Hypertension and Stroke

Can you give me some advice for measuring my blood pressure at home?

DEAR DOCTOR K: My doctor told me to check my blood pressure at home, but he didn't give me many details. Could you provide some guidance?

DEAR READER: Keeping your blood pressure in check is vital to maintaining heart health and preventing stroke. But the way most of us monitor our pressure -- by trekking to the doctor's office for occasional blood pressure checks -- is far from ideal.

Should I be monitoring my blood pressure at home?

DEAR DOCTOR K: I have hypertension and am on treatment. When my doctor checks the pressure, he says I'm doing "OK." Should I be monitoring my blood pressure at home?

DEAR READER: You should definitely talk to your doctor about that. Home blood pressure monitors are easy and inexpensive, and provide you and your doctor with the information you need to protect your health.

Could stress be contributing to my high blood pressure?

DEAR DOCTOR K: Could stress be causing my high blood pressure?

DEAR READER: You bet it could. It surely contributed to my high blood pressure. Most of us experience a lot of stress. I'm not sure today's world is more stressful than the world of our parents or grandparents. We may have different stressors than they did, but life has always been full of stress.

Has the SPRINT trial led to a change in blood pressure goals?

DEAR DOCTOR K: A few months ago, I read that results from a big trial were going to change blood pressure treatment goals. Where do things stand now?

DEAR READER: I'll bet you're referring to SPRINT. In September 2015, the National Institutes of Health (which funded the study) reported that the study had been stopped earlier than planned because its results were clear. Recently, the complete report of the study (called SPRINT) and its results was published in The New England Journal of Medicine.

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.