I am Dr. Willie Lawrence, Medical Director, Center for Better Health and Cardiovascular Wellness, Spectrum Health Lakeland in Benton Harbor, Michigan and a volunteer expert for Get Down With Your Blood Pressure. AMA about high blood pressure!

Best ways to increase HDL?

There is no strong evidence to support the concept of cardiovascular benefit to raising HDL. Aggressively lowering LDL may be more beneficial when HDL cholesterol is low.

Why is my top number higher at the doctors office 137+ but the lower number is below 80? My anxiety is usually through the roof at the doctors office. My heart rate jumps to about 115-135. My normal resting heart rate is low to upper 60's. I'm 28.

Does this sound like white coat hypertension?

Anxiety tends to raise systolic (top) blood pressure more than diastolic blood pressure (bottom #). Measuring BP at home with a validated automated device with proper technique is best way to screen for white coat htn. Check out site ManageYourBP.org for more info.

If high blood pressure runs in someone's family, what sorts of preventative steps could you recommend to them that you might not recommend to someone without that family history? Not asking for too specific medical advice, just in general.

Sometimes while occurs at high rates within families, the link is not necessarily genetic. It may be behavioral and the same lifestyle changes that control or avoid hypertension are recommended.

What is the best way to lower blood pressure without medication? If the answer is diet, what else can one do, is there a specific type of exercise that works better than others?

Exercise cannot compensate for poor diet choices. Certainly sodium restriction to 1500 mg daily is key. Being active is foundational. Check out the Ad Council Get Down with Your Blood Pressure campaign which promotes dancing. ManageYourBP.org is a good site for info.

When during the day would you recommend taking your blood pressure?

Check it twice in the morning and twice in the evening before meals and calculate average over 3 days.

How common (And how concerning) is caffeine related hypertension?

Caffeine is a stimulant and may raise blood pressure. It does not typically cause "hypertension" when used at moderate amounts.

Are electronic blood pressure monitors at places like Walmart accurate, or is manual more accurate?

It is difficult to know with certainty. The best place to check your blood pressure is at home with a validated device the correct technique. Info can be found at ManageYourBP.org. A list of validated home automated bp devices may be found at www.valdatebp.org.

Hi! Are you able to speak on the relationship between salt/sodium and high blood pressure? I was raised believing that salt was this kind of HBP boogeyman that would give me a heart attack and should be avoided as often as possible, but I’ve recently heard from several people that this is blowing the reality of the situation out of proportion. Are these statements true? I’ve been unable to find what look like reliable sources to confirm or deny this.

The evidence that excess sodium intake contributes to high blood pressure is strong and difficult to refute. Similarly, sodium restriction clearly lowers blood pressure over time.

How does one tell the difference between white coat syndrome and problematic blood pressure?

To avoid over diagnosing HBP in patients who may become routinely anxious in their health providers office, it is helpful to purchase a validated automated bp device and follow proper technique for using it. This is well describe at ManageYourBP. org

On average, what would be a safe range for blood pressure to be at when a middle aged person is in the middle of exercising moderately? Also - what causes a normal systolic number but an elevated diastolic number?

It is normal for systolic blood pressure to increase between 160 and 200 during exercise. Your max predicted HR during exercise is 220 - age. Stop exercise if SBP increases to >220 during exercise and check with your doctor.

Hey Doctor! Are Black Americans more at risk of having high blood pressure? What can I do about it? Any websites you'd recommend?

Your blood pressure is a barometer of everything going on in your life. Your blood pressure and your health are impacted by social determinants of health such as your income, education and life stress. Your lifestyle is impactful. HTN is more common in blacks, Hispanics, and indigenous Americans. Rates of adequate bp control are lower in people of color in the US. ManageYourBP.org is a good site.

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Diet and lifestyle modification are foundational to preventing and treating hypertension and other forms of heart disease. Go to ManageYourBP.org for more info.

If you could get everyone to do one thing daily to help their heart health what would it be?

Your blood pressure is a barometer of your life and environment, the so-called social determinants of health. Lifestyle change is fundamental to bp control. All factors are important. Most would argue that dietary sodium restriction is a must.

Hi Dr. Lawrence, what does it mean if your blood pressure is significantly different in each arm? Patient is a 70 yr old male, pre-diabetic. Has joint, arthritis pain and Gerd/Acid Reflux problems, is active and maintains a healthy weight.

A difference in systolic blood pressure between your arms >15 mmHg could be a sign of upper extremity peripheral vascular disease. In hypertension care, this is important because if you check blood pressure in the arm with a narrowing in the artery of the shoulder, you can underestimate blood pressure and miss diagnosing hypertension or under treat someone's hypertension.

My father died of heart disease this year, it was undetected until he just slipped away in his sleep one night. My question is, we both had a history (his of course longer) of abuse of cocaine and eventually meth amphetamines, and while we’d both quit long term by early 2016 I can’t help but think that we damaged our bodies in a self destructive time. I know it didn’t help him, but now I wonder what my odds are, I abused stimulants for almost 2 years personally, from age 16-18, I’m 23 now. Is the damage irreversible? Can I do anything to repair ?

So sorry to hear this. Our bodies are amazing and, generally speaking, overtime favorable lifestyle changes can overcome poor decisions made in our youth.

Can certain abnormal postures lead to hypertension regardless of a good diet and exercise?

I cannot answer this question directly.

An analysis of six trials, so called meta-analysis, suggested that yoga was associated with a reduction in systolic blood pressure by 5 mmHg. The bp lowering was greater in patients <60 years of age. J Altern Comp Med 2017;23(9):685 Epub 2017 Apr 6

Good afternoon, Dr. Lawrence and thank you for sharing your time. I have a few questions (I hope that's ok):

• Is it ok for a blood pressure reading taken at home to be slightly under that taken at the doctor's office?

• Is a 7-day average blood pressure reading a better (or worse) indicator of blood pressure status?

• Why do both feet need to be on the floor during a reading? Why can't legs be crossed at ankle or knee?

• Is it ok to place the cuff over a thin sleeve (such as a tee-shirt) or does it need skin contact?

• Does the arm need to be turned wrist up and, if so, why?

Thanks again!

The best way to determine your blood pressure at home is to take your bp twice in the morning and twice in the evening for 3-7 consecutive days with a validated automated device. Take the average of these readings as your blood pressure.

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More info can be found at ManageYourBP.org

Thanks for the AMA!

Are short blood-pressure spikes because od, say, a emptional outburst equivalent to long term high-blood pressure in the long run? For example: you encounter something stressing during your job and if you‘d measure your BP it would be 170/85 instead of 120/80 for several times a day.

2) Is there a way to tell if a tinnitus is caused by high BP? I feel like sometimes in stressing situations I get a high frequency buzzing sound in my ear and I‘m just curious how this happens.

anyway, have a nice day.

Sustained rather the intermittent spikes in blood pressure increase risk of heart disease and stroke. Hypertension usually does not cause symptoms. The best way to know if you have hypertension is to have it checked. For most adults, it should be checked at least once a year. We begin to see complications of elevated blood pressure when top number it is consistently greater than 120 and that is considered "elevated." (120-130) When it is consistently > 130, that is hypertension.

The best way to know is to check it! Use a validated BP device at home!

GET IT

SLIP IT

CUFF IT

CHECK IT

I am 40 and have an extensive history of heart disease in my immediate family. Besides exercise and nutrition, is there anything specific you would recommend for me to do early on so I can avoid all the open-heart surgeries my dad/grandparents went through?

Knowing your cholesterol and fasting blood sugar is important. You want to aggressively treat risk factors for heart disease. This usually start with lifestyle changes. Even dancing is beneficial. Check out the Ad Council campaign "Get Down With Your Blood Pressure. "

What can you do to lower your blood pressure immediately without medication if it is elevated?

There are no quick fixes for hypertension. Whether meds are indicated early depends upon the level of BP. Lifestyle changes are fundamental.

What is the best test to get an accurate reading of LDL? Also, does psyllium husk work in lowering cholesterol?

Another question I have is: do you know if working out raises cholesterol? I workout 6 days per week and the doctor says my overall cholesterol is high, but my HDL is higher than normal and my LDL is within range. I don’t really see this as a bad thing, thoughts?

Soluble fibers such as psyllium, certain beans, lentils, nuts and oat products can reduce both total cholesterol and LDL cholesterol.

There is evidence that exercise increases HDL. The benefit may be greatest in men with low HDL and elevated triglycerides. There is evidence that the intensity of exercise may impact increases in HDL (STRRIDE Trial)

There is an Infographics channel video on YouTube that says sleep deprivation and too much sleep can mess your heart pretty badly. For two different times, i was an insomniac for 3 months. About 30 hours awake, 12 hours sleep. Right now, for the third time, it's closer to between 40 hours and 50 hours wakefulness. Also, I'm a heavy-ish smoker and i drink lager a lot. I recently went to the hospital, too. My heart rate was 135. I forgot the pressure. But i was once diagnosed with mild hypertension. And that was when my heart was calm.

I believe i am a weak heart, as a 30 year old male. Could slowly building up in cardiovascular endurance be that beneficial, or, from i may sound like, do you think cardio would be too risky. (When i say cardio, i mean speed walking for a few miles and not jogging.) And if i started doing sprint intervals instead of jogging (sprinting is funner, and it doesn't cause as much shin splints as jogging), would that be too much to begin with?

I do have some experience with weight training and calisthenics. And, btw, i'm 5'8 and weigh 232 lbs.

Moderate and/or vigorous exercise is associated with cardiovascular benefit. Check with your health care provider to know what is right/safe for you. We also recommend dancing! It is a way of celebrating life and achieving health. This is why I support the "Get Down With Your Blood Pressure" campaign that promotes dancing as a way of getting more active and thus improving your cardiovascular health. Thank you AHA, AMA, and
Ad Council!

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This is not clear, but I too am always surprised when we perform cardiac catheterizations on patients with symptoms and multiple risk factors and find that they have no high grade blockages.

Be cautious in your interpretation of cardiac calcium scores. Low scores do not mean that you have no coronary artery disease. Normal coronary arteries by arteriography also does not mean that your coronary arteries are normal. Heart attacks most often occur in arteries which are not severely narrowed..