There’s no consensus on best BP goal

Dear Dr. Roach: I read the following in a scientific article: “Older people with preexisting vascular disease or circulation deficits, however, often need higher systolic pressure (around 130-140 mmHg) to ensure adequate circulation to their brain and kidneys.” Is this true?

R.I.

Answer: There remains debate about the optimal blood pressure goal in different patient populations. Recent studies, especially the SPRINT trial, have shown that lowering blood pressure below 120/80 was associated with less risk of heart attack, stroke and death than a blood pressure of 140/90.

There are several caveats. One is that intensive blood pressure treatment often leads to more side effects. The second is that the blood pressure readings in the SPRINT trial were obtained by automatic devices, and a manual blood pressure reading done in most offices is about 5-10 points lower, on average, than with the automated machine.

Given those caveats, I try to bring the blood pressure down to below 130 if the side effects from medicines are not too bad and the blood testing is OK.

Dear Dr. Roach: What can I do to stay healthy in prison? We don’t really get a good choice of food, but I try to eat as healthy as possible.

My stress level is kind of high due to being on lockdown. I exercise five times a day.

A.M.W.

Answer: You’ve identified three major factors that affect health: diet, exercise and stress.

While I understand you have to choose from limited options, a simple rule of more vegetables, legumes, fruits, whole grains and fish is better. Less processed meat and less sodium are best if possible.

Exercise is as important as diet. Five times a day should be enough time to get a good amount of exercise, even if the time per session is limited.

Stress seems like something that you will have difficulty controlling. Some of the advice I give for people with high amounts of stress, such as breathing exercises, meditation, may be helpful for you.