Hypertension and Stroke

Why does diabetes and high blood pressure increase my risk for kidney disease?

DEAR DOCTOR K: I have high blood pressure and diabetes. I was surprised to learn that they increase my risk of kidney disease. How do they do that?

DEAR READER: Many people know that high blood pressure and diabetes increase the risk of getting heart disease. But less well known is the fact that they are also powerful risk factors for kidney disease. The kidneys filter toxins and wastes from the bloodstream, flushing them out of the body in urine. At the same time, they hold on to important proteins and other useful substances. This process helps control levels of fluid, salt and acid in the body. The kidneys also play an important role in regulating blood pressure.

How seriously do I need to take prehypertension?

DEAR DOCTOR K: I'm in my 20s. My doctor says I have prehypertension. How seriously do I need to take this?

DEAR READER: Quite seriously. High blood pressure, or hypertension, is a blood pressure of 140/90 mm Hg or higher. Only a few decades ago, blood pressure lower than that was considered normal -- or, at least, not worth worrying about. But during the last 20 years, multiple long-term studies have shown that people with blood pressures higher than 120/80 but lower than 140/90 have an increased risk of heart disease and stroke.

Why should I increase my postassium intake if I have high blood pressure?

DEAR DOCTOR K: I have high blood pressure. As I expected, my doctor told me to cut down on sodium. But he also told me to increase my potassium intake. Why?

DEAR READER: Sodium and potassium are two minerals that form salts. Your question reminded me of a patient I look care of long ago, who also had a high blood pressure problem. I asked her to substitute potassium salt for the usual table salt (which contains sodium). I'll tell you what happened later. People with diets high in potassium have lower blood pressures than those with potassium-poor diets.

Why did my doctor take my blood pressure in both arms?

DEAR DOCTOR K: At my last checkup, the doctor measured the blood pressure in both of my arms. Why?

DEAR READER: Your doctor had an important reason: a big difference between the two readings can indicate an increased risk of cardiovascular disease. Researchers at Harvard-affiliated Massachusetts General Hospital helped show the importance of measuring arm-to-arm differences in blood pressure. The researchers measured blood pressure in both arms in nearly 3,400 adults age 40 or older with no signs of heart disease.

How does salt affect blood pressure?

DEAR DOCTOR K: I have high blood pressure, and my doctor advised me to cut back on salt. Can you explain how salt affects blood pressure?

DEAR READER: Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. High blood pressure, also known as hypertension, is blood pressure greater than 140/90 mm Hg. High blood pressure increases your risk of stroke, heart attack, kidney damage, loss of vision and other health problems. Many studies show that blood pressure rises with higher levels of sodium in the diet.

Is it possible to go off blood pressure medication through diet and exercise?

DEAR DOCTOR K: Is it possible to get off blood pressure-lowering medication through diet and exercise?

DEAR READER: Yes, it is. I've seen many patients commit to lifestyle changes and get off blood-pressure medicines entirely. More often, I've seen that a commitment to a healthier lifestyle allows people to greatly reduce how much medication they take, even though they still need some medicines to control their blood pressure. While many people, myself included, would like to not have to take medicines at all, being able to reduce the dose is a big deal. Many of the side effects of medicines are reduced or eliminated by reducing the dose.

Do I have to worry about prehypertension?

DEAR DOCTOR K: My doctor says I have prehypertension. If it's "pre," then I don't need to worry about it, right?

DEAR READER: Prehypertension is a blood pressure reading of 120–139/80–89 mm Hg. That's the gray zone between normal blood pressure (below 120/80) and hypertension, or high blood pressure (above 140/90). We know that hypertension is dangerous. It increases your risk of heart disease, stroke, kidney disease and impaired vision.

Can you explain how high cholesterol causes a heart attack or stroke?

DEAR DOCTOR K: Can you explain how high cholesterol causes a heart attack or stroke?

DEAR READER: Cholesterol is a type of fat that travels in the bloodstream. Our bodies need some cholesterol to survive. But high levels of cholesterol in the blood -- particularly low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol -- increase your risk of cardiovascular disease.

Should I monitor my blood pressure at home if I have hypertension?

DEAR DOCTOR K: I have hypertension. Should I be monitoring my blood pressure at home?

DEAR READER: You bet. It's easy and inexpensive, and provides you and your doctor the information you need to protect your health.

About one in three adults in the United States has high blood pressure, or hypertension. And about half of those with high blood pressure don't have it under control. Hypertension increases the risk for heart disease and stroke.

How do blood pressure drugs work and how can I find the one that’s right for me?

DEAR DOCTOR K: How do blood pressure drugs work? And how will my doctor know which one is right for me?

DEAR READER: There are many different drugs for blood pressure and they work in different ways. Finding which one will work best for you may involve a process of trial-and-error. But in the end, you'll be rewarded with a medication that offers the best blood pressure control with the fewest side effects.