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Tackling hypertension, Super Bowl style

The Super Bowl makes any fan's heart race, but if you have hypertension, those game day eats can send your blood pressure rising, too.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

The Super Bowl makes any fan's heart race, but if you have hypertension, those game day eats can send your blood pressure rising, too. Football legend Joe Montana knows how the big game feels and how it feels to have high blood pressure. He joined us, along with cardiologist Dr. James Rippe, to offer lifestyle tips as well as recipes for heart-healthy eating at your Super Bowl party or any time.

Moderator: Dr. Rippe, how much of a problem is hypertension these days?

Rippe: Hypertension is extremely prevalent. It is the leading cause of outpatient visits to physicians in the United States. Over 58 million adults have high blood pressure in our country.

Moderator: What happens if left untreated?

Rippe: The reason we treat hypertension is to lower the risk of heart disease and stroke. A major focus of the campaign that Joe Montana and I are engaged in, which is called "Take the Pressure Off with Better Blood Pressure Control," is to get every person to talk to their doctor about blood pressure, and thereby get better treatment if they need it, and lower their risk of heart disease and stroke.

Moderator: Joe, you were a professional athlete. You should have been in peak condition. What is your hypertension story?

Montana: I was just on the way to a yearly physical and found out from my doctor that I had high blood pressure and was sent to the cardiologist. I was like a lot of Americans who was then treated with medication but still wasn't controlling my blood pressure to the new norm, 120/80. I started on another medication that is a combination of two medicines, one of which I was taking prior, and it subsequently lowered it. Along with that, I increased my exercise and changed my eating habits.

Moderator: How old were you when you were diagnosed?

Montana: 46.

Rippe: The prevalence of high blood pressure increases 10% per decade over the age of 30. So by the time you're in your 40s, there's about a 30 percent prevalence of hypertension; in your 50s the prevalence rises to 40 to 50 percent; and by the time a person in our country is over 60 they have a greater than 60 percent chance of having high blood pressure. So Joe's case is not uncommon.

Member question: My doctor says that my blood pressure is creeping up and I should get more exercise. How does exercise affect blood pressure? If she had said to calm down I would have understood.

Rippe: Many studies have shown that regular aerobic exercise, such as walking or jogging, significantly lowers blood pressure. In addition, exercise is very important for weight control, which further lowers blood pressure. So your doctor is absolutely correct in advising you to get more physical activity.

We have lots of tips about how to get more physical activity in your daily life in our web site that Joe and I created, called

Moderator: Joe, what do you do? What is your workout?

Montana: Right now it consists of six days of cardiovascular. I try to get anywhere between 45 minutes to an hour and will live with 30 if I'm running late. But also I have a three-day lifting schedule. So I will do two, three-day schedules back-to-back and then take a day off.

Member question: I know you must have a busy lifestyle, Joe. How do you manage to do all the things you need to do to keep your blood pressure under control while traveling, etc?

Montana: Obviously I take my medicine with me. I also try to make sure the hotel I'm in has at least some type of cardiovascular machines, preferably at least a small gym, also.

Member question: Is it really necessary to reduce or eliminate salt from my diet to bring my blood pressure down? Without salt, food tastes bland.

Rippe: Absolutely. Human beings are born with a taste for salt. We eat far too much salt in our diet and there is a very strong association between salt consumption and high blood pressure.

Food can taste wonderful without being salty. To illustrate this, we have posted 15 to 20 recipes on the web site to use in conjunction with a Super Bowl party. All of these recipes are either very low salt or no salt and low fat, yet they taste delicious. If you think that low- or no-salt food tastes bland, you should try some of these recipes. You'll be very pleasantly surprised.

For an example, look at this Time Out Chicken Tenders recipe. It includes a homemade mustard recipe, which is very delicious. This recipe is very easy and contains 1 milligram of sodium per teaspoon. In contrast, mustard purchased in the store contains 75 milligrams of sodium per teaspoon. I think most people, once they try both, will prefer the homemade recipe, which contains almost no salt.

Moderator: I tried the chicken last night; it is really good!

Rippe: Our moderator has given us a vote of confidence by confirming she loves the recipes!

Member question: OK, I know we should always take care to eat right, but every now and then on special days, like the Super Bowl is it OK to just dig in and not worry as long as our day-to-day diet is good?

Montana: I believe moderation is the key. It's OK; you're not going to do a lot of damage by having your occasional potato chips, like I do. I've had to basically give them up, but in reality, I have some on occasion. So I believe it's fine. Dr. Rippe might have another opinion on that.

Rippe: I totally agree. We are not food cops. Both Joe's and my goal is to help people understand that very simple modifications in your life can make a huge difference in blood pressure control. We're not asking anyone to turn your life upside down. We asking people to speak with their doctors about blood pressure control and visit our web site for more practical information about both nutrition and physical activity.

Moderator: However, if there are tasty recipes for things like these Playoff Potato Skins, why not give them a try?

Member question: A cardiologist I've seen said weight lifting is dangerous in people with high BP. True?

Rippe: That is basically true. However, with proper caution you can continue to lift weights. Joe was very careful to say that in his strength-training program, he does high-repetition, low-weight strength training. The danger comes from doing very heavy lifting, which can further increase blood pressure in someone who already has high blood pressure. That type of heavy lifting is not recommended.

Member question: If I'm taking medicine, do I need to keep measuring my blood pressure?

Rippe: Although Joe can tell from his experience about how often he monitors his BP, the answer is absolutely yes. One of the best things that an individual can do to help his or her doctor is to periodically take his own blood pressure and report it to your doctor on your regular visit.

Montana: I typically take my blood pressure, at a minimum, three or four times a week and my doctor has requested I keep a chart and bring it in to her when I go in to see her.

Member question: Is it possible to reduce the need for medication by diet and exercise?

Rippe: Absolutely. An individual who is overweight can reliably lower their blood pressure through weight loss. For every 10 pounds lost, you will reliably lower your blood pressure 5 to 7 millimeters. So weight loss is very important. If you're overweight, and properly eating, such as lowering sodium, increased physical activity will further lower your blood pressure.

So many people can reduce the amount of blood pressure medicine they are on through these habits and in some instances even reduce their BP so much they can come off medication. Of course, those considerations need to be discussed by your physician.

Moderator: You used the word "habits." It is important to make good diet and exercise a habit, isn't it?

Rippe: Joe and I are trying to encourage people to understand that simple relatively minor adjustments in their daily habits exert a profound impact on their blood pressure and therefore on their risk of heart disease and stroke.

Member question: I have a question for Dr. Rippe. My husband says it doesn't matter if he skips his medication every now and then. He says it's a pain having to take it.

Rippe: Medicine should always be taken as prescribed. Hypertension is called the silent killer because it typically does not have any symptoms. However, the reason to control it is to lower your risk of heart disease. So make it a routine so that it becomes easier to remember.

Member question: Hey Joe, have you tried the recipes yet? Do you plan to serve some at your Super Bowl party?

Montana: Yes, I have tried them, and I was blown away by the brownies. I don't eat a lot of starches, but I do like potatoes, and must admit that the potato skin recipe is a great alternative with great flavor. I'm a difficult sell, when it comes to alternative for something I love to eat. So those would be my suggestions, along with the chicken.

Moderator: Here are the recipes for Joe's favorites: Fudgey Out of Bounds Brownies and Playoff Potato Skins. If you are looking for something else tasty to serve at your Super Bowl party, check out this recipe for Hall of Fame Hoagie with Low-Salt Dill Pickles.

Member question: Joe, any advice for those of us who are former jocks and while we are no longer active, our appetites have not slowed? I'm 36, 230 pounds, 5 feet 7 inches and feeling miserable.

Montana: It doesn't take a lot to be active. On our web site there are numerous simple ways to add exercise to your daily routine. As an athlete, you shouldn't be satisfied with those numbers.

Rippe: This is common as people age and stop playing sports unless they make a concerted effort and control their eating. It's almost inevitable that weight gain will ensue, because athletes don't often understand how many calories they burn as athletes, which allows them to eat more than the average person. Even someone like Joe, who has remained in excellent condition throughout his life, had to face the reality that he couldn't eat as much when he was no longer an active NFL player, when he had that high level activity in his daily life.

Member question: I will never get my husband to work out every day. Dr. Rippe, what is the minimum amount he should do?

Rippe: The national guidelines from the Centers for Disease Control, which I helped write, recommend 30 minutes of moderate intensity physical activity on most, if not all, days. So your husband should try to find ways of accumulating physical activity on most days.

Most of us will find that easier if we look for the nooks and crannies in our lives where we can get just a little more activity throughout the day, such as climbing stairs at work or taking the dog for a walk or parking further from the store, in the back corner of the parking lot, rather than right next to the store. Tips like these can be found on the web site that Joe and I created and have been discussing with you.

Member question: I have severe hypertension and am on more than one pill and have been seen by several specialists. My mom died from it; my sister has it the same as I do; my daughter and son have the same thing; and just last week found out my 16-year-old granddaughter has it too. Is this inherited?

Rippe: Over 90% of high blood pressure is caused by conditions that we do not fully understand. However, there is clear tracking of high blood pressure in some families.

My recommendation is to seek therapy in a major medical center from a physician who specializes only in the treatment of high blood pressure and, in addition, make a very vigorous attempt to make sure all of your lifestyle issues are optimized, such as maintaining a normal body weight, of course removing the salt shaker from the table and lowering sodium, and being very physically active. Those things, in conjunction with proper medical therapy will often do the trick.

Incidentally, your situation is not unusual. Over half of people who have high blood pressure will require two or more medicines to control it. As Joe has indicated, a combination medication, in his case Lotril, which is a combination of two medicines in one pill, was required to effectively treat his blood pressure.

Member question: Do you think Dr. Atkins' low-carb diet or Dr. Ornish's low-fat diet is better for controlling blood pressure?

Rippe: For individuals who are overweight, any diet that results in weight loss will lower blood pressure. All weight-loss diets are based on the fundamental principle of restricting calories. Dr. Atkins' approach restricts calories by restricting carbohydrates; Dr. Ornish restricts fats, and both will lower weight, and both will lower blood pressure.

Member question: How long does it take for diuretics (HCTZ) to reach full effect?

Rippe: Diuretics act in different durations depending on which one you're on. HTCZ is relatively actively acting and should take effect on a daily basis within a few hours of taking it. For this reason I tell my patients to take this particular diuretic early in the day so that they do not have their sleep interrupted by the need to get up and pass urine.

Member question: I have read that old-fashioned diuretics work better than the newer, more expensive medicines at controlling blood pressure. Dr. Rippe, can you comment? Is this true? Are the drug companies just trying to make more money by offering more expensive drugs? Or are the insurance companies trying to practice medicine by checkbook again?

Rippe: The available diuretics are often very good at controlling blood pressure, but there are also many newer medications that are more convenient and have fewer side effects.

These kinds of questions should always be discussed with your own personal physician. The main thrust of our campaign is to get patients and their doctors having exactly this kind of discussion.

Member question: Joe, has your high blood pressure changed how your family eats? Do they help you stay healthy?

Montana: My family has been a tremendous help. Between my wife and my daughters, they are constantly removing the salt shaker from the table, along with doing what they have always done, finding healthy meals for dinners and allowing me no seconds.

Member question: Has your blood pressure affected your daily routine in any way?

Montana: No, not at all. I work to control it, and therefore I have not had a problem with it.

Rippe: What Joe just said is key: that controlling blood pressure with the modern tools we have available is very easy for 99 percent of people. The only danger is not knowing your blood pressure or doing nothing about it if it's high. That creates unacceptable risk for heart disease and stroke.

Member question: Mr. Montana, did having high blood pressure effect your decision to retire from playing football?

Montana: No, it didn't. My decision was purely of another physical nature. I was too slow.

Moderator: Dr. Rippe, can you reiterate the three pillars of your program to control high blood pressure?

Rippe: Yes. The three pillars are the following:

Enter a dialogue with your physician about your blood pressure. Knowledge is power. So start discussing your blood pressure with your physician to find out if it's under control, or if not, what you need to do about it. Pay attention to healthy nutrition. For most people, that will mean weight control, controlling the amount of fat in a diet, and most importantly, reducing the amount of salt in your diet. Lead a physically active lifestyle. For most of us, that will mean increasing our physical activity.

Moderator: To help with tip No. 2, here are more of Dr. Rippe's heart-healthy Super Bowl party recipes: MVP Hummus and Vegetable Platter and the Pressure Punting Party Mix.

Rippe: Specific recommendations and tips to do all those three things, including some suggested questions to ask your doctor about your blood pressure and specific tips about healthy eating and physical activity, can all be found on our web site,, and you can also obtain a free brochure by going to that web site.

The whole reason that we care about blood pressure control is to lower the risk of heart disease and stroke. Heart disease remains the leading killer of both men and women in our society, and is responsible for 41 percent of deaths every year in the United States. If you combine heart disease and stroke, those two entities are responsible for more deaths every year in the U.S. than all other diseases combined.

We are not doing a good enough job in our country to control our blood pressure. It's relatively easy to control your blood pressure, and the first step is to know what it is and start discussing your options with your medical professional.

Montana: I think by following Dr. Rippe's three pillar approach, people will begin, as I did, to see a significant difference, and that's what we're here for, to get the message out. This is something we can control, if caught early enough. Thank you.

Moderator: Thanks to Dr. James Rippe, and Joe Montana for being with us today. For more information on hypertension, visit our WebMD message boards, where you can post questions for WebMD health professionals, as well as find support and information from WebMD members like you!

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