Hypertension and Stroke

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.

I have high systolic, but normal diastolic blood pressure. Do I need treatment?

DEAR DOCTOR K: I'm 71 years old. My systolic blood pressure is usually in the 150s to 160s, which is high. But my diastolic blood pressure is usually in the 70s, which is normal. Do I need treatment?

DEAR READER: A blood pressure measurement includes two numbers: systolic pressure (the upper number) and diastolic pressure (the lower number). Your systolic pressure is high: 140 mmHg or over is high. And your lower number is normal: normal diastolic pressure is below 80 mmHg. When your systolic blood pressure is high and your diastolic blood pressure is low, it's called isolated systolic hypertension (ISH).

What can I do about resistant hypertension?

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.

What is metabolic syndrome?

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.

How do beta blockers help high blood pressure?

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.

How does stress affect cardiovascular health?

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.