Johns Hopkins Health Alerts - Hypertension and Stroke

7 Questions to Ask Your Doctor About Blood Pressure Medication

Tue, 13 Oct 2009 06:00:00 CDT

Many doctors are pressured for time, and may cut corners when it comes to answering questions. Here is a list of questions you should ask your doctor about blood pressure. The questions come from the National Heart, Lung, and Blood Institute.

To find out where you stand when it comes to your blood pressure and the lifestyle measures needed to control it, make sure you know the answers to these questions:

What is my blood pressure reading in numbers? You should know your blood pressure numbers just as you know your weight. Don't settle for an answer like "You're fine," "Leave that to me," or "You're right in the middle." Ask for the numbers and ask your doctor to write them down for you.

What is my goal blood pressure? Ask your doctor what blood pressure level you're aiming for. The usual goal is less than 140/90 mm Hg. If you have diabetes or kidney disease, your goal may be lower—less than 130/80 mm Hg.

Is my blood pressure under control? If your blood pressure is even a little above 140/90 mm Hg (or 130/80 mm Hg if you have diabetes or kidney disease), it may not be under good control. Tell your doctor that you want your blood pressure at the healthiest possible level and that you are willing to do whatever it takes to reach it -- including taking multiple drugs.

Is my systolic pressure too high (over 140 mm Hg)? Both blood pressure numbers are important. But if you're age 50 or older, your systolic pressure (the top number) is a more important risk factor for heart disease than your diastolic pressure (the bottom number), and that's where your blood pressure-lowering efforts should be focused.

What's a healthy weight for me? Being overweight can lead to high blood pressure. Doctors define overweight as a body mass index of 25 or more, or a waist circumference larger than 40 inches if you are a man or more than 35 inches if you are a woman. Even if you take medication for high blood pressure, losing weight is important because it helps the medication work more effectively. In fact, if you lose weight, you might be able to take a lower dosage, use fewer drugs, or even go off blood pressure medication altogether.

Is there a diet to help me lose weight or to control my blood pressure? If your doctor wants you to lose pounds, ask for specifics: Is there a diet or method that might work best for you?

Is it safe for me to start doing regular physical activity? Getting some physical activity on most days of the week is an excellent way to help lower your blood pressure, especially when combined with dietary changes and sodium restriction. However, you must check with your physician before starting a new exercise routine to make sure that your heart is healthy enough for exercise.

Transcendental Meditation and Your Blood Pressure

Tue, 03 Nov 2009 06:00:00 CST

A reader with high blood pressure asks: Will relieving stress help control high blood pressure? Which stress reduction technique has the most evidence backing it up? Here’s the reply from Johns Hopkins.

In stressful situations, your body releases hormones like epinephrine that cause your blood pressure to rise and your heart rate to accelerate. Whether chronic stress contributes to high blood pressure is less clear. Still, reducing stress may help you follow other lifestyle recommendations and maintain other healthy habits.

Stress reduction techniques include exercising regularly; practicing relaxation techniques such as deep breathing, guided imagery, or meditation; lightening your work or personal schedule; and having a strong social network of friends and family. Some activities that people believe lower stress -- drinking too much alcohol and smoking -- actually increase blood pressure.

The effects of stress on blood pressure are controversial. Likewise, it is unclear if stress-reduction techniques, such as biofeedback, yoga, and tai chi, help lower blood pressure.

But one method of reducing stress called transcendental meditation (TM) has the most evidence. Developed more than 50 years ago, TM involves sitting quietly for 20-minute periods, twice a day, and repeating a one-syllable word called a mantra to relax the mind.

The effects of TM on blood pressure were recently evaluated in a meta-analysis published in the American Journal of Hypertension. When the researchers considered three high-quality, randomized, controlled trials of TM in people with high blood pressure, they found that this form of meditation reduced systolic blood pressure by 6 mm Hg and diastolic blood pressure by 3 mm Hg. TM likely lowers blood pressure because of its effects on the nervous system, slowing heart rate and reducing tension in the muscles.

If you are interested in trying TM, you can learn how to do it through books, audiotapes, and DVDs. You may also find a certified instructor giving classes in your area. Keep in mind, however, that TM is not a substitute for the lifestyle measures or medications proven to lower blood pressure. But trying it will cause you no harm.

Taking the Salt Away

Tue, 01 Sep 2009 06:00:00 CDT

The average American consumes approximately 4,000 mg of sodium a day, which is much higher than the recommended 2,300 mg for a healthy, young adult. The terms “salt” and “sodium” are often used interchangeably, as 90% of the salt we ingest is in the form of sodium chloride, commonly termed table salt. The remaining 10% comes from other sodium-containing substances such as baking soda and a variety of preservatives.

So what should we do to reduce our salt consumption? Taking salt out of the kitchen and off the dining room table is the first step. But these measures alone won’t make much of a dent in your sodium intake.

That’s because only 10% of American’s sodium intake comes from salt added at the table or in cooking. Another 10% occurs naturally in food. But the vast majority -- 80% -- derives from processed and restaurant foods. And this is where you should focus most of your attention by doing the following:

Minimize your intake of processed and packaged foods. Almost all frozen dinners, canned foods, processed meats, savory snacks, bottled sauces and dressings, and condiments are high in sodium.

Read labels for sodium content and try to select products that contain less than 200 mg of sodium per serving.

Look for foods with reduced-sodium labels. A label that says “low sodium” means the product contains less than 140 mg per serving; “very low sodium” indicates 35 mg or less, and “sodium free” is less than 5 mg. Foods labeled unsalted or no-salt-added contain no or only naturally occurring sodium.

Not all manufacturers use labels to draw attention to their reduced-sodium products and not all brands in the same category contain the same amount of salt. For example, the amount of sodium in a cup of canned cream of tomato soup ranges from 340–950 mg, depending on the brand, and the sodium content for various spaghetti sauces runs from 270–770 mg per half cup.

Just because a food does not taste salty does not mean that it is low in salt. While potato chips, hot dogs, and pickles are obviously high in salt, so are many breakfast cereals (up to 450 mg per cup) and breads (up to 400 mg for two slices), because they contain sodium-containing ingredients such as baking soda and baking powder.

Choose fresh fruits and vegetables more often. These foods are naturally low in sodium and are good sources of potassium, a mineral that helps blunt the blood pressure–raising effects of sodium in the diet.

Exercise Your Way to Lower Blood Pressure

Tue, 21 Jul 2009 06:00:00 CDT

Exercise plays a valuable role in controlling blood pressure. In fact, experts recommend engaging in moderate physical activity for at least 30 minutes five to seven days of the week. In this Health Alert, Johns Hopkins explains which exercises yield the greatest rewards.

People who are physically fit are less likely to develop high blood pressure, and exercise may stop people with prehypertension from developing full-blown hypertension. In people with mild to moderate high blood pressure, studies have demonstrated that regular aerobic activity can decrease blood pressure by up to 10/8 mm Hg. In some people with high blood pressure, beginning a regular exercise program can allow their doctors to reduce the dosage of their high blood pressure medication or even eliminate the need for it altogether.

What Kind of Exercises Should You Choose to Lower Blood Pressure?

Resistance exercises: Studies show that resistance exercises -- weight lifting and the use of resistance equipment (like Nautilus machines and resistance bands)—are not an effective way to lower blood pressure. In fact, in people with high blood pressure, very high resistance activities can cause blood pressure to rise, sometimes to dangerous levels.
Nonetheless, experts still recommend the use of resistance exercises as part of an overall exercise plan because these exercises improve strength, balance, and bone mass. But older people and those with high blood pressure need to take special precautions. For example, they should use light weights (no more than 10 lbs.) and do more repetitions. They may also need to avoid activities that involve heavy lifting, such as shoveling snow.

Aerobic exercises: Aerobic exercises -- such as walking, bicycling, swimming, jogging, and dancing -- can help lower blood pressure when done for 30 to 60 minutes at least three days a week. If you are unable to exercise for 30 minutes at a time, try breaking up the exercise into sessions of 5 to 10 minutes. Initially, these activities need not be formal exercises but can be everyday activities that you incorporate into your daily routine. For example, try parking your car further away from the store or mall to increase the amount of time you spend walking. When possible, take the stairs instead of an elevator.

Bottom line advice: Before beginning an exercise program, you need to know what intensity of exercise is beneficial and safe for your age and health status. So, first check with your doctor to determine if you need to take any special precautions.

Essentially, exercise should cause you to sweat but should not be so intense that you cannot hold a conversation during the activity. You should always warm up and cool down before and after exercising with activities like light walking and stretching. If you are just getting started, remember that even small increases in physical activity have a beneficial effect not only on your blood pressure but on many other aspects of your health as well.

Masked Hypertension: What It's Doing to Your Arteries

Tue, 11 Aug 2009 06:00:00 CDT

Many of us are familiar with the condition called white coat hypertension in which people experience high blood pressure in the doctor's office because of anxiety or stress – but do not actually have hypertension. The reverse of white coat hypertension is masked hypertension. And it is dangerous condition.

Masked hypertension -- blood pressure that's normal at the doctor's office but elevated out of the office -- is just as dangerous as regular hypertension, according to a study in the American Journal of Hypertension (volume 20, page 385).

The study looked at 282 people who were not taking antihypertensive medication but who had at least one risk factor for cardiovascular disease, for example, hypertension, diabetes, high cholesterol, kidney disease, or smoking.

The researchers found that participants with masked hypertension had signs of damage to their arteries. For example, they had more thickening of the carotid artery than people with sustained hypertension (high blood pressure at the doctor's office and at home), white coat hypertension (high blood pressure at the doctor's office but not at home), or normal blood pressure (both at the doctor's office and at home). They also had stiffer arteries than people with white coat hypertension or normal blood pressure. Thus, masked hypertension is not a benign condition.

Your doctor will suspect masked hypertension if your blood pressure is normal or high-normal at the doctor's office but you have multiple cardiovascular risk factors. There's not yet evidence that medication will reduce the risks of masked hypertension, so aggressive lifestyle measures -- restricting alcohol, losing weight, exercising, quitting smoking, and reducing salt intake -- are the best approach.

Tweaking Your Diet to Lower Your Blood Pressure

Tue, 30 Jun 2009 06:00:00 CDT

A study led by Johns Hopkins professor Dr. Lawrence Appel shows that making lifestyle adjustments can lower blood pressure and improve the effectiveness of blood pressure-lowering medication.

Hypertension is more treatable than ever before, thanks to a wide variety of lifestyle measures and blood pressure medications. When effective, these treatments can not only lower blood pressure, but also reduce the risk of complications from hypertension -- specifically, stroke, heart attack, heart failure, and kidney disease.

Research shows that the effects of lifestyle changes are additive. Thus, the more you adopt, the greater the benefits. In a study led by Dr. Lawrence Appel (coauthor of the Johns Hopkins Hypertension and Stroke White Paper), people with prehypertension or mild hypertension who lost weight, followed the DASH diet, reduced salt and alcohol intake, and exercised regularly lowered their systolic blood pressure by an extra 4 mm Hg over a six-month period, compared with people who only received advice on these lifestyle changes. By making lifestyle adjustments, you’ll also improve the effectiveness of your blood pressure-lowering medication and lower your risk of hypertension complications such as heart attack and stroke.

Many people can keep up the diet and other lifestyle changes that help control hypertension and ward off disease, according to a study in the Annals of Internal Medicine (Volume 144, page 485 ). In a study of 810 adults with prehypertension or mild hypertension, researchers found that those who underwent a lifestyle overhaul were generally able to maintain the changes during the 18-month study. But it did take some work.

Participants had regular counseling sessions on how to incorporate lifestyle changes into their daily routines -- which included eating more fruits, vegetables, whole grains, and low-fat dairy products and cutting down on saturated fat and sodium; getting at least three hours of exercise a week; and, if overweight, trying to shed 15 lbs. Some participants received only advice on making these lifestyle changes, and they served as the control group. Compared with the advice-only group, those in the counseling group were about one fifth less likely to have hypertension at the study’s end. These findings show that with some help you can shake up your lifestyle and stick with it.

Interested in learning more about the DASH diet? See these articles:

Should You Try a DASH-Style Diet?

Tweaking the DASH Diet

DASH Diet Tips

DASH Diet Tips

Tue, 07 Apr 2009 06:00:00 CDT

Clinical trials show that the DASH (Dietary Approaches to Stop Hypertension) eating plan can have a significant and positive effect on your blood pressure. The diet is rich in fruits, vegetables, and low-fat dairy products and low in saturated fat and cholesterol. It also includes whole-grain products, fish, poultry, and nuts. Red meat, sweets, and sugar-containing beverages are kept to a minimum.

If you're already following the DASH diet and are interested in tweaking it to reap the most benefits, here are some tips on increasing the protein or monounsaturated fat content of your diet.

Which is better to increase -- protein or monounsaturated fat? Both are good options in your fight against high blood pressure and heart attacks and strokes, so go with the one that includes more of the foods you enjoy. However, if your HDL cholesterol is low you might want to choose the monounsaturated-fat diet to take advantage of its HDL-raising effects.

Don't forget that calories count. Making your diet richer in protein or monounsaturated fat doesn't mean simply adding these foods to your diet. They need to be substituted for carbohydrates. Otherwise, you will gain weight and the blood pressure-lowering effects of these diets will be negated.

General Diet Tips

Eat 1-2 servings of fruit at every meal and have an extra fruit at breakfast.
Have 2-3 servings of vegetables at lunch and dinner.
Make up a fruit-and-nut trail mix for snacks: 1 ⁄4 cup dried fruit with 1 oz unsalted nuts. Have a serving of fat-free or low-fat milk, yogurt, or cheese at 2 meals each day.
Use whole grains rather than refined grains as often as possible.
Select lean versions of meats and remove skin from poultry.

Tips To Increase Protein in Your Diet

Have a serving of legumes, nuts, seeds, high- protein grains (such as bulgur wheat or millet), lean meats, fish, or poultry with skin removed at 2-3 meals each day.
Have a serving of fat-free or low-fat milk or milk products at each meal.
Use egg whites or egg substitutes at breakfast and other meals and in recipes.
Top whole-grain cereals with 1 oz unsalted nuts.
Spread unsalted peanut butter on whole-grain toast.
Add different kinds of beans to salads, recipes, and main dishes.
Try vegetarian meat substitutes in sandwiches, salads, mixed dishes (such as chili), and as a main course entrée.

Tips To Increase Monounsaturated Fat in Your Diet

Have 1 tsp of olive oil or canola oil-based margarine on bread at lunch.
Have 1-2 Tbsp of salad dressing made with olive or canola oil and drizzle on salads. Add 1 tsp of olive or canola oil or canola oil-based margarine to vegetables at dinner.
Use olive or canola oil to sauté vegetables and in recipes.
Have 1 oz of unsalted nuts rich in monounsaturated fat (for example, almonds, peanuts, and pecans) each day as a snack or add to cereals.
Add avocado to salads, sandwiches, and dips.

For more information on the DASH diet:

Read Tweaking the DASH Diet
Visit www.nhlbi.nih.gov/ health/public/heart/hbp/dash

Stroke Awareness

Tue, 19 May 2009 06:00:00 CDT

May is National Stroke Awareness Month. It's the prefect time to make sure you know the warning signs of stroke, so you can take quick action and minimize serious damage to your brain.

You probably know the symptoms of a heart attack, but it’s just as important to know the symptoms of a stroke. Why is it important? Like a heart attack, a stroke is an emergency that requires immediate medical attention. Even a transient ischemic attack or TIA, in which stroke symptoms appear suddenly and quickly subside, is a medical emergency.

Whether you are having an ischemic or hemorrhagic stroke, the symptoms are the same. With a TIA, the symptoms are transitory, often lasting only minutes. If you (or someone you’re with) experiences the sudden onset of any of the stroke symptoms listed below -- even if the symptoms begin to subside -- you must call 911 or go straight to the hospital. Rapid diagnosis and treatment of a stroke may minimize damage to brain tissue and improve the chances of survival.

Stroke symptoms include:

Sudden weakness or numbness in the face, arm, or leg on one side of the body.

Sudden loss, blurring, or dimness of vision.

Mental confusion, loss of memory, or sudden loss of consciousness.

Slurred speech, loss of speech, or problems understanding others

A sudden, severe headache with no apparent cause.

Unexplained dizziness, drowsiness, lack of coordination

Nausea and vomiting, especially when accompanied by any of the above symptoms

The importance of responding immediately to symptoms of a stroke is underscored by a study reported in the journal Neurology (Volume 64, page 817): Warning signs of an ischemic stroke may occur up to seven days before the event itself, according to researchers, and these signs should be taken seriously to minimize the chance of a major stroke.

The study examined data on 2,416 people, all of whom had an ischemic stroke. About a quarter of them described having symptoms consistent with a transient ischemic attack before their stroke, most often during the prior week. Seventeen percent of the transient ischemic attack group had symptoms of a transient ischemic attack on the day of the ischemic stroke. However, transient ischemic attack symptoms occurred earlier in other patients -- 9% on the previous day, and 43% on another day during the seven days before the stroke. There was no correlation between patient characteristics (including cardiovascular risk factors) and the timing of the transient ischemic attack.

Bottom line: This study clearly shows that having a transient ischemic attack is a sign that a stroke could be in your near future. If you experience symptoms of a transient ischemic attack, you should be evaluated by a doctor within a few hours. After the evaluation, you may be prescribed anti-clotting drugs or undergo a surgical procedure to remove plaques in the carotid arteries. These steps will help prevent a major ischemic stroke.

Linking Hypertension and Weight Gain

Tue, 28 Apr 2009 06:00:00 CDT

Being only a bit overweight -- or even on the high side of "normal" -- may increase the risk of developing high blood pressure over the years, according to a report in the American Journal of Hypertension (volume 20, page 370).

People who are over weight or obese are more likely to have high blood pressure than people without weight problems. One reason is that the more weight you have, the more blood your body needs to carry oxygen and nutrients to your organs and tissues. As blood volume increases, so does the pressure against the artery walls, thus raising blood pressure.

Now an analysis of data from the Physicians Health Study looked at the relationship between body mass index (BMI) and blood pressure in more than 13,000 middle-aged and older men followed for over 15 years. The higher the men's BMI at the outset of the study, the higher their risk of developing high blood pressure over the years. In addition, the risk increased as weight increased, even after taking into consideration other possible contributing factors such as age, smoking, physical activity, diabetes, and high cholesterol.

What's more, it didn't take many extra pounds to raise the risk of high blood pressure. Even men with a normal BMI of between 22 and 24 -- albeit on the high side of normal -- were 20% more likely to develop high blood pressure than those with a BMI of under 22.

In comparison, overweight and obese men (BMI of greater than 26) were 85% more likely to have high blood pressure. So preventing weight gain, even small amounts, can lower the risk of developing high blood pressure in men -- and, most likely, in women as well.

Another Reason To Go Easy on the Salt Shaker

Tue, 17 Mar 2009 06:00:00 CST

You know that cutting back on salt is good for your blood pressure, but now there's evidence it also prevents heart attack and stroke and death from cardiovascular disease.

Blood pressure levels tend to increase with higher intakes of sodium. By limiting your salt intake, you may be able to lower your systolic blood pressure by 2-8 mm Hg.

Salt added to foods during cooking and at the table makes up only about 10% of the sodium consumed in the typical American diet. A much larger proportion of the salt we consume comes from the sodium in processed foods like cold cuts; canned vegetables, meats, and soups; frozen dinners; cheeses; salad dressings; snack foods (such as potato chips); and fast food. Thus, reducing your salt intake means not only avoiding the saltshaker while cooking and at meals, but also reading food labels and choosing foods that are low in sodium.

And now there's even more reason to go easy on the salt shaker, according to a study reported in the journal BMJ (volume 334, page 885). Researchers followed more than 3,100 adults with prehypertension. Participants who cut their sodium intake were 25% less likely to suffer a cardiovascular event (heart attack, stroke, or need for angioplasty or bypass surgery) or die of cardiovascular disease than those who stuck with their regular, often salt-laden diets. The findings come from two clinical trials that involved men and women 30-54 years old with high-normal blood pressure.

The participants were randomly assigned to either follow their usual diets or learn how to cut salt from their meals; those in the latter group lowered their sodium intake by 25-35%. During the five-year follow-up period, which began 10-15 years after the trials ended, the salt reducers had fewer heart attacks, strokes, and heart procedures, as well as a lower death rate.

Bottom line: These new findings show that the benefits of salt reduction extend beyond lowered blood pressure. So it's even more important to follow experts' advice on sodium: no more than 2,300 mg per day, and less than 1,500 mg if you have high blood pressure. Since processed foods are a major sodium source, always read product labels and opt for low-sodium versions whenever possible.

Did Yelling At My Spouse Give Me a Stroke?

Tue, 03 Feb 2009 06:00:00 CST

Are you stressed out? There is a growing body of research connecting chronic stress with an increased risk of stroke, particularly ischemic stroke. In a study of more than 13,000 people, men reporting chronic stress over a 20-year period had double the risk of stroke as men without chronic stress (the increased risk was not significant in women).

Q. Did yelling at my spouse give me a stroke?

A. No. While chronic elevated blood pressure increases the risk of a stroke, a brief increase in blood pressure due to emotions or exercise does not.

On the other hand, chronic stress -- emotional or physical stress that continues for some time -- does contribute to stroke risk. This is especially true if you have other stroke risk factors.

For example, in a Danish study of more than 12,000 adults, those who reported experiencing stress at least weekly were nearly 50% more likely to die of a stroke over a 13-year period than those who said they never or hardly ever felt stress. Participants who often felt stress also tended to have other stroke risk factors such as smoking, a diagnosis of hypertension, or little physical activity.

If you feel chronically stressed -- or are constantly yelling at your spouse -- consider some therapy or lifestyle changes. Counseling can help with emotional and relationship issues, and stress-reduction courses, offered at many hospitals and clinics, can teach you specific techniques for coping with stress. Lifestyle practices such as exercise, yoga, tai chi, and meditation can also help lower stress and blood pressure.

Call 911 -- Not a Healthline -- for Suspected Stroke

Tue, 13 Jan 2009 06:00:00 CST

Much more publicity is given to the symptoms of a heart attack than a stroke. Yet like a heart attack, a stroke is an emergency that requires immediate medical attention. It's essential to get to the hospital as soon as symptoms start, since drug therapy is most likely to be effective within the first three hours of stroke onset.

People who call a hospital's medical-advice healthline instead of 911 for a suspected stroke can lose critical time due to delays or misinformation, according to a study published in the journal Stroke (Volume 38, page 2376) .

The researchers called 46 U.S. hospital healthlines and presented operators with a typical scenario of stroke symptoms. The operators were then asked which of four responses they would give: wait and see if symptoms subside; call your primary care doctor; drive to your local urgent-care center; or call 911 for an ambulance. While 78% of the healthline operators gave the correct response -- call 911 -- 22% recommended that the caller contact his or her primary care doctor, including 32% of the operators who worked for healthlines at certified stroke centers. Moreover, 39% of the healthline calls were transferred at least once (usually to the emergency department), and one quarter of the operators couldn't identify even one sign or symptom of a stroke.

A stroke is a medical emergency and time is of the essence, so if you suspect that you or someone else is having a stroke, immediately call 911, not a medical-advice healthline. Emergency-room doctors are the ones who should make the decision whether symptoms are of a stroke or not.

Listed below are the symptoms of a stroke, as well as what to do in the event of a stroke.

Symptoms of Stroke:

Sudden weakness or numbness in the face, arm, or leg on one side of the body.

Sudden loss, blurring, or dimness of vision.

Mental confusion, loss of memory, or sudden loss of consciousness.

Slurred speech, loss of speech, or problems understanding others.

Sudden, severe headache with no apparent cause.

Unexplained dizziness, drowsiness, loss of coordination, or falls.

Nausea and vomiting, especially when accompanied by any of the above symptoms.

Actions To Take in the Event of a Stroke:

Stay calm. Ignore any tendency to downplay a stroke symptom; it's common for people to deny the possibility of something as serious as a stroke. Don't hesitate to take prompt action.

Call or have someone call an ambulance. (Dial 911 in most parts of the United States.) Be sure to give your name, telephone number, and exact whereabouts.

While waiting for the ambulance, the person suffering the stroke should be made as comfortable as possible and should not eat or drink anything other than water.

If an ambulance cannot arrive for an extended period of time, a family member or neighbor should drive the stroke patient to the hospital. Under no circumstances should the person experiencing the stroke symptoms attempt to drive.

Notify the stroke patient's doctor. He or she can provide the hospital with the patient’s medical history, which may be important for determining the best type of treatment for the stroke.

Questions About Hypertension Medication

Tue, 02 Dec 2008 06:00:00 CST

Do you take medication to control your high blood pressure? In this Health Alert, Johns Hopkins cardiologist Roger S. Blumenthal answers questions of concern to many of us.

Q. I am not averse to taking medication, but my doctor told me that once I start with a hypertension medication, I would have to take it forever. I am only 51 years old, so "forever" seems like a real long time. What if I were able to stop smoking, and to lose the 40 to 50 pounds the doctor recommends? Would I still need the high blood pressure drugs? Oxford, MI

Dr. Blumenthal answers: Weight loss is highly beneficial in terms of dropping blood pressure for most people. Exercise can also be very helpful in reducing blood pressure in individuals with mild to moderate levels of hypertension. Moderate intensity aerobic exercise has been shown to drop systolic (top number) pressure by 10 to 11 mmHg, and diastolic (bottom number) pressure by 7–8 mmHg.

But the answer to your question about medication depends on the degree of your high blood pressure. It is certainly possible that if your blood pressure is only mildly elevated, a combination of weight loss, exercise, and smoking cessation could lower your blood pressure to the point where medication is not needed. In general, though, most people with high blood pressure tend to remain on their antihypertensive medication for life and often require additional medication to control blood pressure as they age.

Q. My doctor recently started me on hypertension medication. He said my blood pressure was slightly elevated and had not gone down since my exam last year. If my blood pressure is really not that high, is there a risk that the drug will lower my blood pressure too much? Hanover, NH

Dr. Blumenthal answers: It is possible that an antihypertensive medication can work "too well," and cause someone to become hypotensive, that is, for their blood pressure to drop too low.

Physicians typically try to prevent this adverse effect by starting with a low dose of medication and slowly increasing the dosage until optimal blood pressure is achieved. Occasionally, a patient may be more sensitive than expected to a hypertension drug, and sometimes interactions with other medications may enhance the drug's action.

Given that your blood pressure is only "slightly elevated," it is likely that your doctor has prescribed a low dose of medication. If you monitor your blood pressure regularly after starting on the drug, you should be able to avoid hypotension.

The Best Exercises To Lower Your Blood Pressure

Tue, 23 Dec 2008 06:00:00 CST

Exercise plays a valuable role in controlling blood pressure. Experts recommend engaging in moderate physical activity for at least 30 minutes five to seven days of the week. You do not need to push yourself to the point of discomfort to achieve benefits. In a recent analysis of more than 50 trials, regular, moderate physical activity reduced blood pressure by an average of 4/3 mm Hg.

When it comes to blood pressure lowering, aerobic exercise is very important. Aerobic exercise raises your pulse, expands your lungs, and works the heart and circulatory system. Some examples of aerobic exercise are walking, swimming, cycling, gardening, yard work, dancing, cleaning the house, tennis, and golfing (carrying clubs without a cart).

Adding some strength training (hand weights or weight machines) to aerobic exercise can help as well, because it builds muscle mass. Increased muscle boosts metabolism and helps with weight control, which, in turn, lowers blood pressure. But lifting weights alone will not reduce blood pressure as much as aerobic exercise.

Balance exercises also are beneficial for people with hypertension. These exercises won't lower blood pressure but can help prevent falls related to orthostatic hypotension -- dizziness or light-headedness that occurs when you get up too quickly from a seated or lying position.

Gadgets That Can Help With Exercise -- Devices that measure progress or entertain while working out can both offer incentives to exercise and make it more pleasant. Here are some popular gadgets:

Pedometers. One way to track exercise is to count your steps with a pedometer, working up to 10,000 steps per day. Pedometers range from inexpensive to high-tech devices that can download walking information onto your computer. Cost: $4–30.

Heart monitors. These devices are worn on your wrist or chest and measure heart rate during any activity, from mowing the lawn to working out in the gym. They are especially good for people who are starting an exercise program and are concerned about overdoing it. While not inexpensive (around $100), they also serve as a watch and timer.

Audio players with headphones. An MP3, CD, tape, or other audio player for listening to music or books can make the time pass while working out. Player prices range from $20 to more than $100.

How High Blood Pressure Can Affect Your Memory

Tue, 21 Oct 2008 06:00:00 CDT

The most serious effects of untreated hypertension are well known: strokes, heart attacks, heart failure, kidney disease, and vision loss. But hypertension can contribute to lesser-known health conditions, including cognitive (thinking) impairments. In this Health Alert, Johns Hopkins explains how hypertension leads to thinking problems and provides advice.

Hypertension, particularly in mid-life, may be a major risk factor for cognitive decline, dementia, and Alzheimer's disease. On the plus side, research is showing that treating hypertension may lower the risk.

How does hypertension lead to thinking problems? One obvious reason is that high blood pressure increases the risk of stroke by damaging blood vessels that carry blood to the brain. This damage leads to the buildup of plaques, and when one of these plaques ruptures, a blood clot forms. If this blood clot cuts off blood supply to brain cells responsible for memory or other cognitive functions, the death of these cells can lead to impairments in thinking ability.

But researchers are starting to find that hypertension has a more insidious effect on the brain -- that is, you don't need to have a full-blown stroke for hypertension to do its damage. Brain scans show that individuals with hypertension are more likely to have brain lesions, called white matter hyperintensities (WMHs), than people with normal blood pressure. And the greater the number of these WMHs, the higher the risk of cognitive problems like dementia and Alzheimer's disease.
So what are WMHs, and how do they affect your thinking? Your brain has two layers: an outer layer of gray matter that is packed with brain cells that process information, and an inner layer of white matter that contains nerve fibers that transmit information between brain cells. Hypertension-related buildup of plaque reduces blood flow to nerve fibers in the white matter, and the insufficient blood flow causes decay of the nerve fibers' myelin sheaths, which are necessary for transmittal of information.
What can you do? Research indicates that gaining control of your blood pressure can reduce your risk of dementia. There is also some evidence that lowering blood pressure reduces the occurrence of new WMHs. The study looked only at people who were taking an ACE inhibitor in combination with a thiazide diuretic. But those taking this drug combination had fewer and smaller new WMHs after three years than those who received a placebo. More research is needed, however, to find out whether other blood pressure medications have the same effect.

Stroke--A "Man's Disease" No Longer

Tue, 09 Sep 2008 06:00:00 CDT

Stroke has long been considered a "man's disease," but that notion seems to hold no more. Each year in the United States, 46,000 more women than men have a stroke, and three out of five deaths from stroke occur in women. What's more, if you think that breast cancer is a woman's biggest health concern, think again. A woman's lifetime risk of breast cancer is one in nine, but nearly one in five women over age 45 will have a stroke by the time they reach age 85.

The differences in stroke between men and women don't just lie in the statistics. Women have some unique risks and different responses to shared risks. They also respond better than men to certain preventive measures. For example ...

Stroke Risk-Factor 1 -- Aging. Women ages 30-50 have a five times lower risk of stroke than men, but this difference disappears when women hit menopause. That's when estrogen levels drop substantially and low-density lipoprotein (LDL) cholesterol levels begin to rise, which spurs along the process of atherosclerosis, the gradual buildup of plaques that narrow arteries and can lead to ischemic strokes.

Stroke Risk-Factor 2 -- Heredity. Women are more likely than men to inherit a risk of ischemic stroke. In a recent study from the United Kingdom, women who suffered a stroke were 40% more likely than men to have a parent or sibling with a history of stroke.

Stroke Risk-Factor 3 -- Hormone replacement therapy. Researchers had once hoped that hormone replacement therapy would protect women from strokes, but the truth is the therapy slightly increases stroke risk. As a result, experts no longer recommend estrogen with or without progestin to lower stroke risk in women.

Stroke Risk-Factor 4 -- Atrial fibrillation. Women with this heart rhythm irregularity are more likely to have an ischemic stroke than men. In a recent study of nearly 14,000 adults with atrial fibrillation, 4% of the women not taking warfarin to prevent blood clots had an ischemic stroke, compared with 2% of the men. Fortunately, warfarin was just as effective in preventing ischemic strokes in the female participants as it was in the men.

Stroke Risk-Factor 5 -- Lipid abnormalities. High cholesterol is a risk factor for ischemic strokes, and a recent 11-year study found that high total and LDL cholesterol levels doubled the chances of having a stroke in about 28,000 healthy women ages 45 and older. Research also suggests that having high triglycerides may increase stroke risk more for women than for men.

Stroke Risk-Factor 6 -- Migraines. Women who have migraines with aura (visual disturbances such as light sensitivity; seeing lines, spots, or flashes of light; or temporary vision loss) are up to 10 times more likely to suffer a stroke, depending on what other stroke risk factors they have.

How Low Should You Go?

Tue, 19 Aug 2008 06:00:00 CDT

Aggressively treating high blood pressure may not be good medicine after age 80, according to a new study reported in the Journal of the American Geriatrics Society (Volume 55, page 383).

In this study, researchers looked at the medical records of more than 4,000 veterans age 80 and older with high blood pressure. Participants who lowered their blood pressure to just below the upper limit of normal -- 139/89 mm Hg -- were less likely to die of any cause over a five-year period than those who reduced their blood pressure to lower levels. This relationship held when the researchers took into account other illnesses that can lead to premature death.

These findings do not contradict current guidelines that recommend lowering blood pressure to below 140/90 mm Hg. But they do suggest that aggressive lowering of blood pressure beyond this level could be harmful for people over age 80, possibly because of reduced blood flow to vital organs.

The potential dangers of lower blood pressure levels in people over age 80 need to be confirmed in randomized, controlled trials before experts recommend less stringent blood-pressure goals for this age group. But if you experience any symptoms of aggressive blood-pressure lowering -- dizziness, weakness, or thinking problems -- tell your doctor, who may then make a change in your treatment regimen.

More Reasons to Eat Dark Chocolate

Tue, 30 Sep 2008 06:00:00 CDT

Can eating dark chocolate help lower your blood pressure? Studies reported in the Archives of Internal Medicine and Journal of the American Medical Association suggest the answer is "yes!"

Cocoa-rich dark chocolate may be as good at lowering blood pressure as some medications, according to two studies. But tea -- green or black -- doesn’t seem to have any significant effect.

A meta-analysis looked at 10 trials that studied the effects of polyphenol-rich tea and cocoa on blood pressure levels. The tea studies revealed no significant effect on blood pressure. But the cocoa studies found that people who ate 50–100 g of dark chocolate a day for two weeks had an average blood pressure decrease of 5/3 mm Hg.

In the second study, cocoa lowered blood pressure in 44 adults with untreated pre-hypertension or mild hypertension who received 6 g a day of dark chocolate or a matching amount of polyphenol-free white chocolate for 18 weeks.

Those eating dark chocolate had an average drop in blood pressure of 3/2 mm Hg, without any change in weight or cholesterol levels. This is one dietary change most people won’t have trouble making.

But beware: Chocolate is high in calories and eating too much can cause weight gain, which could undo cocoa’s blood pressure–lowering effect. So stick with the 6-g dose (0.25 oz) used in the second study; it was nearly as effective and contains only 30 calories.

[These studies were reported in the Archives of Internal Medicine (Volume 167, page 626) and the Journal of the American Medical Association (Volume 298, page 49).]

Is It A Stroke? Signs You Should Know

Tue, 17 Jun 2008 06:00:00 CDT

You probably know the symptoms of a heart attack, but it's just as important to know the symptoms of a stroke. Rapid diagnosis and treatment of a stroke may minimize damage to brain tissue and improve the chances of survival. Here's advice from Johns Hopkins.

Like a heart attack, a stroke is an emergency that requires immediate medical attention. Since drug therapy is most likely to be effective within the first three hours of stroke onset, getting to the hospital as soon as symptoms start is essential. Listed below are the symptoms of a stroke, as well as actions to take.

Symptoms of a Stroke:

Sudden weakness or numbness in the face, arm, or leg on one side of the body

Sudden loss, blurring, or dimness of vision

Mental confusion, loss of memory, or sudden loss of consciousness

Slurred speech, loss of speech, or problems understanding other people

A sudden, severe headache with no apparent cause

Unexplained dizziness, drowsiness, lack of coordination, or falls

Nausea and vomiting, especially when accompanied by any of the above symptoms.

Actions To Take:

Stay calm, but don’t downplay any of the symptoms or hesitate to take prompt action.

Call or have someone call an ambulance. (Dial 911 in most parts of the United States.) Be sure to give your name, telephone number, and exact whereabouts.

While waiting for the ambulance, the person having stroke symptoms should be made as comfortable as possible and should not eat or drink anything other than water.

If an ambulance cannot arrive for an extended period of time, a family member, neighbor, or someone else should drive the stroke patient to the hospital. Under no circumstances should the person experiencing the stroke symptoms drive.

Notify the stroke patient’s doctor. The doctor can provide the hospital with the patient’s medical history, which may be important for determining the best type of treatment.

At the hospital, be sure to list any medical conditions the stroke patient has (for example, high blood pressure or diabetes), any allergies the patient has (particularly to medication), and any medications the patient is currently taking.

Controlling Blood Pressure May Forestall Dementia

Tue, 08 Jul 2008 06:00:00 CDT

Hypertension is more treatable than ever before, thanks to a wide variety of lifestyle measures and blood pressure medications. When effective, these treatments can not only lower blood pressure, but also reduce the risk of complications from high blood pressure -- specifically, stroke, heart attack, heart failure, and kidney disease.

Now there's another important reason to take your blood pressure medication. Researchers have found that keeping blood pressure in check with medication may help prevent Alzheimer’s disease and other forms of dementia. A pair of studies found that older adults on blood pressure drugs were less likely to develop dementia than those with untreated high blood pressure.

The first study, of nearly 1,300 men followed since the 1960s, found that the longer the men were on blood pressure medication, the lower their dementia risk. Those who were treated for more than 12 years were 60–65% less likely to develop dementia, including Alzheimer’s, than those who never had their high blood pressure treated.

The second study, which followed about 5,100 adults age 65 and older, found that those who were using blood pressure medication at the outset were about one third less likely to develop Alzheimer’s over the next three years. Potassium-sparing diuretics -- which allow the kidneys to excrete water and sodium without depleting potassium -- seemed particularly protective.

Over time, high blood pressure can damage blood vessels leading to the brain, which may explain why treatment is linked to a lower dementia risk. It’s not clear why potassium-sparing diuretics appear especially protective. The study was reported in the journal Stroke (Volume 37, page 1165) and in the Archives of Neurology (Volume 63, page 686).

The Fiber-Blood Pressure Connection

Tue, 27 May 2008 06:00:00 CDT

A diet rich in fiber can help lower blood pressure. But should you eat more soluble or insoluble fiber? Recent research provides the answer.

The shift in Western societies from a diet based on whole grains, vegetables, fruits, and legumes to a diet based on meats, refined grains, and processed foods has been associated with an increase in the incidence of heart disease and type 2 diabetes -- and several studies pointed to a lack of dietary fiber as a primary cause. Debate followed as to whether fiber has a protective effect or is simply a hallmark of a healthy diet. But recent studies are finding that fiber is an independent factor in the development of these diseases.

There are two types of fiber: soluble fiber (which dissolves in water) and insoluble fiber (which absorbs large amounts of water). Both types are important for disease prevention. Most plant foods contain some of each type, but usually one type predominates. Soluble fiber is found in legumes, barley, oats, and dried and fresh fruits. Wheat and other whole grains and some vegetables contain mostly insoluble fiber.

Diets rich in whole grains can protect against high blood pressure. But researchers wanted to know whether soluble or insoluble fiber was responsible for the effect.

To find out, seven men and 18 women with blood pressures less than 140/90 mm Hg were put on the American Heart Association’s Step I diet. After two weeks, refined carbohydrates in the diet were replaced by whole wheat/ brown rice (insoluble fiber), barley (soluble fiber), or half wheat rice/ half barley (a combination of soluble and insoluble fiber) for five weeks each. Blood pressure was taken weekly and weight measured daily.

Systolic blood pressure (the upper number) was reduced by the wheat-rice and the combination diets. Diastolic blood pressure (the lower number) was reduced by all three diets. There were no differences between the three groups in urinary excretion of minerals (such as sodium and potassium) that might affect blood pressure.

The researchers conclude that, in a healthful diet, replacing refined carbohydrates with any type of whole grains -- from brown rice and barley to whole-wheat bread and cereals -- can reduce blood pressure. Doing so may also help to control your weight. The participants lost about 2 lbs during the study. This study was reported in the Journal of the American Dietetic Association I (Volume 106, page 1445).

Should You Try a DASH-Style Diet?

Tue, 06 May 2008 06:00:00 CDT

If you are concerned about hypertension, perhaps you should try the DASH (Dietary Approaches to Stop Hypertension) diet. In this article – and a related article Tweaking the DASH Diet -- Johns Hopkins specialists explore the benefits of a DASH-style diet.

The DASH diet is an eating plan that can have a significant and positive effect on your blood pressure. The diet is rich in fruits, vegetables, and low-fat dairy products and low in saturated fat and cholesterol. The diet also includes whole-grain products, fish, poultry, and nuts. Red meat, sweets, and sugar-containing beverages are kept to a minimum.

Two major clinical trials have evaluated the DASH diet, and a third tested a modified version of the diet:

In the first trial, people who followed the DASH diet for eight weeks reduced their blood pressure by an average of 5.5/3 mm Hg, compared with people who ate a typical American diet (low in fruits and vegetables and high in fat). The benefits of the DASH diet were greatest in people with hypertension. In these people, the DASH diet lowered systolic blood pressure by 11 mm Hg, which is similar to the amount that a single blood pressure drug can lower blood pressure.

In the second trial, people who combined the DASH diet with a low sodium intake (1,500 mg a day) for four weeks had an average blood pressure reduction of 9/5 mm Hg, compared with people who followed a typical American diet with a high sodium intake (3,300 mg a day). As in the first trial, the benefits were greater in people with hypertension—their systolic blood pressure dropped by an average of 12 mm Hg.

In the third trial, called OmniHeart, a DASH-style diet that replaced some of the carbohydrates in the DASH diet with protein (mostly from plants) or fat (mostly monounsaturated fat from olive oil) lowered blood pressure even further.

For more information about the DASH diet, visit the website of the National Heart, Lung and Blood Institute.

Experimental Drug Shows Promise for Stroke

Tue, 25 Mar 2008 06:00:00 CST

UPDATE

As part of our ongoing effort to ensure that this website is up to date, we have determined that the information in the article Experimental Drug Shows Promise for Stroke is no longer current, and has therefore been removed. NXY-059 is no longer in development because of lack of effectiveness in more recent trials. Thank you.

Coping With Emotional Incontinence After Stroke

Tue, 04 Mar 2008 06:00:00 CST

Are you or a friend experiencing bouts of uncontrollable crying or laughter? Are the episodes inappropriate or disproportionate to the situation at hand? What’s going on? It’s called "emotional incontinence” and occurs in 20-25% of people in the first year after a stroke.

Researchers have not yet pinpointed the exact cause of emotional incontinence after a stroke. One possibility is that a stroke damages areas of the brain that control emotions. This stroke damage can disrupt the function of a brain chemical called serotonin, which also plays a role in depression and other mental health problems such as anxiety. It’s also possible that the psychological stress of a stroke may be partly to blame for emotional incontinence.

Assuming that serotonin is at the root of emotional incontinence, some physicians prescribe antidepressants called serotonin reuptake inhibitors (SSRIs) to treat the problem. These medications increase serotonin levels in the brain. This approach appears to be helpful in some cases.

For example, in a study reported in the journal Stroke, 152 people diagnosed with post-stroke depression, proneness to anger, or emotional incontinence were randomly assigned to receive either the SSRI fluoxetine (Prozac) or a placebo for three months. The result: Treatment with Prozac among these stroke victims significantly improved emotional incontinence -- especially for those who suffered from excessive or inappropriate crying.

If you’re interested in trying an antidepressant to control inappropriate crying or laughing, ask your doctor to refer you to a neurologist or a psychiatrist who specializes in stroke-related emotional problems. The National Stroke Association offers these suggestions for helping you or a loved one cope with emotional incontinence due to stroke.

Don’t try to hide it from others. Let others know ahead of time that sometimes the emotions you express on the outside are not what you are feeling inside. By doing this, you won’t need to avoid social situations. In fact, maintaining social relationships is an important part of recovering from a stroke.

If you feel an inappropriate emotion coming on, distract yourself. Focus on something boring or unrelated.

Engage in activities that are incompatible with crying or laughing. For example, try relaxation techniques like deep breathing and progressive muscle relaxation to stifle an inappropriate emotion before it rears its head.

Join a stroke support group. Just knowing that you are not alone and having someone else to share your concerns are comforting to many people.

Lowering High Blood Pressure With Lifestyle Changes

Tue, 12 Feb 2008 06:00:00 CST

A study led by Johns Hopkins professor Dr. Lawrence Appel shows that making lifestyle adjustments can lower blood pressure and improve the effectiveness of blood pressure-lowering medication.

Hypertension is more treatable than ever before, thanks to a wide variety of lifestyle measures and blood pressure medications. When effective, these treatments can not only lower blood pressure, but also reduce the risk of complications from hypertension -- specifically, stroke, heart attack, heart failure, and kidney disease.

Research shows that the effects of lifestyle changes are additive. Thus, the more you adopt, the greater the benefits. In a study led by Dr. Lawrence Appel (coauthor of The Johns Hopkins Hypertension and Stroke White Paper), people with prehypertension or mild hypertension who lost weight, followed the DASH diet, reduced salt and alcohol intake, and exercised regularly lowered their systolic blood pressure by an extra 4 mm Hg over a six-month period, compared with people who only received advice on these lifestyle changes. By making lifestyle adjustments, you’ll also improve the effectiveness of your blood pressure–lowering medication and lower your risk of hypertension complications such as heart attack and stroke.

Many people can keep up the diet and other lifestyle changes that help control hypertension and ward off disease, according to a study in the Annals of Internal Medicine (Volume 144, page 485 ). In a study of 810 adults with prehypertension or mild hypertension, researchers found that those who underwent a lifestyle overhaul were generally able to maintain the changes during the 18-month study. But it did take some work.

Participants had regular counseling sessions on how to incorporate lifestyle changes into their daily routines -- which included eating more fruits, vegetables, whole grains, and low-fat dairy products and cutting down on saturated fat and sodium; getting at least three hours of exercise a week; and, if overweight, trying to shed 15 lbs. Some participants received only advice on making these lifestyle changes, and they served as the control group. Compared with the advice-only group, those in the counseling group were about one fifth less likely to have hypertension at the study’s end. These findings show that with some help you can shake up your lifestyle and stick with it.

Nighttime Blood Pressure May Predict Heart Trouble

Tue, 22 Jan 2008 06:00:00 CST

Are you a "dipper" or "nondipper?” A recent study suggests that men with "nondipping” nighttime blood pressure are at greater risk for heart failure even when their daytime blood pressure was taken into account.

If you’ve had high blood pressure for many years, it can take a major toll on your health. It can damage both large and small arteries, leading to strokes as well as diseases of the heart, kidneys, and eyes. Fortunately, by controlling your blood pressure, you can help prevent or slow the progression of many of these complications.

Now a study reported in the Journal of the American Medical Association (Volume 295, page 2859 ) suggests that blood pressure that fails to take the normal overnight dip may be a sign that your heart is in trouble. Researchers found that in 951 elderly Swedish men, those whose blood pressure remained relatively high at night were more than twice as likely to develop heart failure.

In heart failure, the heart cannot pump blood well enough to meet the body’s needs, leading to symptoms like fatigue and breathlessness. High blood pressure is one of the most important risk factors for heart failure, but no studies had examined whether changes in blood pressure over 24 hours -- measured with a portable ambulatory blood pressure monitor -- could help predict the disease.

The new study suggests that when blood pressure fails to take the dip normally seen during sleep, the added stress on the heart and blood vessels may lead to heart failure. Men with "nondipping” nighttime blood pressure were at greater risk for heart failure even when their daytime blood pressure was taken into account. It’s too soon, however, to start strapping portable blood pressure monitors onto everyone. More studies are needed to see how important nighttime blood pressure is in predicting heart health.

The Dangers of a TIA

Tue, 11 Dec 2007 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | The Dangers of a TIA

In the past, doctors and patients didn’t take a TIA as seriously as a stroke. But today that has changed, and a TIA or mini-stroke is treated as a medical emergency.

Most people who have a stroke never see it coming. The stroke occurs without any warning of the impending danger. However, some people are fortunate enough to get a warning that could save their life -- if they heed the signal.

The warning comes in the form of a transient ischemic attack (TIA), often called a mini-stroke, because it causes stroke-like symptoms that are not as severe or long lasting as the symptoms of a full-blown stroke. A TIA usually lasts only a few minutes and does not cause any permanent brain damage.

But don’t be fooled. A TIA is just as much of a medical emergency as a stroke. That is because about a third of people who suffer a TIA go on to have a stroke in the days, weeks, or months that follow. Fortunately, by receiving immediate treatment for a TIA, you can reduce your chances of having a full-blown stroke.

The signs and symptoms of a TIA are the same as those of a stroke and include the sudden onset of:

Weakness or numbness of the face, arms, or legs, often affecting only one side of the body

Confusion, slurred or garbled speech, or difficulty understanding what someone else is saying

Blurring or blindness in one or both eyes

Dizziness, trouble walking, or loss of balance or coordination

Severe headache with no obvious cause

These symptoms rarely last more than 20 minutes and usually go away after a few minutes. When the symptoms last more than 24 hours, the attack is considered a stroke.

Just like a stroke, a TIA is a medical emergency. That means calling 911 at the first signs or symptoms, even if the symptoms last only a few minutes, which they often do. You might feel that being attended to and rushed off to the hospital by paramedics once the symptoms have subsided is making a mountain out of a molehill. But keep in mind that an immediate, thorough medical evaluation -- and treatment based on that evaluation -- is the best way to reduce your risk of a full-blown stroke. In addition, if you happen to experience a full-blown stroke while in the hospital (about 6% of TIAs are followed by a stroke within 48 hours), you can be given the emergency stroke drug t-PA within the three-hour window and your chances of a full recovery will be greatly improved.

Johns Hopkins Health Alerts | Hypertension & Stroke | The Dangers of a TIA

New Research on Diuretics

Tue, 09 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | New Research on Diuretics

The diuretic chlorthalidone -- an older, cheaper drug for high blood pressure -- may be the best for lowering night-time blood pressure and preventing heart failure, at least in the short term, studies suggests.

What’s the Best Diuretic for High Blood Pressure? When it comes to the diuretic drugs used to treat high blood pressure, the original may still be the best, researchers report in the journal Hypertension (Volume 47, page 352). In a study of 30 adults with high blood pressure, researchers found that a diuretic called chlorthalidone bested a newer, more widely used diuretic called hydrochlorothiazide (HCTZ). Specifically, the diuretic chlorthalidone was more effective at keeping nighttime blood pressure down, likely because it is more long acting than HCTZ.

The diuretic chlorthalidone became available in 1957 and was the first of the modern diuretics used to treat hypertension. In the past 20 years, the diuretic has fallen out of favor, in part because it can cause blood potassium levels to fall -- but also because many doctors assume chlorthalidone and HCTZ are equally effective.

But in the study, 24-hour systolic blood pressure fell to a greater degree when participants took the diuretic chlorthalidone for eight weeks than when they took HCTZ (12 vs. 7 mm Hg). Chlorthalidone was more effective primarily because of its effects on overnight blood pressure. Whether the difference translates into fewer heart attacks and strokes is unknown. And even if the diuretic chlorthalidone is the better drug, HCTZ is more widely available and used in many more combination blood pressure products.

More on chlorthalidone ...

A study, of more than 33,000 older adults with hypertension, found that those given the diuretic chlorthalidone were about half as likely to develop heart failure in their first year of treatment as those who took a calcium channel blocker or an ACE inhibitor.

In general, diuretics are recommended as the first drug of choice for hypertension -- with ACE inhibitors, calcium channel blockers, or other medications added if necessary. The new findings are based on data from a study, which pitted the diuretic chlorthalidone against the calcium channel blocker amlodipine (Norvasc) and the ACE inhibitor lisinopril (Prinivil, Zestril). Researchers wanted to know whether the three drugs had different effects on the risk of heart failure, a common complication of hypertension.

Overall, people given the diuretic were less likely to develop heart failure in the first year. After that, ACE inhibitor patients fared just as well. Those on the calcium channel blocker, however, still had a somewhat higher heart failure risk. Nonetheless, heart failure is only one potential consequence of hypertension, and medication choices have to be individualized. Many people need more than one drug to control their blood pressure. This study was reported in the journal Circulation (Volume 113, page 2201).

Johns Hopkins Health Alerts | Hypertension & Stroke | New Research on Diuretics

Shopping for a Home Blood Pressure Monitor

Tue, 20 Nov 2007 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | Home Blood Pressure Monitors

Using a home blood pressure monitor daily can help you learn how well your lifestyle measures and medications are working.

Did you know that you don’t have to wait until your next doctor’s appointment to have your blood pressure measured? You can measure your blood pressure in the privacy of your own home with a home blood pressure monitor.

A home blood pressure monitor can help you diagnose certain types of hypertension -- for example, white coat hypertension, which occurs when a person’s blood pressure is high in the doctor’s office but lower when measured at home, and masked hypertension, when blood pressure is lower in the doctor’s office but higher at home.

There are a wide variety of home blood pressure monitors on the market, but they can be distilled down to two main types: aneroid and electronic.

Aneroid monitors. These blood pressure monitors consist of a dial gauge and a stethoscope attached to an arm cuff. The cuff is inflated by squeezing a rubber bulb that forces air into the cuff. Measuring blood pressure as the cuff deflates involves listening with the stethoscope for when thumping sounds begin and end and watching the needle on the dial gauge.

Electronic monitors. Much simpler to use, electronic blood pressure monitors consist of only a cuff and a gauge. What’s more, most electronic blood pressure monitors are fully automated -- meaning that they inflate and deflate automatically. These monitors also don’t require a stethoscope, and the results are shown on an easy-to-read digital display.

In our opinion, the best types of blood pressure monitors are the electronic ones. For ease of use, choose one that has both automatic inflation and deflation. Avoid the fingertip and wrist models, however, because they can give unreliable results. Before purchasing a blood pressure monitor, make sure that the cuff fits your arm properly. A cuff that is too small or too large can produce inaccurate readings. In addition, don’t be reluctant to shop around for the best price.

Here are some tips on getting the most accurate results from your home blood pressure monitor:

Don’t exercise, eat, drink caffeinated beverages, or smoke in the 30 minutes before measuring your blood pressure.

Relax for three to five minutes before taking the reading. Don’t forget to remove any jewelry or clothing that could interfere with placement of the cuff.

Once you’re ready to measure your blood pressure, sit in a chair with your back supported, legs uncrossed, and feet flat on the floor.

Strap the cuff around your upper arm at least one inch above the crease of your elbow. Make sure the cuff is strapped on tightly enough so that only one fingertip can fit underneath. Keep you arm at waist level when taking the measurement.

Take two readings, one to three minutes apart, and average the results.

Johns Hopkins Health Alerts | Hypertension & Stroke | Home Blood Pressure Monitors

Tweaking the DASH Diet

Tue, 07 Aug 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Tweaking the DASH Diet

Johns Hopkins professor, Lawrence Appel, M.D., suggests improvements to the DASH diet to help lower blood pressure and improve lipids.

If you have hypertension, your doctor most likely recommended that you make changes in your diet. That’s because a variety of dietary factors -- from salt and alcohol to fruits and vegetables -- can influence blood pressure, and getting the right amounts of these foods can go a long way toward keeping your blood pressure under control.

In fact, for the past 10 years, research has been accumulating that a carbohydrate-rich diet that emphasizes fruits, vegetables, and low-fat dairy products and limits saturated fat and cholesterol -- the so-called DASH diet -- can substantially lower blood pressure. The DASH diet also lowers low-density lipoprotein (LDL) cholesterol.

But can the DASH diet be improved? While following the DASH diet can help lower both your blood pressure and LDL cholesterol, it won’t do much for the other lipids (fats) in your blood. For example, the DASH diet reduces levels of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol that protects against heart attacks and strokes). In addition, the DASH diet has no effect on triglycerides (another blood lipid that increases the risk of heart attacks and strokes).

So Lawrence Appel, M.D., (coauthor of the Johns Hopkins Hypertension and Stroke White Paper) and his colleagues decided to investigate whether these drawbacks to the DASH diet might be minimized with a little tweaking of the DASH diet’s components -- specifically, the mix of carbohydrate, fat, and protein. Here are what they did and what they found.

The researchers compared three different healthy diets in 164 adults with prehypertension or mild hypertension. The first diet resembled the traditional DASH diet -- rich in carbohydrates. In the second diet, some of the carbohydrates were replaced with protein, about half of which came from plant sources such as beans. For the third diet, unsaturated fat, primarily healthy monounsaturated fat, substituted for a portion of the carbohydrates.

All three diets were low in saturated fat, cholesterol, and sodium and rich in fruits, vegetables, fiber, potassium, and other minerals. The participants were then randomly assigned to one of the three diets for six weeks. After a two- to four-week break, participants began a six-week trial of another diet and continued until they had eaten all three diets. The participants’ blood pressure, cholesterol, and triglyceride levels were measured during each phase of the study.

What Was Found -- All three diets lowered blood pressure, but the protein-rich diet and the one that emphasized monounsaturated fat lowered blood pressure even more than did the carbohydrate-rich, DASH diet. What’s more, both the protein- and monounsaturated- fat diets lowered triglycerides -- which the traditional DASH diet did not. In addition, the monounsaturated-fat diet raised HDL levels.

Johns Hopkins Health Alerts | Hypertension & Stroke | Tweaking the DASH Diet

Another Reason to Keep Your Blood Pressure Normal

Tue, 30 Oct 2007 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | Reason to Keep Your Blood Pressure Normal

Researchers report that your odds of ever suffering a stroke depend largely on your blood pressure in middle age and beyond.

No matter how good your health is, it's important to prevent any rise in blood pressure. The main reason is that blood pressure can cause damage to your body when it goes above 110/70 mm Hg -- long before hypertension is diagnosed. In addition, if you keep your pressure at a normal level, you won’t need to take blood pressure medication, which can have side effects and be financially costly over time. Last, people with hypertension who bring their blood pressure down to normal levels with medication still have a higher risk of hypertension complications than individuals who do not require drugs to keep their blood pressure within the normal range.

Now a study in the journal Stroke (Volume 37, page 345 ) reveals yet another good reason to keep your blood pressure under control. Researchers report that your odds of ever suffering a stroke depend largely on your blood pressure in middle age and beyond.

In a decades-long study of nearly 5,000 adults age 55 and older, researchers found that men and women with normal blood pressure (less than 120/80 mm Hg) were about half as likely as those with hypertension to suffer a stroke at some point in their lives.

Overall, men had a one in six chance of ever having a stroke, while the odds for women were one in five. Women face a greater lifetime risk than men, mainly because of their generally longer life expectancy. But blood pressure control was key in lowering stroke risk: Women with normal blood pressure at age 65 had a one in six chance of ever suffering a stroke, while men with normal blood pressure at age 65 had a one in 10 odds.

To put the health threat of strokes into perspective, the researchers also calculated the participants’ lifetime risk of Alzheimer's disease. Only among women older than age 85 was the risk of Alzheimer's greater than the risk of stroke.

The take home message: Keeping your blood pressure under control after age 55 is an important part of reducing your risk of a stroke. So closely follow your doctor’s recommendations for lowering blood pressure.

Johns Hopkins Health Alerts | Hypertension & Stroke | Reason to Keep Your Blood Pressure Normal

Sleep and Your Blood Pressure

Tue, 28 Aug 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Sleep and Your Blood Pressure

Here's another reason for you to catch your Zs: healthier blood pressure.

In 90–95% of people with high blood pressure, doctors are unable to pinpoint the exact cause. In these cases, the condition is called essential or primary hypertension. In the remaining 5–10% of people, doctors are able to identify a cause, and this type of high blood pressure is called secondary hypertension.

Now researchers may have found a connection between sleep habits and high blood pressure. In a study reported in the journal Hypertension (Volume 47, page 833) researchers studied more than 4,800 Americans and found that young and middle-aged adults who clocked five or fewer hours of sleep each night were 60% more likely than their well-rested peers to develop hypertension over the next decade. Lack of sleep did not appear to raise blood pressure in adults older than age 59, however.

The link between sleep habits and blood pressure remained even after the researchers controlled for weight, depression, smoking, and physical activity levels. This means there may be something about chronic sleep deprivation that raises a person’s blood pressure.

One possibility is that people who get little sleep have more exposure to the elevations in heart rate, blood pressure, and nervous system activity that come with being awake. As a result, the body may adapt to these chronic elevations by operating at a new, higher level. Chronic sleep deprivation might also throw a wrench in the central "clock” in your brain, which governs the rhythm of bodily processes, including blood pressure control. People vary in the amount of sleep they need, but experts recommend that adults get at least six hours of sleep a night.

Johns Hopkins Health Alerts | Hypertension & Stroke | Sleep and Your Blood Pressure

Questions and Answers About Blood Pressure Drugs

Tue, 24 Apr 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Q and A About Blood Pressure Drugs

Concerned about the risks associated with blood pressure medication? Roger S. Blumenthal, M.D., medical editor of the Johns Hopkins Heart Bulletin, answers readers’ questions.

Q. I am not averse to taking medication, but my doctor told me that once I start with a high blood pressure medication, I would have to take it forever. I am only 51 years old, so "forever” seems like a real long time. What if I were able to stop smoking, and to lose the 40 to 50 pounds the doctor recommends? Would I still need the high blood pressure drugs? Oxford, MI

A. Weight loss is highly beneficial in terms of dropping blood pressure for most people. Exercise can also be very helpful in reducing blood pressure in individuals with mild to moderate levels of hypertension. Moderate intensity aerobic exercise has been shown to drop systolic (top number) pressure by 10 to 11 mmHg, and diastolic (bottom number) pressure by 7–8 mmHg. But the answer to your question about high blood pressure medication depends on the degree of your hypertension.
It is certainly possible that if your blood pressure is only mildly elevated, a combination of weight loss, exercise, and smoking cessation could lower your blood pressure to the point where medication is not needed. In general, though, most people with high blood pressure tend to remain on their blood pressure medication for life and often require additional medication to control blood pressure as they age.

Q. I know hormone replacement theory is a very controversial topic, but what is your advice for a woman (my 55-year-old wife) who was recently diagnosed with high blood pressure. The hot flashes and sleep problems accompanying Nancy’s menopause are so severe that she now is willing to consider hormonal therapy to relieve her symptoms. She mentioned this to her 60-year-old sister, who warned Nancy that the drugs could make her high blood pressure worse. If this is true, what should she do? Orleans, MA

A. Gynecologists prescribe hormone replacement therapy (HRT) as a highly effective treatment for the more troublesome symptoms of menopause. There is no contraindication to the use of HRT in hypertensive women. There may sometimes be an idiosyncratic reaction to HRT causing high blood pressure, but this is uncommon. Your wife’s blood pressure should be monitored two to three times in the first six months after starting HRT and then routinely afterwards.

Q. My doctor recently started me on high blood pressure medication. He said my blood pressure was slightly elevated and had not gone down since my exam last year. If my blood pressure is really not that high, is there a risk that the drug will lower my blood pressure too much? Hanover, NH

A. It is possible that a high blood pressure medication can work “too well,” and cause someone to become hypotensive, that is, for their blood pressure to drop too low. Physicians typically try to prevent this adverse effect by starting with a low dose of blood pressure medication and slowly increasing the dosage until optimal blood pressure is achieved. Given that your blood pressure is only “slightly elevated,” it is likely that your doctor has prescribed a low dose of medication. If you monitor your blood pressure regularly after starting on the drug, you should be able to avoid hypotension.

For more Alerts and Special Reports, please visit the Hypertension and Stroke Topic page.

Johns Hopkins Health Alerts | Hypertension & Stroke | Q and A About Blood Pressure Drugs

Stroke and Memory Loss

Tue, 15 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Stroke and Memory Loss

This Heart Health Alert on the connection between stroke and memory loss comes from a longer article that appeared in the Johns Hopkins Heart Bulletin. The author, Roger S. Blumenthal, M.D. is medical editor of the Heart Bulletin and director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.

Cerebrovascular disease, including stroke, is the second leading cause of death and a major cause of long-term disability in Western societies. Several studies have shown that the known risk factors for cardiovascular disease -- diabetes, elevated cholesterol, and hypertension -- are also associated with stroke, which may in turn increase the risk for dementia and Alzheimer's disease. However, it remains unclear whether stroke is directly related to cognitive decline -- increasing problems with thinking, learning, and memory -- in patients without dementia or cognitive impairment.

A recent report helps answer that question. The latest news-making study comes from Christiane Reitz, M.D., and her colleagues at Columbia University in New York, who examined the relationship between stroke and memory in patients without dementia or cognitive impairment. Their study appeared in the Archives of Neurology. The goal of the study was to determine whether people who have had a stroke are more vulnerable to worsening memory as they age. The results were affirmative.

People who have had strokes are more likely to develop memory problems, and they experience a more rapid decline. The study’s authors also found that stroke increases the risk of developing Alzheimer's disease. Men were especially vulnerable to these effects.

A stroke occurs when a blood vessel that supplies the brain with oxygen and nutrients either bursts or becomes clogged by a clot or some other particle. Nerve cells in the affected area begin to die within minutes. This same process occurs in a heart attack, which is why strokes are now being referred to as "brain attacks.”

However, not all strokes are so dramatic. Many people experience so-called "partial strokes” -- the clinical term is "transient ischemic attack,” or TIA -- in which a clot blocks a blood vessel, but only temporarily (for less than 24 hours). Like the blockage itself, the TIA symptoms can disappear in a few minutes. There are also "silent strokes,” which occur when very small vessels in the brain are blocked or when a stroke occurs in a seemingly unimportant part of the brain. Even though silent strokes don’t cause the noticeable classic stroke symptoms such as vision changes, speech problems, paralysis, or weakness in one side, they do cause the death of brain cells.

Given that more than 700,000 strokes occur in the United States every year, the implications of the Columbia study are significant. An earlier report from some of the same researchers at Columbia found that the risk of Alzheimer"s disease or dementia was highest when the survivor of a stroke also had some other form of cardiovascular disease, such as high blood pressure or diabetes. Two other major studies have reported that suffering a stroke can double your chances of developing dementia.

For more Alerts and Special Reports on Stroke, please visit the Hypertension and Stroke Topic page.

Johns Hopkins Health Alerts | Hypertension & Stroke | Stroke and Memory Loss

New Data on High Blood Pressure

Tue, 03 Apr 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | New Data on High Blood Pressure

If you or a loved one has high blood pressure, you’ll want to take note of this important research reported in two leading scientific journals.

Hypertension shortens lifespan

If you’re middle-aged and have hypertension, your high blood pressure may shorten your lifespan. A study by Dutch researchers reported in the journal Hypertension (Volume 46, page 260) found that by maintaining normal blood pressure readings people live longer and have a better chance of avoiding cardiovascular disease.

The researchers looked at data from more than 3,100 men and women participating in the well-known Framingham Heart Study. Blood pressure measurements were taken at age 50, and the participants were followed for 28 years on average. People with normal blood pressure at age 50 lived an average of five years longer than those who had high blood pressure at this age. In addition, 50-year-old people with normal blood pressure lived seven years longer without cardiovascular diseases (such as heart attacks and strokes) than 50-year-olds who had hypertension. Weight and body mass index (BMI) increased in men and women as their blood pressure rose. There was also an increase in the risk of cardiovascular disease as blood pressure levels climbed.

This effect of high blood pressure on life expectancy, write the study authors, is larger than previously estimated and clearly shows how important blood pressure control is to survival, particularly to years lived free from cardiovascular disease.

When’s the best time to take your daily aspirin?

If you’re taking a daily aspirin tablet to reduce your risk of a heart attack, perhaps you should consider the time of day you take it. A study from Spain reported in the Journal of the American College of Cardiology (volume 46, page 975) found that aspirin at bedtime might have the greatest heart benefit.

The researchers studied 328 people with mild (and untreated) high blood pressure, and randomized them to take a daily low-dose (100 mg) aspirin tablet either upon awakening or at bedtime, or not to take aspirin at all. Three months after the trial began, the morning aspirin users experienced a slight increase in their blood pressure (by 3 mm Hg systolic/2 mm Hg diastolic), but blood pressure decreased in people taking aspirin at night (by 7mm Hg systolic/5 mm Hg diastolic). Individuals not using aspirin also had a slight dip in their blood pressure.

The study authors write that taking a heart-protective aspirin tablet at bedtime instead of some other time during the day could be particularly helpful for people with mild high blood pressure who are struggling to lower their blood pressure despite lifestyle measures. However, these results need to be confirmed before doctors start recommending that a daily aspirin be taken at night, rather than at other times of the day, to lower blood pressure.

For more Alerts and Special Reports, please visit the Hypertension and Stroke Topic page.

Johns Hopkins Health Alerts | Hypertension & Stroke | New Data on High Blood Pressure

Sudden Headache? Blurred Vision? It could be a warning of a stroke.

Tue, 17 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Warnings of a Stroke

Research from the journal Neurology explains why acting promptly at the first sign of a transient ischemic attack may prevent a major stroke.

You probably know the symptoms of a heart attack, but it’s just as important to know the symptoms of a stroke. Why is it important? Like a heart attack, a stroke is an emergency that requires immediate medical attention. Even a transient ischemic attack or TIA, in which stroke symptoms appear suddenly and quickly subside, is a medical emergency.

Whether you are having an ischemic or hemorrhagic stroke, the symptoms are the same. With a TIA, the symptoms are transitory, often lasting only minutes. If you (or someone you’re with) experiences the sudden onset of any of the stroke symptoms listed below -- even if the symptoms begin to subside -- you must call 911 or go straight to the hospital. Rapid diagnosis and treatment of a stroke may minimize damage to brain tissue and improve the chances of survival. Stroke symptoms include:

Sudden weakness or numbness in the face, arm, or leg on one side of the body.

Sudden loss, blurring, or dimness of vision.

Mental confusion, loss of memory, or sudden loss of consciousness.

Slurred speech, loss of speech, or problems understanding others

A sudden, severe headache with no apparent cause.

Unexplained dizziness, drowsiness, lack of coordination

Nausea and vomiting, especially when accompanied by any of the above symptoms

The importance of responding immediately to symptoms of a stroke is underscored by a study reported in the journal Neurology (Volume 64, page 817). Warning signs of an ischemic stroke may occur up to seven days before the event itself, according to researchers, and these signs should be taken seriously to minimize the chance of a major stroke.

The study examined data on 2,416 people, all of whom had an ischemic stroke. About a quarter of them described having symptoms consistent with a transient ischemic attack before their stroke, most often during the prior week. Seventeen percent of the transient ischemic attack group had symptoms of a transient ischemic attack on the day of the ischemic stroke. However, transient ischemic attack symptoms occurred earlier in other patients -- 9% on the previous day, and 43% on another day during the seven days before the stroke. There was no correlation between patient characteristics (including cardiovascular risk factors) and the timing of the transient ischemic attack.

This study clearly shows that having a transient ischemic attack is a sign that a stroke could be in your near future. If you experience symptoms of a transient ischemic attack, you should be evaluated by a doctor within a few hours. After the evaluation, you may be prescribed anti-clotting drugs or undergo a surgical procedure to remove plaques in the carotid arteries. These steps will help prevent a major ischemic stroke.

Johns Hopkins Health Alerts | Hypertension & Stroke | Warnings of a Stroke

Understanding Central Pain Syndrome

Tue, 26 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Understanding Central Pain Syndrome

Post-stroke pain is difficult to treat and misdiagnosis is common. Can anything be done?

If you’ve never heard of the central pain syndrome, you’re not alone. In fact, many doctors are unfamiliar with this syndrome, which can affect people who have had a stroke -- and can make their lives miserable.

The central pain syndrome is a neurological disorder that develops when the central nervous system (CNS) has been damaged; it can happen not only in individuals who’ve had a stroke but also in those with multiple sclerosis, epilepsy, Parkinson’s disease, and other conditions involving the CNS (which includes the brain, brain stem, and spinal cord).

Central pain syndrome can occur when a stroke injures the thalamus or parietal lobe -- the parts of the brain that process sensory stimuli. This damage causes sensory neurons in these areas of the brain to misfire, which can lead to disabling pain that is constant and anguishing, and may become more severe with time. About 9% of people who have a stroke develop central pain syndrome (which is also called post-stroke pain syndrome). The pain can begin immediately afterward, but sometimes does not appear until weeks, months, or even years later. So you and your doctor might not consider the pain to be a result of your stroke.

What’s the pain like? Some people describe the pain as burning or cutting. For others, the pain is an intense aching or throbbing pain or excruciating pins-and-needles sensations. Particularly distressing is that the pain does not affect a small area of the body; instead, it is often head to-toe or occurs in large portions of the body. If that weren’t enough, a light touch can elicit pain; so can clothing or a blanket brushing up against the skin. Even a change in room or outdoor temperature (or a rise or fall in barometric pressure) can intensify the discomfort. Emotions can increase the pain as well.

Because many doctors are unfamiliar with the central pain syndrome, misdiagnosis is common. Some people are told that they’re imagining it or making up the excruciating pain, or that the pain can’t possibly be as bad as they say it is. These individuals may be told that they need to see a mental health professional like a psychiatrist.

Getting help for your pain -- If you’ve had a stroke, and are coping with severe pain, see your family doctor or a neurologist. If the doctor is unable to provide the pain relief you need, or raises a skeptical eyebrow over whether you’re actually feeling pain, ask for a referral to a pain management clinic that specializes in chronic, difficult-to-treat pain.

For more Alerts and Special Reports, please visit the Hypertension and Stoke Topic page.

Johns Hopkins Health Alerts | Hypertension & Stroke | Understanding Central Pain Syndrome

Are You Forgetting to Take Your Blood Pressure Medication?

Tue, 30 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | Taking Prescribed Blood Pressure Medication

High blood pressure is a silent disease. So even though you may feel great, it’s critical that you take your blood pressure medication. Here’s are some practical tips to help you remember.

Many people don’t take their medications as often as they should and this is particularly true when it comes to blood pressure drugs. In a report published in the journal Hypertension, researchers looked at data from 51,517 people (age 65 and over) who were taking medication for a variety of medical conditions, including high blood pressure. People were more diligent about taking pills to treat illnesses that cause symptoms, but they were lax about taking medication for symptom-free high blood pressure.

Specifically, the participants were 57% less likely to take their blood pressure pills than their medication for asthma or chronic obstructive pulmonary disease. In addition, their adherence to the use of blood pressure medicines was 50% less than for depression medications, 41% less than drugs for gastrointestinal disorders, and 37% less than osteoarthritis pills.

Keep in mind that even though high blood pressure is a silent disease, its treatment is no less important than that for any other illnesses you might have. Here’s some advice to help you remember to take your blood pressure pills:

Buy and use an inexpensive plastic pillbox (available at pharmacies). Look for one with seven compartments that correspond to the days of the week (Sunday through Saturday), as well as times of day (morning, noon, evening), and keep your blood pressure medication there. It will help you organize your blood pressure pills, and give you a way of keeping track of what pills you need to take and when.

Leave a Post-It note on the refrigerator or bathroom mirror, or anywhere else you’re likely to see it, as a reminder to take your blood pressure pills. Or set your watch, alarm clock, or cell phone to alert you to take your blood pressure medication.

Take your blood pressure pills at the same time each day, and at the same time as an everyday activity (for example, eating breakfast or brushing your teeth). This will help make taking your blood pressure medication a part of your daily routine.

Medical pagers and electronic pillboxes are also available. These products make a beeping noise when it’s time for your blood pressure medication. Some of the electronic pillboxes even record the day and time when the cap of the pillbox was opened.

Each time you take your blood pressure medication, write it down in a log or on a calendar, including the date and time that you took it.

And by the way, if you forget to take your blood pressure pills, don’t “double up” with an extra dose to make up for the lapse. Instead, just take your next scheduled dose. When you travel, make sure to pack an adequate supply of blood pressure pills in your carry-on luggage, purse, or briefcase. Also, bring some extra pills with you in case your return home is delayed.

Never stop taking your blood pressure medication (or adjust its dose) on your own without first discussing it with your physician. Doing so can cause a dangerous spike in your blood pressure. Nor should you take a smaller dose (or skip a dose) in order to make your medicine last longer. Let your doctor know if you’re having difficulty sticking with or paying for your blood pressure pill regimen, and he or she may have some suggestions. In addition, don’t forget to refill your prescription with plenty of time to spare so you don’t run out of pills.

Johns Hopkins Health Alerts | Hypertension & Stroke | Taking Prescribed Blood Pressure Medication

Meditation -- A New Way to Lower Blood Pressure

Tue, 09 Jan 2007 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | Meditate to Lower Blood Pressure

Research shows that meditation not only calms the mind, but affects the nervous system as well.

While the evidence is not definitive, it appears that chronic stress causes long-term elevations in blood pressure, and that certain stress-management techniques may be able to counteract these rises in blood pressure.

There are many ways to reduce stress: Massage, yoga, tai chi, and stress management classes are some of the more popular methods. But the relaxation technique that has been studied most widely—and has been shown to be effective for reducing blood pressure—is a type of meditation called transcendental meditation.

Introduced to the Western world by Maharishi Mahesh Yogi in 1959, transcendental meditation involves sitting comfortably in a quiet place with your eyes closed. You start off with a few slow, deep breaths, and then silently repeat a soothing one-syllable word, called a mantra, in your mind to focus your concentration. After 20 minutes, you open your eyes, take a few moments to reorient to the world around you, and then continue with your day.

Proponents of transcendental meditation believe that it works through its effects on the nervous system; transcendental meditation calms the mind, slows the heartbeat, and releases tension from the muscles. As a result, transcendental meditation might also have an impact on your blood pressure readings and overall cardiovascular health.

Here is what recent research on meditation has shown:

At the Medical College of Georgia and other institutions (including the University of Illinois and Maharishi University of Management), researchers evaluated 150 people with slightly elevated blood pressure (an average of 142/95 mm Hg), and had them practice either transcendental meditation or progressive muscle relaxation (tensing and relaxing muscle groups in succession) two times a day for 20 minutes, or to participate in a health education program.

In a report in the American Journal of Hypertension, investigators noted that the meditation group experienced greater decreases in blood pressure (average declines of 3/6 mm Hg), compared to the other groups (average decreases of 0.5/3 mm Hg) over a 12-month period. The meditation group also was able to reduce its use of blood pressure medication, while the other groups actually increased their reliance on these drugs.

The American Journal of Cardiology published a report that combined the results of two randomized trials, which examined the effect of stress reduction on death rates in 202 people age 55 and older with prehypertension or mild hypertension. Some of them participated in a transcendental meditation program, while the rest practiced other relaxation techniques (progressive muscle relaxation, mindfulness training, and mental relaxation) or were part of a control group. They were followed for an average of eight years. At the end of the follow-up period, those in the meditation group fared the best, experiencing a 30% decline in the rate of cardiovascular deaths, and a 23% reduction in the rate of death from all causes, compared to the control group. When compared with the other relaxation techniques, transcendental meditation was associated with a 32% lower incidence of cardiovascular deaths, and a 27% reduction in death from all causes.

Johns Hopkins Health Alerts | Hypertension & Stroke | Meditate to Lower Blood Pressure

Setting the Record Straight on Aging and Your Blood Pressure

Fri, 08 Dec 2006 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | Aging and High Blood Pressure

Why treating high blood pressure is important at any age.

For years, some doctors told their middle-aged and older patients not to worry if their blood pressure climbed with age. In fact, there was even a commonly held belief that if your systolic blood pressure (the top number in a reading) climbed as you aged, it was a positive sign that your blood was being propelled more forcefully through the blood vessels.

But today, doctors know better. If your blood pressure increases into the hypertensive range—no matter what your age—it can put your health in jeopardy. Conversely, keeping your blood pressure under control will lower your risk of hypertension complications, such as heart attacks and strokes, and help you live a long life— whether you are young or old.

Despite the erroneous beliefs of the past, age remains a major risk factor for high blood pressure in both men and women. As you get older, your blood vessels become less flexible, which increases the pressure on the artery walls as blood moves through them. In general, systolic blood pressure continues to increase with age, while diastolic pressure rises until the sixth decade of life, and then is likely to become stable (or even decline modestly).

It’s difficult to avoid high blood pressure with age. Studies show that even if you manage to remain hypertension free until age 65, you still have a 90% risk of developing high blood pressure in your lifetime. But although you may be more susceptible to high blood pressure as the years go by, you can take steps to postpone its arrival and successfully treat high blood pressure if it eventually catches up with you.

Unfortunately, not all doctors have recognized the importance of successfully treating high blood pressure in their older patients, especially those age 80 and beyond. In a study in the Journal of the American Medical Association, researchers reported on the treatment of high blood pressure in participants in the well known Framingham Heart Study. Overall, only a third of the participants with high blood pressure had their blood pressure under control (less than 140/90 mm Hg), and the number tended to decrease as age increased. This was particularly true in women: While 38% of women under age 60 had their blood pressure under control, the percentage dropped to 28% between the ages of 60 and 79 and 23% for those age 80 and older.

If you do not have high blood pressure, consider yourself fortunate but don’t let down your guard. Doctors are in agreement that whether you’re 25 or 85, lifestyle recommendations -- keeping your weight under control, exercising regularly, incorporating vegetables and fruits in your diet, reducing your intake of salt (sodium chloride), and if you drink, doing so moderately—are essential steps in the fight against high blood pressure. So, for example, don’t let age become a barrier to maintaining a healthy weight or engaging in regular physical activity. Eat smaller portions and limit high calorie foods to compensate for a slowing metabolism. And, when it comes to exercise, you may not be able to run marathons when you’re 70 (although some people do), but you can still take daily walks through the park or swim in the community lap pool.

Johns Hopkins Health Alerts | Hypertension & Stroke | Aging and High Blood Pressure

Simple Steps to Help You Prevent High Blood Pressure Without Medication

Thu, 09 Nov 2006 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | Preventing High Blood Pressure Without Medication

Diet and exercise are key, but there’s more you can do to prevent high blood pressure.

No matter how good your health is, it is important to prevent any rise in blood pressure. The main reason is that blood pressure can cause damage to your body when it goes above 110/70 mm Hg— long before high blood pressure is diagnosed. Also, if you keep your blood pressure at a normal level, you won’t need to take blood pressure medication, which has potential side effects and can be costly. Lastly, people with high blood pressure who bring their blood pressure down to normal levels with medication still have a higher risk of high blood pressure complications than individuals who do not require drugs to keep their blood pressure within the normal range. So you have at least three good reasons to prevent high blood pressure in the first place.

What steps can you take to prevent high blood pressure? The most important ones are losing weight (if necessary), eating a healthy diet rich in fruits and vegetables and low in salt (the DASH eating plan is ideal, see below), engaging in regular physical activity, and drinking only moderate amounts of alcohol.

Lifestyle measures can have a considerable impact on your blood pressure readings. In a recent study, a weight loss of just 10 lbs. decreased the risk of high blood pressure by 50% in individuals with a systolic blood pressure between 130 and 139 mm Hg or a diastolic blood pressure between 85 and 89 mm Hg. In another study, the more preventive strategies individuals incorporated into their lifestyle, the greater the overall impact on their blood pressure reading.

What’s the DASH diet and how can it help you control your blood pressure?

The DASH diet (Dietary Approaches to Stop Hypertension) is an eating plan that can have a significant and positive effect on your blood pressure readings. The diet is rich in fruits, vegetables, and low-fat dairy products and low in saturated fat, cholesterol, and total fat. It also includes whole-grain products, fish, poultry, and nuts. Red meat, sweets, and sugar-containing beverages are kept to a minimum.

Two major clinical trials have evaluated the DASH diet:

In the first trial, individuals who followed the DASH diet for eight weeks reduced their blood pressure by an average of 5.5/3 mm Hg, compared with people who ate a typical American diet (low in fruits and vegetables and high in fat). The benefits of the DASH diet were greatest in people with high blood pressure. In these individuals, the DASH diet lowered systolic blood pressure by 11 mm Hg, which is similar to the level of blood pressure reduction typically achieved with a single blood pressure drug.

In the second trial, people who combined the DASH diet with a low sodium intake (1,500 mg a day) for 4 weeks had an average blood pressure reduction of 9/5 mm Hg, compared with people who followed a typical American diet with a high sodium intake (3,300 mg a day). As in the first trial, the benefits were greater in people with high blood pressure—their systolic blood pressure dropped by an average of 12 mm Hg.

For more information about the DASH diet, go to the website: www.nhlbi.nih.gov/health/public/heart/hbp/dash

Johns Hopkins Health Alerts | Hypertension & Stroke | Preventing High Blood Pressure Without Medication

Research Update on High Blood Pressure

Mon, 09 Oct 2006 12:18:29 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Benefits of Weight Loss on High Blood Pressure

Even Modest Weight Loss Lowers Blood Pressure

If you’re middle-aged and overweight, a recent study reported in the Archives of Internal Medicine may motivate you to shed a few pounds. The researchers found that people may be able to prevent high blood pressure by losing even modest amounts of weight.

Men and women with a body mass index of 25 or greater (an indication of being overweight) participated in the study; 623 were age 30–49 (the younger group), and 605 were age 50–65 (the older group). After adjusting for various patient characteristics that could skew their findings (including activity level, smoking, and the occurrence of cancer or cardiovascular disease), the investigators found that in individuals who lost 15 lbs. or more over a four-year period, the long-term risk of high blood pressure was reduced by 28% and 37% in the younger and the older groups, respectively. More modest weight loss also lowered the chances of high blood pressure, as long as the losses were sustained for an additional four years. Individuals in the younger group who lost at least four lbs. and kept it off for the next four years had a 22% decline in the risk of high blood pressure; a 26% decrease occurred in the older patients.

One easy way to lose weight and lower your blood pressure is to add more high-fiber foods to your diet. Here’s a summary of a recent study on “Fiber’s Effect on Blood Pressure,” reported in the Journal of Hypertension.

A diet rich in fruits, vegetables, and whole grains (and thus high in fiber) is known to lower blood pressure. But whether it is the fiber or some other component of these foods that is responsible for reduction in blood pressure has been uncertain. Researchers from Tulane University analyzed the results of 25 randomized, controlled trials that included more than 1,400 adults. The researchers found that individuals who ate between 7 and 19 grams of fiber a day experienced significant reductions in blood pressure—averaging 3 mm Hg systolic and 2 mm Hg diastolic. These improvements in blood pressure occurred when people increased their fiber intake for at least eight weeks. Shorter durations of increased intake did not lower blood pressure as much.

The best way to boost your fiber intake is to eat more fruits, vegetables, and whole grains. Fiber can also be consumed in pill form, but the study found that when fiber was taken as a pill significant declines occurred only in diastolic blood pressure (the lower number in a blood pressure reading).

Johns Hopkins Health Alerts | Hypertension & Stroke | Benefits of Weight Loss on High Blood Pressure

The Benefits of Using a Home Blood Pressure Monitor

Thu, 10 Aug 2006 13:49:04 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Using a Home Blood Pressure Monitor

Does your blood pressure soar at the doctor’s office? If so, you’ll want to try a home blood pressure monitor. It’s convenient, inexpensive – and the results may surprise you!

If you have high blood pressure, you don’t have to wait until a doctor’s appointment to measure your blood pressure. A home blood pressure monitor can give your doctor important feedback and give you the motivation you need to lower your numbers. A recent study published in the American Journal of Hypertension found that high blood pressure patients who monitored blood pressure at home lowered their blood pressure by 3.3 mm Hg more than patients with office-only blood pressure measurement.

By using a home blood pressure monitor, you can also take more accurate readings of your resting blood pressure. The home environment helps eliminate “white coat hypertension”—a condition where blood pressure rises owing to the stress of a visit to the doctor.

There are many different models of home blood pressure monitors. James Weiss, M.D., Professor of Medicine at Johns Hopkins, recommends a digital automatic cuff that fits around the arm as “the very best way of monitoring high blood pressure.” Automatic cuffs inflate at the touch of a button, eliminating the need for a bulb pump. The digital display is easy to read and can also store readings and other medical information, such as pulse rate. And a cuff that fits around the arm measures blood pressure in the brachial artery, the method used in doctors’ offices.

Fingertip and wrist models, while popular, can give unreliable readings. Most digital automatic blood pressure monitors cost between $50 and $100. It’s important that you make sure that your blood pressure monitor is producing accurate readings. Before you start using your home blood pressure monitor, ask a health care professional to show you how the machine works and to test it for accuracy. You can also find out where you can take your monitor for regular “checkups.” (Pharmacists often can perform accuracy checks.) Dr. Weiss suggests that you take duplicate readings to make sure that your monitor is functioning properly.

Tips for home monitoring:

Don’t exercise, eat, or drink caffeinated beverages for 30 minutes before measuring your blood pressure;
Silently rest for 3 to 5 minutes before you start. And don’t forget to take off any jewelry or clothing that could interfere with the cuff placement;
Once you’re ready to take your blood pressure reading, sit down in a comfortable position, with your back supported and your legs uncrossed and feet on the floor;
Strap the cuff around the upper part of your arm (at least 1 inch above the crease of your elbow), tightly enough so that only a fingertip can fit under the cuff. Keep your arm at waist level;
Measure your blood pressure at different times of the day. According to Dr. Weiss, “Usually blood pressure is lower in the early morning than in the evening, so measuring at various times of the day is helpful.”
Johns Hopkins Health Alerts | Hypertension & Stroke | Using a Home Blood Pressure Monitor

The Power of Exercise to Lower Your Blood Pressure

Tue, 11 Jul 2006 13:21:03 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Exercise and Lower Blood Pressure

A regular exercise program might let your doctor reduce your high blood pressure medication, or possibly eliminate the need for it altogether! Learn which exercises yield the greatest rewards.

People who are physically fit are less likely to develop high blood pressure, and exercise may stop people with prehypertension from developing full-blown hypertension. In people with mild to moderate high blood pressure, studies have demonstrated that regular aerobic activity can decrease blood pressure by up to 10/8 mm Hg. In some people with high blood pressure, beginning a regular exercise program can allow their doctors to reduce the dosage of their high blood pressure medication or even eliminate the need for it altogether.

What Kind of Exercises Should You Choose to Lower Blood Pressure?

Resistance exercises: Studies show that resistance exercises—weight lifting and the use of resistance equipment (like Nautilus machines and resistance bands)—are not an effective way to lower blood pressure. In fact, in people with high blood pressure, very high resistance activities can cause blood pressure to rise, sometimes to dangerous levels.
Nonetheless, experts still recommend the use of resistance exercises as part of an overall exercise plan because these exercises improve strength, balance, and bone mass. But older people and those with high blood pressure need to take special precautions. For example, they should use light weights (no more than 10 lbs.) and do more repetitions. They may also need to avoid activities that involve heavy lifting, such as shoveling snow.

Aerobic exercises: Aerobic exercises—such as walking, bicycling, swimming, jogging, and dancing—can help lower blood pressure when done for 30 to 60 minutes at least three days a week. If you are unable to exercise for 30 minutes at a time, try breaking up the exercise into sessions of 5 to 10 minutes. Initially, these activities need not be formal exercises but can be everyday activities that you incorporate into your daily routine. For example, try parking your car further away from the store or mall to increase the amount of time you spend walking. When possible, take the stairs instead of an elevator.

Before beginning an exercise program, you need to know what intensity of exercise is beneficial and safe for your age and health status. So, first check with your doctor to determine if you need to take any special precautions. Essentially, exercise should cause you to sweat but should not be so intense that you cannot hold a conversation during the activity. You should always warm up and cool down before and after exercising with activities like light walking and stretching. If you are just getting started, remember that even small increases in physical activity have a beneficial effect not only on your blood pressure but on many other aspects of your health as well.

Johns Hopkins Health Alerts | Hypertension & Stroke | Exercise and Lower Blood Pressure

Should You Worry About White Coat Hypertension?

Thu, 08 Jun 2006 11:26:32 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Treatment Options for White Coat Hypertension

As many as 20% to 35% of people diagnosed with white coat hypertension have what appear to be normal blood pressure readings at home.

Does going to a doctor’s office cause you enough stress to raise your blood pressure? If so, you’re not alone. Most people with hypertension (high blood pressure) have higher readings when a doctor takes their blood pressure than when they take it themselves. In fact, as many as 20% to 35% of people diagnosed with hypertension have what appear to be normal blood pressure readings at home.

This phenomenon is known as white coat hypertension. Some, but not all, experts believe that white coat hypertension can lead to unnecessary use of medication.

If your blood pressure is greater than 140/90 mm Hg on two or more separate occasions in a doctor’s office, there are several ways to find out whether you have white coat hypertension:

First, if your doctor usually measures your blood pressure, see whether it goes down when a nurse measures it—some people experience white coat hypertension only with a physician.

Second, you could get a home monitor and measure your own blood pressure twice a day for a week.

Finally, if your average home blood pressure reading is below 135/85 mm Hg, ask your doctor whether you’re a candidate for ambulatory blood pressure monitoring, in which blood pressure is repeatedly measured over a 24- to 48-hour period. An average ambulatory blood pressure reading below 130/80 mm Hg despite elevated office readings is termed white coat hypertension.

Whether to treat white coat hypertension with antihypertensive medication is controversial. Several studies have suggested that people with white coat hypertension are at higher risk for heart attack and stroke than people with normal blood pressure and should be treated. Other studies have found that people with white coat hypertension are not at increased risk.

Until a definitive answer is reached, you should follow your doctor’s advice on taking blood pressure medication. If you have no other risk factors for cardiovascular disease (such as diabetes or being a smoker) or damage to organs such as the heart, brain, or kidneys, ask your doctor whether it would be safe for you to be monitored without medication.

People with white coat hypertension, like other adults, should follow a healthy lifestyle to reduce the likelihood of heart attack and stroke. In addition, they should have repeat ambulatory blood pressure monitoring every one or two years if they are not taking medication.

Johns Hopkins Health Alerts | Hypertension & Stroke | Treatment Options for White Coat Hypertension

Statin Drug For Cholesterol Also Lowers the Risk of Stroke

Tue, 13 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts | Hypertension & Stroke | Statins and Stroke Prevention

The researchers found that people who received Zocor were 25% less likely than those receiving the placebo to have a stroke.

Cholesterol-lowering drugs called statins are used primarily to reduce the risk of heart attack. But research published in The Lancet shows that statin drugs also appear to reduce the risk of stroke.

Researchers identified more than 20,000 people at elevated risk for stroke, including people with cerebrovascular disease, coronary heart disease, and diabetes. Study participants were randomly assigned to receive either 40 mg of the cholesterol-lowering statin drug Zocor (simvastatin) or a placebo daily for five years.

The researchers found that people who received Zocor were 25% less likely than those receiving the placebo to have a stroke. When they looked only at participants who had preexisting cerebrovascular disease but not coronary heart disease, those who received Zocor were still less likely to have a stroke.

According to the study authors, the results indicate that statin therapy should now be considered routinely for all patients at high risk for stroke, regardless of how high their initial cholesterol levels are and even if they do not have coronary heart disease.

Johns Hopkins Health Alerts | Hypertension & Stroke | Statins and Stroke Prevention

What To Do When A Stroke Occurs

Mon, 17 Apr 2006 13:15:34 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Stroke Symptoms

It’s common for people to deny the possibility of something as serious as a stroke -- don’t hesitate to take prompt action.

Much more publicity is given to the symptoms of a heart attack than a stroke. Yet like a heart attack, a stroke is an emergency that requires immediate medical attention—and getting to the hospital as soon as symptoms start is essential, since drug therapy is most likely to be effective within the first three hours of stroke onset.

Listed below are the symptoms of a stroke, as well as what to do in the event of a stroke.

Symptoms of Stroke:

Sudden weakness or numbness in the face, arm, or leg on one side of the body.

Sudden loss, blurring, or dimness of vision.

Mental confusion, loss of memory, or sudden loss of consciousness.

Slurred speech, loss of speech, or problems understanding others.

Sudden, severe headache with no apparent cause.

Unexplained dizziness, drowsiness, loss of coordination, or falls.

Nausea and vomiting, especially when accompanied by any of the above symptoms.

Actions To Take in the Event of a Stroke:

Stay calm. Ignore any tendency to downplay a stroke symptom; it’s common for people to deny the possibility of something as serious as a stroke. Don’t hesitate to take prompt action.

Call or have someone call an ambulance. (Dial 911 in most parts of the United States.) Be sure to give your name, telephone number, and exact whereabouts.

While waiting for the ambulance, the person suffering the stroke should be made as comfortable as possible and should not eat or drink anything other than water.

If an ambulance cannot arrive for an extended period of time, a family member or neighbor should drive the stroke patient to the hospital. Under no circumstances should the person experiencing the stroke symptoms attempt to drive.

Notify the stroke patient’s doctor. He or she can provide the hospital with the patient’s medical history, which may be important for determining the best type of treatment for the stroke.

At the hospital, be sure to list any medical conditions the stroke patient has (such as high blood pressure), any allergies the patient has (particularly to medication), and any medications the patient is currently taking.

Johns Hopkins Health Alerts | Hypertension & Stroke | Stroke Symptoms

Weight Loss--A Key Player In Fighting High Blood Pressure

Mon, 17 Apr 2006 21:28:25 CDT

Johns Hopkins Health Alerts | Hypertension & Stroke | Benefits of Weight Loss to Reduce High Blood Pressure

A recent study provides “unequivocal evidence that weight loss makes an important contribution to the treatment of high blood pressure.”

A number of lifestyle measures can effectively lower blood pressure in people with high blood pressure. But for people who are overweight, the cornerstone of lifestyle modifications should be losing excess weight.

Research consistently shows that overweight people who drop pounds also drop millimeters of mercury, according to a recent report published in Hypertension. The researchers found that, on average, for every 2.2 lbs. of weight lost, blood pressure dropped by about 1/1 mm Hg. For example, people who lost about 11 lbs. had their blood pressure drop by 4.4/3.6 mm Hg.

Weight loss was especially effective at reducing blood pressure in people taking antihypertensive drugs (such as Coreg, Toprol, and Norvasc), and people who lost weight by exercising had even greater decreases in blood pressure than those who simply cut calories. This study provides “unequivocal evidence that weight loss makes an important contribution to the treatment of high blood pressure,” the authors conclude.

Focusing on weight control is especially important given the enormous and escalating weight problem in the United States. Despite the nearly $40 billion that Americans spend each year on weight-loss programs, the nation is getting heavier. By current estimates, nearly two out of three people in the Unites States are at least overweight, with almost one in three being obese. Yet losing weight needn’t be either complicated or expensive.

If you are overweight, weight loss—along with other lifestyle changes—is an excellent way not only to improve overall health but also to specifically lower blood pressure, even if you are already on antihypertensive medication. However, be sure to talk to your physician before you start any type of diet or exercise program.

Johns Hopkins Health Alerts | Hypertension & Stroke | Benefits of Weight Loss to Reduce High Blood Pressure