BP control is key to preventing stroke

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.

J.L. Answer: You are quite right that blood pressure goes up and down during the day. He is right that exercise helps keep blood pressure down, but it is usually not enough by itself. For these people, blood pressure control is key to preventing another stroke.

I am concerned that seeing elevated readings is 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 is in the 130s or higher, it might be time to consider a slightly higher dose of enalapril. I would not increase the metoprolol since his pulse is already quite slow.

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 more protection to you and to others.