Dr. Roach: Can high blood pressure readings cause high blood pressure?
DEAR DR. ROACH: My husband had a hemorrhagic stroke in 2014. He is 75 years old. His blood pressure in the past five days has gone from 123/64 with a heart rate of 50 to 142/77 with a heart rate of 45. It will be in the green for days and then read in 140s for a couple of days. He becomes very upset when he sees the yellow light come on. He walks 2 miles each morning and thinks this should keep his BP at a normal level, in addition to the metoprolol and enalapril he takes twice daily.
I am having great difficulty in making him understand that it is normal for blood pressure readings to go up and down. I feel he is worrying about having another stroke. He takes his reading multiple times during the day. -- J.L.
ANSWER: You are quite right that blood pressure goes up and down during the day, sometimes over surprisingly short periods. He is right that exercise helps keep blood pressure down, but it is usually not enough by itself, especially for a person with a history of hemorrhagic stroke (bleeding inside the brain). For these people, blood pressure control is key to preventing another stroke.
Although I recommend home blood pressure cuffs, I am concerned that seeing elevated readings is causing him to be upset -- and potentially contributing to transient high blood pressure.
The most important number is the average of many blood pressure readings over the week. A goal of 120/80 is ideal for a person at risk for a stroke, like your husband. If his average reading is close to 120/80, he should not worry too much about the occasional 140 reading. However, if his average systolic pressure (the top number) is in the 130s or higher, it might be time to consider a slightly higher dose of enalapril, as long as he isn't having any side effects. I would not increase the metoprolol since his pulse is already quite slow. His physician should be able to explain the benefits.
DEAR DR. ROACH: I've seen many people wearing a full face shield without any mask covering the nose or mouth. Does this make sense? -- C.B.
ANSWER: A face shield provides some protection against COVID-19, but not as much as a face mask does. Health care workers use both a face mask and a shield when taking care of people with known or suspected COVID, since the shield provides protection against droplets entering the eyes. If you only wear one, though, the face mask provides significantly more protection to you and to others.
DEAR DR. ROACH: I am a 75-year-old male in good health. I just got this year's flu shot in August. I would like to get another shot later in the season, perhaps in late November. Is there any downside? -- B.N.
ANSWER: Flu shots provide protection for most people for about six months, so a vaccine in August should cover you until February. Some years, the flu season lasts well into April or even May, at least where I practice, in the Northeast. Authorities do not recommend a second flu vaccine, but I have considered it for some of my highest-risk patients. The downside to you is a sore arm, and maybe a day of low-grade fever and muscle aches. The downside to society is that in a vaccine shortage, you would be taking away someone else's chance for protection.
Since there is no rush, I'd talk to your doctor, who should have more information about how bad the flu season is (and how long it's likely to last) as well as about availability of the vaccine.