Blood pressure with exercise

27. April 2007 William Davis (10)
Here's a frequently neglected cause for an increasing CT heart scan score: High blood pressure with exercise. Let me explain.

Paul's blood pressure at rest, sitting in the office or on arising in the morning, or at other relatively peaceful moments: 110/75 to 130/80--all in the conventional normal range.

We put Paul on the treadmill for a stress test. At 10 mets of effort (on the protocol used, this means 3.4 mph treadmill speed at 14 degree incline), Paul's blood pressure skyrockets to 220/105. That's really high.

Now, blood pressure is expected to increase with exercise. If it doesn't rise, that's abnormal and may, in fact, be a sign of danger. Normally, blood pressure should rise gradually in a stepwise fashion with increasing levels of exercise. But any blood pressure exceeding 170/90 is clearly too high with exercise. (Not to be confused with high blood pressures not involving exercise.) A handful of studies have suggested that a "breakpoint" of 170/90 also predicts heightened risk of heart attack over a long period.)

I see this phenomenon frequently--normal blood pressure at rest, high with exercise. This also suggests that when Paul is stressed, upset, in traffic congestion, under pressure at work, etc., his blood pressure is high during those periods, as well. I wouldn't be surprised to see other phenomena of underappreciated high blood pressure, like abnormally thick heart muscle (left ventricular hypertrophy), an enlarged thoracic aorta (visible on your heart scan), left atrium, perhaps even an abnormal EKG or abnormal kidney function (evidenced by an elevated creatinine on a standard blood panel).

Unfortunately, the treatments that reduce blood pressure are "stupid," i.e., they have no appreciation for what you are doing and they reduce blood pressure all the time, whether or not you're stressed, exercising, or sleeping.

Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

The message: Watch out for the blood pressures when you have a stress test. Or, if you have a friend who is adept at getting blood pressures, get a blood pressure immediately upon ceasing exercise. It should be no higher than 170/90.
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Comments (10) -

  • Anonymous

    11/7/2007 8:57:00 PM |

    Dr. Davis,
    Sorry, this isn't about high blood pressure and exercise.  Do you believe there is a connection between high blood pressure and tinnitus?  Also, do you think that there are any vitamins or minerals that could relieve tinnitus?

  • Dr. Davis

    11/7/2007 10:02:00 PM |

    I know very little about tinnitus. However, I have seen some people get relief with niacin (immediate-release).

  • Sara

    5/5/2009 11:02:00 PM |

    Dr. Davis:

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop, or a slight rise in systolic but a slight drop in diastolic, even with moderately vigorous exercise; my doctor doesn't think it's a concern (he's only worried about it being high, and I run 115/75 on average when just sitting around), and I haven't been able to find anything on my own. I'd like to know more about what conditions it can signal, and that I should therefore ask my doctor about specifically.

  • blood pressure medications

    8/19/2009 9:02:48 AM |

    What's the significance of blood pressure that does NOT increase with exercise? I frequently experience a slight blood pressure drop,High blood pressure cure supplement, natural herbal remedy to lower & control high blood pressure. Use Alistrol everyday to help maintain healthy circulation and support cardio-vascular health.

  • Anonymous

    6/20/2010 8:06:42 AM |

    Just chiming in on the enzyme called serrapeptase. I have the capsules and only use it when any of my dogs get bitten by a centipede. As soon as they come into the house squirming and licking the bitten paw, I give them one capsule and w/in a few minutes, they stop squirming and licking and fall asleep. So I think it works even if the stomach acid might destroy some of it. BTW, I used to take 1000 mgs of bromelain at night before bed and once when I was taking it regularly for about a week, I took a cholesterol lab test and my results came back showing a big decrease in my LDL and Total cholesterol numbers. The only change I could think of that might have caused the decrease was taking the bromelain.

  • Brian

    9/15/2010 10:26:52 AM |

    I have the same problem as Paul. Low/Good blood pressure while sitting around, but extremely high blood pressure after/during exercising, going up stairs, playing the trumpet, etc.

    Although I understand and agree with all of the natural remedies you listed for lowering blood pressure (exercise, lower carbs, etc), why do you recommend low saturated fat intake? Are there any sources/studies that indicate that saturated fat has a direct effect on BP, and if so, that it's a bad thing? And would these studies take into account other variables such as carbohydrates and trans fats?

    Any information you have would be GREATLY appreciated! Thanks.

    Brian

  • buy jeans

    11/3/2010 3:11:53 PM |

    Blood pressure reduction should begin with weight loss, exercise, reduction of saturated fats and processed carbohydrates (esp. wheat), magnesium replacement, vitamin D replacement. Think about CoQ10. After this, blood pressure medication might be necessary.

  • Brian

    11/3/2010 3:31:04 PM |

    I can understand the weight loss, exercise, and reduction of carbs (although not just processed, IMO) as well as magnesium and Vitamin D supplementation, but why the lower saturated fat? If you're trying to link lower sat fat intake to weight loss, I'd have to ask for a good source of information before I would believe you. In my practical experience in weight loss, I have lost tons of weight even though lots of my calories came from fat, and fat is needed for energy.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

  • Mark "High Blood Pressure Causes " Lampson

    3/26/2011 4:27:59 AM |

    Wow, I thought that to get your high blood pressure is to rest for a while. When you are from a walk or something.

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A second chance

A second chance

29. September 2006 William Davis (1)
Stewart had a CT heart scan in 2004. Score: 475.

As always in the Track Your Plaque program, Stewart had his lipoproteins assessed. Among his patterns were LDL 157 mg/dl, severe small LDL, and the (post-prandial, or after-eating) IDL. Stewart was also "pre-diabetic" with a blood sugar of 123 mg/dl. Blood pressure was also a major issue. Although initially concerned, life and distractions got in the way, and Stewart's attentions drifted away.

Two years of a lackadaisical effort and Stewart's heart scan score was 600, a 26% increase. Not as bad as it could have been doing nothing (i.e., 30% per year), but still far from great. But, even with the increase in score, we still really didn't get Stewart's attention. He went about his business with a very lax dietary program, overindulging in breads, crackers, goodies, hot dogs, etc., and following a virtually non-existent exercise program except for playing golf once or twice a week.

Unfortunately, Stewart started having pains in his chest with very minimal efforts like climbing a single flight of stairs. His stress test proved abnormal. Stewart then received a stent in his left anterior descending coronary and another in his circumflex. His right coronary artery had a 40-50% blockage, close to requiring a stent.

I stressed to Stewart that this had been preventable. Should motivation remain unchanged, the next step would be bypass surgery.

I think I finally succeeded in getting Stewart's attention. He found the prospect of a bypass operation a lot more concrete than the idea of progression or regression of coronary plaque. So Stewart is being given a second chance. Unfortunately, we will no longer be able to track Stewart's plaque very effectively, since two of three arteries now contain stents, and only the right coronary remains scorable.

I hope Stewart succeeds. But I sure wish he had done this earlier. He had realistic hopes of never requiring stents or bypass surgery.

Learn from Stewart's mistakes. Attention to your program requires vigilance. You can't ignore the causes of your coronary plaque for any length of time without it catching up to you. But seize your first and best chance.
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Comments (1) -

  • Rick

    1/27/2009 4:56:00 AM |

    I hadn't realised that a stent prevented calcium scoring. Why is that?

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Heart disease is reversible

Heart disease is reversible

13. February 2008 William Davis (10)
In a previous post, Take this survey: I double-dare you, I posed a challenge:

Ask your doctor: Is heart disease reversible? Their answer:

1) No. Heart disease is definitely not reversible.

2) Yes, in rare instances, like lightning striking twice.

3) Yes, of course it is! Let's talk about how to do it!

I predicted that few readers of this blog would respond. I also predicted that the few who did would respond with the first answer, Heart disease is definitely not reversible. After all, in nearly all medical practices, the only parameters routinely followed to track risk for heart disease are LDL cholesterol and blood pressure. A measure of the disease itself (i.e., coronary atherosclerotic plaque) is not followed. So how can your doctor actually tell whether heart disease is reversed or not? When I engage in this conversation with colleagues, it goes no farther than rolled eyes or a snort. In my experience, talking about reversal of heart disease is a wasted effort.

To my great surprise, this simple survey received a total of 177 responses. Even more surprising, 122 (69%) of respondents chose number 3, claiming that their doctor said that heart disease is reversible.

Overall results:

1--31 responses (17.5%)

2--24 responses (13.5%)

3--122 responses (69%)


Now wait a minute: Where is the disconnect? Why are doctors saying that heart disease is reversible, yet not following this concept in practice? Contrary to the survey results, I have yet to meet a patient who said their doctor was trying to reverse their heart disease. Of course, this may be a skewed population, but I find it hard to believe that the prevailing view is that heart disease is reversible.

Anyway, this simple survey cannot settle the why or how, nor can it suggest just how prevalent this opinion is.

I am encouraged by these results. If true, it means that the message that heart disease is a reversible process is spreading. It may be make-believe heart disease reversal as preached by Dr. Dean Ornish or claimed by statin drug manufacturers. It may be the hocus-pocus of practices like chelation, or scams like nattokinase. But perhaps the seed of this notion has been planted in the minds of the medical community.

I'd be interested in hearing from the respondents who reported that their doctor said heart disease is reversible. How exactly are they going about achieving reversal?
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Comments (10) -

  • Anonymous

    2/13/2008 3:33:00 PM |

    "How I voted": After diet, exercise,Lowest Lipitor(1/2 a 10)and 1500 Niacin(high LP a)....my Cardio told me I was the only one of his patients able get to counts so low. And at that level he felt I would have "some chance for a little reversal". HDL70/LDL34/TR32/LPa30. I gave him a "2" because his tone of voice sounded forced to say "some chance" like he wasn't really convinced. Love your blog info....many thanks!

  • JJC

    2/13/2008 3:53:00 PM |

    Dr. Davis,

    I don't think there is a lot of inconsistency. I first got a scan because my Dr. was frustrated with me for not wanting to do the statin and niacin and lisinopril that he thought were needed. So he challenged me to get a heartscan. I'd never heard anything about them before. Once I came back motivated he was delighted. So, the only reason I got a scan was that I had a Dr. who already thought that heart disease was reversible, though to a more limited degree than you have documented.

    Before I got the scan I found your book and site and took your advice on EBT.

    When I talked to the cardiologists in the HMO, the first and supposedly the most flexible one told me that it was not reversible. The others were downhill from there. The primary care Dr's of 4 close friends that I keep bugging on this issue all either deny the usefulness of scans and/or maintain that niacin is useless if you are on a statin. (I guess they don't even read the NYtimes.)

    So, I think you got the responses you did because one way people come to this program is through Drs. that already know a bit more than the average Dr. about these issues. I find it very hard to motivate friends on these issues if their docs are not supportive, even if they have terrible scan scores.

    Best,
    Jim

  • vin

    2/13/2008 4:59:00 PM |

    May be the result is not such a surprise because the question is not answered by a random group.

    Most of the people who read this blog are already aware that heart disease is reversible. Majority with heart problems are not aware and are not told by their doctors that such a possiblity exists.

    It would be interseting to find out what course the "reversible" doctors take to achieve reversal: is it drugs to lower LDL and raise HDL or low fat diet or TYP.

  • Anonymous

    2/13/2008 5:12:00 PM |

    Hello Dr.Davis
    I responded heart disease is reversible because of data that I have read and personal experience on body's ability to heal.

    Also just a thought that your survey results might be weighted because people reading this blog would tend to be better informed. They also must think there are positive results in proactive (and preventive) health management to invest time in reading this blog, etc..

  • Anonymous

    2/13/2008 5:20:00 PM |

    One other thought - it seems that doctors do prescribe activities that they think reverses ( or at least halts) heart disease - such as quit smoking, lose weight, exercise, etc..
    But they aren't paid to educate - they are paid to treat disease (as you have pointed out so many times; there is no money in prevention).
    It seems like we need a new mandatory addition to the public education system.

  • Anonymous

    2/13/2008 9:03:00 PM |

    I am subscribed to the newsfeed of this blog, and try not to skip over anything you post. But perhaps I missed something, because you bashed nattokinase in a few of your recent posts.

    Isn't nattokinase also called natto, which is high in K2? Didn't you post about how it could be promising here:
    http://heartscanblog.blogspot.com/2007/12/food-sources-of-vitamin-k2.html

    Maybe I didn't understand the December post, or maybe you've changed your views on it.

    Well back to this posts theme: my parents dropped in from their motorhome-gypsy trip, and my father told me about his GP, who's a DO, that has him taking the supplements you recommend, as well as on a low-glycemic diet to control his newly diagnosed diabetes.

    His fasting sugars now range between 110-120s without pills or insulin, but he didn't know his cholesterol profile. I'll have to follow up with him via snail mail to ask him about that, now that I have their national forwarding address (it's difficult to finish a conversation with him with interruptions from my mother -- I asked my father his DO/GP's name, but instead I got my mother's doctor's name for her condition, sigh).

    I mentioned K2 to him, so now I'm wondering if I should tell him to forget it.

  • Anonymous

    2/14/2008 1:35:00 PM |

    Hi Doc:
    My cardiologist says that heart disease can be reversed by driving down LDL, pure and simple.  He has no interest in any other numbers.  To accomplish this he prescribes statins, and has not counseled me about any other lifestyle changes.

  • Anonymous

    2/14/2008 5:26:00 PM |

    I agree with what others have said.  The people who would take time to read your blog are better informed and probably seeking out better than average medical advice.  My doctor is very proactive on many things and not just a pill pusher.  In fact I would not continue to visit a doctor that is just pushing pills, surprisingly to me, there still seems to be a lot of people in the country that think that because their doctor has perscribed them something it is totally safe.

  • buy jeans

    11/3/2010 3:15:29 PM |

    Now wait a minute: Where is the disconnect? Why are doctors saying that heart disease is reversible, yet not following this concept in practice? Contrary to the survey results, I have yet to meet a patient who said their doctor was trying to reverse their heart disease. Of course, this may be a skewed population, but I find it hard to believe that the prevailing view is that heart disease is reversible.

  • johndouglas

    11/8/2010 7:54:20 PM |

    I appreciate the concern which is been rose.This is a wonderful opinion. The things mentioned are unanimous and needs to be appreciated by everyone.

    Well, it’s amazing. The miracle has been done. Hat’s off. Well done, as we know that “hard work always pays off”, after a long struggle with sincere effort it’s done.
    --------
    johndouglas

    Cycle Covers Motorhome Facts

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