DEAR DOCTOR K: I've made lifestyle changes and take three blood pressure medications, but my blood pressure still isn't where my doctor wants it to be. What else can I do?
DEAR READER: Sometimes high blood pressure (hypertension) doesn't respond to lifestyle changes and medications. This is called resistant hypertension. It is blood pressure that lingers above target levels despite the use of three medications.
DEAR DOCTOR K: A friend recently told me about a condition called metabolic syndrome. What is it? And what can I do if I have it?
DEAR READER: Metabolic syndrome may be the most common condition you've never heard of. Many of my patients have it; nearly 50 million Americans have it -- and many of them don't know it. Metabolic syndrome is dangerous. If you have it, you have a much higher risk of stroke or a heart attack, and of developing diabetes, kidney and liver disease.
DEAR DOCTOR K: My doctor wants me to take a beta blocker for my high blood pressure. Can you tell me about these drugs?
DEAR READER: Beta blockers are one of the most important classes of drugs invented in the past half-century. In fact, they are so important that their inventor, Sir James Black, was honored with the Nobel Prize. They have saved many lives -- but that doesn't mean they are for everyone, or without possible side effects.
DEAR DOCTOR K: I'm under a lot of stress at work. My doctor warned me that if I don't get my stress under control, it could affect my cardiovascular health. Is this true?
DEAR READER: Yes, it's true. Long-term, constant stress can harm many aspects of your health, including your cardiovascular health. Stress is the body's way of responding to threat. Our distant prehistoric ancestors had a pretty stressful life, but it was different than the stressful lives we have. They knew that at any moment they might be killed. Back then, it was lions that were the threat.
DEAR DOCTOR K: At my last checkup, my blood pressure was 130/85. I'd like to have a better understanding of what those numbers mean.
DEAR READER: Your heart is a pump, pushing blood throughout your body 60 to 80 times a minute. After each pump it relaxes, fills up with more blood and then pumps again. The heart pumps blood out through blood vessels called arteries, and collects blood returning from the body in blood vessels called veins.
DEAR DOCTOR K: My blood pressure has been creeping up lately, so my doctor suggested I reduce the amount of salt in my diet. Where should I start?
DEAR READER: That's good advice -- and it's good advice for most people, especially for people with high blood pressure. Cutting back on salt (sodium chloride) lowers blood pressure and saves lives. Aim to limit your daily sodium intake to no more than 2,300 milligrams (about a teaspoon) per day.
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Dr. Anthony Komaroff is a practicing physician, Professor of Medicine at Harvard Medical School, and Editor in Chief of Harvard Health Publications. Learn more »
Harvard Health Publications is the publishing division of Harvard Medical School, providing the general public with authoritative, trustworthy, and accessible health information. Learn more »
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