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An Interview with Joe Montana

Four-time Super Bowl champion Joe Montana is also known by the nickname Joe Cool for his steely grace under pressure.  As a highly conditioned professional athlete, you might think that it would be inconceivable that Joe would become one of the 65 million people in the nation living with high blood pressure (HBP). Think again.  Gary Barg, Editor-in-Chief, sat down with Joe and Dr. James Rippe, M.D., an associate professor of cardiovascular medicine at Tufts University School of Medicine in Boston, Massachusetts, and a leading authority on preventative cardiology, to discuss high blood pressure prevention techniques of importance to caregivers and loved ones alike.

GARY BARG: Tell me about the BP Success Zone Campaign.
DR. JAMES RIPPE: It’s a public education campaign. Joe and I have been crisscrossing the country for now two and a half years, and we’ve been to 30 cities. We are trying to move the needle to raise awareness about the dangers of high blood pressure and get more people’s high blood pressure into the Blood Pressure Success Zone.   The great thing about having Joe as a partner is that people say, “He is a relatively young athlete with high blood pressure…maybe I could have it too.” We are trying to get people in a dialog with their doctor. That’s what this campaign is all about.  The sad truth here is that of the 90% of the people who have high blood pressure, we don’t know the cause. We know there are associations between being overweight and smoking cigarettes and being inactive. There is a hereditary component too. Having said that, when you go across the board and talk about the causes of hypertension, 90% are of unknown origin.

GARY BARG:  So, depending on your situation, it could be genetics, it could be dieting, it could be exercise—we just don’t know.
DR. JAMES RIPPE:  We just know if you have hypertension and you are overweight, are sedentary, smoke cigarettes, it’s dangerous. We know if we can get you to stop smoking, be active and lose weight, then you’ll get tremendous benefits for your blood pressure and lower your risk for heart disease. One of the reasons Joe Montana is such a wonderful spokesperson for this campaign is he represents the absolutely classic case. He never smoked, was always fit, and was never overweight. There was a little heredity, but he’s like the 90% of people in that he just got it. One out of every three adults has it (65 million). There is a 10% increase in problems per decade. By the time you are 40, there is a 40% chance, by the time you are 50, there is a 50% chance of getting hypertension. So Joe is not in an unusual situation, where he is diagnosed with hypertension seemingly out of the blue.

GARY BARG:  Joe, since you didn’t have any symptoms, how did you find out that you had high blood pressure?
JOE MONTANA:  I went for a physical. I was doing my husbandly duty and was just trying to get in and out of the doctor’s office so I could check that box for the year. I was perfectly fine. I went in there with the expectation I’d go through the motions and get out of there. When she told me my blood pressure was high, she sent me directly to a cardiologist, so I did not end up getting very far after all.

GARY BARG:  What was your blood pressure?
JOE MONTANA:  It was over 140 over 90. That was way up from the year before. 

GARY BARG: What did they say caused it?
JOE MONTANA: I have no idea. But it was probably due to my cutting back on exercise when I was on the team. I’m sure my diet did not help. I was eating foods like steak and fried chicken.  I did have a family history on top of it. I did not think that would affect me even though I knew of my family history.  My grandfather passed away when he was 54 from heart disease. So it could have been a combination of a lot of things.

GARY BARG: Are you on medication now?
JOE MONTANA:  Yes. Actually the first medication they gave me did not work. Now I am on a combination of medications. But that’s what it took to get mine under control. The key to the program is to consult with your doctor, to get proper exercise with your diet, and also make sure you are on the right medication. Just because it’s right with me, doesn’t mean it’s right with everyone else.

GARY BARG:  Do you still have to watch what you eat even though you are on medications?
JOE MONTANA:  Yes, one of the things that I have found is that I was eating a typical American diet where you eat a lot of food that is not good for you. I was eating so much of it—all in one sitting. I just had to have that 20 ounce Porterhouse steak or filet. But then, I started by making moderate changes; cutting back on portion size was the easiest way to make changes in my diet. In the past, I would rarely order fish in restaurants; now I find a lot of fish that I like. But it all started by cutting back on things like steak and fried chicken. Instead of ordering the fried chicken, you can order the grilled chicken. You find that your taste buds will change eventually.  I still have the fried chicken on occasion, but I won’t eat that super size of chips. Now, I can just have a few, and I’m O.K.

GARY BARG:  What exactly is the Blood Pressure Success Zone? 
JOE MONTANA:  The success zone is when your blood pressure is between 139 over 89 or below 120 over 80. So anything below that 139 over 89 is the goal you want to reach.

GARY BARG:  Is that the blood pressure reading that  everybody should try to reach and maintain?
DR. JAMES RIPPE: I think that the first and foremost thing is that you can’t treat it if you don’t know what it is. We in the caregiving business tend to not be good about caregiving for ourselves. We need to recognize that this happens to one out of every three of us. In our adult lives, 90% of us will get high blood pressure. This is not some isolated deal. We have to make sure that while we are caring for other people, we have to care for ourselves. Get your blood pressure taken. That’s number one—and know what that number is. We have very good medicines now. The vast majority of people that have hypertension, meaning having blood pressure over 140/90, are going to require medication. In addition to that, try to be disciplined about keeping your weight down, try not smoking cigarettes, engage in regular physical activity, pay attention to having fruits and vegetables and whole grains, and less processed foods because there is salt in them. On our web site, Joe and I have a lot of recipes, and tips on how people can improve their nutrition.   We try to be helpful. Realistically, for most health care professionals and caregivers, if you have hypertension, it’s going to mean a combination of medicine and lifestyle changes. If you are in this huge category of pre-hypertension (120-139 over 80-89),  you need more physical activity, to lose weight if you are overweight, and improve your nutrition. You probably do not need to be on medicine. That’s the time that the yellow flag should go up (if your blood pressure is 135 over 85).

GARY BARG: That’s really a great point because people think, “I’m under that range—I can do anything I want.” So at least it gives them a yellow flag.
DR. JAMES RIPPE: The reason it is called pre-hypertension is that those people are most likely to develop hypertension.

GARY BARG: What you are saying is not only that you have to pay attention to your loved one’s care, but you have to pay attention to yourself and once you realize you are at risk for having high blood pressure, you have to moderate it.
JOE MONTANA: Yes. You have to stay on top of it and find the right medicine and continually monitor it. I do it once or twice a week. My kids like doing it. They like playing with the machine.

GARY BARG: Joe, you have really gotten your family involved in caring for you.
JOE MONTANA:  They’ve been great. They remove the salt shaker from my side of the table. My boys are at that age when they eat anything. So as I order that cheeseburger, they say you really don’t want that cheeseburger so I’ll eat it for you. And my wife’s always on me to take my meds, especially when I am on the road. We talk every night and she will always ask if  I have taken my medicine. They’ve been a big help. Getting there is hard enough. Staying there is another issue.

GARY BARG: What advice do you have for family caregivers?
JOE MONTANA: You have to eventually remember to take care of number one. If you do that, you’ll be able to take care of someone else. People look at it the other way. They are so busy taking care of someone else they end up losing sight of themselves.