DEAR DR. ROACH: I would like your opinion about the need to lower blood pressure to the standard 120/80. 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. The theory had been that elevated blood pressure was essential to provide adequate blood flow to critical organs. The term "essential high blood pressure" is still in use, though we often forget the original meaning. However, recent studies, especially the SPRINT trial, have shown that lowering blood pressure below 120/80, even in older people with blockages in the arteries, was associated with less risk of heart attack, stroke and death than a blood pressure of 140/90. Many experts have changed their practice to a more aggressive goal in high-risk patients.

There are several caveats. One is that intensive blood pressure treatment often leads to more side effects, such as fainting and abnormalities in blood sodium levels. 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. Treating blood pressure to below 120/80 with a manual cuff could lead to even higher risk of adverse effects.

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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. If a person's systolic blood pressure is between 120 and 130, I will not usually add additional medications.

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: Trying to stay healthy when you have limited choices is a problem faced not only by people who are incarcerated, but also people in nursing homes and even those who rely on others a great deal, especially for their food.

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. I just don't know how much control you have.

Exercise is as important as diet. Any exercise is good, but more intensive exercise leads to more benefits, and weightlifting exercise has additional benefits on top of aerobic exercise. Five times a day should be more than 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 usual advice I give for people with high amounts of stress, such as fostering close relationships, may seem out of place for a person in prison, while others -- breathing exercises, meditation -- may be helpful for you.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

Editor

I have been editor of the Rockdale Citizen since 1996 and editor of the Newton Citizen since it began publication in 2004. I am also currently executive editor of the Clayton News Daily, Henry Daily Herald and Jackson Progress-Argus.

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