Let’s discuss making medical care cost-effective and boring by starting with one of the basic “6+2 normals.” All can and should have: a blood pressure between 85 and 120 systolic (the pressure being exerted when the heart contracts; the first or top number) and between 55 and 85 diastolic (the pressure in the arteries when the heart is at rest; the bottom or second number). Hypertension affects roughly 1 billion people worldwide and is responsible for 8 million deaths a year, mostly from cardiovascular causes like heart attacks and strokes, heart and kidney failure, and vascular cognitive dysfunction. 

There are two of the graphs that motivated me to get all patients I came in contact with to know their BP’s and if elevated, get it normal or be treated for such. The graphs are from an article published in The Journal of the American Medical Association in 1970 from the VA on the treatment of even mild elevation of diastolic pressure):  

The control group was untreated and suffered three times (50-plus percent) more serious cardiovascular events like strokes over the five-year study period compared to 17 percent in those treated with even borderline effective drugs in that era. We now have more than 150 medications approved to treat high BP. Exercise and waist loss (food choices, portion size and routine stress management are key to waist size) reduce high BP and are first steps to decrease BP.

There are many reasons why exercise is important. Walking just a few extra minutes a day lowers your LDL cholesterol, raises your HDL cholesterol, decreases inflammation,increases your immune system’s

long-term ability to fight infections and cancer, and the size of your brain’s memory center or relay station, among other benefits.

Any amount of physical activity lowers both your systolic and diastolic blood pressure, which are the most important factors in arterial aging. Arterial aging is the aging of your arteries associated with development of heart attacks, strokes, kidney failure and mental dysfuntion, as well as impotence, wrinkling of the skin and just not having enough energy to run as fast and as far as you did in your youth. A recent study found when you exercise might be important to controlling your BP, or at least the speed with which you got it under control. Exercising at night was more effective at lowering BP. Now since so few American’s regularly exercise, I would advocate any time you feel like walking or exercising is fine. 

Researchers randomly assigned 50 men with hypertension, or high blood pressure, to one of three exercise regimens: cycling three times weekly for 45 minutes between 7 and 9 a.m., or doing the same between 6 and 8 p.m., or stretching three times weekly in the morning or evening for 30 minutes. After 10 weeks, researchers found that only evening workouts were associated with meaningful reductions in blood pressure. Men in the study were typically in their early 50s and overweight. Many were taking one or more medications to manage their high BP. 

At the start, their resting systolic blood pressure ranged from 133 to 135 mmHg and their resting diastolic blood pressure ranged from 88 to 92 mmHg. With evening workouts, the average decrease in systolic blood pressure was 8 mmHg and the average decrease in diastolic pressure was 3 mmHg.  

It’s not clear if the results from this study of men would also hold true for women. Because the only exercise tested was cycling, it’s also possible results might be different for other types of exercise. But almost all exercise is good. 

It’s key if you want to live long and prosper, and to have your medical appointments be low cost and boring. Know your BP numbers and do whatever you need to do to get them below 125 and below 85.

Here are three action steps:

• Buy a BP cuff, and read the instruction manual.

• Use it at least once a month at various times. If your BP is greater than 125/85 on any of these readings, schedule an appointment with your primary care provider.

• Do whatever is necessary, exercise, stress management, eating to get your BP to be less than 125/85 all the time unless your doctor says not to. 

Dr. Michael Roizen writes about wellness for the Cleveland Jewish News. He is chief wellness officer and chair of the Wellness Institute at Cleveland Clinic.

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