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Variable High Blood Pressure More Likely to Cause Strokes

Four studies in the British medical journals, Lancet and Lancet Neurology (March 10, 2010), show that people whose high blood pressures go up and down are up to six times more likely to suffer strokes than those who have more stable high blood pressures. The greater the variability in blood pressure, the higher the risk. This is astounding because doctors usually reassure people with intermittent high blood pressure and often do not treat them.

• High blood pressure is a powerful risk factor for strokes and heart attacks.
• Lifestyle changes and drugs to lower high blood pressure markedly reduce these risks.
• Blood pressures that vary over time markedly increase risk for stroke.

Ninety-one percent of Americans will have high blood pressure. That doesn't mean that they all have to take drugs. More than 80 percent of people with high blood pressure can control their blood pressures with • a diet with lots of fruits, vegetables, whole grains, beans, seeds and nuts; some fish; and marked reduction in meat, whole milk dairy products, and refined carbohydrates; • exercise; • weight loss if overweight; • reduction of salt intake; • avoidance of tobacco smoke.

What you should do: Buy a blood pressure cuff and check your blood pressure each night before you go to bed. If your systolic blood pressure is above 120, you have high blood pressure and are at increased risk for heart attacks and strokes. If your systolic blood pressure varies from 120 to 135 or higher, you are at greater risk for a stroke, and the greater the variance, the greater the risk.

If your blood pressure cannot be controlled with lifestyle changes, you may have to take drugs. According to these studies, you probably should take a calcium channel blocker plus some other drug. A meta-analysis of 389 randomized trials involving different classes of antihypertensive medications found that calcium channel blockers were most likely to protect against blood pressure variability, whereas ACE inhibitors, beta blockers, and angiotensin receptor antagonists tended to cause wide swings in blood pressure. This explains why calcium channel blockers are better than beta blockers at reducing the risks of stroke when their effects on average blood pressure were the same. A problem is that calcium channel blockers are weak blood pressure lowerers so they almost always have to be given in combination with other drugs to be effective. If you are on blood pressure medication, check with your doctor about these important new studies.

• Calcium Channel Blockers: amlodipine (Norvasc), clevidipine (Cleviprex), diltiazem (Cardizem), felodipine (Plendil), isradipine (Dynacirc), nifedipine (Adalat, Procardia), nicardipine (Cardene), nimodipine (Nimotop), nisoldipine (Sular), and verapamil (Calan) Isoptin.

• ACE Inhibitors: benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril, (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace).

• Beta Blockers: Acebutolol (Sectral), Atenolol (Tenormin), Betaxolol (Kerlone), Bisoprolol (Zebeta, Ziac), Carteolol (Cartrol), Carvedilol (Coreg), Labetalol (Normodyne, Trandate), Metoprolol (Lopressor, Toprol), Nadolol (Corgard), Penbutolol (Levatol), Propranolol (Inderal, Inderal LA), Timolol (Blocadren).

• Angiotensin II Receptor Blockers: Candesartan (Atacand), Irbesartan (Avapro), Losartan (Cozaar), Telmisartan (Micardis), Valsartan (Diovan).

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Dear Dr. Mirkin: Will lower-body weight training make me a better cyclist?

A study from Cowan University in Joondalup, Australia shows that adding resistance leg weight training does not help competitive bicycle racers to race faster (Journal of Strength and Conditioning Research, November 2009).

The cyclists were divided into two groups: one that continued their bicycling training, while the other group did the same cycling training but added a six-week undulating, periodized resistance training program (3/wk). Before and after the six-week training period, the cyclists completed a maximal graded exercise test, a 30-km dynamic cycling test with three intermittent 250-m and 1-km sprints, and a 1 repetition maximum (1RM) squat test for the assessment of lower-limb strength. The weight lifters became stronger and improved their one-repetition maximum squat, but they failed to improve any aspect of cycling. Surprisingly, their final sprint in their 1-km time trials were significantly slower than their previous times.

Cycling is a power sport. Those with the strongest legs are the fastest sprinters. Yet lifting weights made them slower sprinters. Lifting weights with their legs left them too sore to train most intensely on their more intense cycling days, and the faster you ride on your intense days in training, the faster you usually ride in races. Further studies in the future may change the way we think now, but most research show that resistance leg training with weights does not help experienced and well trained long distance cyclists to race faster.

On the other hand, strength training may help some runners run faster. Research shows that strengthening the leg muscles of runners allows them to run faster because they stay closer to the ground and do not waste energy by bobbing up and down as much with each stride. References

Riding a bicycle does little to strengthen the upper body. All riders can benefit from a weight training program to improve upper body strength and give added protection against bone fractures.

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Dear Dr. Mirkin: My wife believes that I will wear out my heart with all my training to run marathons. Is this true?

Researchers from the Athens Medical School in Greece reported that "marathon runners are at risk for high blood pressure and heart complications because endurance training can stress the cardiovascular system." The lead author wrote: "The cardiovascular system is like a sports car engine. If you do not use it, it will decay, but if you run it too fast for too long, you might burn out." (American College of Cardiology meeting in Atlanta, March 15, 2010). She showed that marathon runners who ran 10 to 19 hours a week for two to 20 years have higher blood pressures and stiffer aortas, the major artery to the heart. She recommends that "Endurance athletes should be cautious about the amount and volume of their training programs, trying not to wear themselves out, and always work in close collaboration with their physicians, especially before participating in an intense endeavor like marathon running".

To support these recommendations, she should be able to cite data showing that marathon runners suffer from an increased rate of heart attacks and premature death. I don't believe that she can find any evidence of marathon runners dying earlier or suffering more heart attacks than non-runners.

Dr. Paul Williams of the University of California at Berkeley as followed more than 100,000 runners for 20 years and has shown that training for a marathon dramatically reduces the high incidence of heart attacks, strokes, certain cancers, glaucoma, diabetes, cataracts, macular degeneration, gout, gall stones, diverticulitis, and many other ailments (Medicine & Science in Sports & Exercise, March 2009). Dr. Williams found that running 40 miles per week can lower risk of stroke by 69 percent, heart attacks by 37 percent and diabetes by 68 percent. More

Fifty-year-old men who ran more than 50 miles per week at a fast pace have telomeres (chromosome caps) that are almost the same length as those of 20-year-old runners on the German National Team, and more than 40 percent longer than those or inactive men of the same age (Circulation, December 2009). Shortened telomeres represent aging. More

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Recipe of the Week:

Lemony Lentil-Spinach Soup

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

June 21st, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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