injecting light into your skin, it does not hurt, you do not feel anything. So this light goes into the skin, this light will find arteries in the skin that will be pulsating, so changing the diameter at every heartbeat. And some of this light will manage to go out of the skin again. And then we capture that light. So every time that the light has found that artery pulsating, it will change its intensity, its colour, it will change a lot of things. So when we capture that light back from the skin, we will see the things that the artery has done to that light.

Alex X-Health.show: 29:17

So the light, basically, is bouncing back and it is changed after that.

Dr. Josep Solà: 29:21

Correct. It is called backscatter. So it goes down back to the skin, and it has changed its amplitude and its colour. And out of the analysis of the change of amplitudes of colour and colours, we can get a lot of things, like blood pressure.

Alex X-Health.show: 29:36

OK, so you started at the chest and the fingertip and you were looking all over the body. How did you end up at the wrist and why?

Dr. Josep Solà: 29:43

OK, that is a fantastic one. This thing, and this photoplethysmography technique could work everywhere, literally. Now, that is where the difference between academics and startups or industry come. So we could have a perfect sensor placed somewhere at the chest, for instance, or at the forehead. Now, would you ever wear a sensor on the forehead?

Alex X-Health.show: 30:09

Like a band(laughter).

Dr. Josep Solà: 30:11

Correct! You would not! You would never do that. No, you would not. So that is where applied research and then going into a startup mode plays a role. So we decided to optimise, which will be the perfect location of a sensor that could provide accurate information. And most importantly, people would be willing to wear. And the most obvious thing, and all the research we did was obvious, the result is that the wrist is the best place. It is a kind of a real estate problem because wrists are being used for other things, like wearing a watch. But still, we can ask anyone in the street, and we see it with our data, to wear a bracelet. And it is easy. And they will use it for years as we see with our data. But we could not ask them to have a device on the chest every day and every night for the next 20 years. They will not do it. So we did a compromise in what is the best place that people are willing to use or to wear a device on. And that still provides the relevant information to manage their blood pressure and provide data to the physician. And that one is clearly the wrist.

Alex X-Health.show: 31:27

So you did the research for like, how many... like 15 years?

Dr. Josep Solà: 31:31

That was 15 or 16 years, yes.

Alex X-Health.show: 31:33

And then you decided, it is ready, we have got the products. What was that time like? Why then?

Dr. Josep Solà: 31:41

It was not exactly like that, no. So let me change the perspective. We had, after 14 years of research, the first hints that this could work. And we started pitching this around. We literally went to all big biotech companies, as a Swiss Research Institute, we wanted them to take licence to those technologies. What we got as an answer from them, is that, we do not need that, there are already devices, which are these cuffs, available, we do not need that, it is fine.

Alex X-Health.show: 32:17

But a cuff is something else, isn't it?

Dr. Josep Solà: 32:21

But from their perspective, and this is the problem with these legacy companies and institutions, that they were already in the market. They already were selling devices, they did not want to break through that thing, they did not want to change the domain. So what we saw is that we knew this had a huge potential. We knew this is feasible but no one really cared about it. But every time we discussed this with patients, because we had clinical trials ongoing, they were all like, wow, can I take this home? Can I use it? And we were like, you know what, it is still not commercial, we cannot give it to you out of the clinical trial. So there was this, this mismatch between the patients that wanted to use it and the big biotech or med-tech companies saying, we do not want to deploy this, we do not need it. So at that point, we decided, OK, let's take it ourselves. Let's pull it away from the research institute. Let's get venture capital money into that so we can grow at the speed it should grow. And let's start a startup. And that is how Aktiia started. Aktiia started as a decision to... let's take the potential of this technology and make it as big as it can be.

Alex X-Health.show: 33:40

How did the product change during the research years? Or how did the bracelet maybe changed?

Dr. Josep Solà: 33:49

It was not even a bracelet at the beginning. So I said we started at the chest, at the forehead, different parts, I do not want to name all of them...

Alex X-Health.show: 33:56

So these were like bands, right?

Dr. Josep Solà: 33:57

Bands, patches, things that we were really attaching to the skin. The first one that we had at the wrist, we call it Shrek. Because it was big and ugly.

Alex X-Health.show: 34:10

And green!

Dr. Josep Solà: 34:11

Yeah, and it was shining green light, we have one of those at the office, I can show you afterwards. So we still call it Shrek, it was very huge. And you could only use it for one day, no – half a day, then the battery was off. So they were not commercial devices. They were just prototypes, and we tested, pff, about 20-30 of them. Then when we started Aktiia as a company, then the mission of the team that we started building here was... let's take the basic things of that bracelet and reduce them to the minimum amount that needs to be used for a real device. And that is how the bracelet become smaller, smaller, and smaller,

Alex X-Health.show: 34:49

Were you also reducing features available on the device or...

Dr. Josep Solà: 34:54

Correct. So we really went to the very basics. Since we started the company, let's say, every day we get inbound messages from physicians and different groups saying, oh, can you also measure this? And can you measure this? And that? And that? And the answer is, yes, we can. Because it's optical sensing, the PPG can measure a lot of things. But we will not. So the hypertensive space, and that's something for startups very important, this space is so big. And the problem is so unsolved, that we prefer to focus on one single and unique thing, let's measure blood pressure right than dispersing. Because we are really being pulled in any direction every day, but the only way we can survive and do the things right is to focus on one single and unique thing. And that's how we really reduce everything else, remove any feature reduce any part of the electronics of this device that was not for blood pressure, and have a final device that can be used in real life.

Alex X-Health.show: 35:58

Wasn't it tempting to have more? And what could that be?

Dr. Josep Solà: 36:05

So to the first part of your question, yes, it is tempting everyday. I mean, I am still a researcher, so I still want to try that because it is so cool! But we have a limited number of hours per day, I showed you my blood pressure curves of last night – we do not sleep a lot. We have a limited group, so we better focus on doing one thing right than disperse. So at the end, we will see what we can do in the future. But as for today, and for the next many, many years, until we managed to deploy at the humankind scale, this technology, so that we can reduce the burden of hypertension, we will only focus on that.

Alex X-Health.show: 36:45

You mentioned that you wanted to move closer to the Alps. Why?

Dr. Josep Solà: 36:50

Oh, that is a personal thing. But I love climbing, I love skiing, I love these kind of mountain activities, so I wanted to find a balance between doing research and climbing out there.

Alex X-Health.show: 37:03

What happens... because I am pretty sure you are wearing the bracelet when you are climbing, what happens when you are up there, at 3000-4000 metres?

Dr. Josep Solà: 37:11

That is scary, you do not want to know it.(laughter)

Alex X-Health.show: 37:14

Tell me(laughter)

Dr. Josep Solà: 37:15

So while climbing or skiing is like doing sport here, close to the lake of Neuchâtel – your blood pressure will go up, which is normal, I mean, you do exercise, your muscles need more oxygen, so your heart will start pumping quicker, faster, that is what you feel with the heart rate, but also the blood pressure will increase. The scary part is during the night. So during the night... I said your blood pressure should go down during the night. That is the way your heart can relax and can be ready for the next day. When I am sleeping in a hut somewhere at 3000 metres or so some of my friends or clients are up there with me... We have tried to measure with Aktiia bracelet the blood pressure. What happened? It does not go down.

Alex X-Health.show: 38:02

So it is all up up there?

Dr. Josep Solà: 38:04

Yeah and it will stay there. So I mean, normally, when we go in the Alps up to a hut, we stay there for one, two nights, three nights maximum. We do not stay for one week, two months. That is the thing that will happen if you go to the Himalayas, for instance, that you will be at very high altitude for a very long term. And at every night, your blood pressure will not go down. And that is where hypoxic... so problems with lack of oxygen will start, is that you will get into big problems that will force you to go down.

Alex X-Health.show: 38:37

But wait, you are speaking now about staying up in the mountains for the night, not going back down.

Dr. Josep Solà: 38:43

Correct. So the thing is that you can have one night with your blood pressure which is high, like eating a cheese fondue – this will not kill you. At least not today. But if you repeat this every night of your life or for the next one month, something will start there. That is not good. So what we see, to your point, what we see is that using our bracelet, I see it myself, is that every night I am sleeping up there, my blood pressure will be as high during the night as if I have been eating cheese fondue.

Alex X-Health.show: 39:12

Well, that is scary indeed.

Dr. Josep Solà: 39:14

The worse, and that is to your point, is what if you eat the cheese fondue in the hut. (laughter) It will still go up. So, really, your blood pressure is very important. The night dipping thing is very important. You want your blood pressure to go down during the night. If it is not the case, you need to figure out what is the problem. And if you are in a hut, it is easy, just go down. If you are at home and it never goes down during the night, you should find out what is the problem there.

Alex X-Health.show: 39:40

OK. Now, where is it available, Aktiia? You said you started expanding, right? So where is it available now? And yeah, what are your plans?

Dr. Josep Solà: 39:54

So literally now it is available in 6-7 countries across Europe.

Alex X-Health.show: 40:00

You have already mentioned Germany, Switzerland.

Dr. Josep Solà: 40:02

Switzerland, Germany, Austria, UK, Ireland, Italy. I think that is all. I am not a commercial guy here. Now we are just expanding to more and more countries across Europe. And the thing is that we are still a pretty small company, so it just takes time to expand the market. But what we see, it is very clear, in each market that we go to, in each country, as we go the demand is so high that we cannot even follow it. So there is a clear attraction from the patients, they want to have these.

Alex X-Health.show: 40:36

So you sell it already online, right?

Dr. Josep Solà: 40:40

Now it is sold online. It is more than enough. So we have our website, people that come to the website they buy it there, they get it at home.

Alex X-Health.show: 40:49

Are there any challenges in introducing Aktiia device?

Dr. Josep Solà: 40:54

A lot.

Alex X-Health.show: 40:55

What are they?

Dr. Josep Solà: 40:57

OK, let's start with the first one. As I said before, patients and users, they love wearing that.

Alex X-Health.show: 41:04

So there is enthusiasm from the patients.

Dr. Josep Solà: 41:06

There is a lot traction there. Now the biggest challenge... so patients they want to wear it. Experts in hypertension, they love the idea. They love the idea that finally they could have patients engaged, and they could have this kind of continuous data. In the middle, so in between those patients and those experts, each of those in each country, there is the family doctor, the physician. Those elements of the chain... they have been trained at med school, using regular cuffs. So they have learned how to treat hypertensive patients, measuring once a year. And that is what they know what to do. They do it as well as they can.

Alex X-Health.show: 41:54

That isa huge difference – once a year. And how many times a day can you do it with Aktiia?

Dr. Josep Solà: 41:59

Normally we do it about 30 times a day.

Alex X-Health.show: 42:02

So there is a huge difference.

Dr. Josep Solà: 42:04

It is an exponential difference. So to your point, what are the best, the biggest challenges we have now, it is how can we best educate those people, so those physicians, family doctors, those that are interfacing with the patients every day, to use this data. So there is a lot of clinical evidence that this continuous monitoring makes sense. This comes from the experts, there is a lot of traction of users that they want to measure their blood pressure if they use an active device. But now, if the physicians, so those that will prescribe the medications, they still do not know how to use it, something is broken there. So the biggest challenge now on our site, I mean, not only Aktiia - all the companies working in this space- the biggest challenge is how we will manage the quicker as possible to educate those family doctors. How to handle this data? And how to better make use of this to improve the cardiovascular outcomes of the patients.

Alex X-Health.show: 43:07

What do they measure blood pressure with? What are the current devices they use?

Dr. Josep Solà: 43:13

So most of the physicians, they still measure at the office. So imagine you are a person, you are a human being, your blood pressure is changing continuously over one year. And now, today, you need to go to the physician, today you will be sitting there in front of that guy with a white coat, who will be putting a cuff squeezing you arm... Do you really think that the blood pressure you will get there really represents your blood pressure of the last one year?

Alex X-Health.show: 43:43

Especially that I ate fondue last night.

Dr. Josep Solà: 43:47

Correct. And you are extremely stressed. It is called the white coat effect, because you will be extremely stressed. So to your question, they measure the blood pressure using a cuff, with them sitting in front of you and asking you to be quiet and relaxed. Can you imagine... (laughter)

Alex X-Health.show: 44:05

(laughter) Just sit still, do not move, be quiet...

Dr. Josep Solà: 44:08

and relax, yeah. That is a reality today. I mean, it is not their fault. That is the best thing they were providing some years ago. But now we know there are different ways of doing it. So our challenge is to convince them or to explain them, or make them hear to the patient that there is a new way of doing that. And that new way will give them more insightful data.

Alex X-Health.show: 44:30

And how did we go from these mercury devices through electronic ones to the optical ones? Like, the history of measuring blood pressure.

Dr. Josep Solà: 44:41

That is a fascinating one. So I will give you the two minutes summary because it can be very, very long. So everything started about three centuries ago when a monk, a guy in France, decided to measure the blood pressure of a horse.

Alex X-Health.show: 44:58

A horse?

Dr. Josep Solà: 44:58

Yeah, so, literally, he put a glass tube inserted into the artery of the horse. But it was a long glass tube and he saw that blood was going up but it did not go out at some point, it stopped. So he understood that there was a given pressure of the blood. If the pressure was infinite, it would just go out of the tube. But it stopped at some point. So he started measuring the blood pressure of horses, by looking at how high did the blood go up in that tube. So a horse with a higher blood pressure would have a tube which was filled higher up. Now, that was not very practical. So then he started changing. Instead of just getting the blood going up, he was putting mercury, which is a very dense material, into the tube. So then he started measuring how many millimetres of mercury the blood was going up. So that is why still today we measure blood pressure in the unit which is called millimetres of mercury. Because of that guy measuring blood pressure of horses, inserting tubes into the arteries of those horses. That was until one century ago. Then the first cuffs started coming. And those cuffs still needed a physician to the measurement. So they were squeezing the arm of the patient and they were measuring with a stethoscope, so with the device to hear the sounds of the arteries on the same arm.

Alex X-Health.show: 46:21

Now, this is how my grandmother was also measuring her blood pressure.

Dr. Josep Solà: 46:24

And that is still the gold standard today. So that is still how it is considered to be the most reliable way to measure blood pressure, which we kind of disagree. Then in the 80s, there were these new electronic devices that can... they are still squeezing your arm but you can use these alone at home. So you do not need to go to the physician. So if you are engaged enough, you could measure these everyday at home at least once a day. And then the next chapter is our chapter. It is a chapter of cuffless. We call it cuffless, so without a cuff, cuffless optical devices. And they started about 20 years ago, and the first commercial devices... indeed, the first one in Europe today is the Aktiia device, which was less than two years ago.

Alex X-Health.show: 47:08

How much are you worrying about competition?

Dr. Josep Solà: 47:11

I would love to have competition. So, look, as I said, our problem is not market traction. We have a lot of market traction. Our problem is to convince and to educate the physicians to start using it. But doing it alone is a very difficult task. So we'd love to have ten more competitors now in the market but no one has ever figured out how to do it yet.

Alex X-Health.show: 47:36

So it is not too crowded.

Dr. Josep Solà: 47:38

It is not crowded at all, we are alone. So we are literally alone selling devices, what we call, over the counter, so everyone can buy them. In Europe today, there is no one else. So we would love to have a lot of them. Now, the competition will come some day, hopefully and we will just share the space. There is over 1 billion patients around this world. So I think there is enough space for everyone here.

Alex X-Health.show: 48:08

What are the next steps and for Aktiia? You mentioned publishing the paper...

Dr. Josep Solà: 48:13

We have a lot of papers to be published.(laughter)

Alex X-Health.show: 48:16

You already published a lot of them, right?

Dr. Josep Solà: 48:18

We just published a lot, we continue to publish a lot of papers. And we are publishing a lot of papers on how we validate and we make sure that the device performs properly. But now, when you think about how many tens or thousands of data points come to our servers every day, and you think about how much insights on understanding blood pressure are coming to us...

Alex X-Health.show: 48:42

I can imagine you employing more researchers...

Dr. Josep Solà: 48:45

Correct. So we should be 200 scientific writers now preparing papers, it just is becoming so huge. So the next steps for us, to your question, is we want to continue to deploy it, to make sure that as many patients that need it, they have the device today on their wrist. And we need to continue to educate the in-the-middle physicians, so the family doctors, how to use these to treat their patients better.

Alex X-Health.show: 49:15

And the papers that are you going to publish, can you say something about the the upcoming ones?

Dr. Josep Solà: 49:22

You will need to wait. (laughter) That is our scoop. So we have a backlog of papers of data coming. Just keep tracking our website. So we keep putting everything in there. It is aktiia.com.

Alex X-Health.show: 49:35

And Aktiia is spelled with double 'i', right.

Dr. Josep Solà: 49:38

Yeah, it's A K T I I A .com And that is where we also push all the papers. So we invest a lot of our resources, money, into those scientific dissemination activities, because we think it is important, and that is so cool. So we are really, we are literally having and creating a new corpus of scientific data that did not exist in the past. So it is very cool to be the first ones to use our data and look at ourselves, our bodies from a different perspective.

Alex X-Health.show: 50:09

That is fascinating. And, Josep, thank you very much for this fascinating conversation.

Dr. Josep Solà: 50:14

Thanks to you.

Alex X-Health.show: 50:15

And yeah, I'm looking forward to reading the papers.

Dr. Josep Solà: 50:19

Of course, just keep tracking us. Thank you very much.

Alex X-Health.show: 50:21

Thank you.[POST-ROLL] I am totally impressed by the audacity of researchers turned startup founders, doctors turned entrepreneurs, ordinary parents turned healthcare innovators. People battling the battles that no one fought before. For the eXtra health of the future. So if you see a startup posting on LinkedIn, show them some love, hit like, comment, that's fabulous. If you have a couple drops more of that altruism, follow the X-Health.show, leave a review here. I'll be able to bring more of these visionaries to you. So a big thank you. You are awesome. See you next week.

SPEAKER: 51:05

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