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home : columns : ask the doctors June 25, 2018

5/22/2018 8:19:00 AM
Reader feedback encourages follow-up on BP guidelines

Hello, dear readers! Spring is officially here, and the weather is mostly cooperating. (Like many of you, we were awed by the late-season snowstorms some of you had to cope with!) The change in seasons means fewer layers of clothes and more outdoor activities. With that in mind, we'd like to remind you to please use sunscreen, consider bug sprays to deal with the return of mosquitoes and ticks, and to ease into the return to physical activity to avoid injuries.

And now, onward.

-- A lot of you asked about Shingrix, the new shingles vaccine. For those of you age 50 and over, our answer is yes, please get vaccinated. The new vaccine was 96.6 percent effective in clinical trials, a significant improvement over the older vaccine, Zostavax. And, yes, even if you've had the older vaccine, the new guidelines recommend that you get vaccinated with Shingrix as well.

-- In a column about avoiding air pollution while walking for exercise in cities, we suggested seeking out areas with less traffic. However, a reader from Lincoln, Nebraska, worries this can put older adults at risk of becoming victims of robbery or assault. Instead, he recommends indoor malls, which actively encourage walkers.

"Our indoor mall marks the floor, so walkers can gauge how far they have walked," he writes. "They are then encouraged to have coffee or tea with a donut or roll at the mall after their walk. Thus, they are walking in a safe, air-conditioned area and also have a chance for social interaction."

-- We had an unusual letter from a reader in Terre Haute, Indiana, asking about the relationship between cannabis and spontaneous orgasms. The reader, who is 73 and uses cannabis to help with insomnia, said this has been happening to her for the last three months.

While there are several anecdotal accounts of spontaneous orgasms associated with cannabis, we were unable to locate any clinical research on the topic. We imagine that at some point, if this is indeed a widespread phenomenon, there will be a study or two to report on it.

-- A number of you are confused by the recent changes to blood pressure guidelines. Let us assure you that you're not alone. Part of the problem is that in the initial category for abnormal blood pressure, which is referred to as "elevated," the lower number (diastolic pressure) remains the same as the number for normal blood pressure.

What's happening is that the new guidelines consider blood pressure to be elevated even if only the systolic, or top number, exceeds its bracket. The bottom number can remain in "normal" territory and, due to the higher top number, be considered out of the normal range.

To clarify, here is the complete chart:

-- Normal: Less than 120/80

-- Elevated: Systolic between 120-129 and diastolic less than 80

-- Stage 1: Systolic between 130-139 or diastolic between 80-89

-- Stage 2: Systolic at least 140 or diastolic at least 90

-- Hypertensive crisis: Systolic over 180 and/or diastolic over 120

Thank you for the many kind and encouraging (and occasionally critical) notes you sent. We love this ongoing conversation with you and look forward to continuing it next time.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

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